在治疗慢性缺血性下肢疾病时抬高和牵引胫骨骨膜。

IF 1.6 4区 医学 Journal of Orthopaedic Surgery Pub Date : 2024-09-01 DOI:10.1177/10225536241295483
Meng Gan, Xiqin Xia, Yi You, Wei Xu, Xinyu Peng, Jinjun Xu, Wengao Wu, Yinkui Tang, Qiong Chen, Yun Wu, Naxin Zeng
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引用次数: 0

摘要

研究目的本研究探讨了应用胫骨骨膜牵张术(TPD)治疗缺血性糖尿病足和血管炎性足部疾病的有效性:对 2019 年 6 月至 2022 年 5 月期间接受 TPD 的 33 名患者(36 条肢体)进行了回顾性分析。研究对象包括 21 名男性(23 个肢体)和 12 名女性(13 个肢体),年龄在 41 岁至 80 岁之间(平均年龄:63.4 岁)。糖尿病足患者 27 例,血栓闭塞性脉管炎患者 2 例,动脉闭塞性疾病患者 4 例。受影响肢体的分布情况为左足 15 例,右足 21 例。骨膜牵引从术后第三天开始,速度约为每天 0.75 毫米,每两周调整一次。两周后拆除牵引装置。评估包括毛细血管再充盈和伤口愈合评估,以及术前和术后的足部皮肤温度、踝肱指数(ABI)、视觉模拟量表(VAS)疼痛评分和外周血氧饱和度分析。CT 血管造影术(CTA)用于评估双下肢血管状况:所有 33 名患者均成功接受了 4 至 24 周(平均 11.03 周)的随访。VAS 疼痛评分从术前(5.09 ± 1.70,范围:2-8)明显降低至术后两周(2.24 ± 0.90,范围:1-4)(t = 9.44,p < .001)。血氧饱和度从术前的 83.88% ± 11.82%(范围:58%-97%)升至术后两周的 91.36% ± 5.69%(范围:76%-98%)(t = -4.21,p < .001)。足部皮肤温度也有明显升高(t = -3.98,p < .001)。术后两周的毛细血管再充盈测试显示病情明显好转。与术前相比,CTA 显示手术肢体有明显的新生血管。术后两个月内,所有 33 名患者的伤口均有明显改善:TPD是一种治疗慢性下肢缺血性疾病的有前途的技术,在促进伤口愈合和降低截肢率方面显示出良好的初步效果。尽管如此,大规模的随机对照试验对进一步验证其疗效至关重要。
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Elevation and distraction of the Tibial periosteum in the management of chronic ischemic lower limb diseases.

Objective: This study investigates the effectiveness of tibia periosteum distraction (TPD) applied to the tibial periosteum, an innovative approach grounded in Ilizarov's tension-stress theory, for the treatment of ischemic diabetic foot and vasculitic foot conditions.

Methods: A retrospective analysis was conducted on 33 patients (36 limbs) who underwent TPD between June 2019 and May 2022. The study comprised 21 males (23 limbs) and 12 females (13 limbs), aged 41 to 80 years (mean age: 63.4 years). Diabetic foot accounted for 27 cases, thromboangiitis obliterans for 2 cases, and arterial occlusive disease for 4 cases. The distribution of affected limbs included 15 left feet and 21 right feet. Periosteum traction commenced on the third postoperative day at a rate of approximately 0.75 mm/day, adjusted biweekly. The traction device was removed after two weeks. Evaluation included capillary refill and wound healing assessment, along with pre- and postoperative analysis of foot skin temperature, ankle-brachial index (ABI), visual analogue scale (VAS) pain scores, and peripheral blood oxygen saturation. CT angiography (CTA) was utilized to assess vascular conditions in both lower limbs.

Results: All 33 patients were successfully followed up for a duration ranging from 4 to 24 weeks (mean: 11.03 weeks). VAS pain scores significantly decreased from preoperative (5.09 ± 1.70, range: 2-8) to postoperative two weeks (2.24 ± 0.90, range: 1-4) (t = 9.44, p < .001). Oxygen saturation levels increased from 83.88% ± 11.82% (range: 58%-97%) preoperatively to 91.36% ± 5.69% (range: 76%-98%) at two weeks postoperatively (t = -4.21, p < .001). Foot skin temperature also showed a significant increase (t = -3.98, p < .001). Capillary refill test at two weeks postoperatively demonstrated notable improvement. CTA revealed evident neovascularization in the operated limbs compared to preoperative conditions. Wound improvement was significant in all 33 patients within two months postoperatively.

Conclusion: TPD emerges as a promising technique for chronic ischemic lower limb diseases, demonstrating favorable preliminary outcomes in wound healing promotion and amputation rate reduction. Nevertheless, large-scale randomized controlled trials are essential to further validate its efficacy.

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期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
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