胫骨横向骨搬移联合鼻烟窝引流治疗重度糖尿病足溃疡
[Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain].
作者信息
Yu Jie, Hua Qikai, Kuang Xiaocong, Liu Jie, Liu Guangwei, Li Shanlang, Nie Xinyu, Su Hongjie, Ding Yi, Zhong Zhaowei, Yang Jiangtao, He Liexun, Chen Yan
机构信息
Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China.
Guangxi Diabetic Foot Salvage Engineering Research Center, Nanning Guangxi, 530021, P.R.China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Aug 15;35(8):984-988. doi: 10.7507/1002-1892.202103039.
OBJECTIVE
To investigate the effectiveness of tibial transverse transport (TTT) combined with nose ring drain (NRD) in the treatment of severe diabetic foot ulcer.
METHODS
The clinical data of 60 patients with severe diabetic foot (Wagner grade 3 or 4) ulcer who were admitted between April 2017 and August 2020 and met the selection criteria were retrospectively analyzed. Among them, 30 cases were treated with TTT combined with NRD (TTT+NRD group), and 30 cases were treated with TTT (TTT group). There was no significant difference in gender, age, diabetes duration, preoperative glycated hemoglobin, comorbidities, wound area, and duration, side, and grade of diabetic foot ( >0.05). The wound healing time, wound healing rate, amputation rate, recurrence rate, duration of antibiotic therapy, hospital stay, number of hospitalizations, and number of operations were recoreded and compared between the two groups.
RESULTS
No obvious surgical complications occurred in the two groups. Patients in both groups were followed up 3-13 months, with an average of 5.7 months. The duration of antibiotic therapy and hospital stay in the TTT+NRD group were significantly shorter than those in the TTT group ( <0.05). There was no significant difference in wound healing time, wound healing rate, number of hospitalizations, and number of operations between the two groups ( >0.05). During follow-up, there was no recurrence of ulcer in the TTT+NRD group while 2 recurrent cases (6.7%) in the TTT group. The difference in recurrence rate was not significant ( =0.492). One case (3.3%) in the TTT+NRD group underwent amputation due to acute lower extremity vascular embolism, and 1 case (3.3%) in the TTT group underwent amputation due to secondary necrosis. The difference in amputation rate was not significant between the two groups ( =1.000).
CONCLUSION
TTT combined with NRD is an effective method for the treatment of severe diabetic foot ulcers with deep infections or relatively closed cavities or sinuses. It can shorten the time of antibiotic use and the length of hospitalization; and the NRD has a good drainage effect without obvious comorbidities, procedure and the postoperative care are simple and easy to obtain materials.
目的
探讨胫骨横向骨搬移（TTT）联合鼻烟窝引流（NRD）治疗重度糖尿病足溃疡的疗效。
方法
回顾性分析2017年4月至2020年8月收治的60例符合入选标准的重度糖尿病足（Wagner 3级或4级）溃疡患者的临床资料。其中，30例采用TTT联合NRD治疗（TTT+NRD组），30例采用TTT治疗（TTT组）。两组患者在性别、年龄、糖尿病病程、术前糖化血红蛋白、合并症、创面面积、病程、糖尿病足的部位及分级等方面比较，差异均无统计学意义（>0.05）。记录并比较两组患者的创面愈合时间、创面愈合率、截肢率、复发率、抗生素使用时间、住院时间、住院次数及手术次数。
结果
两组均未发生明显手术并发症。两组患者均随访3～13个月，平均5.7个月。TTT+NRD组抗生素使用时间和住院时间均明显短于TTT组（<0.05）。两组创面愈合时间、创面愈合率、住院次数及手术次数比较，差异均无统计学意义（>0.05）。随访期间，TTT+NRD组溃疡无复发，TTT组有2例复发（6.7%），复发率差异无统计学意义（=0.492）。TTT+NRD组1例（3.3%）因急性下肢血管栓塞行截肢术，TTT组1例（3.3%）因继发坏死行截肢术，两组截肢率差异无统计学意义（=1.000）。
结论
TTT联合NRD是治疗重度糖尿病足溃疡伴深部感染或相对封闭腔隙或窦道的有效方法，可缩短抗生素使用时间和住院时间；且NRD引流效果良好，无明显合并症，操作及术后护理简单，取材容易。
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