不同手术方法治疗麻风足底溃疡的疗效分析

EFFECT OF DIFFERENT SURGICAL METHODS ON LEPROSY PLANTAR ULCERS

目的分析不同手术方法治疗麻风足底溃疡的临床疗效。方法回顾分析1950年10月-2006年10月采用不同外科方法治疗的71例麻风足底溃疡患者的临床资料。采用清创术治疗34例(A组):男26例,女8例;年龄53～88岁,平均72.4岁。溃疡病程平均29.0年,溃疡范围5cm×3cm×2cm～11cm×7cm×3cm。根据自定溃疡足残疾程度评定为轻度25例,重度9例。采用足部压力分布重建手术治疗22例(B组):男19例,女3例;年龄48～83岁,平均69.8岁。溃疡病程平均33.5年,溃疡范围5cm×3cm×2cm～12cm×7cm×3cm。足残疾程度轻度12例,重度10例。采用足趾、足弓、足背皮瓣或胫内侧皮瓣移位修复15例(C组):男11例,女4例;年龄43～73岁,平均64.6岁。溃疡病程平均29.3年,溃疡范围6cm×3cm×2cm～11cm×5cm×3cm。足残疾程度轻度9例,重度6例。A组与C组患者年龄比较,差异有统计学意义(P<0.05);其余各组一般资料比较差异均无统计学意义(P>0.05)。结果A组19例溃疡愈合,平均愈合时间46.8d。34例均获随访2～45年,平均17.2年。术后1年溃疡愈合率为55.9%(19/34);12例愈合溃疡平均于术后1.5年复发。末次随访溃疡愈合率为20.6%(7/34)。B组18例溃疡愈合,平均愈合时间29.2d。22例均获随访2～50年,平均13.3年。术后1年溃疡愈合率为81.8%(18/22);7例愈合溃疡平均于术后3.3年复发。末次随访溃疡愈合率为50.0%(11/22)。C组14例溃疡愈合,平均愈合时间27.1d。15例均获随访3～12年,平均8.8年。术后1年溃疡愈合率为93.3%(14/15);7例愈合溃疡平均于术后4年复发。末次随访溃疡愈合率为46.7%(7/15)。术后1年随访溃疡愈合率B、C组与A组比较差异有统计学意义(P<0.05),B、C组间差异无统计学意义(P>0.05);末次随访溃疡愈合率A、B组间差异有统计学意义(P<0.05),A、B组与C组比较差异无统计学意义(P>0.05)。结论麻风足底溃疡手术治疗应消除足部高压力区,同时联合皮瓣移位修复,可获得较好的近期与远期疗效。

Objective To explore the effects of different surgical methods on plantar ulcers in leprosy. Methods The clinical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A,34 cases underwent debridement,including 26 males and 8 females aged 53-88 years old （average 72.4 years old）; the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 11 cm × 7 cm × 3 cm; the disability degrees of the affected foot was mild in 25 cases and severe in 9 cases according to the self-designed evaluation system. In group B,22 cases received foot pressure rebuilding surgery,including 19 males and 3 females aged 48-83 years old （average 69.8 years old）; the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 12 cm × 7 cm × 3 cm; the disability degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C,15 cases were repaired with the transposition of toe flap,foot arch flap,acrotarsium flap,or medial tibia flap,including 11 males and 4 females aged 43-73 years old （average 64.6 years old）; the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm × 3 cm × 2 cm to 11 cm × 5 cm × 3 cm; the disability degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information （P 〉 0.05）,except for the difference between group A and group C on age （P 〈 0.05）. Results Group A：19 out of 34 cases healed and the average healing time was 46.8 days; all patients were followed up for 2-45 years （average 17.2 years）; the rate of ulcer healing 1 year after operation was 55.9% （19/34）; 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate of ulcer healing at last follow-up was 20.6% （7/34）. Group B：18 out of 22 cases healed and the average healing time was 29.2 days;all patients were followed up for 2-50 years （average 13.3 years）; the rate of ulcer healing 1 year after operation was 81.8% （18/22）; 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer healing at last follow-up was 50.0% （11/22）. Group C：14 out of 15 cases healed and the average healing time was 27.1 days; all patients were followed up for 3-12 years （average 8.8 years）. The rate of ulcer healing 1 year after operation was 93.3% （14/15）; 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer healing at final follow-up was 46.7% （7/15）. For the rate of ulcer healing 1 year after operation,there was a significant difference between group A and group B,and between group A and group C （P 〈 0.05）,but no significant difference was evident between group B and group C （P 〉 0.05）. For the rate of ulcer healing at the final follow-up visit,there was a signifi cant difference between group A and group B （P 〈 0.05）,but no significant difference was evident between group A and group C,and between group B and group C （P 〉 0.05）. Conclusion The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps,providing good short-term and long-term therapeutic effect.