胫骨膜与胫骨段搬移治疗糖尿病足的比较△（开放获取）

Tibial periosteum transportation versus tibial cortical bone transportation for treatment of diabetic foot

摘要:

[目的]比较胫骨膜搬移术与胫骨段搬移术治疗糖尿病足的临床疗效。[方法]回顾性分析2018年—2023年于新疆维吾尔自治区中医医院采用骨膜或骨段搬移术治疗的78例糖尿病足病患者的临床资料，根据术前医患沟通结果，39例采用骨膜搬移，另外39例采用骨段搬移，比较两组围手术期、随访及辅助检查资料。[结果]两组患者均顺利完成手术。骨膜组手术时间[(26.5±4.4)minvs(52.4±7.2)min,P＜0.001]、术中出血量[(30.2±11.4)mLvs(81.0±22.4)mL,P＜0.001]、住院时间[(11.9±2.1)d vs(13.3±3.5)d,P=0.044]显著优于骨段组，两组创面清创次数、换药次数、创面面积差异无统计学意义（P＞0.05）。与入院时相比，出院时两组创面面积均显著减小（P＜0.05）。两组创面愈合时间的差异无明显统计学意义（P＞0.05）。两组治疗后12周 VAS评分及足背皮温显著改善（P＜0.05），相同时间点，两组间VAS评分及足背皮温的差异均无统计学意义（P＞0.05）。两组患者治疗后12周，WBC、CRP、ESR均显著降低（P＜0.05），相同时间点，两组间上述检验指标的差异均无统计学意义（P＞ 0.05）。[结论]胫骨膜搬移术与胫骨段搬移术均能够通过刺激血管微循环重建，从而加快糖尿病足的创面愈合，效果相近，相比之下胫骨膜搬移技术手术操作用时短，难度明显降低。

Abstract:

[Objective] To compare the clinical consequences of tibial periosteum transportation (TPOT) versus tibial cortical bonetransportation (TCBT) in the treatment of diabetic foot. [Methods] A retrospective study was conduced on 78 patients who received TPOTor TCBT for diabetic foot in our hospital from 2018 to 2023. According to preoperative communication between doctors and patients, 39 pa-tients were treated with TPOT, while the other 39 patients received TCBT. The perioperative period, follow-up and auxiliary examinationdata of the two groups were compared. [Results] All patients in both groups had operation performed successfully. The TPOT group provedsignificantly superior to the TCBT group in terms of operation time [(26.5±4.4) min vs (52.4±7.2) min, P＜0.001], intraoperative blood loss[(30.2±11.4) mL vs (81.0±22.4) mL, P＜0.001], and hospital stay [(11.9±2.1) days vs (13.3±3.5) days, P=0.044]. However, there was no sig-nificant difference in wound debridement times, dressing times and wound area between the two groups (P＞0.05). Compared with that at ad-mission, the wound area in both groups was significantly reduced at discharge (P＜0.05). There was no significant difference in wound heal-ing time between the two groups (P＞0.05). At 12 weeks after treatment, the VAS score and foot dorsal skin temperature were significantlyimproved in both groups (P＜0.05), whereas which were not significantly different between the two groups at any time points accordingly (P＞0.05). At 12 weeks after treatment, the WBC, CRP and ESR in both groups were significantly decreased (P＜0.05), which proved not statisti-cally significant between two groups at any matching time points (P＞0.05). [Conclusion] Both tibial periosteum transportation and tibialcortical bone transportation do accelerate the wound healing of diabetic foot by stimulating vascular microcirculation reconstruction,achieve comparable clinical outcomes. In comparison, the tibial periosteum transportation takes considerable advantages in shortening oper-ation time, reducing iatrogenic trauma, and declining surgical difficulty over the tibial cortical bone transportation.