胫骨横向骨搬移手术治疗糖尿病足效果的影响因素分析

Influencing factors analysis of the curative effect of transverse tibial bone transport on diabetic foot

目的分析胫骨横向骨搬移手术治疗糖尿病足效果的影响因素。方法将2017年1月—2019年12月于广州市增城区新塘医院行胫骨横向骨搬移手术治疗的80例糖尿病足患者作为研究对象,收集其临床资料。根据其治疗效果将患者分为愈合组63例和未愈合组17例,比较两组临床资料,并采用多因素logistic回归分析胫骨横向骨搬移手术治疗糖尿病足患者效果的影响因素。结果本研究80例糖尿病足患者均完成胫骨横向骨搬移手术,术后1周足部皮肤温度、踝臂血压指数均高于术前,视觉模拟评分低于术前(P<0.05)。随访显示溃疡愈合例数为63例,愈合组年龄<60岁、病程<10年、糖尿病肾病、溃疡性质为神经性、溃疡面积<5 cm2、单一感染、足背动脉搏动正常、白蛋白(Alb)≥35 g/L、血红蛋白(Hb)≥90 g/L比例高于未愈合组,差异有统计学意义(P<0.05)。愈合组截骨面积为10 cm×2 cm、搬移速度为1.0 mm/d和搬移时间为术后第4天占比低于未愈合组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,糖尿病肾病(OR=2.815,95%CI:1.161~6.827)、溃疡性质(OR=2.694,95%CI:1.204~6.029)、足背动脉搏动(OR=2.754,95%CI:1.202~6.310)、Alb(OR=0.359,95%CI:0.161~0.799)、Hb(OR=0.373,95%CI:0.172~0.808)、截骨面积(OR=2.762,95%CI:1.196~6.378)、搬移速度(OR=2.651,95%CI:1.178~5.968)和搬移时间(OR=2.740,95%CI:1.168~6.428)是胫骨横向骨搬移手术治疗糖尿病足效果的影响因素(P<0.05)。结论胫骨横向骨搬移手术在糖尿病足治疗中有较好应用价值,但效果会受到糖尿病肾病、溃疡性质、足背动脉搏动、Alb、Hb、截骨面积、搬移速度和搬移时间的影响。

Objective To analyze the influencing factors of the curative effect of transverse tibial bone transport on diabetic foot.Methods From January 2017 to December 2019,a total of 80 patients with diabetic foot who underwent tibial lateral bone transport surgery at Xintang Hospital of Zengcheng,Guangzhou City were taken as the research objects,and their clinical data were collected.According to the treatment effect,the patients were divided into 63 cases in the healing group and 17 cases in the unhealed group.The clinical data of the two groups were compared,and multivariate logistic regression was used to analyze the influencing factors of the curative effect of the treatment of diabetic foot.Results In this study,80 patients with diabetic foot completed the tibial lateral bone transport surgery.The foot skin temperature and ankle-brachial blood pressure index were higher than those of the preoperative one week after the operation,and the visual analogue score was lower than that of the preoperative(P<0.05).Follow-up showed that the number of ulcers healed was 63 cases.The proportions of under 60 years old,the course of the disease less than 10 years,diabetic nephropathy,the nature of the ulcer was neurogenic,the area of the ulcer less than 5 cm2,single infection,normal dorsal artery pulsation,albumin(Alb)≥35 g/L and hemoglobin(Hb)≥90 g/L of the healing group were greater than those of the unhealed group,and the differences were statistically significant(P<0.05).The osteotomy area of 10 cm×2 cm,the moving speed of 1.0 mm/d,while the moving time of the 4th day after surgery of healing group were all smaller than those of the unhealed group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that diabetic nephropathy(OR=2.815,95%CI:1.161-6.827),nature of ulcers(OR=2.694,95%CI:1.204-6.029),dorsal artery pulsation(OR=2.754,95%CI:1.202-6.310),Alb(OR=0.359,95%CI:0.161-0.799),Hb(OR=0.373,95%CI:0.172-0.808),osteotomy area(OR=2.762,95%CI:1.196-6.378),moving speed(OR=2.651,95%CI:1.178-5.968)and moving time(OR=2.740,95%CI:1.168-6.428)were the influencing factors of the curative effect of tibia lateral bone transport surgery in the treatment of diabetic foot(P<0.05).Conclusion Tibia lateral bone transport surgery has good application value in the treatment of diabetic foot,but the curative effect will be affected by diabetic nephropathy,ulcer nature,dorsal artery pulsation,Alb,Hb,osteotomy area,moving speed and moving time.