胫骨横向搬运技术联合持续低负压伤口疗法治疗Wagner Ⅲ至Ⅴ级糖尿病足慢性溃疡的临床效果

廖元丹; 陈宇; 马熙坤; 李亚星; 甘廷江; 张晖; 解慧琪

doi:10.3760/cma.j.cn501225-20241106-00436

胫骨横向搬运技术联合持续低负压伤口疗法治疗Wagner Ⅲ至Ⅴ级糖尿病足慢性溃疡的临床效果

doi: 10.3760/cma.j.cn501225-20241106-00436

廖元丹¹,
陈宇¹,
马熙坤¹,
李亚星¹,
甘廷江¹,
张晖^1, ,,
解慧琪^2, ,

1.
四川大学华西医院骨科,成都　　610041
2.
四川大学华西医院生物治疗国家重点实验室干细胞与组织工程研究中心,成都　　610041

基金项目:

四川大学华西医院专职博士后科研发展基金 2024HXBH076

四川省科技厅自然科学基金 2024NSFSC1810

详细信息

通讯作者:
张晖,Email：zhanghui1437@wchscu.cn

解慧琪,Email：xiehuiqi@scu.edu.cn

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出版历程
- 收稿日期: 2024-11-06
- 网络出版日期: 2025-10-22

Clinical effect of tibial transverse transport technique combined with continuous low negative pressure wound therapy in the treatment of Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers

1.
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China
2.
Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China

Funds:

Postdoctoral Research Development Fund of West China Hospital of Sichuan University 2024HXBH076

Natural Science Foundation of Science and Technology of Sichuan Province of China 2024NSFSC1810

More Information

Corresponding author: Zhang Hui, Email: zhanghui1437@wchscu.cn; Xie Huiqi, Email: xiehuiqi@scu.edu.cn

摘要

摘要: 目的探讨胫骨横向搬运（TTT）技术联合持续低负压伤口疗法治疗Wagner Ⅲ~Ⅴ级糖尿病足慢性溃疡的临床效果。方法该研究为回顾性队列研究。2016年1月—2022年12月,四川大学华西医院骨科收治38例符合入选标准的Wagner Ⅲ~Ⅴ级糖尿病足慢性溃疡患者。根据溃疡创面的治疗方式,将患者分为采用单纯TTT技术治疗的对照组[20例,男10例、女10例,年龄（64.0±2.3）岁]和采用TTT技术联合持续低负压伤口疗法治疗的联合治疗组[18例,男10例、女8例,年龄（60.8±2.9）岁]。清创后,对照组、联合治疗组患者溃疡创面的面积分别为（29±13）、（30±18）cm²。术后,观察溃疡创面愈合情况及并发症发生情况,统计2组患者并发症发生比例、溃疡创面愈合时间、去除外固定支架时间、下地行走时间、患肢完全负重时间并进行比较。术前及末次随访时,统计2组患者患足踝肱指数或踝肱指数差值、皮肤温度、视觉模拟评分法（VAS）评分并进行比较。以溃疡创面愈合时间为主要观察指标,其余指标为次要观察指标。结果术后,联合治疗组1例患者溃疡创面愈合后在其他部位新发溃疡,该溃疡创面经患者再次入院行TTT技术联合持续低负压伤口疗法治疗后愈合；1例患者术后因血糖控制不佳,在相同部位复发溃疡并行截肢手术；其他患者溃疡创面愈合良好。对照组4例患者溃疡创面因血糖控制不佳而复发,其中1例患者截肢,3例患者通过TTT技术联合持续低负压伤口疗法治疗后愈合。联合治疗组与对照组患者的并发症发生比例分别为2/18和4/20,组间比较,差异无统计学意义（P>0.05）。术后,与对照组比较,联合治疗组患者溃疡创面愈合时间、去除外固定支架时间、下地行走时间、患肢完全负重时间均明显缩短（Z值分别为2.52、4.90,t值分别为3.99、4.10,P<0.05）。2组患者溃疡创面愈合时间差值为6（1,11）d。术前,2组患者患足VAS评分、踝肱指数、皮肤温度比较,差异均无统计学意义（P>0.05）。末次随访时,与对照组比较,联合治疗组患者患足VAS评分明显降低（Z=2.24,P<0.05）,踝肱指数差值明显变大（t=3.53,P<0.05）,皮肤温度明显升高（Z=4.49,P<0.05）。结论 TTT技术联合持续低负压伤口疗法治疗Wagner Ⅲ~Ⅴ级糖尿病足慢性溃疡,能显著缩短溃疡创面愈合时间、去除外固定支架时间、下地行走时间及患肢完全负重时间,并有效改善患足踝肱指数、皮肤温度及疼痛,展现出良好的临床应用前景与安全性。
- 伤口愈合 /
- 糖尿病足 /
- 足溃疡 /
- 胫骨横向搬运 /
- 持续低负压伤口疗法 /
- 下肢缺血
Abstract: Objective To explore the clinical effect of tibial transverse transport (TTT) technique combined with continuous low negative pressure wound therapy in the treatment of Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers. Methods This study was a retrospective cohort study. From January 2016 to December 2022, 38 patients with Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers who met the inclusion criteria were admitted to the Department of Orthopedics of West China Hospital of Sichuan University. According to the treatment method for the ulcer wounds, the patients were divided into a control group (20 cases, 10 males and 10 females, aged (64.0±2.3) years) treated with TTT technique alone and a combined treatment group (18 cases, 10 males and 8 females, aged (60.8±2.9) years) treated with TTT technique combined with continuous low negative pressure wound therapy. After debridement, the ulcer wound areas in control group and combined treatment group were (29±13) cm² and (30±18) cm², respectively. Postoperatively, ulcer wound healing and the occurrence of complications were observed. The incidence of complications, ulcer wound healing time, external fixator removal time, time to ambulation, and time to full weight-bearing of the affected limb in the two groups of patients were statistically analyzed and compared. Before surgery and at the last follow-up, the ankle-brachial index or differences in ankle-brachial index, skin temperature, and visual analogue scale (VAS) score of the affected foot were statistically analyzed and compared between the two groups of patients. The ulcer wound healing time was the primary observation indicator, and the other indicators were secondary observation indicators. Results Postoperatively, in combined treatment group, one patient developed a new ulcer at another site after the original ulcer wound healed; this ulcer wound healed after the patient was re-admitted for treatment with TTT technique combined with continuous low negative pressure wound therapy. One patient had a recurrence of the ulcer at the same site due to poor blood glucose control and underwent amputation. The ulcer wounds of the other patients healed well. In control group, four patients had recurrence of the ulcer wound due to poor blood glucose control, among whom one patient underwent amputation and three patients healed after treatment with TTT technique combined with continuous low negative pressure wound therapy. The incidence of complications in combined treatment group and control group of patients were 2/18 and 4/20, respectively, showing no statistically significant difference between the two groups (P>0.05). Postoperatively, compared with those in control group, the ulcer wound healing time, external fixator removal time, time to ambulation, and time to full weight-bearing of the affected limb in combined treatment group of patients were significantly shortened (with Z values of 2.52 and 4.90, respectively, and t values of 3.99 and 4.10, respectively, P<0.05). The difference in ulcer wound healing time between the two groups of patients was 6 (1, 11) days. Before surgery, there were no statistically significant differences in the VAS score, ankle-brachial index, and skin temperature of the affected foot between the two groups of patients (P>0.05). At the last follow-up, compared with those in control group, the VAS score of the affected foot in combined treatment group of patients was significantly decreased (Z=2.24, P<0.05), the differences in ankle-brachial index was significantly increased (t=3.53, P<0.05) and the skin temperature was significantly increased (Z=4.49, P<0.05). Conclusions The TTT technique combined with continuous low negative pressure wound therapy can significantly shorten the ulcer wound healing time, external fixator removal time, time to ambulation, and time to full weight-bearing of the affected limb in the treatment of Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers, and effectively improve the ankle-brachial index, skin temperature, and pain of the affected foot, showing good clinical application prospects and safety.
- Wound healing /
- Diabetic foot /
- Foot ulcer /
- Tibial transverse transport /
- Continuous low negative pressure wound therapy /
- Lower limb ischemia
廖元丹：研究构思与文章撰写；陈宇：手术实施、数据整理；马熙坤：研究的实施与方法设计；李亚星：论文修订、基金支持；甘廷江：统计分析；张晖：手术实施、研究监督、论文审阅、基金支持；解慧琪：研究监督、论文审阅、基金支持

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参考文献(40)

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图 1 胫骨横向搬运技术联合持续低负压伤口疗法治疗Wagner Ⅳ级糖尿病足患者右足慢性溃疡的效果及治疗过程示意图。1A.术前足部外观,可见第3足趾发生坏疽；1B.胫骨横向搬运装置组装后即刻,胫骨X线检查确认外固定支架安装成功；1C.术前CT血管成像,可见下肢远端局部循环受损；1D.术后1周,可见胫骨外固定支架安装稳固,未见明显并发症；1E.术后3个月,可见足部溃疡创面中肉芽组织生长良好；1F.外固定支架拆除后,胫骨X线检查可见局部骨愈合；1G. 术后36个月随访时,CT血管成像检查可见局部血液循环显著改善；1H.胫骨横向搬运技术联合持续低负压伤口疗法的治疗过程示意图

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Table 1. 2组Wagner Ⅲ至Ⅴ级糖尿病足慢性溃疡患者临床资料比较

组别	例数	性别（例）		年龄（岁,x¯±s）	糖尿病病程（年,x¯±s）	cDFU病程（d,x¯±s）	Wagner分级（例）			是否植皮（例）		溃疡创面面积（cm²,x¯±s）
组别	例数	男	女	年龄（岁,x¯±s）	糖尿病病程（年,x¯±s）	cDFU病程（d,x¯±s）	Ⅲ级	Ⅳ级	Ⅴ级	是	否	溃疡创面面积（cm²,x¯±s）
对照组	20	10	10	64.0±2.3	10.1±2.5	22±8	10	5	5	10	10	29±13
联合治疗组	18	10	8	60.8±2.9	10.1±3.6	24±11	8	7	3	8	10	30±18
统计量值		—		t=0.86	t=0.11	t=0.73	—			—		t=0.18
P值		0.757		0.396	0.991	0.471	>0.999			0.757		0.859
注：对照组、联合治疗组患者的糖尿病足慢性溃疡创面分别采用单纯胫骨横向搬运技术及胫骨横向搬运技术联合持续低负压伤口疗法进行治疗；“—”表示无此统计量值；cDFU为糖尿病足慢性溃疡

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Table 2. 2组Wagner Ⅲ至Ⅴ级糖尿病足慢性溃疡患者各指标比较

组别	例数	术后溃疡创面愈合时间[d,M（Q₁,Q₃）]	术后下地行走时间（d,x¯±s）	术后患肢完全负重时间（d,x¯±s）	术后去除外固定支架时间[d,M（Q₁,Q₃）]	患足VAS评分[分,M（Q₁,Q₃）]
组别	例数	术后溃疡创面愈合时间[d,M（Q₁,Q₃）]	术后下地行走时间（d,x¯±s）	术后患肢完全负重时间（d,x¯±s）	术后去除外固定支架时间[d,M（Q₁,Q₃）]	术前	末次随访时
对照组	20	35（31,42）	56±5	104±8	43.50（38.25,49.75）	7（6,8）	2（1,3）
联合治疗组	18	30（24,35）	50±5	94±6	31.50（29.75,34.25）	7（6,8）	1（0,2）
统计量值		Z=2.52	t=3.99	t=4.10	Z=4.90	Z=0.26	Z=2.24
P值		0.011	<0.001	<0.001	<0.001	0.808	0.025
注：对照组、联合治疗组患者的糖尿病足慢性溃疡创面分别采用单纯胫骨横向搬运技术及胫骨横向搬运技术联合持续低负压伤口疗法进行治疗；VAS为视觉模拟评分法