PTA联合NPWT治疗缺血性糖尿病足溃疡的疗效分析

Efficacy analysis of PTA combined with NPWT on the treatment of ischemia diabetic foot ulcer

目的探讨经皮腔内血管成形术(PTA)联合负压伤口疗法(NPWT)治疗缺血性糖尿病足溃疡的临床效果。方法64例缺血性糖尿病足溃疡患者,依据治疗方法不同分为NPWT组和PTA联合NPWT组,每组32例。NPWT组患者采用NPWT治疗,PTA联合NPWT组患者采用PTA联合NPWT治疗。比较两组治疗前后踝肱指数、伤口愈合时间、保足率。结果PTA术后足部皮肤温度升高,血液供应明显改善,足背动脉搏动增强。术后患肢CT血管造影(CTA)图像见:患肢动脉狭窄闭塞动脉开通,远端可见足背血管显影。坏死趾节截趾清创NPWT治疗后创面肉芽生长良好。植皮治疗后伤口愈合良好。治疗前,两组患者踝肱指数比较差异无统计学意义(P>0.05);PTA合并NPWT组患者治疗2周后踝肱指数(0.52±0.19)、保足率93.8%均高于NPWT组的(0.44±0.08)、75.0%,差异具有统计学意义(P<0.05);两组患者创面愈合时间比较差异无统计学意义(P>0.05)。结论PTA联合NPWT治疗缺血性糖尿病足溃疡的疗效优于单独应用NPWT治疗,可提高保足率。

Objective To discuss the clinical effect of percutaneous transluminal angioplasty(PTA)combined with negative pressure wound therapy(NPWT)on the treatment of ischemia diabetic foot ulcer.Methods A total of 64 patients with ischemia diabetic foot ulcer were divided into NPWT group and PTA combined with NPWT group by different treatment methods,with 32 cases in each group.NPWT group was treated by NPWT,and PTA combined with NPWT group was treated by PTA combined with NPWT.The ankle brachial index before and after treatment,wound healing time and foot preservation rate was compared between the two groups.Results After PTA,the temperature of the foot skin increased,the blood supply improved,and the pulse of the dorsalis pedis artery increased.Postoperative CT angiography(CTA)images of the affected limb showed that the stenosis and occlusion of the artery in the affected limb were opened,and the dorsal foot artery was visualized at the distal end.After treatment of NPWT with necrotic toe amputation,the wound granulation grew well.The wounds healed well after skin grafting.Before treatment,there was no statistically significant difference in ankle brachial index between the two groups(P>0.05).After 2 weeks of treatment,ankle brachial index(0.52±0.19)and foot preservation rate 93.8%in PTA combined with NPWT group was higher than(0.44±0.08)and 75.0%in NPWT group.Their difference was statistically significant(P<0.05).There was no statistically significant difference in wound healing time between the two groups(P>0.05).Conclusion PTA combined with NPWT is better than NPWT alone in the treatment of ischemic diabetic foot ulcer,which can improve foot preservation rate.