骨膜牵张技术治疗糖尿病足的初步结果

Preliminary outcome of periosteal stretching for diabetic foot

[目的]探讨骨膜牵张术治疗糖尿病足的初步疗效。[方法]回顾性分析本院2020年4月—2022年3月采用骨膜牵张技术治疗的22例糖尿病足溃疡患者的临床资料。评估临床及检验结果。[结果]所有患者均顺利完成手术,术中无神经血管损伤等严重并发症。所有患者均获得随访,随访时间平均(8.7±1.2)个月,患足愈合时间平均(31.5±2.2)d,保肢率100%。与术前相比,术后23 d和93 d VAS评分[(5.3±0.8),(3.1±0.7),(2.9±0.7),P<0.001]、踝肱指数[(0.6±0.1),(0.8±0.3),(1.0±0.4),P<0.001]、足部温度[(25.9±2.4)℃,(27.7±3.1)℃,(29.0±4.0)℃,P<0.001]、经皮氧分压[(24.7±4.2)mmHg,(36.2±3.8)mmHg,(45.7±5.3)mmHg,P<0.001]、赛姆斯-温斯坦单纤维感觉试验[(4.8±0.9)g,(5.4±0.8)g,(7.5±0.8)g,P<0.001]均显著改善。检验方面,与术前相比,术后10、24 d,血管内皮生长因子、碱性成纤维细胞生长因子、表皮细胞生长因子、血小板源性生长因子表达水平均显著增加(P<0.05)。[结论]骨膜牵张技术能够显著促进糖尿病足慢性难愈创面中的微血管再生和血管重建、促进患肢创面愈合。

[Objective]To present the preliminary results of periosteal stretching in the treatment of diabetic foot.[Methods]A retro⁃spective study was conducted on 22 patients who received tibial periosteal stretching for diabetic foot in our hospital from April 2020 to March 2022.The clinical and laboratory results were evaluated.[Results]All patients were operated on successfully,with no serious compli⁃cations such as neurovascular injury,and were followed up for an average of(8.7±1.2)months.The patients got foot wound healing in an aver⁃age of(31.5±2.2)days,with the limb preservation rate of 100%.Compared with those preoperatively,the VAS score[(5.3±0.8),(3.1±0.7),(2.9±0.7),P<0.001],ankle brachial index[(0.6±0.1),(0.8±0.3),(1.0±0.4),P<0.001],the foot skin temperature[(25.9±2.4)℃,(27.7±3.1)℃,(29.0+4.0)℃,P<0.001],percutaneous oxygen partial pressure[(24.7±4.2)mmHg,(36.2±3.8)mmHg,(45.7±5.3)mmHg,P<0.001],Semmes-Weinstein monofilament test[(4.8±0.9)g,(5.4±0.8)g,(7.5±0.8)g,P<0.001]improved significantly 23 days and 93 days postoperatively.In terms of blood test,the levels of vascular endothelial growth factor,basic fibroblast growth factor,epidermal cell growth factor,and plateletderived growth factor increased significantly 10 days or 24 days after surgery compared with those preoperatively(P<0.05).[Conclusion]Periosteal stretching does significantly promote microvascular regeneration and vascular reconstruction in chronic refractory wounds of dia⁃betic foot,and promote wound healing of affected limb.