摘要
目的 探讨微创胫骨横向骨搬移治疗糖尿病足的临床疗效.方法 回顾性分析2019年1月至2022年12月常州市第一人民医院创伤骨科收治的糖尿病足患者82例,糖尿病足Wagner分级2级12例、3级50例、4级20例.按手术方式分为骨搬移组45例,男29例、女16例,年龄(65.27±10.74)岁(范围44～87岁),行微创胫骨横向骨搬移联合局部清创治疗;非骨搬移组37例,男26例、女11例,年龄(66.05±11.08)岁(范围44～86岁),行局部清创治疗.比较两组患者性别、年龄、Wagner分级、患肢体表温度差、术前及术后1个月患肢部位疼痛视觉模拟评分(visual analogue scale,VAS)、术后1个月创面愈合率、术后1年患足复发或再发率,并比较不同Wagner分级的临床效果.结果 两组性别、年龄、Wagner分级及术前VAS的差异无统计学意义(P＞0.05);82例均获得随访,随访时间为(14.23±1.20)个月.骨搬移组在术前1天和术后第1天的患肢皮肤温度差为(6.01±0.28)℃,较非骨搬移组的(1.93±0.31)℃高,差异有统计学意义(P＜0.05);术后1个月骨搬移组VAS为(2.18±0.58)分,低于非骨搬移组的(5.41±0.93)分,且骨搬移组手术前后VAS差为(4.80±1.24)分,降低幅度大于非骨搬移组的(1.62±1.48)分,差异均有统计学意义(P＜0.05).骨搬移组术后1个月创面愈合率为98.78％±2.17％,非骨搬移组愈合率为52.57％±6.41％;术后1年骨搬移组双下肢溃疡未发现复发或再发,非骨搬移组复发率为86％(32/37),差异有统计学意义(P＜0.05).Wagner分级2、3、4级术前VAS的差异无统计学意义(P＞0.05).Wagner2、3、4级骨搬移组患者术后1个月VAS、VAS下降幅度、手术前后患肢皮肤温度差、术后1个月局部创面愈合率、术后12个月下肢溃疡复发或再发率的差异有统计学意义(P＜0.05).结论 胫骨微创横向骨搬移联合局部精准清创,可以提高糖尿病足溃疡的愈合率,改善患肢末梢微循环,减轻患肢疼痛,降低糖尿病足溃疡的复发再发率.
Abstract
Objective To investigate the precautions and clinical effects of minimally invasive lateral bone transfer of tib-ia in the treatment of diabetic foot.Methods A retrospective analysis was performed on 82 patients with diabetic foot admitted to the Trauma Department of Changzhou First People's Hospital from January 2019 to December 2022.According to the Wagner grade of diabetic foot,there were 12 cases of grade 2,50 cases of grade 3,and 20 cases of grade 4.According to the surgical meth-od,45 patients were divided into bone transfer group.There were 29 males and 16 females,with an average age of 65.27±10.74 years(ranging from 44-87 years),who underwent minimally invasive bone transfer of tibia combined with local debridement treat-ment.In the non-bone transfer group,there were 37 cases(26 males and 11 females)with an average age of 66.05±11.08 years(ranging from 44 to 86 years),who were treated with local debridement.Gender,age,Wagner grade,surface temperature differ-ence of the affected limb,visual analogue scale(VAS)score of the affected limb before and 1 month after surgery,wound healing rate 1 month after surgery,and recurrence rate of the affected foot 1 year after surgery were compared between the two groups.Out-comes of the cases of different Wagner grades were compared.Result All 82 patients were followed up for 14.23±1.20 months.There was no significant difference in gender,age,Wagner grade and preoperative VAS between the two groups(P＞0.05).The skin temperature of the affected limb before and after surgery in the bone transfer group was significantly higher than that in the non-bone transfer group 1.93±0.31 ℃(P＜0.05),and the VAS of the bone transfer group was 2.18±0.58 points 1 month after surgery,which was lower than that in the non-bone transfer group of 5.41±0.93.The VAS difference before and after surgery in the bone transfer group was 4.80±1.24 points,which was greater than that in the non-bone transfer group of 1.62±1.48 points with signifi-cant difference(P＜0.05).The wound healing rate was over 98.78％±2.17％in the bone transfer group and 52.57％±6.41％in the non-bone transfer group one month after surgery.No recurrence or recurrence was found in the bone transfer group one year after surgery,and the recurrence rate was 86％(32/37)in the non-bone transfer group with significant difference(P＜0.05).There was no difference in preoperative VAS for different grades of diabetic foot(grades 2,3,and 4).There were significant differences in VAS,VAS decrease,postoperative limb surface temperature increase,local wound healing rate at 1 month,and lower limb ulcer recur-rence or recurrence rate at 12 months in the bone transfer groups of Wagner grade 2,3,and 4(P＜0.05).Conclusion Minimally invasive lateral bone transfer of tibia combined with local precision debridement could significantly increase the healing rate of di-abetic foot ulcer,improve the peripheral microcirculation of the affected limb,reduce the pain of the affected limb,and decrease the recurrence rate of diabetic foot ulcer.
维普
万方数据