摘要
Abstract
Objective To compare clinical efficacy of tibial transverse transport(TTT)microcirculation reconstruction and periosteal distraction in treating patients with early diabetic foot(DF).Methods From June 2021 to June 2024,60 patients with DF were admitted and divided into bone transport group and stretch group according to different treatment methods.There were 30 patients in bone transport group,including 16 males and 14 females;aged from 48 to 65 years old with an average of(55.59±3.78)years old;the course of disease ranged from 2 to 9 months with an average of(5.95±1.32)months;TTT microcir-culation reconstruction surgery was performed.There were 30 patients in distraction group,including 17 males and 13 females;aged from 47 to 67 years old with an average of(55.24±3.81)years old;the course of disease ranged from 2 to 10 months with an average of(5.68±1.54)months;periosteal distraction surgery was performed.The skin temperature of the affected feet,the time of getting out of bed and walking after operation,the time of full weight-bearing,the wound healing time and complications were compared between two groups;the pain was evaluated by visual analogue scale(VAS)before operation and one month after operation respectively;the changes of blood flow velocity of dorsal foot arteries,ankle brachial index(ABI),epidermal growth factor(EGF),and basic fibroblast growth factor(bFGF)before and after operation at 3 months were compared between two groups.Results All patients were followed up for 3 to 4 months with an average of(3.52±0.12)months.There were no sta-tistically significant differences in comparison of foot skin temperature,postoperative walking time,full weight-bearing time and complications between two groups(P＞0.05).The wound healing time of bone transport group(61.26±7.31)days was shorter than that of distraction group(70.17±7.15)days,and the difference was statistically significant(P＜0.05).Postoperative VAS at 1 month of bone transport group(2.19±0.21)was lower than that of distraction group(2.55±0.20),and the difference was statistically significant(P＜0.05).At 3 months after operation,the blood flow velocity of dorsal foot artery,ankle-brachial in-dex,EGF and bFGF in bone transport group were(34.73±4.18)cm·s-1,(0.95±0.13),(716.61±71.13)pg·ml-1 and(175.69±31.28)pg·ml-1,respectively;which were higher than that of distraction group(31.86±3.23)cm·s-1,(0.84±0.11),(677.37±70.21)pg·ml-1,(149.26±30.13)pg·ml-1,and the differences were statistically significant(P＜0.05).There was no recurrence of ulcers in situ or at other sites in both groups during follow-up.Conclusion Compared with periosteal distraction,TTT micro-circulation reconstruction surgery has a definite effect in the treatment of early DF.It could effectively reduce pain level,im-prove blood flow indicators and vascular endothelial function of the foot,and has a relatively high safety.关键词
糖尿病足/骨膜牵张术/胫骨横向骨搬移/足部血流/血管内皮Key words
Diabetic foot/Periosteal distraction/Tibial transverse transport/Foot blood flow/Vascular endothelium分类
医药卫生
