微骨窗骨搬移联合负压封闭引流治疗糖尿病足:双中心回顾性队列研究  

Micro⁃osteotomy bone transport combined with vacuum sealing drainage for the treatment of diabetic foot:A retrospective cohort study of 128 patients from two centers

作　　者：刘俊鹏 杜心如[1] 要星晨 徐子彧[1] 裴福春 张林 赵会[1] LIU Junpeng;DU Xinru;YAO Xingchen;XU Ziyu;PEI Fuchun;ZHANG Lin;ZHAO Hui(Department of Orthopaedic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]北京朝阳中西医结合急诊抢救医院骨科,北京100021

出　　处：《实用医学杂志》2024年第18期2590-2596,共7页The Journal of Practical Medicine

摘　　要：目的 评估微骨窗胫骨横向骨搬移(tibial transverse transport, TTT)的疗效,并探讨其与负压封闭引流(vacuum sealing drainage, VSD)联合治疗的潜在益处。方法 回顾分析自2020年7月至2022年12月收治的Wagner分级≥2级的糖尿病足患者资料。依据治疗方案的差异,将患者分为三组:VSD治疗(VSD组)、微骨窗TTT治疗(TTT组)以及微骨窗TTT联合VSD治疗(联合组)。进行为期1年的随访。记录并比较三组患者的一般资料、术前及术后3个月的溃疡面积、踝肱指数、疼痛目测类比评分,以及术后1年内溃疡复发、手术并发症以及截肢情况。结果 共纳入VSD组患者43例,TTT组43例,联合组42例。三组患者的基线资料差异无统计学意义(P> 0.05)。与TTT组相比,VSD组患者的溃疡愈合时间更长,术后3个月时患者的疼痛评分更高,踝肱指数更低(P <0.05),溃疡面积更大(P=0.029),1年溃疡复发率更高(P=0.021)。与TTT组相比,联合组患者的溃疡愈合时间更短(P=0.046)。术后3个月时溃疡面积(P=0.362)、疼痛评分(P=0.932)、踝肱指数(P=0.671)以及1年溃疡复发率(P=0.710)差异均无统计学意义。结论 微骨窗TTT在促进溃疡愈合,缓解疼痛,改善下肢血运方面的效果明显优于VSD。在应用微骨窗TTT的基础上加用VSD可以进一步缩短伤口愈合时间,降低患者和医护的创面护理负担。Objective To assess the effectiveness of enhanced tibial transverse transport(TTT)in con⁃junction with vacuum-assisted closure(VAC)therapy for managing recalcitrant diabetic foot ulcers.Methods A retrospective analysis was conducted on data from diabetic foot patients with Wagner grade≥2 who were treated at Beijing Chaoyang Hospital and Beijing Chaoyang Hospital of Integrated Traditional Chinese and Western Medicine between July 2020 and December 2022.The patients were categorized into three groups based on their treatment regimen:VSD treatment(VSD group),modified TTT treatment(TTT group),and combined application of TTT and VSD(combined group).A one-year follow-up was performed to assess general data,ulcer area before and three months after surgery,ankle brachial index,visual analog pain score,as well as adverse events within one year post-surgery among the three groups.Results The VSD group consisted of 43 patients,while the TTT group consisted of 43 patients,and the combined group consisted of 42 patients.There were no statistically significant differences in baseline characteristics among the three groups(P>0.05).Patients in the VSD group had longer ulcer healing time,higher pain scores,lower ankle brachial index(P<0.05),larger ulcer area(P=0.029),and higher one-year ulcer recurrence rate compared to those in the TTT group.On the other hand,patients in the combined group had shorter ulcer healing time compared to those in the TTT group(P=0.046).However,there were no significant differences observed between these two groups regarding ulcer area(P=0.362),pain scores(P=0.932),ankle brachial index(P=0.671),and one-year ulcer recurrence rate(P=0.710).Conclusions The efficacy of modified TTT surpasses that of VSD in promoting ulcer healing,alleviating pain,and enhancing lower limb circulation.Furthermore,the combination of VSD with modified TTT demonstrates a potential to further expedite wound healing time.

关 键 词：糖尿病足 胫骨横向骨搬移 负压封闭引流 血管再生 清创术 

分 类 号：R687.3[医药卫生—骨科学] R587.2[医药卫生—外科学]