Study on the Effect of the Five-in-One Comprehensive Limb Salvage Technologies of Treating Severe Diabetic Foot
Study on the Effect of the Five-in-One Comprehensive Limb Salvage Technologies of Treating Severe Diabetic Foot
复制标题
五合一综合保肢技术治疗重症糖尿病足的效果研究
DOI：
10.1089/wound.2018.0903
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发表时间：
2019-11-19
影响因子：
4.9
通讯作者：
Xie, Julin
中科院分区：
文献类型：
--
作者：
Liu, Yiling;Shi, Yan;Xie, Julin
目的：探讨五位一体综合保肢技术治疗重度糖尿病足溃疡的临床疗效及优势。方法：回顾性分析了2012年1月至2017年12月期间接受治疗的120例重度DFU患者的临床数据。对照组48例采用控制血糖、改善微循环、保护神经功能、换药等传统治疗方法;实验组72例采用传统治疗方法加早期彻底清创、负压伤口治疗、血运重建、植皮或皮瓣等技术治疗。记录踝臂指数（ABI）、经皮氧分压（TcPO 2）、创面愈合率、愈合时间、溃疡复发率和截肢率。结果如下：与对照组相比，实验组创面愈合率明显提高（93.1% vs. 72.9%; p < 0.01），伤口愈合时间缩短（16.2 +/- 5.4天vs. 32.2 +/- 7.8天; p < 0.05），降低了主要肢体截肢率（1.4%对10.4%，p < 0.05），溃疡复发率（5.6%对14.6%; p < 0.05）。实验组和对照组的截肢率无显著差异（29.2% vs. 33.3%，p = 0.628）。血运重建后，血运重建组显示ABI（0.75 +/- 0.21 vs. 0.35 +/- 0.16，p < 0.05）和TcPO 2（36 +/- 6 mmHg vs. 15 +/- 4 mmHg，p < 0.05）显著改善。创新：我们提出了“五位一体”的综合治疗方法，为DFU的内外科综合治疗提供了多学科合作模式。结论：五位一体的综合保肢治疗技术在提高重度DFU的治愈率、缩短治愈时间、降低复发率和大截肢率、提高患者整体生活质量方面发挥了重要作用。
Objective: To explore the clinical efficacy and advantages of five-in-one comprehensive limb salvage technologies for the treatment of severe diabetic foot ulcer (DFU). Approach: Clinical data for 120 patients with severe DFU treated between January 2012 and December 2017 were analyzed retrospectively. The control group (48 cases) was treated with traditional therapies, including controlling blood sugar, improving microcirculation, preserving nerve function, and dressing changes, whereas the experimental group (72 cases) was treated with traditional therapy combined with additional techniques, such as early and thorough debridement, negative pressure wound therapy, revascularization, and skin graft or flap. Ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), wound healing rate, healing time, ulcer recurrence rate, and amputation rate were recorded. Results: Compared with the control group, the experimental group significantly improved wound healing rate (93.1% vs. 72.9%; p < 0.01), decreased wound healing time (16.2 +/- 5.4 days vs. 32.2 +/- 7.8 days; p < 0.05), reduced major limb amputation rate (1.4% vs. 10.4%, p < 0.05), and ulcer recurrence rate (5.6% vs. 14.6%; p < 0.05). There were no significant differences in amputation rate between experimental and control group (29.2% vs. 33.3%, p = 0.628). After revascularization, the revascularization group showed significantly improved ABI (0.75 +/- 0.21 vs. 0.35 +/- 0.16, p < 0.05) and TcPO2 (36 +/- 6 mmHg vs. 15 +/- 4 mmHg, p < 0.05). Innovation: We propose a five-in-one comprehensive treatment method, which provides a multidisciplinary cooperative model for comprehensive medical and surgical treatments for DFU. Conclusion: The five-in-one comprehensive limb salvage treatment technologies played a vital role in enhancing the healing rate of severe DFU, shortening the healing time, and reducing the rate of recurrence and major amputation, thus improving the overall quality of life.