Objective: To investigate the effectiveness of tibial transverse transport (TTT) combined with nose ring drain (NRD) in the treatment of severe diabetic foot ulcer.
Methods: The clinical data of 60 patients with severe diabetic foot (Wagner grade 3 or 4) ulcer who were admitted between April 2017 and August 2020 and met the selection criteria were retrospectively analyzed. Among them, 30 cases were treated with TTT combined with NRD (TTT+NRD group), and 30 cases were treated with TTT (TTT group). There was no significant difference in gender, age, diabetes duration, preoperative glycated hemoglobin, comorbidities, wound area, and duration, side, and grade of diabetic foot ( P>0.05). The wound healing time, wound healing rate, amputation rate, recurrence rate, duration of antibiotic therapy, hospital stay, number of hospitalizations, and number of operations were recoreded and compared between the two groups.
Results: No obvious surgical complications occurred in the two groups. Patients in both groups were followed up 3-13 months, with an average of 5.7 months. The duration of antibiotic therapy and hospital stay in the TTT+NRD group were significantly shorter than those in the TTT group ( P<0.05). There was no significant difference in wound healing time, wound healing rate, number of hospitalizations, and number of operations between the two groups ( P>0.05). During follow-up, there was no recurrence of ulcer in the TTT+NRD group while 2 recurrent cases (6.7%) in the TTT group. The difference in recurrence rate was not significant ( P=0.492). One case (3.3%) in the TTT+NRD group underwent amputation due to acute lower extremity vascular embolism, and 1 case (3.3%) in the TTT group underwent amputation due to secondary necrosis. The difference in amputation rate was not significant between the two groups ( P=1.000).
Conclusion: TTT combined with NRD is an effective method for the treatment of severe diabetic foot ulcers with deep infections or relatively closed cavities or sinuses. It can shorten the time of antibiotic use and the length of hospitalization; and the NRD has a good drainage effect without obvious comorbidities, procedure and the postoperative care are simple and easy to obtain materials.
目的: 探讨胫骨横向骨搬移（tibial transverse transport，TTT）联合牛鼻子引流术（nose ring drain，NRD）治疗重度糖尿病足溃疡的疗效。.
方法: 回顾性分析 2017 年 4 月—2020 年 8 月收治并符合选择标准的 60 例重度糖尿病足（Wagner 分级 3、4 级）溃疡患者临床资料，其中 30 例采用 TTT 联合 NRD 治疗（TTT+NRD 组），30 例采用单纯 TTT 治疗（TTT 组）。两组患者性别、年龄、糖尿病病程、术前糖化血红蛋白、合并症以及糖尿病足病程、侧别、分级、创面面积等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。TTT+NRD 组均有深部（关节腔、骨髓腔或骨膜）感染或相对密闭的腔隙或窦道形成，TTT 组均无该情况。记录并比较两组创面愈合时间及愈合率、截肢率、复发率、抗生素使用时间、住院时间、住院次数及手术次数。.
结果: 两组手术均顺利完成，未出现严重手术并发症。患者均获随访，随访时间 3～13 个月，平均 5.7 个月。TTT+NRD 组抗生素使用时间及住院时间均较 TTT 组缩短（ P<0.05）。两组创面愈合时间、愈合率、住院次数及手术次数比较，差异均无统计学意义（ P>0.05）。随访期间，TTT+NRD 组溃疡无复发，TTT 组 2 例（6.7%）复发，复发率差异无统计学意义（ P=0.492）。TTT+NRD 组 1 例（3.3%）因急性下肢血管栓塞截肢，TTT 组 1 例（3.3%）因继发坏死截肢，截肢率差异无统计学意义（ P=1.000）。.
结论: TTT 联合 NRD 是治疗合并深部感染或相对密闭腔隙或窦道的重度糖尿病足溃疡有效方法，可缩短抗生素使用及住院时间；而且 NRD 技术引流效果佳，无明显合并症，操作和术后护理简单，取材方便。.
Keywords: Diabetic foot; nose ring drain; tibia transverse transport; ulcer.