胫骨横向骨搬运术治疗糖尿病足溃疡的疗效
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摘要
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。
Objective To evaluate the effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer. Methods Between 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, and2 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.Results All 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. Conclusion Transverse tibial bone transports has good effectiveness for diabetic foot ulcer.
Objective To evaluate the effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer. Methods Between 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, and2 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.Results All 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. Conclusion Transverse tibial bone transports has good effectiveness for diabetic foot ulcer.
引文
1Jiang YJ, Wang XM, Xia L, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair and Regeneration, 2015, 23(2):222-230.
2高磊,王硕,王雷,等.皮肤牵张闭合器在糖尿病足创面修复中的应用.中国修复重建外科杂志, 2018, 32(5):591-595.
3李来春,王爱红,胡呈炜,等.糖尿病足患者住院费用调查及影响因素的研究.中国糖尿病杂志, 2017, 25(4):339-343.
4余霄,俞光荣.糖尿病足截肢技术进展.中国修复重建外科杂志,2011, 25(6):750-754.
5 徐波,杨彩哲,吴石白,等.糖尿病足患者截肢相关危险因素分析.中华内科杂志, 2017, 56(1):24-28.
6王江宁,高磊.糖尿病足慢性创面治疗的新进展.中国修复重建外科杂志, 2018, 32(7):832-837.
7Coxon JP, Gallen IW. Laterality of lower limb amputation in diabetic patients:retrospective audit. BMJ, 1999, 318(7180):367-369.
8Ilizarov GA. The tension-stress effect on the genesis and growth of tissues:PartⅡ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989, 239:263-285.
9Makarov M, Birch J, Samchukov M. The role of variable muscle adaptation to limb lengthening in the development of joint contractures:an experimental study in the goat. Journal of Pediatric Orthopedics, 2009, 29(2):175-181.
10镇普祥,陈炎,高伟,等.应用Ilizarov技术胫骨横向骨搬移术治疗合并全身性炎症反应综合征的重度糖尿病足.中国修复重建外科杂志, 2018, 32(10):1261-1266.
11王斌,杨漪舸.股-股动脉旁路移植联合胫骨横向骨搬移术治疗动脉硬化闭塞症一例.中国修复重建外科杂志, 2015, 29(9):1188.
12 曲龙,王爱林,汤福刚.胫骨横向搬移血管再生术治疗血栓闭塞性脉管炎.中华医学杂志, 2001, 81(10):622-624.
13徐显章,王爱林,靖冬梅.胫骨迁移血管再生治疗血栓闭塞性脉管炎35例分析.中国实用外科杂志, 2011, 31(6):523-524.
14冼呈,赵劲民,苏伟,等.胫骨横向骨搬移微循环再生技术治疗糖尿病足的临床疗效观察.广西医科大学学报, 2015, 32(4):605-607.
15花奇凯,王林,冼呈,等. Ilizarov胫骨横向骨搬移微循环重建术治疗下肢慢性缺血性疾病的临床疗效.中国矫形外科杂志,2015, 23(21):2007-2011.
16花奇凯,秦泗河,赵良军,等. Ilizarov技术胫骨横向骨搬移术治疗糖尿病足.中国矫形外科杂志, 2017, 25(4):303-307.
17周强. CTA评价胫骨横向骨搬移术治疗老年糖尿病足的临床疗效.影像研究与医学应用, 2018, 2(3):154-156.
18 冼呈,赵劲民,苏伟,等.外固定架骨搬移系统修复糖尿病足:功能与影像学评价.中国组织工程研究, 2015, 19(46):7539-7544.
2高磊,王硕,王雷,等.皮肤牵张闭合器在糖尿病足创面修复中的应用.中国修复重建外科杂志, 2018, 32(5):591-595.
3李来春,王爱红,胡呈炜,等.糖尿病足患者住院费用调查及影响因素的研究.中国糖尿病杂志, 2017, 25(4):339-343.
4余霄,俞光荣.糖尿病足截肢技术进展.中国修复重建外科杂志,2011, 25(6):750-754.
5 徐波,杨彩哲,吴石白,等.糖尿病足患者截肢相关危险因素分析.中华内科杂志, 2017, 56(1):24-28.
6王江宁,高磊.糖尿病足慢性创面治疗的新进展.中国修复重建外科杂志, 2018, 32(7):832-837.
7Coxon JP, Gallen IW. Laterality of lower limb amputation in diabetic patients:retrospective audit. BMJ, 1999, 318(7180):367-369.
8Ilizarov GA. The tension-stress effect on the genesis and growth of tissues:PartⅡ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989, 239:263-285.
9Makarov M, Birch J, Samchukov M. The role of variable muscle adaptation to limb lengthening in the development of joint contractures:an experimental study in the goat. Journal of Pediatric Orthopedics, 2009, 29(2):175-181.
10镇普祥,陈炎,高伟,等.应用Ilizarov技术胫骨横向骨搬移术治疗合并全身性炎症反应综合征的重度糖尿病足.中国修复重建外科杂志, 2018, 32(10):1261-1266.
11王斌,杨漪舸.股-股动脉旁路移植联合胫骨横向骨搬移术治疗动脉硬化闭塞症一例.中国修复重建外科杂志, 2015, 29(9):1188.
12 曲龙,王爱林,汤福刚.胫骨横向搬移血管再生术治疗血栓闭塞性脉管炎.中华医学杂志, 2001, 81(10):622-624.
13徐显章,王爱林,靖冬梅.胫骨迁移血管再生治疗血栓闭塞性脉管炎35例分析.中国实用外科杂志, 2011, 31(6):523-524.
14冼呈,赵劲民,苏伟,等.胫骨横向骨搬移微循环再生技术治疗糖尿病足的临床疗效观察.广西医科大学学报, 2015, 32(4):605-607.
15花奇凯,王林,冼呈,等. Ilizarov胫骨横向骨搬移微循环重建术治疗下肢慢性缺血性疾病的临床疗效.中国矫形外科杂志,2015, 23(21):2007-2011.
16花奇凯,秦泗河,赵良军,等. Ilizarov技术胫骨横向骨搬移术治疗糖尿病足.中国矫形外科杂志, 2017, 25(4):303-307.
17周强. CTA评价胫骨横向骨搬移术治疗老年糖尿病足的临床疗效.影像研究与医学应用, 2018, 2(3):154-156.
18 冼呈,赵劲民,苏伟,等.外固定架骨搬移系统修复糖尿病足:功能与影像学评价.中国组织工程研究, 2015, 19(46):7539-7544.