胫骨横向骨搬移联合封闭引流治疗糖尿病足溃疡

Tibial transverse transport combined with vacuum sealing drainage for diabetic foot ulcers

[目的]探讨胫骨横向骨搬移术联合封闭引流技术(vacuum sealing drainage,VSD)治疗糖尿病足的临床疗效。[方法]2017年4月~2019年6月本院收治糖尿病足患者45例,其中,23例行胫骨横向骨搬移术联合封闭式负压引流技术治疗(VSD组),22例单纯行胫骨横向骨搬移术治疗(非VSD组);对比两种方法的临床疗效。[结果]两组下地行走时间、完全负重活动时间的差异无统计学意义(P>0.05)。VSD组的溃疡创面愈合时间显著早于非VSD组(P<0.05)。与术前相比较,两组患者术后1、3个月及末次随访时VAS评分、踝肱指数和患足皮肤温度均较术前明显改善(P<0.05)。术后1、3个月,VSD组踝肱指数和患足皮肤温度显著优于非VSD组(P<0.05)。术后3个月血管彩超显示两组患者小腿动脉开放,侧支循环较术前明显增多,足背动脉增粗清晰。[结论]胫骨横向骨搬移术联合封闭式负压引流技术治疗糖尿病足可加快溃疡创面愈合,提升治疗效果。

[Objective]To evaluate the clinical outcomes of tibial transverse transport combined with vacuum sealing drainage(VSD)in the treatment of diabetic foot ulcers.[Methods]From April 2017 to June 2019,45 patients with diabetic foot ulcers underwent surgical treatment in our department.Of them,23 patients received tibial transverse transport combined VSD,while the remaining 22 patients were treated by only tibial transverse transport without VSD.The two groups were compared regarding clinical documents.[Results]The VSD group got the ulcers healed significantly earlier than the non-VSD group(P<0.05),although no statistical differences were noted in time to return ambulation and time to recover full weight bearing activity between the two groups(P>0.05).The VAS score,ankle-brachial score and the skin temperature of the affected foot significantly improved in both groups at 1 and 3 months postoperatively compared with those before operation(P<0.05),and the VSD group proved significantly superior to the non-VSD group in the aforesaid items at 1 and 3 months after operation(P<0.05).At 3 months after operation,the color ultrasonography revealed that the collateral branches of arteries in the leg significantly increased compared with those before operation,with clear presentation of the pedis arteries in both groups.[Conclusion]The tibial transverse transport combined with vacuum sealing drainage does accelerate the healing of foot ulcer,and improve the clinical outcomes in comparison of the tibial transverse transport only.