[胫骨横向骨搬运治疗糖尿病足溃疡的疗效]
[Effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer].
作者信息
Li Hongye, You Jiaxing, Liu Chao, Ma Yan
机构信息
Department of Orthopedics, Xiasha Campus, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310018, P.R.China.
Department of Orthopedics, Xiasha Campus, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310018,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Jan 15;33(1):23-27. doi: 10.7507/1002-1892.201807143.
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, 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.
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 ( <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.
目的
评估胫骨横向骨搬运治疗糖尿病足溃疡的有效性。
方法
2014年6月至2017年12月，对17例糖尿病足溃疡患者进行治疗。其中男性11例，女性6例，年龄中位数为57岁（范围46 - 72岁）。糖尿病病程为2.4 - 32.0年（平均16.0年）。根据Wagner分级标准，2级7例，3级8例，4级2例。CT血管造影（CTA）显示膝关节以下存在不同程度的动脉闭塞或狭窄。所有病例均采用胫骨横向骨搬运治疗。骨搬运在放置外固定架后3至5天开始，持续14天（每天1毫米），然后开始反向搬运。总搬运时间为28 - 30天。
结果
17例患者均获随访5 - 12个月（平均8.5个月）。搬运过程中，4例出现螺钉孔感染，3例出现液化渗液。其余15例溃疡愈合，愈合时间为35 - 72天（平均48天）。溃疡愈合前后视觉模拟评分（VAS）、皮肤温度、踝肱指数（ABI）差异有统计学意义（<0.05）。CTA显示侧支循环建立。2例患者（Wagener 3级1例，4级1例）足部溃疡治疗后仍进展，行截肢手术。
结论
胫骨横向骨搬运治疗糖尿病足溃疡疗效良好。
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