应用Ilizarov技术胫骨横向骨搬移术治疗合并全身性炎症反应综合征的重度糖尿病足

The effectiveness of Ilizarov technique-based transverse tibial bone transport on treatment of severe diabetic foots complicated with systemic inflammation response syndrome

目的探讨应用Ilizarov技术胫骨横向骨搬移术治疗合并全身性炎症反应综合征(systemic inflammatory response syndrome,SIRS)的重度糖尿病足(Wagner 3~5级)的临床疗效。方法 2014年8月—2017年12月,采用Ilizarov技术胫骨横向骨搬移术治疗合并SIRS的重度糖尿病足患者33例。其中男27例,女6例;年龄34~79岁,平均60.6岁。均患2型糖尿病,糖尿病病程1~28年,平均10年。糖尿病足病程1~12个月,平均2.7个月。根据Wagner分级,3级8例,4级23例,5级2例。术后观察患足创面愈合情况,并计算保肢率。评估体温、心率、呼吸频率、白细胞计数、红细胞沉降率和C反应蛋白浓度变化。测量足背皮肤温度;行疼痛视觉模拟评分(VAS)评价患足疼痛改善情况。结果术后33例患者均获随访,随访时间3~30个月,平均14.1个月。足部溃疡全部愈合,愈合时间3~12个月,平均5.3个月;保肢率100%。术后体温、心率、呼吸频率、白细胞计数、红细胞沉降率和C反应蛋白浓度均较术前显著下降(P<0.05)。术后1个月患足皮温为(32.64±2.17)℃,较术前的(31.28±1.99)℃显著改善(t=0.05,P=0.00);但与健侧皮温(32.46±2.10)℃比较差异无统计学意义(t=2.04,P=0.41)。术后1个月VAS评分为(2.4±0.7)分,较术前的(4.3±0.8)分显著改善(t=3.10,P=0.00)。结论 Ilizarov技术胫骨横向骨搬移术能有效治疗合并SIRS的重度糖尿病足,可促进患足溃疡愈合,避免截肢。

Objective To evaluate the effectiveness of Ilizarov technique-based transverse tibial bone transport on the treatment of severe diabetic foot ulcer（Wagner grades 3 to 5） complicated with systemic inflammatory response syndrome（SIRS）. Methods Between August 2014 and December 2017, 33 patients with severe diabetic foot and SIRS were treated with Ilizarov technique-based transverse tibial bone transport. There were 27 males and 6 females, with a mean age of 60.6 years（range, 34-79 years）. All of them suffered from type 2 diabetes mellitus. The duration of diabetes was 1-28 years（mean, 10 years） and the duration of diabetic foot was 1-12 months（mean, 2.7 months）. According to Wagner classification, there were 8 cases in grade 3, 23 cases in grade 4, and 2 cases in grade 5. The wound healing condition was observed after operation, and the limb salvage rate was calculated. The changes in body temperature, heart rate, respiratory rate, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein concentration were assessed. The skin temperature of the dorsum of the foot was measured, and the visual analogue scale（VAS） score was used to evaluate the improvement of foot pain. Results All 33 patients were followed up 3-30 months（mean, 14.1 months）. All ulcers healed and the healing time was 3-12 months（mean, 5.3 months）; the limb salvage rate was 100%.Postoperative body temperature, heart rate, respiratory rate, white blood cell count, erythrocyte sedimentation rate, and Creactive protein concentration were significantly lower than those before operation（P〈0.05）. The skin temperature of the dorsum of the foot was（32.64±2.17）℃ at 1 month after operation, which was significantly improved when compared with preoperative value [（31.28±1.99）℃]（t=0.05, P=0.00）; but there was no significant difference in skin temperature compared with healthy side [（32.46±2.10）℃]（t=2.04, P=0.41）. The VAS score was 2.4±0.7 at 1 month after operation,which was significantly improved when compared with preoperative score（4.3±0.8）（t=3.10, P=0.00）. Conclusion Ilizarov technique-based transverse tibial bone transport is an effective way to treat severe diabetic foot complicated with SIRS. It can promote foot ulcer healing and avoid amputations.