【摘要】 目的 ：比较胫骨横向骨搬移（tibial transverse transport,TTT）微循环重建术与骨膜牵张术治疗早期糖尿病足（diabetic foot,DF）患者的临床疗效。方法：自2021年6月至2024年6月收治60例DF患者，根据治疗方法不同分为骨搬运组和牵张组。骨搬运组30例，男16例，女14例；年龄48～65（55.59±3.78）岁；病程2～9（5.95±1.32）个月；采用胫骨横向骨搬移微循环重建术。牵张组30例，男17例，女13例；年龄47～67（55.24±3.81）岁；病程2～10（5.68±1.54）个月；采用骨膜牵张术。比较两组患足皮温、术后下地行走时间、完全负重时间、创面愈合时间及并发症情况，分别于术前及术后1个月采用疼痛视觉模拟评分（visual analogue scale,VAS）评价疼痛情况，并比较两组术前、术后3个月足背动脉血流速度、踝肱指数（ankle brachial index,ABI）、表皮生长因子（epidermal growth factor,EGF）、碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF）的变化情况。结果：两组患者均获得随访，时间3～4（3.52±0.12）个月。两组患足皮温、术后下地行走时间、完全负重时间及并发症比较，差异均无统计学意义（P>0.05）；骨搬运组创面愈合时间（61.26±7.31） d短于牵张组（70.17±7.15） d，差异有统计学意义（P<0.05）。术后1个月，骨搬运组VAS（2.19±0.21）分低于牵张组（2.55±0.20）分，差异有统计学意义（P<0.05）。术后3个月，骨搬运组足背动脉血流速度、ABI、EGF、 bFGF分别为（34.73±4.18） cm·s^-1、（0.95±0.13）、（716.61±71.13） pg·ml^-1、（175.69±31.28） pg·ml^-1，高于牵张组的（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，差异均有统计学意义（P<0.05）。两组随访期间均无原位及其他部位溃疡复发。结论：与骨膜牵张术相比，TTT微循环重建术治疗早期DF效果确切，可有效降低疼痛水平，改善足部血流指标和血管内皮功能，且安全性较高。更多还原

【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 were30 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 microcirculation 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 statistically 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 index,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^-1and（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 microcirculation reconstruction surgery has a definite effect in the treatment of early DF. It could effectively reduce pain level,improve blood flow indicators and vascular endothelial function of the foot,and has a relatively high safety.更多还原