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胫骨横向骨搬运联合负压引流治疗糖尿病足溃疡的临床疗效分析

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

作者信息

Jia Zhong-Wei, Yu Jian-Ping, Su Yun-Xing, Guo Xiu-Sheng, Yu Jin-Bin, Yang Zhi-Jun, Niu Jia-Wei, Wei Jie

机构信息

Department of Orthpaedic, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi, China.

Department of Orthpaedic, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi, China;

出版信息

Zhongguo Gu Shang. 2018 Mar 25;31(3):232-236. doi: 10.3969/j.issn.1003-0034.2018.03.008.

Abstract

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(=13.63, =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 (=7.31, =0.000). Postoperative angiography and vascular ultrasound showed satisfied regeneration of micro-vessel and affected foot achieved normal movement and daily life.

CONCLUSIONS

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.

摘要

目的

探讨胫骨横向骨搬运微血管再生技术联合负压引流治疗糖尿病足溃疡的临床效果。

方法

回顾性分析2015年11月至2016年12月采用胫骨横向骨搬运微血管再生技术联合负压引流治疗的19例糖尿病足溃疡患者的临床资料,其中男15例,女4例,年龄42~82岁,平均(64.57±7.14)岁;糖尿病病程(14.62±6.19)年;左侧12例,右侧7例;溃疡面积2 cm×3 cm~8 cm×6 cm。所有患者按德州分类均为D期,2级3例,3级10例,4级6例。采用踝肱指数及密歇根神经病变筛查量表(MNSI)评估术前及术后外周血管及神经恢复情况,术后比较血管造影及血管超声结果。

结果

19例患者中17例获随访,随访时间3~13个月,平均6.9个月。17例患者创面均愈合。踝肱指数由术前的(0.51±0.20)升至术后3个月的(0.93±0.18),差异有统计学意义(t=13.63,P=0.000);MNSI由术前的(4.06±1.36)升至术后3个月的(5.76±1.44),差异有统计学意义(t=7.31,P=0.000)。术后血管造影及血管超声显示微血管再生满意,患足恢复正常活动及日常生活。

结论

胫骨横向骨搬运微血管再生技术可重建下肢远端微血管,促进外周血管及神经恢复,联合负压引流可促进创面愈合,具有操作简单、临床效果明显、保肢成功率高的优点,是糖尿病足溃疡理想的治疗方法之一。

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