胫骨内后横向骨搬移治疗糖尿病足溃疡（开放获取）

Posteromedial tibial osteotomy and transverse bone fragment transport for diabetic foot ulcer

摘要:

[目的] 评价胫骨内后侧截骨法横向骨搬移治疗糖尿病足溃疡的临床疗效。[方法] 回顾性分析 2019 年 3 月—2022 年 10 月收治的 52 例糖尿病足溃疡（56 足），均采用胫骨内后横向骨搬移术。评价临床资料。[结果]56 足均顺利完成截骨，手术时间 20~40 min，切口长度 5~7 cm，术中骨折块大小 5 cm×1.5 cm~6 cm×1.8 cm。术后 3 足出现截骨切口渗出，经换药和延迟 2 周搬运后伤口愈合。随访时间平均（15.5±2.7）个月。3 足因严重感染并伴有剧烈疼痛而选择截肢，截肢率 5.4%，保肢成功率 94.6%。带架时间最短 6 周，最长 17 周。随术前、术后 7 d 和 12 个月的时间推移，VAS 评分 [( 6.2±0.7), ( 3.2±0.6), ( 1.0±0.3), P= 0.022]、踝臂指数 （ankle brachial index, ABI） [( 0.7±0.1), (0.8±0.1), ( 1.0±0.2), P=0.042] 和趾端皮温 [( 28.2±2.1)℃, ( 32.3±0.5)℃, (36.1±0.6)℃, P=0.031] 均显著改善。除 3 足截肢外，创面均愈合 [愈合/未愈合/截肢, (0/56/0), (0/56/0), (53/0/3), P＜0.001] 。[结论] 胫骨内后侧截骨法横向骨搬移术治疗糖尿病足溃疡时能有效改善足部血液供应，手术简单安全，并发症少。

Abstract:

[Objective] To investigate the clinical efficacy of posteromedial tibial osteotomy and transverse bone fragment transport for diabetic foot ulcer. [Methods] A retrospective study was performed on 52 patients (56 feet) who had diabetic foot ulcers treated by abovesaid surgical technique from March 2019 to October 2022. The relative clinical documents were evaluated. [Results] All 56 feet were operated on successfully with the operation time from 20 min to 40 min, the incision length from 5 cm to 7 cm, and the osteotomy bone fragment from 5 cm×1.5 cm to 6 cm×1.8 cm in size. Among them, 3 feet got osteotomy incision exudation after surgery, which healed after dressing change and delayed bone transportation for 2 weeks. The patients were followed up for (15.5±2.7) months in a mean, with amputation rate of 5.4% and the success rate of limb salvage of 94.6%, frame bearing time 6 weeks in the minimum and 17 weeks in the maximum. With time elapsed preoperatively, 7 days and 12 months after surgery, the VAS score [(6.2±0.7), (3.2±0.6), (1.0±0.3), P=0.022], ankle brachial index (ABI) [(0.7±0.1), (0.8±0.1), (1.0±0.2), P=0.042] and toe skin temperature [(28.2±2.1)℃, (32.3±0.5)℃, (36.1±0.63)℃, P=0.031] were significantly improved. Except 3 foot amputation, all the patients had the ulcer healed well over time [healing /non-healing/ amputation, (0/56/0), (0/56/ 0), (3/53/0), P＜0.001]. [Conclusion] The posteromedial tibial osteotomy and transverse bone fragment transport does effectively improve blood supply of the foot, with advantages of simplifying therapeutic operation, high safety and less complications.