胫骨横向骨搬移联合VSD治疗严重糖尿病足的临床效果  

Clinical effect of tibial transverse transport combinedwith VSD in the treatment of severe diabetic foot

作　　者：陈俊杰 邢新风 周树萍 郑立武 王焕鹏 常超楠 黄原宁 李士民[1] CHEN Junjie;XING Xinfeng;ZHOU Shuping(Department of Burn and Plastic Surgery,The 988 Hospital of Joint Logistic Support Force,Zhengzhou,Henan,450000,China)

机构地区：[1]中国人民解放军联勤保障部队第988医院烧伤整形外科,河南郑州450000 [2]中国人民解放军联勤保障部队第920医院骨科,云南昆明650000

出　　处：《实用手外科杂志》2025年第1期54-57,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨胫骨横向骨搬移联合VSD负压引流术治疗糖尿病足的临床效果,以期为严重糖尿病足患者提供更多的治疗方式和参考依据。方法选取2018年9月-2023年9月收治的严重糖尿病足患者10例,Wagner分级为Ⅲ-Ⅴ级,均待血糖稳定后行胫骨横向骨搬移联合VSD负压引流术。所有患者入院后予以控制血糖、控制感染、加强营养、康复训练等对症支持治疗,待患者病情稳定后行胫骨横向骨搬移,使用“手风琴”技术进行骨搬移,待搬移结束后给予持续VSD负压引流,待创面肉芽新鲜后,根据创面受损情况选择行游离皮片移植术或邻近皮瓣转位术。结果经上述一系列治疗后,所有患者严重糖尿病足创面均修复良好,治疗5个月左右创面基本愈合。术后随访,所有患者复查影像学显示侧支循环均有所增加,患肢皮肤温度均较术前有明显的升高,疼痛麻木感均较术前有明显减轻,患者满意度也相对较高。结论在控制感染和血糖的基础上,根据患者基础病用药和创面具体情况,在严格把握好手术适应证的前提下,征求患者及家属同意后,选择横向骨搬移联合VSD负压引流术治疗严重糖尿病足是一种安全有效的治疗方案。值得临床进行推广和使用。Objective To investigate the clinical effect of tibial transverse transport combined with VSD negative pressure drainage in the treatment of diabetic foot,and to provide more treatment methods and reference basis for the treatment of severe diabetic foot.Methods A total of 10 patients with severe diabetic foot were admitted to our department from September 2018 to September 2023,Wagner grade Ⅲ to Ⅴ,tibial transverse transport combined with VSD negative pressure drainage was performed after blood glucose was stabilized.After admission,all patients were given symptomatic support treatment such as blood sugar control,infection control,nutrition enhancement,and rehabilitation exercise.After the patients'condition was stabilized,tibial transverse transport was performed using the"accordion"technique,continuous VSD negative pressure drainage was given after the transport was completed,and free skin transplantation or adjacent flap was selected according to the patients'wound condition.Results After the above series of treatment,all patients with severe diabetes foot had good wound repair,Through 5 months'treatment,wound healed.Postoperative follow-up showed that collateral circulation increased in all patients,skin temperature of affected limbs increased significantly compared with that before surgery,pain and numbness of patients were significantly reduced compared with that before surgery,and postoperative satisfaction of patients was relatively high.Conclusion On the basis of controlling infection and blood sugar,according to the medication conditions of the patient's underlying diseases and the specific conditions of the wound,under the premise of strictly grasping the surgical indications,and after seeking the consent from the patient and his family,tibial transverse transport combined with VSD negative pressure drainage is a safe and effective treatment plan for the treatment of severe diabetic foot.It is worth promoting and using in clinic.

关 键 词：糖尿病 糖尿病足 横向骨搬移 负压封闭引流 

分 类 号：R47[医药卫生—护理学]