展肌肌瓣联合创面负压治疗在糖尿病足窦道的效果

Effect of abductor halluces muscle flap combined with negative pressure wound therapy in the treatment of sinus tract in diabetic foot

目的探讨展肌肌瓣联合创面负压治疗糖尿病足窦道的疗效。方法选取2013年1月至2015年12月北京大学第四临床医学院烧伤科41例患者,按照简单随机化分为实验组(n=20)和对照组(n=21)。所有病例均在抗感染、抗凝、控制血糖、血压、血脂的前提下进行。实验组采取两次手术,第一次手术彻底清创后应用负压创面治疗,第二次手术采用展肌肌瓣填塞窦道腔。对照组清创手术后一直应用负压创面治疗。比较两组患者创面的愈合时间、平均住院时间、住院花费的平均费用以及手术次数。数据比较采用独立样本的t检验。结果实验组平均愈合时间(20.8±1.8)d比对照组(34.2±3.3)d明显缩短,差异有统计学意义(t=-16.40,P<0.05);实验组平均住院时间(23.4±2.3)d比对照组(36.7±3.7)d明显缩短,差异有统计学意义(t=-13.87,P<0.05);实验组平均医疗花费(31710.45±1092.70)元比对照组(42528.57±1071.05)元明显降低,差异有统计学意义(t=-32.01,P<0.05);实验组手术次数(2.0±0.0)次比对照组(4.7±0.7)次明显减少,差异有统计学意义(t=-13.87,P<0.05)。结论彻底清创是糖尿病足窦道愈合必要前提。展肌肌瓣联合创面负压装置治疗糖尿病足窦道,尤其足跟位置的窦道,能够取得满意的效果。

Objective To explore the therapeutic effect of abductor halluces muscle flap combined with negative pressure wound therapy in the treatment of sinus tract in diabetic foot. Methods From January 2013 to December 2015,41 patients suffering diabetic foot with sinus tract were included in the department of burns,Fourth Clinical Hospital of Peking University. They were divided into experimental group( n = 20) and control group( n = 21) by simple-randomization. All patients were under the effective treatments of anti-infection,anti-coagulation and control of blood sugar,blood pressure as well as blood lipid level. The patients in the experimental group were adopted two subsequent operations. In the first operation,they received rational debridement and negative pressure wound therapy. The sinus tract was filled by abductor halluces muscle flap in the second operation. The patients in the control group received rational debridement and negative pressure wound therapy throughout. The wound healing time,average hospital stays,average medical cost and operation times were compared between the two groups by using independent-samples t test. Results The average healing time of wound in experimental group( 20. 8 ±1. 8) d was obviously shorter than the control group( 34. 2 ± 3. 3) d,there was significant difference between the two groups( t =-16. 40,P < 0. 05). The average hospitalization time( 23. 4 ± 2. 3) d in experimental group was obviously less than the control group( 36. 7 ± 3. 7) d,there was significant difference between the two groups( t =-13. 87,P < 0. 05). The average medical cost in the experimental group( 31710. 45 ± 1092. 70) yuan was obviously less than the control group( 42528. 57 ±1071. 05) yuan,there was significant difference between the two groups( t =-32. 01,P < 0. 05). The number of operation in the experimental group( 2. 0 ± 0. 0) times was less than the control group( 4. 7 ±0. 7) times,there was significant difference between the two groups( t =-13. 87,P < 0. 05).Conclusion The treatment of abductor halluces muscle flap combined with negative pressure wound therapy can provide satisfactory healing for sinus tract in diabetic foot. Rational debridement is the key prerequisite for healing of sinus tract in diabetic foot.