胫骨横向骨搬移技术结合抗生素骨水泥治疗下肢慢性缺血性疾病伴足踝部慢性感染

Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement

目的研究胫骨横向骨搬移技术结合抗生素骨水泥治疗下肢缺血性疾病伴足踝部慢性感染的临床疗效。方法回顾性分析2015年8月—2019年10月应用胫骨横向骨搬移技术结合抗生素骨水泥治疗的28例下肢缺血性疾病伴足踝部慢性感染患者。其中男22例,女6例;年龄41~86岁,平均65.6岁。糖尿病足25例,下肢动脉硬化闭塞症2例,血栓闭塞性脉管炎1例。感染病程1~27年,平均14.9年。记录所有患者足踝部愈合情况及愈合时间,以及糖尿病足患者术前及末次随访时Wagner分级、WIFi(W:下肢创面分级;I:缺血分级;Fi:足部感染分级)分级,并进行比较。结果1例糖尿病足患者于术后111 d创面好转,无脓性分泌物,后失访;余27例均获随访,随访时间5~21个月,平均8.4个月。术后胫骨截骨切口和局部皮瓣均未出现坏死。术后21例出现外固定架针道反应,经相应处理后好转,均未出现针道感染。24例糖尿病足患者中,1例因肺部感染致多器官功能衰竭死亡;1例出现急性下肢血管栓塞,足部急性坏疽而截肢;余22例足踝部均愈合,愈合时间2.5~11.0个月,平均4.6个月。末次随访时患者Wagner分级和WIFi分级均较术前显著改善(P<0.05)。1例血栓闭塞性脉管炎患者于术后6个月足踝部愈合;2例下肢动脉硬化闭塞症患者分别于术后16、18个月足踝部愈合。结论胫骨横向骨搬移技术结合抗生素骨水泥治疗下肢慢性缺血性疾病伴足踝部慢性感染疗效显著。

Objective To study the effectiveness of tibial transverse transport combined with the antibiotics embedded bone cement in the treatment of chronic infection of foot and ankle with lower extremity ischemic diseases.Methods A retrospective analysis was performed on 28 patients with ischemic diseases of lower extremities associated with chronic foot and ankle infection who were treated with tibial transverse transport combined with antibiotic bone cement between August 2015 and October 2019.There were 22 males and 6 females,with an average age of 65.6 years(range,41-86 years).There were 25 cases of diabetic foot,2 cases of arteriosclerosis obliterans,and 1 case of thromboangiitis obliterans.The course of infection ranged from 1 to 27 years,with an average of 14.9 years.The healing condition and time of foot and ankle in all patients were recorded and compared,and the Wagner grading and WIFi(W:lower extremity wound classification;I:ischemic classification;Fi:foot infection classification)grading were compared before and at last follow-up.Results The wound surface of 1 diabetic foot patient improved at 111 days after operation,without purulent secretion,and lost follow-up.The remaining 27 cases were followed up 5 to 21 months(mean,8.4 months).There was no necrosis in the tibial osteotomy incision and the local flap.After operation,21 cases showed needle reaction of external fixator,but the needle infection gradually improved after the corresponding treatment.Among the 24 patients with diabetic foot,1 died of multiple organ failure due to pulmonary infection.Acute lower extremity vascular embolism occurred in 1 case,and the foot was amputated due to acute gangrene.In the remaining 22 cases,the wound healing time of foot and ankle was 2.5-11.0 months(mean,4.6 months).At last follow-up,Wagner grading and WIFi grading of the patients were significantly improved when compared with those before operation(P<0.05).One patient with thromboangiitis obliterans had foot and ankle healing at 6 months after operation.Two patients with lower extremity arteriosclerosis obliterans had foot and ankle healing at 16 and 18 months after operation,respectively.Conclusion Tibial transverse transport combined with the antibiotics embedded bone cement is effective in treating chronic infection of foot and ankle with lower extremity ischemic diseases.