| 胫骨横向搬移治疗糖尿病足溃疡 |
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Received:March 18, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 孙勇 |
SUN Yong |
湖北省中西医结合医院骨科, 武汉 湖北 430000 |
Department of Orthopaedics, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430000, Hubei, China |
sunyfire5@126.com |
| 肖耀广 |
XIAO Yao-guang |
湖北省中西医结合医院骨科, 武汉 湖北 430000 |
Department of Orthopaedics, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430000, Hubei, China |
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| 王贺 |
WANG He |
湖北省中西医结合医院骨科, 武汉 湖北 430000 |
Department of Orthopaedics, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430000, Hubei, China |
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| 期刊信息：《中国骨伤》2018年31卷，第10期，第949-952页 |
| DOI：10.3969/j.issn.1003-0034.2018.10.014 |
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目的：探讨采用Ilizarov技术行胫骨横向搬移术治疗糖尿病足溃疡的临床疗效。
方法：自2013年7月至2017年3月，采用Ilizarov胫骨横向搬移术治疗20例糖尿病足溃疡患者，男14例，女6例；年龄46~61（51.6±6.8）岁。Wagner分级：3级5例，4级15例。手术前后观察并记录截肢平面、溃疡愈合情况、创面愈合时间、VAS疼痛评分、患足皮温，CTA观察血管再通及血管网重建情况。
结果：20例患者均进行了随访，时间12~58个月，平均22.4个月，所有患者足部溃疡顺利愈合，时间6~18（13.2±3.7）周，坏死及截肢平面没有上移，患足疼痛明显缓解，VAS评分由术前的5.6±0.8降低至术后1年的0.9±0.4，差异有统计学意义（t=-26.55，P<0.05）；患足皮温由治疗前的（27.9±1.1）℃提高至术后1年的（30.9±1.1）℃（t=-5.98，P<0.05）。CTA可见术前闭塞的血管再通，微血管数量明显增加，足部血管网重建。
结论：Ilizarov胫骨横向搬移术能促进足部血管的再生、微血管网的再通或重建，从而改善糖尿病足患者的血液循环，促进溃疡的愈合，适合以微血管病变为主的糖尿病足患者。对于主干大动脉严重狭窄或闭塞的患者应当慎重或配合介入等血管再通技术联合应用。 |
| [关键词]:胫骨 糖尿病足 足溃疡 |
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| Transverse tibial bone movement for the treatment of diabetic foot ulcers |
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Abstract:
Objective:To explore Ilizarov technique in treating diabetic foot ulcers with transverse tibial bone movement.
Methods:From July 2013 to March 2017,20 patients with diabetic foot ulcers were treated by transverse tibial bone movement,including 14 males and 6 females aged from 46 years to 61 years with an average of (51.6 ±6.8) years old. According to Wagner's criteria,5 patients were Grade Ⅲ and 15 patients were Grade Ⅳ. Amputation level,ulcer healing time,VAS score,foot skin temperature before and after operation,vascular recanalization or reconstruction were observed by CTA of affected limb.
Results:Twenty patients followed up from 12 to 58 months with an average of 22.4 months. Foot ulcers were healed from 6 to 18 weeks with an average of (13.2±3.7) weeks. There was no upper movement in the level of necrosis and amputation,and pain was relieved. VAS score was decreased from 5.6±0.8 before operation to 0.9±0.4 after operation at 1 year; skin temperature was increased from(27.9±1.1)℃ before operation to (30.9±1.1)℃ after operation at 1 year. CTA indicated vessel occluded artery was dredged,and the number of micro-vessel was increased,and vasoganglion of foot was reconstructed.
Conclusion:Transverse tibial bone movement by Ilizarov technique could promote angiogenesis,reconstructive of vasoganglion to improve blood circulation of diabetic patients with foot ulcers,promote healing of ulcers,so it is suitable for diabetic patients with foot ulcers occurred on microangiopathy. For patients with severe stenosis or occlusion of trunk artery should be used carefully or combination with interventional therapy. |
| KEYWORDS:Tibia Diabetic foot Foot ulcer |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙勇,肖耀广,王贺.胫骨横向搬移治疗糖尿病足溃疡[J].中国骨伤,2018,31(10):949~952 |
| 英文格式: | SUN Yong,XIAO Yao-guang,WANG He.Transverse tibial bone movement for the treatment of diabetic foot ulcers[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(10):949~952 |
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