EMO评分系统指导胫骨近端横向骨搬移治疗糖尿病足创面的可行性研究  

A feasibility study of the EMO scoring system to guide proximal tibial transverse transport in treatment of diabetic foot wounds

作　　者：刘文昊 单健杨 朱明明 文根[2] 成亮[2] LIU Wenhao;SHAN Jianyang;ZHU Mingming;WEN Gen;CHENG Liang(College of Fisheries and Life Science,Shanghai Ocean University,Shanghai,201306,P.R.China;Department of Orthopedic Surgery,Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,200233,P.R.China;Department of Rehabilitation Medicine,Shanghai Donghai Senior Nursing Hospital,Shanghai,201303,P.R.China)

机构地区：[1]上海海洋大学水产与生命学院,上海201306 [2]上海交通大学医学院附属第六人民医院骨科,上海200233 [3]上海市东海老年护理医院康复医学科,上海201303

出　　处：《中国修复重建外科杂志》2025年第3期326-331,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家重点研发计划资助项目(2020YFC2004906);国家自然科学基金重点项目(81930069);上海市第六人民医院2024年度院级回顾性临床研究课题(ynhglg202401)。

摘　　要：目的自定多学科(内分泌科、血管外科与骨科)评分系统(简称:EMO评分系统),初步探讨其指导糖尿病足创面选择胫骨近端横向骨搬移(proximal tibial transverse transport,TTT)治疗的可行性。方法广泛查阅文献,基于目前临床常用糖尿病足判断标准、TTT治疗糖尿病足创面专家共识、指南及相关研究进展,结合临床经验,制定一套包括内分泌学、血管外科与骨科的EMO评分系统,并提出基于评分结果选择保守治疗、改善基线后TTT及TTT的标准。以2017年9月—2022年7月收治且符合选择标准的56例糖尿病足创面患者作为研究对象,其中28例行TTT治疗,28例行保守治疗。参照EMO评分系统对患者进行分级,选择对应治疗方法,并与实际治疗方法及结果进行对比。结果经文献检索以及临床经验等总结,形成EMO评分系统。该系统共包括3方面标准,分别为内分泌科(E)、血管外科(M)、骨科(O),根据相关评价条目分为多个亚型,最终将糖尿病足创面分为8种类型,分别对应选择需要TTT治疗、改善基线后TTT治疗、保守治疗。临床56例患者治疗后均获随访12个月。其中,TTT组创面愈合率达85.71%(24/28),高于保守治疗组的53.57%(15/28);术后12周CT血管造影示创面和同侧肢体较保守治疗组出现更多小血管。基于EMO评分系统判断,56例患者中需保守治疗14例、TTT治疗29例、改善基线后TTT治疗13例。对比患者临床资料,判断为TTT治疗患者的创面愈合率为75.86%(22/29),其中临床实际采用TTT治疗21例,愈合率90.48%;保守治疗8例,愈合率37.50%。判断为保守治疗患者创面愈合率为92.86%(13/14),其中临床实际采用TTT治疗1例,愈合率100%;保守治疗13例,愈合率92.31%,其中1例小截肢。判断为改善基线后TTT治疗患者创面愈合率仅为30.77%(4/13),其中临床实际采用TTT治疗6例,愈合率66.67%;保守治疗7例,愈合率0。结论基于EMO评分系统可以对糖尿病足创面进行全面Objective The self-defined multidisciplinary(endocrinology,vascular surgery,and orthopedics)scoring system(EMO scoring system for short)was designed.The feasibility of the EMO scoring system to guide the proximal tibial transverse transport(TTT)for diabetic foot wounds was preliminarily explored.Methods Based on the current commonly used clinical criteria for diabetic foot judgment,expert consensus,guidelines,and related research progress in the treatment of diabetic foot wounds,combined with clinical experience,a set of EMO scoring systems including endocrinology,vascular surgery,and orthopedics was formulated.The criteria for selecting conservative treatment,TTT after baseline improvement,and TTT based on scoring results was proposed.A total of 56 patients with diabetic foot wounds who were admitted between September 2017 and July 2022 and met the selection criteria was taken as the study subjects.Among them,28 patients were treated with TTT and 28 patients were treated conservatively.The patients were graded according to the EMO scoring system,the corresponding treatment methods were selected,and the actual treatment methods and results of the patients were compared.Results The EMO scoring system was formed through literature retrieval and clinical experiences.The system included three criteria,namely endocrinology(E),macrovascular disease(M),and orthopedics(O),which were divided into multiple subtypes according to the relevant evaluation items,and finally the diabetic foot wound was divided into 8 types,which correspondingly selected TTT,TTT after baseline improvement,and conservative treatment.All 56 patients were followed up 12 months after treatment.Among them,the wound healing rate of the TTT group was 85.71%(24/28),which was higher than that of the conservative treatment group[53.57%(15/28)].At 12 week after treatment,CT angiography showed that there were more small blood vessels in the wound and ipsilateral limb in TTT group than in the conservative treatment group.Based on the EMO scoring system,14 of

关 键 词：糖尿病足 创面 胫骨近端横向骨搬移 评分系统 

分 类 号：R47[医药卫生—护理学]