中国修复重建外科杂志

中国修复重建外科杂志

胫骨横向骨搬运术治疗糖尿病足溃疡的疗效

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目的探讨胫骨横向骨搬运术治疗糖尿病足溃疡的疗效。 方法2014 年 6 月—2017 年 12 月,收治 17 例糖尿病足溃疡患者。男 11 例,女 6 例;年龄 46~72 岁,中位年龄 57 岁。糖尿病病程 2.4~32.0 年,中位时间 16.0 年。Wagner 分期:2 期 7 例、3 期 8 例、4 期 2 例。下肢 CT 血管造影(CT angiography,CTA)显示膝关节以下动脉闭塞或不同程度狭窄。患者均接受胫骨横向骨搬运术,术后 3~5 d 开始牵拉搬运胫骨截骨块(1 mm/d),14 d 后逆向搬运;总搬运时间 28~30 d。 结果患者均获随访,随访时间 5~12 个月,平均 8.5 个月。骨搬运期间,4 例出现局部钉道口感染,3 例钉道脂肪液化、渗液。15 例糖尿病足溃疡愈合,愈合时间 35~72 d,平均 48 d;溃疡愈合后的疼痛视觉模拟评分(VAS)、足部皮温、踝肱指数较术前显著改善,差异均有统计学意义(P<0.05);CTA 复查示侧支循环形成。2 例(Wagner 3、4 期各 1 例)治疗后足部溃疡仍进展,行足部及小腿截肢治疗。 结论胫骨横向骨搬运术治疗糖尿病足溃疡可取得较满意疗效。

ObjectiveTo evaluate the effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer. MethodsBetween June 2014 and December 2017, 17 patients with diabetic foot ulcer were treated. There were 11 males and 6 females, with a median age of 57 years (range, 46-72 years). The duration of diabetes was 2.4-32.0 years (mean, 16.0 years). According to the Wagner grading criteria, 7 cases were rated as grade 2, 8 cases as grade 3, and 2 cases as grade 4. The CT angiography (CTA) showed the arterial occlusion or stenosis of varying degrees below knee joint. All cases were treated with transverse tibial bone transport. Bone transport started at 3 to 5 days after placing external fixator and lasted 14 days (1 mm per day), and then reverse transport started. The total transport time was 28-30 days. ResultsAll 17 patients were followed up 5-12 months (mean, 8.5 months). During transportation, 4 cases had screw orifice infection, and 3 cases had liquefaction and seepage. And other 15 cases ulcers healed and the healing time was 35-72 days (mean, 48 days). There were significant differences in visual analogue scale (VAS) scores, skin temperature, ankle brachial index (ABI) between before and after ulcer healed (P<0.05). The CTA showed that the collateral circulation was established. The foot ulcer of 2 cases (Wagener grade 3 in 1 case and grade 4 in 1 case) still progressed after treatment, and amputation was performed. ConclusionTransverse tibial bone transports has good effectiveness for diabetic foot ulcer.

关键词: 胫骨横向骨搬运术; 糖尿病足; 溃疡

Key words: Transverse tibial bone transport; diabetic foot; ulcer

引用本文: 李宏烨, 尤加省, 刘超, 马彦. 胫骨横向骨搬运术治疗糖尿病足溃疡的疗效. 中国修复重建外科杂志, 2019, 33(1): 23-27. doi: 10.7507/1002-1892.201807143 复制

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