胫骨横向搬移治疗合并慢性肾病的糖尿病足△

Tibial transverse transport for treatment of diabetic foot accompanied with chronic kidney disease

摘要:

［目的］研究胫骨横向骨搬移（tibia transverse transport, TTT）治疗合并慢性肾病（chronic kidney disease, CKD）的糖尿病足溃疡（diabetic foot ulcer, DFU）的临床疗效。［方法］回顾性分析 2015 年 2 月—2019 年 8 月于本科采用 TTT 治疗的糖尿病足病例资料，其中合并慢性肾病的 67 例列入肾病组，同期无肾病患者 53 例，列入无肾病组。比较两组临床与辅助检查结果。［结果］肾病组手术时间、住院时间、拆除外固定时间均大于无肾病组（P<0.05）。随访 4~24 个月，平均（14.38±4.38）个月。在随访期间肾病组患者有 7 例患者死亡于心脑血管疾病，无肾病组无患者死亡（P<0.05）。末次随访时两组间足部溃疡愈合率的差异无统计学意义（P>0.05），但是肾病组溃疡愈合时间显著晚于无肾病组（P<0.05）。至末次随访时，肾病组足部溃疡复发率、截肢率均高于无肾病组，但两组间差异均无统计学意义（P>0.05）。与术前相比，术后两组血管显像均显著改善（P<0.05）； 术后 1 个月时无肾病组的血管显像优于肾病组（P<0.05），术后 3 个月时两组间血管显像的差异无统计学意义（P>0.05）。检验方面，与术前相比，术后 1 个月两组 CRP 水平、Cr 及 HbA1c 均显著下降（P<0.05），但 Hb，Alb 和 Urea 无显著变化（P>0.05）。相应时间点，肾病组的 Hb，Alb 显著低于无肾病组（P<0.05），而 Urea、Cr 和 CRP 显著高于无肾病组（P<0.05）。［结论］TTT 治疗合并慢性肾病的糖尿病足取得愈合率较高，截肢率、复发率较低的良好效果。

Abstract:

[Objective] To investigate the clinical outcomes of tibia transverse transport (TTT) for diabetic foot ulcer (DFU) complicat- ed with chronic kidney disease (CKD) . [Methods] A retrospective study was conducted on the patients who underwent TTT for DFU in our department from February 2015 to August 2019. Among them, 67 patients with chronic kidney disease were fall into the CKD group, while the other 53 patients without kidney disease were termed as the non-CKD group. The clinical and auxiliary examination results were com- pared between the two groups. [Results] The CKD group consumed significantly longer operation time, hospital stay and external fixator wearing time than non-CKD group (P＜0.05) . All the patients were followed up for 4~24 months, with an average of (14.38±4.38) months. During the follow-up period, 7 patients in CKD group died of cardiovascular and cerebrovascular diseases, while no patients in the nonCKD group died (P＜0.05) . Although there was no significant difference in the healing rate of foot ulcers between the two groups at the last follow-up (P＞0.05) , the CKD group got ulcer healing significantly later than the non-CKD group (P＜0.05) . At the last follow-up, the CKD group had higher recurrence rate of foot ulcers and amputation than the non-CKD group, despite of the fact that no significant differences were noted between the two groups (P＞0.05) . Angiographically, the findings significantly improved in both groups after surgery(P＜0.05) , which in the non-CKD group proved significantly superior to the CKD group at 1 month postoperatively, and bacame not statistically signifi- cant between the two groups at 3 months after surgery(P＞0.05) . In terms of lab tests, CRP, Cr and HbA1c significantly decreased in both groups 1 month after operation compared with that before operation (P＜0.05) , whereas the Hb, Alb and Urea remained unchanged in both groups (P＞0.05) . At the corresponding time point, the CKD group had significantly lower Hb and Alb (P＜0.05) , while significantly higher Urea, Cr and CRP than the non-CKD group (P＜0.05) . [Conclusion] TTT for treatment of diabetic foot ulcer complicated with chronic kid- ney disease does achieve a higher chance of ulcer healing, with low amputation and recurrence rates.