创周皮瓣修复糖尿病足创面以及预后影响因素分析  

Repair of diabetic foot wounds with periwound flaps and analysis of prognostic factors

作　　者：闫昌葆 张杰[1] 耿一鹤 刘大方 王艳阳 赵亮[1] YAN Chang-bao;ZHANG Jie;GENG Yi-he;LIU Da-fang;WANG Yan-yang;ZHAO Liang(Department of Vascular Surgery,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京路河医院血管外科,北京通州101100

出　　处：《河北医科大学学报》2025年第3期317-322,共6页Journal of Hebei Medical University

摘　　要：目的探讨创周皮瓣治疗糖尿病足的初步临床效果。方法回顾性分析2022年1-6月于首都医科大学附属北京潞河医院诊断为糖尿病足的52例患者,均行创周皮瓣修复糖尿病足创面,分析一般资料,比较各组患者创面一期愈合率、溃疡再发率、溃疡复发率、踝上截肢率、不良事件发生率、以及切口愈合时间。分析影响患者预后的危险因素。结果本研究中患者总体创面一期愈合率为96.20%,溃疡再发率为9.60%,溃疡复发率为3.80%,踝上截肢率为1.90%,不良事件发生率为11.50%,愈合时间为(44.52±14.85)d。合并脑梗死患者的一期切口愈合率为83.30%明显小于未合并脑梗塞患者的100%(P=0.050);年龄≤60岁溃疡再发率为28.60%,明显高于年龄>60岁的2.60%(P=0.022);合并冠心病患者的溃疡复发率为16.70%明显高于未合并冠心病患者的0%(P=0.050);Wagner3级患者切口愈合时间为(37.32±10.54)d明显小于Wagner4级患者的(48.59±13.07)d(P=0.001)。缺血性糖尿病足及非缺血性糖尿病足各项预后指标比较差异均无统计学意义(P>0.05)。回归分析结果显示,年龄≤60岁为溃疡再发的独立危险因素(P=0.022);Wagner分级高为切口愈合时间延长的独立危险因素(P=0.001)。结论创周皮瓣是快速闭合糖尿病足创面的有效方法,同时应关注糖尿病足患者足外并发症以及重视周围血管病的诊治。Objective To explore the preliminary clinical effect of periwound flap in the treatment of diabetic foot.Methods From January to June 2022,52 patients diagnosed with diabetic foot in Beijing Luhe Hospital Affiliated to Capital Medical University were retrospectively analyzed.All patients underwent repair of diabetic foot wound susing periwound flaps.The general data were analyzed,and primary wound healing rate,ulcer reappear rate,ulcer recurrence rate,ankle amputation rate,incidence of adverse events,and wound healing time were compared among the groups.The risk factors affecting the prognosis of patients were analyzed.Results The overall primary wound healing rate was 96.20%,the ulcer reappear rate was 9.60%,the ulcer recurrence rate was 3.80%,the ankle amputation rate was 1.90%,the incidence of adverse events was 11.50%,and the healing time was(44.52±14.85)d.The primary wound healing rate of patients with cerebral infarction(83.30%)was significantly lower than that of patients without cerebral infarction(100%,P=0.050).The recurrence rate of ulcer in patients aged≤60 years was 28.60%,which was significantly higher than 2.60%in patients aged>60 years(P=0.022).The recurrence rate of ulcer in patients with coronary heart disease(CHD)(16.70%)was significantly higher than that in patients without CHD(0%)(P=0.050).The wound healing time of patients with Wagner3 was(37.32±10.54)d,which was significantly shorter than that of patients with Wagner4[(48.59±13.07)d,P=0.001].There was no significant difference in the prognostic indicators between ischemic and non-ischemic diabetic foot.Regression analysis showed that age≤60 years was an independent risk factor for ulcer recurrence(P=0.022).Higher Wagner grade was an independent risk factor for prolonged wound healing time(P=0.001).Conclusion Periwound flap represents an effective method for rapid closure of diabetic foot wounds.In the meantime,attention should be paid to the non-foot comorbidities of diabetic foot and the diagnosis and management of peripheral vascula

关 键 词：糖尿病足 创周皮瓣 创面修复 血运重建 

分 类 号：R587.29[医药卫生—内分泌]