摘要
目的:探讨重度糖尿病足胫骨横向骨搬移术治疗后创面愈合方式及机制。方法:2014年12月至2018年6月收治136例重度糖尿病足患者。按照Wagner分级标准,3级66例、4级60例、5级10例。按照TEXAS分级标准,2B级32例、2C级2例、2D级11例、3B级13例、3D级78例。均采用胫骨横向骨搬移术治疗。对创面愈合过程进行大体观察,同时分别于术前及术后1个月复诊时切取创面边缘组织,HE染色观察创面组织形态,免疫组织化学染色观察Ki-67、CD31和血管内皮生长因子(vascular endothelial growth factor,VEGF)表达情况。结果:①创面大体观察结果。术后初期创面处于炎性期,有炎性细胞浸润,创面黄白;随后有新鲜肉芽组织形成,肉芽组织由创面周围向创面中心移行,创面红润,进入增生期;肉芽组织覆盖创面的过程中,上皮组织逐渐由创面四周向中心移行,1~3个月时创面愈合50%左右,上皮组织最终覆盖创面,仅留线性瘢痕。②创面组织形态观察结果。术前创面边缘组织表皮结构不完整,坏死结构较多。术后1个月创面边缘组织可清晰地观察到完整表皮结构,分为角质层、颗粒层、棘层和基底层;真皮层结缔组织中可观察到血管及胶原纤维,纤维结构少见。术前、术后创面边缘组织表皮均有大量炎性细胞浸润。③术后1个月时,创面边缘组织中Ki-67、CD31、VEGF染色阳性细胞面积百分比均大于术前[(1.850±1.287)%,(7.480±5.272)%,Z=3.292,P=0.001;(0.395±0.139)%,(1.082±0.636)%,Z=3.403,P=0.001;(0.341±0.217)%,(2.428±1.502)%,Z=3.780,P=0.000]。结论:胫骨横向骨搬移术能有效促进重度糖尿病足创面愈合,治疗后创面愈合方式为再生愈合,其机制可能是该手术能促进创面组织细胞增殖与毛细血管再生。
Objective:To explore the pattern and mechanism of action of wound healing of severe diabetic foot after treatment with transverse tibial bone transport surgery.Methods:One hundred and thirty-six patients with severe diabetic feet were recruited from December 2014 to June 2018.According to the Wagner classification criteria,the diabetic feet belonged to grade 3(66),4(60)and 5(10).According to the TEXAS classification criteria,the diabetic feet belonged to grade 2B(32),2C(2),2D(11),3B(13) and 3D(78).All patients were treated with transverse tibial bone transport surgery.The roughly observation on wound healing procedure was performed,and the wound margin biopsies was performed before the surgery and at 1 month after the surgery.The wound tissue morphology and the expressions of Ki-67,CD31 and vascular endothelial growth factor(VEGF)were observed through HE staining and immunohistochemical staining respectively.Results:The results of roughly observation on wound surface showed that(1)the early postoperative wound was in the inflammatory stage,presenting with inflammatory cell infiltration and yellowish-white surface;(2)the fresh granulation tissues formed subsequently and migrated from the periphery to the center of the wound,and the ruddy wound surface demonstated that the wound entered into the hyperplasia stage;(3)the epithelial tissues gradually migrated from the periphery to the center of the wound when wound surface was covered by granulation tissues;(4)about 50% of wound healed within 1-3 months,and the wound surface was covered by epithelial tissues in the end,only the linear scars were found.The results of histomorphology observation on wound surface showed that(1)the epidermal structures of marginal tissues of wound were incomplete and many necrotic structures were found in wound surface before the surgery;(2)the complete epidermal structures,including cuticle,granular layer,spinous layer and basal layer were found in the marginal tissues of the wound at 1 month after the surgery;(3)the blood vessels and collagen fibers were found within the connective tissues of dermis and less fiber structure was found;(4)a large number of inflammatory cell infiltration was found in the epidermis of marginal tissues of wound surface before and after the surgery.The area percentages of positive Ki-67,CD31 and VEGF staining cells in marginal tissues of wound were higher at1 month after the surgery compared to pre-surgery(1.850+/-1.287 vs 7.480+/-5.272%,Z=3.292,P=0.001;0.395+/-0.139vs 1.082+/-0.636%,Z=3.403,P=0.001;0.341+/-0.217vs2.428+/-1.502%,Z=3.780,P=0.000).Conclusion:The transverse tibial bone transport surgery can effectively promote the wound healing of severe diabetic foot by means of regenerative healing,and its mechanisms of action may be that it can promote the cells proliferation and capillary regeneration in wound tissues.
作者
连浩宇
花奇凯
陈炎
何立环
庄胜
杨思捷
李山郎
镇普祥
高伟
丁毅
刘光炜
聂新宇
邝晓聪
LIAN Haoyu;HUA Qikai;CHEN Yan;HE Lihuan;ZHUANG Sheng;YANG Sijie;LI Shanlang;ZHEN Puxiang;GAO Wei;DING Yi;LIU Guangwei;NIE Xinyu;KUANG Xiaocong(School of Basic Medical Sciences of Guangxi Medical University,Nanning 530021,Guangxi,China;The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;Research Center for Regenerative Medicine of Guangxi Medical University,Nanning 530021,Guangxi,China;Guangxi Collaborative Innovation Center for biomedicine,Nanning 530021,Guangxi,China)
出处
《中医正骨》
2019年第12期15-19,33,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
广西自然科学基金项目(2017GXNSFAA198293)
广西壮族自治区医疗卫生重点学科资助项目(S2017032)
广西生物医药协同创新中心研究生创新创业项目(GCICB-IE-2018007)
关键词
糖尿病足
足溃疡
骨搬移
临床试验
diabetic foot
foot ulcer
bone transport
clinical trial
