膝下动脉球囊成形治疗动脉缺血导致的糖尿病足溃疡的疗效

Effect of subpatellar artery balloon molding on diabetic foot ulcer caused by arterial ischemia

目的探索膝下动脉球囊成形治疗动脉缺血导致的糖尿病足溃疡的可行性及疗效。方法回顾分析首都医科大学宣武医院2020年12月至2022年4月诊治的膝下血管病变导致的糖尿病足溃疡患者的临床资料,其中接受药物球囊扩张治疗者29例,接受单纯球囊扩张治疗者30例。分析两组患者术后3个月和6个月的下肢缺血改善情况,观察指标包括病死率、保肢率、溃疡愈合情况、Rutherford分级和疼痛评分。结果术前两组Rutherford分级比较差异无统计学意义(P>0.05);术后3、6个月两组Rutherford分级均较术前明显改善(P<0.05),且组间差异无统计学意义(P>0.05)。术前两组疼痛评分比较差异无统计学意义(P>0.05);术后3、6个月两组疼痛评分均较术前明显降低(P<0.05),且组间差异无统计学意义(P>0.05)。术后3、6个月,药物球囊组的伤口溃疡愈合率均高于单纯球囊组[51.7%(15/29)vs 43.3%(13/30),P=0.519;86.2%(25/29)vs 50.0%(15/30),P=0.002]。两组术后3、6个月均无死亡、截肢者。结论球囊扩张可以改善糖尿病足重度肢体缺血,对比单纯球囊扩张,药物球囊扩张更有助于糖尿病肢体缺血患者溃疡伤口的愈合。

Objective To explore the feasibility and efficacy of subpatellar artery balloon molding in the treatment of diabetic foot ulcer caused by arterial ischemia.Methods The clinical data of patients with diabetic foot ulcer caused by subpatellar artery disease treated in Xuanwu Hospital of Capital Medical University from December 2020 to April 2022 were retrospectively analyzed.Among them,29 patients received medical balloon dilatation(drug balloon group)and 30 patients received balloon dilatation alone(simple balloon group).The improvement of lower limb ischemia at 3 and 6 months after surgery was analyzed in the two groups.The observation indicators included case-fatality rate,limb preservation rate,ulcer healing,Rutherford grading and pain score.Results There was no significant difference in preoperative Rutherford grading between the two groups(P>0.05).Three and six months after operation,the Rutherford grading in both groups was significantly improved compared with that before surgery(all P<0.05),and there was no statistical significance between the two groups(P>0.05).There was no significant difference in preoperative pain scores between the two groups(P>0.05).The pain scores of both groups were significantly decreased 3 and 6 months after surgery(P<0.05),and there was no statistical significance between the two groups(P>0.05).Three and six months after surgery,the wound ulcer healing rate in the drug balloon group was higher than that in the simple balloon group[51.7%(15/29)vs 43.3%(13/30),P=0.519;86.2%(25/29)vs 50.0%(15/30),P=0.002].There was no death or amputation in the two groups 3 and 6 months after surgery.Conclusions Balloon dilatation can improve severe limb ischemia of diabetic foot.Compared with balloon dilatation alone,drug balloon dilatation is more beneficial to the healing of ulcer wounds in diabetic limb ischemia patients.