Ding Xiao-Fang, Xu Hai-Lin, Wang Yuan-Li, Ji Kun-Yu, Yang Li-Li
Department of Traumatic Orthopaedics, Peking University People's Hospital, Beijing 100044, China.
Zhongguo Gu Shang. 2021 May 25;34(5):462-6. doi: 10.12200/j.issn.1003-0034.2021.05.013.
To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot.
From August 2016 to June 2018, 87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction, inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of (68.9±11.3) years old;2 patients were grade 2, 37 patients were grade 3 and 50 patients were grade 4 according to Wagner's classification;the courses of diabetic were for 10 to 16 years with an average of (13.0±2.2) years;the courses of diabetic feet were for 21 to 48 days with an avergae of (34.2±8.6) days. Postoperative comlications were observed. Skin temperature, visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation.
All patients were followed up for 4 to 19 months with an average of (12.6±2.8) months. Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer, and scabed without special treatment. One patient was performed amputation above 5 cm of ankle joint because of severe infection, and 1 patient occurred re-ulceration at 1 year after wound healing, bone transfer was performed again at the same site, and was completely healed at 8 weeks after operation. The healing time of wound ranged from 3 to 24 weeks with an average of (11.9± 3.8) weeks. Foot skin temperature before operation was (28.9±0.91) ℃, and increased to (31.70±0.32)℃ at 3 months after operation(=5.72 =0.006);VAS score before opertaion was (7.80±0.72), and improved to (2.20±0.13) at 3 months after operation (=25.38, =0.000);ABI beforeoperation was(0.48±0.30), increased to(0.98±0.24) at 3 months after oeprtaion(= 14.68, =0.000).
Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg, promote recovery of peripheral blood vessels, and promote wound healing of foot, reduce or avoid amputation. At the same time, the improved osteotomy is one of the effective methods for the treatment of diabetic foot which has advantags of less trauma, simple opertaion.
探讨改良胫骨横向骨搬移微循环重建术治疗终末期糖尿病足的临床效果。
选取2016年8月至2018年6月采用改良胫骨横向骨搬移微循环重建术治疗的糖尿病足患者87例，其中男54例，女33例；年龄39～95岁，平均（68.9±11.3）岁；按Wagner分级，2级2例，3级37例，4级50例；糖尿病病程10～16年，平均（13.0±2.2）年；糖尿病足病程21～48天，平均（34.2±8.6）天。观察术后并发症情况。记录术前及术后3个月时的足部皮肤温度、视觉模拟评分（VAS）、踝肱指数（ABI）及伤口愈合情况。
所有患者均获随访，随访时间4～19个月，平均（12.6±2.8）个月。骨搬移过程中2例出现皮下组织液化及针道渗液，未特殊处理自行结痂。1例因严重感染行踝关节上5 cm以上截肢术，1例伤口愈合1年后出现再溃疡，于原部位再次行骨搬移术，术后8周完全愈合。伤口愈合时间3～24周，平均（11.9±3.8）周。术前足部皮肤温度为（28.9±0.91）℃，术后3个月升至（31.70±0.32）℃（t=5.72，P=0.006）；术前VAS评分为（7.80±0.72），术后3个月改善为（2.20±0.13）（t=25.38，P=0.000）；术前ABI为（0.48±0.30），术后3个月升至（0.98±0.24）（t=14.68，P=0.000）。
改良胫骨横向骨搬移术能有效重建小腿下段微循环网络，促进外周血管恢复，促进足部伤口愈合，减少或避免截肢。同时，改良截骨术是治疗糖尿病足的有效方法之一，具有创伤小、操作简单的优点。
