改良胫骨近端和远端截骨搬移治疗糖尿病足的临床研究

Clinical and Experimental Study of Modified Proximal and Distal Tibial Osteotomy and Transposition for Diabetic Foot

目的:比较改良胫骨近端和远端截骨搬移与改良单纯近端截骨搬移治疗Wagner 3/4级糖尿病足的临床疗效。方法:2021年1月至2023年1月收治的40例Wagner 3/4级糖尿病足患者,应用随机数字表法随机纳入观察组(一般治疗+改良胫骨近端和远端截骨搬运)与对照组(一般治疗+改良单纯近端截骨搬移),每组各20例。观察两组患者经相应治疗后的密歇根神经病变筛查仪(MNSI)评分、疼痛视觉模拟量表(VAS)评分、踝肱指数(ABI)、经皮氧分压、足踝部皮温。观察组男12例,女8例;年龄为59~88岁,平均为(72.6±6.4)岁;体重指数(BMI)为22~35 kg/m^(2),平均为(23.4±2.1)kg/m^(2)。术前足背皮肤温度为(27.50±1.08)℃,VAS评分为(7.40±0.36)分,踝肱指数为0.27±0.47,经皮氧分压为(28.4±2.14)mmHg。对照组男11例,女9例;年龄为55~85岁,平均为(76.2±6.9)岁;体重指数为22~36 kg/m^(2),平均为(25.8±1.7)kg/m^(2)。术前足背皮肤温度为(28.10±1.02)℃,VAS评分为(6.80±0.33)分,踝肱指数为0.30±0.64,经皮氧分压为(27.90±2.01)mmHg。两组患者术前基线资料及临床数据差异无统计学意义(P>0.05)。结果:观察组MNSI评分、踝肱指数、经皮氧分压、足踝部皮温高于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05)。结论:改良胫骨近端和远端截骨搬移治疗Wagner 3/4级糖尿病足临床疗效优于改良单纯近端截骨搬移,促进周围血管及周围神经恢复较改良单纯近端截骨搬移快,对于治疗Wagner 3/4级重度糖尿病足患者保肢成功率高,是治疗重度糖尿病足溃疡的理想方法之一。

Objective:To compare the clinical efficacy of modified proximal and distal tibial osteotomy and modified simple proximal tibial osteotomy on the treatment of Wagner 3/4grade diabetic foot.Methods:40patients with Wagner 3/4grade diabetic foot from January 2021to January 2023were randomly included in the observation group(general treatment and modified proximal and distal tibial osteotomy and transfer)and the control group(general treatment and modified simple proximal osteotomy and transfer)with 20cases in each group.The Michigan neuropathy screening instrument(MNSI)scores,visual analogue scale(VAS)scores,ankle-brachial index(ABI),percutaneous oxygen partial pressure,and ankle skin temperature of two groups of patients after corresponding treatment were recorded.Among them,there were 12males and 8females in the observation group;the age ranged from 59to 88years old,with an average of(72.6±6.4)years old.Body mass index(BMI)ranged from 22to 35kg/m^(2),with an average of(23.4±2.1)kg/m^(2).The preoperative skin temperature of the foot dorsum were(27.50±1.08)℃the VAS scores of pain were(7.40±0.36)points,the ABI were 0.27±0.47,and the transcutaneous partial pressure of oxygen were(28.4±2.14)mmHg.There were 11males and 9females in the control group,aged frome 55to 85years old,with an average of(76.2±6.9)years old and a body mass index of 2236kg/m^(2),with an average of(25.8±1.7)kg/m^(2).Preoperative skin temperature of the foot dorsum were(28.10±1.02)℃,VAS scores were(6.80±0.33)points,ABI were 0.30±0.64,and transcutaneous partial oxygen pressure were(27.90±2.01)mmHg.There was no statistically significant difference in preoperative baseline and clinical data between the two groups of patients.Results:The MNSI scores of ABI,percutaneous partial pressure of oxygen and skin temperature of foot and ankle in the observation group were higher than those in the control group,the VAS scores were lower than that of the control group(P<0.05).Conclusion:The clinical efficacy of modified proximal and distal tibial osteotomy on the treatment of Wagner 3/4grade diabetic foot is better than that of modified simple proximal osteotomy,which can promote the recovery of peripheral blood vessels and peripheral nerves faster than that of modified simple proximal osteotomy.The success rate of limb salvage on the treatment of Wagner 3/4grade severe diabetic foot is high,and it is one of the ideal methods for the treatment of severe diabetic foot ulcers.