[1]杨黎黎,王庆甫△,王元利,等.改良胫骨近端和远端截骨搬移治疗糖尿病足的临床研究[J].中国中医骨伤科杂志,2024,32(02):44-49+55.[doi:10.20085/j.cnki.issn1005-0205.240208]
　YANG Lili WANG Qingfu WANG Yuanli DING Xiaofang XU Hailin ZHOU Haitao JI Kunyu LIANG Huan YANG Pengjie.Clinical and Experimental Study of Modified Proximal and Distal Tibial Osteotomy and Transposition for Diabetic Foot[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(02):44-49+55.[doi:10.20085/j.cnki.issn1005-0205.240208]
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改良胫骨近端和远端截骨搬移治疗糖尿病足的临床研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年02期
页码:
44-49+55
栏目:
临床研究
出版日期:
2024-02-15

文章信息/Info

Title:
Clinical and Experimental Study of Modified Proximal and Distal Tibial Osteotomy and Transposition for Diabetic Foot
文章编号:
1005-0205(2024)02-0044-06
作者:
杨黎黎1; 王庆甫2△; 王元利1; 丁小方1; 徐海林3; 周海涛1; 纪坤羽1; 梁欢1; 杨朋杰1
1北京市隆福医院(北京,100010); 2北京中医药大学第三附属医院; 3北京大学人民医院
Author(s):
YANG Lili1 WANG Qingfu2△ WANG Yuanli1 DING Xiaofang1 XU Hailin3 ZHOU Haitao1 JI Kunyu1 LIANG Huan1 YANG Pengjie1
1Beijing Longfu Hospital,Beijing 100010,China; 2Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China; 3People's Hospital of Peking University,Beijing 100044,China.
关键词:
胫骨近端和远端;  截骨搬移;  糖尿病足
Keywords:
proximal and distal tibia;  osteotomy and removal;  diabetic foot
分类号:
R687
DOI:
10.20085/j.cnki.issn1005-0205.240208
文献标志码:
A
摘要:
目的:比较改良胫骨近端和远端截骨搬移与改良单纯近端截骨搬移治疗Wagner 3/4级糖尿病足的临床疗效。方法:2021年1月至2023年1月收治的40例Wagner 3/4级糖尿病足患者,应用随机数字表法随机纳入观察组(一般治疗+改良胫骨近端和远端截骨搬运)与对照组(一般治疗+改良单纯近端截骨搬移),每组各20例。观察两组患者经相应治疗后的密歇根神经病变筛查仪(MNSI)评分、疼痛视觉模拟量表(VAS)评分、踝肱指数(ABI)、经皮氧分压、足踝部皮温。观察组男12例,女8例; 年龄为59～88岁,平均为(72.6±6.4)岁; 体重指数(BMI)为22～35 kg/m2,平均为(23.4±2.1)kg/m2。术前足背皮肤温度为(27.50±1.08)℃,VAS评分为(7.40±0.36)分,踝肱指数为0.27±0.47,经皮氧分压为(28.4±2.14)mmHg。对照组男11例,女9例; 年龄为55～85岁,平均为(76.2±6.9)岁; 体重指数为22～36 kg/m2,平均为(25.8±1.7)kg/m2。术前足背皮肤温度为(28.10±1.02)℃,VAS评分为(6.80±0.33)分,踝肱指数为0.30±0.64,经皮氧分压为(27.90±2.01)mmHg。两组患者术前基线资料及临床数据差异无统计学意义(P>0.05)。结果:观察组MNSI评分、踝肱指数、经皮氧分压、足踝部皮温高于对照组,VAS 评分低于对照组,差异有统计学意义(P<0.05)。结论:改良胫骨近端和远端截骨搬移治疗Wagner 3/4级糖尿病足临床疗效优于改良单纯近端截骨搬移,促进周围血管及周围神经恢复较改良单纯近端截骨搬移快,对于治疗Wagner 3/4级重度糖尿病足患者保肢成功率高,是治疗重度糖尿病足溃疡的理想方法之一。
Abstract:
Objective:To compare the clinical efficacy of modified proximal and distal tibial osteotomy and modified simple proximal tibial osteotomy on the treatment of Wagner 3/4 grade diabetic foot.Methods:40 patients with Wagner 3/4 grade diabetic foot from January 2021 to January 2023 were randomly included in the observation group(general treatment and modified proximal and distal tibial osteotomy and transfer)and the control group(general treatment and modified simple proximal osteotomy and transfer)with 20 cases in each group.The Michigan neuropathy screening instrument(MNSI)scores,visual analogue scale(VAS)scores,ankle-brachial index(ABI),percutaneous oxygen partial pressure,and ankle skin temperature of two groups of patients after corresponding treatment were recorded.Among them,there were 12 males and 8 females in the observation group; the age ranged from 59 to 88 years old,with an average of(72.6±6.4)years old.Body mass index(BMI)ranged from 22 to 35 kg/m2,with an average of(23.4±2.1)kg/m2.The preoperative skin temperature of the foot dorsum were(27.50±1.08)℃,the VAS scores of pain were(7.40±0.36)points,the ABI were 0.27±0.47,and the transcutaneous partial pressure of oxygen were(28.4±2.14)mmHg.There were 11 males and 9 females in the control group,aged frome 55 to 85 years old,with an average of(76.2±6.9)years old and a body mass index of 2236 kg/m2,with an average of(25.8±1.7)kg/m2.Preoperative skin temperature of the foot dorsum were(28.10±1.02)℃,VAS scores were(6.80±0.33)points,ABI were 0.30±0.64,and transcutaneous partial oxygen pressure were(27.90±2.01)mmHg.There was no statistically significant difference in preoperative baseline and clinical data between the two groups of patients.Results:The MNSI scores of ABI,percutaneous partial pressure of oxygen and skin temperature of foot and ankle in the observation group were higher than those in the control group,the VAS scores were lower than that of the control group(P<0.05).Conclusion:The clinical efficacy of modified proximal and distal tibial osteotomy on the treatment of Wagner 3/4 grade diabetic foot is better than that of modified simple proximal osteotomy,which can promote the recovery of peripheral blood vessels and peripheral nerves faster than that of modified simple proximal osteotomy.The success rate of limb salvage on the treatment of Wagner 3/4 grade severe diabetic foot is high,and it is one of the ideal methods for the treatment of severe diabetic foot ulcers.

参考文献/References:

[1] American Diabetes Association.Classification and diagnosis of diabetes:standards of medical care in diabetes-2019[J].Diabetes Care,2019,42(Suppl 1):S13-S28.
[2] OGURTSOVA K,DA ROCHA FERNANDES J D,HUANG Y,et al.IDF diabetes atlas:global estimates for the prevalence of diabetes for 2015 and 2040[J].Diabetes Res Clin Pract,2017,128:40-50.
[3] MA R C.Epidemiology of diabetes and diabetic complications in China[J].Diabetologia,2018,61(6):1249-1260.
[4] LAVERY L A,OZ O K,BHAVAN K,et al.Diabetic foot syndrome in the twenty-first century[J].Clin Podiatr Med Surg,2019,36(3):355-359.
[5] LLIZAROV G A.The tension-stress effect on the genesis and growth of tissues,Part 1.The influence of stability of fixation aIld soft-tissue preservation[J].Clin Orthop Res,1989,238:249-281.
[6] 曲龙,王爱林,汤福刚.胫骨横向搬移血管再生术治疗血栓闭塞性脉管炎[J].中华医学杂志,2001,81(10):622-624.
[7] 潘圆,刘福尧,董志军,等.Ilizarov技术骨与软组织侧向搬移治疗局灶性胫骨骨髓炎[J].中华骨与关节外科杂志,2021,14(6):501-505.
[8] 冯东伟,张雅欣,武伟泽,等.骨搬运治疗胫骨骨缺损中轴向偏移的危险因素分析[J].创伤外科杂志,2023,25(6):443-447.
[9] 赵永鑫,覃忠,丁毅,等.胫骨横搬移和介入治疗重度下肢动脉闭塞症[J].中国矫形外科杂志,2023,31(15):1368-1373.
[10] 杨松杰,林晓旭,张清旭,等.胫骨横向骨搬移术联合封闭引流技术治疗糖尿病足溃疡的临床比较研究[J].现代生物医学进展,2022,22(21):4143-4147.
[11] 王林华,周富强,卢敏,等.应用Ilizarov横向骨搬移技术微创截骨治疗糖尿病足13例[J].中国中医骨伤科杂志,2018,26(11):42-45.
[12] CHEN Y,KUANG X C,ZHOU J,et al.Proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers[J].Clin Orthop Relat Res,2020,478(4):836-851.
[13] 丁小方,袁玉松,徐海林,等.传统单骨瓣弧形切口与改良双骨瓣直切口胫骨横向骨搬移治疗Wagner 3/4级糖尿病足的对比研究[J].实用骨科杂志,2021,27(5):448-452.
[14] 徐永清,朱跃良,范新宇,等.二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损[J].中华创伤骨科杂志,2012,14(10):831-834.
[15] 袁宝明,常利民,冯学会,等.胫骨近端与远端截骨搬运对胫骨骨髓炎患者搬运区骨生长钙化情况及足踝功能的影响探析[J].世界最新医学信息文摘,2021,21(11):76-78.

备注/Memo

备注/Memo:
△通信作者 E-mail:qingpu-wang@sohu.com
更新日期/Last Update: 2024-02-15