摘要
目的探讨胫骨横向骨搬移(tibial transverse transport,TTT)技术治疗糖尿病足的并发症发生原因及处理方法。方法回顾性分析2015年9月—2019年9月应用TTT技术治疗的196例糖尿病足患者临床资料。其中男109例,女87例;年龄45~86岁,平均67.6岁。糖尿病足根据Wagner分级法:3级124例,4级62例,5级10例;病程1~12个月,平均2.6个月。采用小切口微创胫骨截骨,其中62例于胫骨中下段截骨、134例于胫骨中上段截骨;83例截骨面积为20 cm^2、113例为7.5 cm^2。术后92例单次往返搬移、104例两次往返搬移。记录患者并发症发生情况,包括胫骨截骨处继发骨折、截骨区域皮肤坏死、针道感染,并对发生率进行统计分析。结果196例患者中41例(20.9%)发生并发症。9例(4.6%)发生胫骨截骨处继发骨折;其中,胫骨中下段截骨者6例(9.6%)、中上段截骨者3例(2.2%),不同截骨部位患者间发生率差异有统计学意义(χ~2=5.354,P=0.021);截骨面积为20 cm^2者5例(6.0%)、7.5 cm^2者4例(3.5%),不同截骨面积患者间发生率差异无统计学意义(χ~2=0.457,P=0.499)。12例发生截骨区域皮肤坏死,发生率为6.1%,均为单次往返搬移患者;单次、两次往返搬移患者间发生率差异有统计学意义(P=0.001)。18例(9.1%)发生针道感染,其中轻度感染12例(6.1%)、重度感染6例(3.0%)。轻度、重度感染发生率差异无统计学意义(P=0.107)。结论TTT技术是治疗糖尿病足的一种有效手段,但在骨搬移过程中存在胫骨截骨部位骨折、截骨区域皮肤坏死、针道感染等并发症发生风险。术前适应证评估,规范术中截骨方式、截骨块大小及位置,以及术后制定个性化骨搬移方案、加强针道护理,可有效减少并发症的发生。
Objective To explore the causes and management of the complications in diabetic foot treated with tibial transverse transport(TTT).Methods Between September 2015 and September 2019,196 patients with diabetic foot were treated with TTT.There were 109 males and 87 females,with an average age of 67.6 years(range,45-86 years).According to Wagner’s classification,there were 124 cases of grade 3,62 cases of grade 4,and 10 cases of grade 5;the course of disease was 1-12 months,with an average of 2.6 months.All patients underwent the minimally invasive tibial osteotomy.The osteotomy site was the middle and lower tibia in 62 cases and the middle and upper tibia in 134 cases.The area of osteotomy was 20 cm^2 in 83 cases and 7.5 cm^2 in 113 cases.The osteotomy block was moved back and forth once in92 cases and twice in 104 cases.The complications were recorded,including secondary fracture at tibial osteotomy,skin necrosis in osteotomy area,and pin tract infection.Results Among 196 patients,41 cases(20.9%)had complications.Nine cases(4.6%)had secondary fracture at tibial osteotomy,among which 6 cases(9.6%)of middle and lower segment osteotomies and 3 cases(2.2%)of middle and upper segment osteotomies.The incidence between the patients with different osteotomy sites was significant(χ~2=5.354,P=0.021).The area of osteotomy was 20 cm^2 in 5 cases(6.0%)and7.5 cm^2 in 4 cases(3.5%).There was no significant difference in the incidence between patients with different areas(χ~2=0.457,P=0.499).Skin necrosis occurred in the osteotomy area in 12 cases(6.1%),all of which were moved back and forth once.There was a significant difference in the incidence between patients who were treated with transport once and twice(P=0.001).There were 18 cases(9.1%)with pin tract infection,including 12 cases(6.1%)with mild infection and 6 cases(3.0%)with severe infection.There was no significant difference in the incidence between the patients with mild and severe infections(P=0.107).Conclusion TTT is an effective method to treat diabetic foot,but t
作者
张定伟
黄俊琪
石波
陈斌
ZHANG Dingwei;HUANG Junqi;SHI Bo;CHEN Bin(Department of Orthopedics,Mianyang Central Hospital,Mianyang Sichuan,621000,P.R.China;Department of Medicine,Mianyang People’s Hospital,Mianyang Sichuan,621000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第8期985-989,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省卫生健康委员会科研课题(19PJ056)。
