胫骨横向骨搬移治疗糖尿病足的研究进展  

Advances in tibial transverse transport for the treatment of diabetic foot

作　　者：王禄鹏 赵文君[3] 邢国胜[3] 段小圆[3] 于成月 徐卫国[1] Wang Lupeng;Zhao Wenjun;Xing Guosheng;Duan Xiaoyuan;Yu Chengyue;Xu Weiguo(Department of No.1 Ward of Limb Orthopaedics,Tianjin Hospital,Tianjin 300211,China;Clinical College of Orthopaedics,Tianjin Medical University,Tianjin 300070,China;Orthopaedic Institute,Tianjin Hospital,Tianjin 300050,China)

机构地区：[1]天津市天津医院矫形一病区,天津300211 [2]天津医科大学骨科临床学院,天津300070 [3]天津市天津医院骨科研究所,天津300050

出　　处：《中华骨科杂志》2024年第24期1633-1640,共8页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康科技项目(TJWJ2024XK015);白求恩·医学科学研究基金(B20372FN)。

摘　　要：糖尿病足治疗的难点在于复发率高、难以根治,全身基础治疗和局部外科治疗的效果均不理想。近年来,国内学者将胫骨横向骨搬移应用于糖尿病足的治疗。胫骨横向骨搬移适用于大、中动脉血供良好的严重糖尿病足的治疗,具有愈合率高和复发率低的优点,可有效降低患者的死亡率和截肢率。但术后需关注胫骨截骨处骨折、针道感染、截骨区皮肤坏死、胫骨畸形和骨髓炎等并发症。国内学者从缩小手术切口和截骨面积以及保留截骨部位血供等方面对胫骨横向骨搬移的术式进行了改良,衍生了改良双骨瓣胫骨横向骨搬移和"门"形开窗技术,相关手术器械也向精准化方向改良。目前,胫骨横向骨搬移治疗糖尿病足机制的研究主要集中于促进巨噬细胞极化平衡重建、干细胞动员和血管新生。胫骨横向骨搬移术后巨噬细胞向经典活化型极化减少、选择性活化型极化增多,两种机制相互促进使巨噬细胞极化平衡获得重建;骨搬移激活SDF-1/CXCR4/PI3K/AKT和Wnt等信号通路引起干细胞动员;同时刺激血管生成相关因子释放、内皮祖细胞活化和Ras/Raf/MEK/ERK等信号通路促进血管新生,最终促进糖尿病足溃疡的愈合。The difficulty in the treatment of diabetic foot lies in the high rate of recurrence and difficulty in eradicating the disease,and the results of both systemic basic treatment and local surgical treatment are not ideal.In recent years,domestic scholars have applied tibial transverse transport for the treatment of diabetic foot.Tibial transverse transport is suitable for the treatment of severe diabetic foot with a good blood supply of the large and middle arteries.It has the advantages of high healing rate and low recurrence rate,and can effectively reduce the mortality and amputation rate of patients.However,postoperative complications such as tibial osteotomy fracture,pin tract infection,skin necrosis at osteotomy area,tibial deformity and osteomyelitis should be paid attention to.Domestic scholars have improved the operation of tibial transverse bone transport in terms of reducing the surgical incision,osteotomy area,and preserving the blood supply of the osteotomy site.The modified double bone flap transverse tibial bone transport and"door"shaped window technique have been derived,and related surgical instruments have also been improved in the direction of precision.At present,the research on the mechanism of tibial transverse transport in the treatment of diabetic foot mainly focuses on promoting the reconstruction of macrophage polarization balance,stem cell mobilization and angiogenesis.After tibial transverse transport,the polarization of macrophages to classical activated type was decreased,and the polarization of selective activated type was increased.The two mechanisms promoted each other to reconstruct the polarization balance of macrophages.Bone transport activated SDF-1/CXCR4/PI3K/AKT and Wnt signaling pathways to induce stem cell mobilization.At the same time,it stimulates the release of angiogenic factors,activation of endothelial progenitor cells and Ras/Raf/MEK/ERK signaling pathways to promote angiogenesis and ultimately promote the healing of diabetic foot ulcers.

关 键 词：糖尿病足 溃疡 骨重建 综述 

分 类 号：R47[医药卫生—护理学]