Abstract
Objective To explore clinical efficacy of different technical combinations in treating ischemic diabetic foot(DF).Methods A retrospective analysis was conducted on 35 patients with DF who were treated with vascular interventional opening technique,periosteal distraction technique and bone cement coverage technique from January 2024 to November 2024.They were divided into comprehensive group and periosteal distraction group according to whether the vascular interventional opening technique was used in combination or not.There were 5 patients in comprehensive group,including 4 males and 1 fe-male,aged from 59 to 73 years old with an average of(64.40±5.46)years old;the duration of diabetes ranged from 0.17 to 30.00 years with an average of(14.63±12.02)years;the courses of DF ranged from 30 to 150 days with an average of(84.00±61.48)days;2 patients were grade 2,2 patients were grade 3,and 1 patient was grade 4 according to Wagner classification;combined vascular interventional opening,periosteal distraction and bone cement coverage surgery for treatment.There were 30 patients in periosteal stretch group,including 22 males and 8 females,aged from 58 to 86 years old with an average of(72.63±7.84)years old;the duration of diabetes was 10.00(6.75,16.75)years;the courses of DF was 30.00(15.00,37.50)days;14 patients were grade 2,11 patients were grade 3,and 5 patients were grade 4 according to Wagner classification;com-bined periosteal distraction and bone cement coverage surgery for treatment.Changes of C-reactive protein(CRP),inter-leukin-6(IL-6),and procalcitonin(PCT),toe skin temperature,peripheral capillary oxygen saturation(SpO2),and visual analogue scale(VAS)for pain were compared between two groups before operation and 1 week after operation.The number of operations,healing period,healing number,toe amputation number,preoperative fever situation and the number of complica-tions were compared between two groups.Results Both groups were followed up for at least 6 months.There were no statisti-cally significant differences in the number of operations,healing period,toe amputation rate,wound healing rate and compli-cations between two groups(P＞0.05).Before operation,the toe skin temperature of comprehensive group(26.98±0.88)℃was lower than that of periosteal distraction group(28.17±1.45)℃,and the difference was statistically significant(P＜0.05);while there were no statistically significant difference in CRP,IL-6,PCT,toe SpO2 and VAS between two groups(P＞0.05).At 1 week after operation,IL-6,toe skin temperature,toe SpO2 and VAS in comprehensive group were 12.29(7.92,22.15)pg·ml-1,(36.02±0.23)℃,(95.80±0.84)％and(1.40±0.55)respectively,while those in periosteal distraction group were 5.49(4.36,7.45)pg·ml-1,(31.36±1.57)℃,(84.53±6.38)％,(2.20±0.81);and there were statistically significant differences be-tween two groups(P＜0.05).CRP,IL-6 and VAS at 1 week after operation in both groups were decreased compared with those before operation,and the differences were statistically significant(P＜0.05).The toe skin temperature and SpO2 were in-creased compared with those before operation,and the differences were statistically significant(P＜0.001).Conclusion The multi-technique combination therapy,including vascular interventional opening technique,periostealdistraction technique and bone cement covering technique,could protect each other,enhance efficacy,effectively promote the wound healing of ischemic diabetic foot ulcer,and reduce the toe amputation rate.For moderate to severe ischemic DF,the combined use of periosteal dis-traction and bone cement coverage techniques has a satisfactory effect.For extremely severe ischemic DF with inflow tract le-sions,vascular interventional opening techniques need to be added.关键词
糖尿病足/骨膜牵张技术/血管介入开通技术/骨水泥技术Key words
Ischemic diabetic foot/Periosteal distraction/Vascular intervention/Bone cement covering technology分类
医药卫生
