胫骨横向骨搬移术治疗糖尿病足溃疡的中长期临床疗效

刘思稳; 贾中伟; 张梓航; 郭钊; 张祥祥; 罗茜

doi:10.3760/cma.j.cn501225-20241028-00417

胫骨横向骨搬移术治疗糖尿病足溃疡的中长期临床疗效

doi: 10.3760/cma.j.cn501225-20241028-00417

1.
山西医科大学第五临床医学院,太原　030000
2.
山西省人民医院骨科,太原　　　　030000
3.
西安市中心医院全科医学科,西安　710000
4.
山西医科大学公共卫生学院,太原　030000

基金项目:

山西省基础研究计划项目 202103021224367

山西省卫生健康委科研课题计划项目 2023043

山西省医学重点科研项目 2023XM049

详细信息

通讯作者:
贾中伟,Email： doctor_jiazw@sina.com

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出版历程
- 收稿日期: 2024-10-28
- 网络出版日期: 2026-03-09

Medium- and long-term clinical efficacy of tibial transverse transport in the treatment of diabetic foot ulcers

1.
The Fifth Clinical Medical College, Shanxi Medical University, Taiyuan 030000, China
2.
Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan 030000, China
3.
Department of General Practice, Xi'an Central Hospital, Xi'an 710000, China
4.
School of Public Health, Shanxi Medical University, Taiyuan 030000, China

Funds:

Basic Research Project of Shanxi Province 202103021224367

Scientific Research Project of Shanxi Provincial Health Commission 2023043

Key Medical Research Project of Shanxi Province 2023XM049

More Information

Corresponding author: Jia Zhongwei, Email: doctor_jiazw@sina.com

摘要

摘要: 目的探讨胫骨横向骨搬移术治疗糖尿病足溃疡的中长期临床疗效。方法该研究为回顾性队列研究。2015年1月—2022年12月,山西省人民医院骨科收治87例符合入选标准的糖尿病足溃疡患者,采用胫骨横向骨搬移术治疗。因患者截肢、死亡或失访等,术后3个月、6个月、1年、2年、3年病例数分别为85、82、77、73、63例。统计术前和术后1个月、3个月、6个月、1年、2年、3年,患者的踝肱指数、密歇根神经病变筛查量表（MNSI）体格检查评分、10 g尼龙丝试验结果、视觉模拟评分法（VAS）评分、足趾血氧饱和度,统计术后3年内并发症发生情况、创面愈合、截肢情况。结果术后1个月、3个月、6个月、1年、2年、3年,患者踝肱指数分别为0.70（0.65,0.76）、0.93（0.83,1.01）^{、0.96（0.86,1.06）、0.93（0.88,1.01）、0.91（0.86,0.97）、0.90（0.81,0.97）,均明显高于术前的0.55（）0.47,0.62）,P<0.05。术后1个月、3个月、6个月、1年、2年、3年,患者10 g尼龙丝试验点数均明显多于术前（P<0.05）,VAS评分和MNSI体格检查评分均明显低于术前（P<0.05）,足趾血氧饱和度均明显高于术前（P<0.05）。术后3年内,3例患者骨搬移处骨折,4例患者钉道及切口感染,经保守治疗均康复；80例患者创面愈合,80例患者保肢成功。} 结论胫骨横向骨搬移术治疗糖尿病足溃疡患者能够明显改善下肢血供和足部微循环,减轻疼痛程度,改善神经传导功能及足部感觉,术后并发症少、创面愈合及保肢疗效显著,在术后3年内可保持较好整体疗效。
- 糖尿病足 /
- 溃疡 /
- 胫骨横向骨搬移术 /
- 踝肱指数 /
- 术后中长期疗效
Abstract: Objective To investigate the medium- and long-term clinical efficacy of tibial transverse transport (TTT) in the treatment of diabetic foot ulcers (DFU). Methods This study was a retrospective cohort study. From January 2015 to December 2022, 87 patients with diabetic foot ulcers who met the inclusion criteria were admitted to the Department of Orthopedics of Shanxi Provincial People's Hospital and were treated with TTT. Due to amputation, death, or loss to follow-up of patients, the number of cases was 85, 82, 77, 73, and 62 at 3 months, 6 month, 1 year, 2 years, and 3 years postoperatively. The ankle brachial index (ABI), Michigan Neuropathy Screening Instrument (MNSI) physical examination score, 10 g monofilament test results, visual analogue scale (VAS) score, toe oxygen saturation was recorded preoperatively and at 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively. The occurrence of complications, wound healing, and amputation were recorded during 3 years postoperatively. Results The levels of ABI were 0.70 (0.65, 0.76), 0.93 (0.83, 1.01), 0.96 (0.86, 1.06), 0.93 (0.88, 1.01), 0.91 (0.86, 0.97), and 0.90 (0.81, 0.97) at 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively, which were significantly higher than 0.55 (0.47, 0.62) preoperatively (P<0.05). At 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively, the 10 g monofilament test scores were significantly more than those preoperatively (P<0.05), the VAS scores and MNSI physical examination scores were significantly lower than those preoperatively (P<0.05), and the levels of toe oxygen saturation were significantly higher than those preoperatively (P<0.05). During 3 years postoperatively, 3 patients experienced fractures at the bone transport site, and 4 patients developed infections at the pin tract and incision, all of whom recovered with conservative treatment. The wounds healed in 80 patients, and limbs were salvaged in 80 patients. Conclusions Patients with DFU and treated with TTT can significantly improve lower limb blood supply and foot microcirculation, alleviate pain, and enhance nerve conduction function and foot sensation, with few complications and remarkable results in wound healing and limb salvage. Besides, the overall efficacy within 3 years postoperatively was good.
- Diabetic foot /
- Ulcer /
- Ankle brachial index /
- Tibial transverse transport /
- Medium- and long-term postoperative efficacy
刘思稳：研究方案的实施,数据采集、整理、分析,论文撰写；贾中伟：研究方案制订与指导、论文修改；张梓航、罗茜：数据整理、分析,统计分析；郭钊、张祥祥：数据采集、整理、分析

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图 1 胫骨横向骨搬移术过程。1A.于小腿中段作弧形切口,向胫骨嵴全层掀开软组织,钻孔预开窗；1B.钻孔开窗后胫骨骨面外观；1C.经皮安装胫骨横向骨搬移外固定架；1D.缝合弧形切口后小腿整体外观

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图 2 采用胫骨横向骨搬移术治疗例1患者左足糖尿病足溃疡创面的效果。2A.术前第5趾缺如,第4趾缺血坏死；2B.术后15 d外观,第4趾干性坏疽；2C.术后4个月左足外观,第4趾已自行脱落；2D.术后4个月,拆除外固定架,左胫骨正侧位X线片,骨窗基本复位； 2E.术后7个月外观,左足第4、5趾缺如,皮肤未见明显破损；2F.术后7个月,左胫骨正侧位X线片,骨窗周围大量骨痂形成；2G.术后6年外观,左足第4、5趾缺如,皮肤未见明显破损；2H.术后6年,左胫骨正侧位X线片,骨窗愈合良好

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图 3 采用胫骨横向骨搬移术治疗例2患者左足糖尿病足溃疡创面的效果。3A.术前外观,左前足感染破溃,第2、3趾缺血发黑；3B.术中清创完成后,左足呈劈裂外观,第2、3趾截除后；3C.术后骨搬移10 d,左小腿骨搬移术区皮肤隆起；3D.术后骨搬移10 d,左胫骨正侧位X线片,骨窗移位良好；3E.术后3周左足外观,创面较术中明显缩小并逐渐对合；3F.术后3个月左足外观,创面愈合；3G.术后6个月,左小腿骨搬移术区皮肤愈合良好,无隆起；3H.术后6个月,左胫骨正侧位X线片,骨窗愈合良好

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Table 1. 行胫骨横向骨搬移术治疗的糖尿病足溃疡患者各时间点踝肱指数及微循环和感觉功能相关指标比较[M（Q₁,Q₃）]

时间点	例数	踝肱指数	10 g尼龙丝试验点数（点）	VAS评分（分）	MNSI体格检查评分（分）	足趾血氧饱和度（%）
术前	87	0.55（0.47,0.62）	4（3,4）	5（4,6）	6（5,7）	82.0（81.0,84.0）
术后1个月	87	0.70（0.65,0.76）^a	5（4,6）^a	3（3,4）^a	5（4,5）^a	89.0（88.0,91.0）^a
术后3个月	85	0.93（0.83,1.01）^a	7（7,8）^a	3（2,3）^a	3（3,4）^a	94.0（94.0,96.0）^a
术后6个月	82	0.96（0.86,1.06）^a	8（7,9）^a	1（0,2）^a	2（2,3）^a	94.5（94.0,95.0）^a
术后1年	77	0.93（0.88,1.01）^a	8（7,9）^a	1（0,2）^a	2（1,3）^a	94.0（93.0,95.0）^a
术后2年	73	0.91（0.86,0.97）^a	8（7,9）^a	1（0,1）^a	2（1,3）^a	94.0（93.0,95.0）^a
术后3年	63	0.90（0.81,0.97）^a	8（7,9）^a	1（0,1）^a	2（2,3）^a	94.0（93.0,95.0）^a
Wald χ²值		1 087.639	1 091.274	1 791.401	1 124.677	4 261.206
P值		<0.001	<0.001	<0.001	<0.001	<0.001
注：与术前比较,^aP<0.05；VAS为视觉模拟评分法,MNSI为密歇根神经病变筛查量表