Chinese Journal of Tissue Engineering Research ›› 2024, Vol. 28 ›› Issue (29): 4599-4604.doi: 10.12307/2024.570
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Liu Junpeng1, Yao Xingchen1, Zhao Hui1, Xu Ziyu1, Wu Yue1, Pei Fuchun2, Zhang Lin2, Du Xinru1
Received:
2023-11-06
Accepted:
2023-12-02
Online:
2024-10-18
Published:
2024-03-22
Contact:
Du Xinru, MD, Chief physician, Professor, Doctoral supervisor, Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100027, China
About author:
Liu Junpeng, Master, Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100027, China
CLC Number:
Liu Junpeng, Yao Xingchen, Zhao Hui, Xu Ziyu, Wu Yue, Pei Fuchun, Zhang Lin, Du Xinru. Antibiotic-loaded bone cement enhances ability of tibial cortex transverse transport for treating infected wounds[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(29): 4599-4604.
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46例患者中,男27例,女19例;年龄38-91岁,平均64.37岁;糖尿病病程2-34年,平均18.48年;从此次出现足部溃疡到就诊的时间为18-93 d,平均48.17 d;溃疡创面大小2-34 cm2,平均14.11 cm2;22例患者住院期间至少连续2次血糖监测结果显示空腹血糖≥7.0 mmol/L或餐后血糖≥11.1 mmol/L判定为血糖控制不佳;16例患者入院时无足趾坏疽,22例患者有1根足趾出现坏疽,5例患者有2根足趾坏疽,3例患者有3根或3根以上的足趾出现坏疽。研究期间,对12例患者的15根足趾进行了截趾手术,截趾创面均正常愈合。 2.3 糖尿病足溃疡患者手术参数 平均手术时间为(58.84±8.73) min,平均出血量为(51.32±7.11) mL,平均透视次数为(7.64±1.44)次。1例手术过程中发生钻头断裂,找到钻头,未导致术后并发症。 2.4 糖尿病足溃疡患者治疗后的临床疗效及并发症 溃疡愈合时间为21-104 d,平均58.07 d。 经Kolmogorov-Smirnov检验,胫骨横向骨搬运术前及术后3个月的踝肱指数符合正态分布规律,使用配对样本t检验进行统计学分析。术前溃疡面积呈正态分布,术后溃疡面积呈偏态分布,采用Wilcoxon秩和检验进行统计学分析。目测类比评分及WIFi分级属于等级资料,采用Wilcoxon秩和检验。统计分析结果表明,同胫骨横向骨搬运术前相比,患者胫骨横向骨搬运术后3个月的溃疡面积、踝肱指数、目测类比评分及WIFi分级均得到显著改善(P < 0.05),平均踝肱指数由术前的0.54±0.04提升为术后的0.65±0.06,中位目测类比评分由6分降为1分,平均溃疡面积由(14.11±8.88) cm2缩小为(0.19±0.68) cm2,见表4。"
43例患者的溃疡完全愈合,溃疡愈合率为93%(43/46),随访期间无溃疡或感染复发;3例患者的溃疡未在随访期内愈合,但溃疡面积较术前明显缩小并于后续追踪随访中完全愈合。 术后2例患者发生钉道感染,在对钉道进行乙醇消毒及专业护理后感染得到控制,其余44例患者未出现需要处理的并发症,并发症发生率为4%(2/46)。 2.5 典型病例 1名67岁男性患者,因“右足第二足趾破溃,足背大面积溃疡1个月余”入首都医科大学附属北京朝阳医院接受治疗。既往高血压、反流性食管炎病史。24年前诊断为1型糖尿病,血糖控制不佳。半年前因右足三、四足趾坏疽行截趾术。术前溃疡面积约30 cm2,于外院行敷药、清创等传统治疗无效,入院时溃疡创面暗紫色(图2a)。入院后拍摄X射线片,排除深部感染(图2b)。待术前检查完善后行胫骨横向骨搬运术(图2c、d),同期行扩创+抗生素骨水泥植入术(图2e)。此后每间隔4 d行清创术并更换抗生素骨水泥(图2f),期间行第二足趾截趾,累计4次清创术后观察到创面血供丰富,肉芽新鲜,行植皮术(图2g)。胫骨横向骨搬运术后5周拆除外固定架,此时创面基本愈合,外架拆除1周后创面完全愈合(图2h)。术后3个月随访期结束时,该患者的目测类比评分由术前6分降至1分,踝肱指数由术前的0.51升至术后的0.69。随访期间该患者没有出现溃疡或感染复发。"
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