摘要目的 探讨胫骨横向骨搬移微血管网再生技术结合高压氧治疗伴溃疡形成的糖尿病足的临床疗效.方法 对2015年11月至2017年3月利用胫骨横向骨搬移微血管网再生技术结合高压氧治疗的21例糖尿病足溃疡患者(治疗组)进行回顾性分析,并与同期利用高压氧治疗的21例糖尿病足溃疡患者(对照组)进行比较.治疗组术中于患侧胫骨中段内侧面上做一范围约2 cm× 10 cm骨窗,安置专用横向外固定牵引架,同时行患足清创术,术后第1天开始采用多人高压氧舱治疗,压力为0.20 MPa,1次/d,10 d为1个疗程,共3个疗程,第5天开始缓慢横向搬移骨窗(1 mm/d);对照组行患足清创术,术后第1天行高压氧治疗,治疗方案同治疗组.观察2组创面愈合时间,术前、术后3个月踝肱指数(ABI)及密歇根神经体征评分(MNSI).结果 2组患者均获随访,平均随访9.3个月,对照组中1例Wagner Ⅴ级患者创面未愈合,最终截肢,其余患者创面均得到愈合,平均愈合时间为(39.52±8.43)d,治疗组创面均得到愈合,平均愈合时间为(31.74±6.12)d;治疗组ABI由术前的0.56±0.18,术后3个月升至0.94 ±0.16,MNSI由术前的5.92±1.13,术后3个月降至4.11±1.25,对照组ABI由术前的0.54±0.21术后3个月升至0.81±0.20,MNSI由术前的5.74±1.26;术后3个月降至4.98±1.34.2组创面愈合时间比较差异有统计学意义(P＜0.05),2组术后3个月ABI及MNSI较术前差异均有统计学意义(P＜0.01).治疗组优于对照组,差异有统计学意义(P＜0.05).结论 胫骨横向骨搬移微血管网再生技术可以重建患肢小腿以下微血管网,促进周围血管及周围神经恢复,结合高压氧可促进创面愈合,具有手术简便、疗效确切,保肢成功率高的优点,是治疗糖尿病足溃疡的理想方法之一.

abstractsObjective To investigate clinical efficacy of lateral tibia bone removal micro vessel regeneration combined with hyperbaric oxygen (HBO) in the treatment of diabetic foot ulcer.Methods A retrospective analysis was made on the clinical practice of lateral tibia bone removal micro vessel regeneration combined with HBO in 21 patients (the treatment group)with diabetic foot ulcer who received treatment in the hospital from November 2015 to March 2017.The patients in the treatment group were compared with the 21 patients (the control group) with diabetic foot ulcer who were treated with HBO at the same period.For the patients in the treatment group,a bone window with an area of about 2 cm × 10 cm was performed at medial surface of the affected lateral tibia,and a special external fixation lateral traction frame was placed and debridement was performed on the affected foot at the same time.On the first day after surgery,the patients received HBO therapy with a pressure of 0.20 MPa,once a day,10 days a treatment course,with a total of 3 courses.On the fifty day after surgery,the bone window was slowly removed laterally (1 mm/day).For the patients in the control group,debridement of the affected foot was performed,and on the first day after surgery,HBO therapy was also implemented in the control group with the same treatment scheme as the treatment group.Before surgery and 3 months after surgery,corresponding dada of healing time,ankle brachial index (ABI) and Michigan neuropathy sensation instruments (MNSI) were closely observed in the patients of the 2 groups.Results The patients of the two groups all had medical followed-ups for an average of 9.3 months.In the control group,the wound of one patient with Wagner Ⅴ failed to heal and in the end had amputation,but the wound of the remaining patients all healed,with an average healing time of (39.52 ± 8.43) days.The wound of the treatment group all healed,with an average healing time of (31.74 ± 6.12) days.Three months after surgery,the ABI level of the treatment group increased from pre-surgical level 0.56 ± 0.18 to post-surgical level 0.94 ± O.16,and the MNSI level decreased from pre-surgical level 5.92 ± 1.13 to post-surgical level 4.11 ± 1.25.Three months after surgery,the ABI level of the control group increased from pre-surgical level 0.54 ±0.21 to post-surgical level 0.81 ±0.20,and the MNSI level decreased from pre-surgical level 5.74 ± 1.26 to post-surgical level 4.98 ± 1.34.Statistical significance could be noted in wound healing time when comparisons were made between the two groups.Three months after surgery,statistical significance could also be found in ABI and MNSI levels as compared with those detected before surgery.The treatment group was superior to the control group,also with statistical significance.Conclusions Lateral tibia bone removal micro vessel regeneration could be used to reconstruct vasoganglion below lower leg and promote surrounding vessel and nerve function recovery.Combined with HBO therapy,it could promote wound surface healing,with the advantages of simple surgery,accurate curative effect,high success rate of limb-salvage.For this reason,it was one of the ideal methods for the treatment of diabetic foot ulcer.