摘要
[目的]评价胫骨内后侧截骨法横向骨搬移治疗糖尿病足溃疡的临床疗效。[方法]回顾性分析2019年3月—2022年10月收治的52例糖尿病足溃疡(56足),均采用胫骨内后横向骨搬移术。评价临床资料。[结果]56足均顺利完成截骨,手术时间20~40 min,切口长度5~7 cm,术中骨折块大小5 cm×1.5 cm~6 cm×1.8 cm。术后3足出现截骨切口渗出,经换药和延迟2周搬运后伤口愈合。随访时间平均(15.5±2.7)个月。3足因严重感染并伴有剧烈疼痛而选择截肢,截肢率5.4%,保肢成功率94.6%。带架时间最短6周,最长17周。随术前、术后7 d和12个月的时间推移,VAS评分[(6.2±0.7),(3.2±0.6),(1.0±0.3),P=0.022]、踝臂指数(ankle brachial index,ABI)[(0.7±0.1),(0.8±0.1),(1.0±0.2),P=0.042]和趾端皮温[(28.2±2.1)℃,(32.3±0.5)℃,(36.1±0.6)℃,P=0.031]均显著改善。除3足截肢外,创面均愈合[愈合/未愈合/截肢,(0/56/0),(0/56/0),(53/0/3),P<0.001]。[结论]胫骨内后侧截骨法横向骨搬移术治疗糖尿病足溃疡时能有效改善足部血液供应,手术简单安全,并发症少。
[Objective]To investigate the clinical efficacy of posteromedial tibial osteotomy and transverse bone fragment transport for diabetic foot ulcer.[Methods]A retrospective study was performed on 52 patients(56 feet)who had diabetic foot ulcers treated by abovesaid surgical technique from March 2019 to October 2022.The relative clinical documents were evaluated.[Results]All 56 feet were operated on successfully with the operation time from 20 min to 40 min,the incision length from 5 cm to 7 cm,and the osteotomy bone fragment from 5 cm×1.5 cm to 6 cm×1.8 cm in size.Among them,3 feet got osteotomy incision exudation after surgery,which healed after dressing change and delayed bone transportation for 2 weeks.The patients were followed up for(15.5±2.7)months in a mean,with amputation rate of 5.4%and the success rate of limb salvage of 94.6%,frame bearing time 6 weeks in the minimum and 17 weeks in the maximum.With time elapsed preoperatively,7 days and 12 months after surgery,the VAS score[(6.2±0.7),(3.2±0.6),(1.0±0.3),P=0.022],ankle brachial index(ABI)[(0.7±0.1),(0.8±0.1),(1.0±0.2),P=0.042]and toe skin temperature[(28.2±2.1)℃,(32.3±0.5)℃,(36.1±0.63)℃,P=0.031]were significantly improved.Except 3 foot amputation,all the patients had the ulcer healed well over time[healing/non-healing/amputation,(0/56/0),(0/56/0),(3/53/0),P<0.001].[Conclusion]The posteromedial tibial osteotomy and transverse bone fragment transport does effectively improve blood supply of the foot,with advantages of simplifying therapeutic operation,high safety and less complications.
作者
何晓清
熊鹰
字国祚
杨雪标
潘德
石岩
徐永清
苏踊跃
HE Xiao-qing;XIONG Ying;ZI Guo-zuo;YANG Xue-biao;PAN De;SHI Yan;XU Yong-qing;SU Yong-yue(Department of Orthopedics,The 920th Hospital,PLAJoint Logistic Support Force,Kunming 650032,Yunnan,China;Department of Orthopedics,Yan'an Hospital of Kunming City,Kunming 650051,Yunnan,China;Department of Trauma,People's Hospital of Yunxian County,Lincang 675803,Yunnan,China)
出处
《中国矫形外科杂志》
北大核心
2025年第21期1988-1992,共5页
Orthopedic Journal of China
基金
兴滇英才支持计划医疗卫生人才专项项目,云南省创伤骨科临床医学中心项目(编号:ZX20191001)
昆明医科大学应用基础研究联合专项项目(编号:202101AY070001-298,202201AY070001-288,202201AY70001-292)
云南省骨科与运动康复临床医学研究中心项目(编号:202102AA310068)。
关键词
糖尿病足
溃疡
胫骨横向骨搬移技术
并发症
diabetic foot
ulcer
transverse tibial bone fragment transportation
complications
