胫骨横向骨搬移结合负压引流治疗糖尿病足溃疡的临床疗效分析

目的 :探讨胫骨横向骨搬移微血管网再生技术结合封闭负压引流治疗伴溃疡形成的糖尿病足的临床疗效。方法:对2015年11月至2016年12月采用胫骨横向骨搬移结合负压引流治疗的19例伴溃疡形成的糖尿病足的临床资料进行回顾性分析,男15例,女4例;年龄42~82岁,平均(64.57±7.14)岁;糖尿病平均病程(14.62±6.19)年;左足12例,右足7例;溃疡面积2 cm×3 cm~8 cm×6 cm;按照Texas分类法进行分类,所有病例为D期,其中2级3例,3级10例,4级6例。手术前后测量踝肱指数及密歇根神经体征评分(MNSI)评价患足周围血管和周围神经功能恢复情况,术后复查血管造影或血管彩超。结果:19例患者中17例术后获得随访,时间3~13个月,平均6.9个月。17例患足创面均得到愈合;术后3个月踝肱指数由术前的0.51±0.20升至0.93±0.18,差异有统计学意义(t=13.63,P=0.000);术后3个月的MNSI为5.76±1.44,优于术前的4.06±1.36,差异有统计学意义(t=7.31,P=0.000)。术后复查血管造影或血管彩超显示患足微血管网再生满意,患足功能达到正常运动和日常生活需要。结论:胫骨横向骨搬移微血管网再生技术可以重建患肢小腿以下微血管网,促进周围血管及周围神经恢复,结合封闭负压引流可促进创面愈合,具有手术简便、疗效确切,保肢成功率高的优点,是治疗糖尿病足溃疡的理想方法之一。

Clinical efficacy analysis of transverse tibial bone transport combined with vacuum drainage for the treatment of diabetic foot ulcer

Objective: To investigate clinical effect of transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage in treating diabetic foot ulcer. Methods: From November 2015 and December 2016,clinical data of 19 diabetic foot ulcer patients treated with transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage were retrospective analyzed,including 15 males and 4 females aged from 42 to 82 years old with an average of (64.57±7.14) years old;the courses of diabetic ranged was (14.62±6.19) years;12 cases on the left side and 7 cases on the right side;the area of ulcer ranged from 2 cm×3 cm to 8 cm×6 cm. All patients were stage D according to Texas classification,3 cases were grade 2,10 cases were grade 3 and 6 cases were grade 4. Ankle-brachial index and Michigan Neuropathy Screening Instrument (MNSI) were used to evaluate recovery of peripheral vessel and nerve before and after operation,the result of angiography and vascular ultrasound were also compared after operation. Results: Seventeen of 19 patients were followed up from 3 to 13 months with an average of 6.9 months. Seventeen patients'' surface wound were healed. Ankle-brachial index was increased from (0.51±0.20) before operation to (0.93±0.18) at 3 months after operation,and had significant difference(t=13.63,P=0.000);MNSI was increased from (4.06±1.36) before operation to(5.76±1.44) at 3 months after operation,and differences were statistically significant (t=7.31,P=0.000). Postoperative angiography and vascular ultrasound showed satisfied regeneration of micro-vessel and affected foot achieved normal movement and daily life. Conclusion: Transverse tibial bone transport micro vessels regeneration technology could reconstruct micro-vessel under lower affected limb,promote recovery of peripheral vessel and nerve,while with vacuum drainage could promote wound healing,has advantages of simple operation,obvious clinical effect,and high success rate of limb-salvage,and is one of ideal treatment for diabetic foot ulcer.