多口引流清创配合胫骨横向骨搬移术治疗Wagner Ⅲ级与Ⅳ级糖尿病足的疗效观察

Efficacy of transverse tibial bone transport with multiple drainage debridement in the treatment of Wagner grade Ⅲ and Ⅳ diabetic foot

目的:观察多口引流清创配合胫骨横向骨搬移术(TTBT)治疗糖尿病足的临床疗效。方法:回顾性分析2020年10月至2023年3月收治的Wagner Ⅲ级与Ⅳ级糖尿病足患者21例,男10例、女11例,年龄28~81岁,平均(55.8±20.7)岁。全部采用多口引流清创配合TTBT治疗,记录从多口引流清创到白细胞计数恢复至11.0×10^(9)/L以下的时间、C反应蛋白水平恢复至10 mg/L以下所需时间,肿胀明显消退、脓性分泌物明显减少所需时间,以及创面愈合时间;并对不同Wagner分级、不同年龄、不同白蛋白水平进行分组,比较白细胞计数恢复时间、C反应蛋白水平恢复时间、肿胀明显消退的时间、脓性分泌物明显减少的时间、创面愈合时间。结果:随访时间3~24个月,平均(6.0±4.1)个月。多口引流清创配合TTBT治疗糖尿病足可以促进白细胞计数、C反应蛋白水平恢复正常,促进肿胀消退和减少脓性分泌物,促进创面愈合。WagnerⅢ级和Ⅳ级糖尿病足患者中,白细胞计数恢复时间、C反应蛋白水平恢复时间、肿胀明显消退时间、脓性分泌物明显减少时间、创面愈合时间的差异均无统计学意义(P均>0.05);不同年龄分组患者中,白细胞计数恢复时间、C反应蛋白水平恢复时间、肿胀明显消退时间、脓性分泌物明显减少时间、创面愈合时间的差异均有统计学意义(P均<0.05);不同白蛋白水平分组患者中,仅脓性分泌物明显减少的时间比较差异有统计学意义(P<0.05)。结论:多口引流清创配合TTBT治疗糖尿病足的临床疗效满意。初步认为糖尿病足的预后与患者年龄、白蛋白水平相关。

Objectives:To investigate the clinical efficacy of transverse tibial bone transport(TTBT)with multiple drainage debridement in the treatment of diabetic foot(DF),and to provide a clinical basis for further treatment research.Methods:A retrospective study was conducted on twenty-one cases with Wagner grade Ⅲ and Ⅳ DF admitted from October 2020 to March 2023.There were 10 males and 11 females,aged 28 to 81 years,with an average age of(55.8±20.7)years.Patients were treated with TTBT with multiple drainage debridement.The time for the recovery of blood leukocyte and C-reactive protein levels to less than 10 mg/L from multiple drainage debridement,the time for a significant reduction in swelling and purulent discharge,and the time for wound healing were recorded.Patients were further grouped based on the Wagner grades,ages,and albumin levels.The time for recovering blood leukocyte levels to below 11.0×10^(9)/L,the time for recovering C-reactive protein to below 10 mg/L,the time for a significant reduction in swelling,the time for a significant reduction in purulent discharge,and the time for wound healing were compared among these groups.Results:Patients were followed up for 3 to 24 months,with an average of(6.0±4.1)months.TTBT with multiple drainage debridement in the treatment of DF promoted the recovery of blood leukocyte and C-reactive protein levels,reduced swelling,reduced purulent discharge,and accelerated wound healing.In patients with Wagner grade Ⅲ and Ⅳ DF,there were no statistically significant differences in the time for recovering blood leukocyte levels to below 11.0×10^(9)/L,time for recovering C-reactive protein to below 10 mg/L,time for significant reduction in swelling,time for significant reduction in purulent discharge,or time for wound healing(P>0.05).However,among patients grouped by age,there were statistically significant differences in the time for recovering blood leukocyte levels to below 11.0×10^(9)/L,time for recovering C-reactive protein to below 10 mg/L,time for significant reduction in swelling,time for significant reduction in purulent discharge,and time for wound healing(P<0.05).Among patients grouped by different albumin levels,only the time for a significant reduction in purulent discharge showed statistically significance(P<0.05).Conclusions:TTBT with multiple drainage debridement is effective in the treatment of DF.It is preliminarily believed that the prognosis of DF correlates with patient age and albumin levels,providing clinical evidence for further treatment research.