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[1]連浩宇,花奇凱,陳炎,等.重度糖尿病足脛骨橫向骨搬移術(shù)治療后創(chuàng)面愈合方式及機制研究[J].中醫(yī)正骨,2019,31(12):15-19.
　LIAN Haoyu,HUA Qikai,CHEN Yan,et al.A study of pattern and mechanism of action of wound healing of severe diabetic foot after treatment with transverse tibial bone transport surgery[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(12):15-19.
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重度糖尿病足脛骨橫向骨搬移術(shù)治療后創(chuàng)面愈合方式及機制研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年12期
頁碼:
15-19
欄目:
臨床研究
出版日期:
2019-12-20

文章信息/Info

Title:
A study of pattern and mechanism of action of wound healing of severe diabetic foot after treatment with transverse tibial bone transport surgery
作者:
連浩宇1; 花奇凱2; 陳炎2; 何立環(huán)3; 莊勝2; 楊思捷2; 李山郎4; 鎮(zhèn)普祥3; 高偉2
(1.廣西醫(yī)科大學(xué)基礎(chǔ)醫(yī)學(xué)院,廣西 南寧 530021; 2.廣西醫(yī)科大學(xué)第一附屬醫(yī)院,廣西 南寧 530021; 3.廣西醫(yī)科大學(xué)再生醫(yī)學(xué)研究中心,廣西 南寧 530021; 4.廣西生物醫(yī)藥協(xié)同創(chuàng)新中心,廣西 南寧 530021)
Author(s):
LIAN Haoyu1; HUA Qikai2; CHEN Yan2; HE Lihuan3; ZHUANG Sheng2; YANG Sijie2; LI Shanlang4
1.School of Basic Medical Sciences of Guangxi Medical University,Nanning 530021,Guangxi,China2.The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China3.Research Center for Regenerative Medicine of Guangxi Medical University,Nanning 530021,Guangxi,China4.Guangxi Collaborative Innovation Center for biomedicine,Nanning 530021,Guangxi,China
關(guān)鍵詞:
糖尿病足;  足潰瘍;  骨搬移;  臨床試驗
Keywords:
diabetic foot;  foot ulcer;  bone transport;  clinical trial
摘要:
目的:探討重度糖尿病足脛骨橫向骨搬移術(shù)治療后創(chuàng)面愈合方式及機制。方法:2014年12月至 2018年6月收治136例重度糖尿病足患者。按照Wagner分級標(biāo)準(zhǔn),3級66例、4級60例、5級10例。按照TEXAS分級標(biāo)準(zhǔn),2B級32例、2C級2例、2D級11例、3B級13例、3D級78例。均采用脛骨橫向骨搬移術(shù)治療。對創(chuàng)面愈合過程進行大體觀察,同時分別于術(shù)前及術(shù)后1個月復(fù)診時切取創(chuàng)面邊緣組織,HE染色觀察創(chuàng)面組織形態(tài),免疫組織化學(xué)染色觀察Ki-67、CD31和血管內(nèi)皮生長因子(vascular endothelial growth factor,VEGF)表達情況。結(jié)果:①創(chuàng)面大體觀察結(jié)果。術(shù)后初期創(chuàng)面處于炎性期,有炎性細(xì)胞浸潤,創(chuàng)面黃白; 隨后有新鮮肉芽組織形成,肉芽組織由創(chuàng)面周圍向創(chuàng)面中心移行,創(chuàng)面紅潤,進入增生期; 肉芽組織覆蓋創(chuàng)面的過程中,上皮組織逐漸由創(chuàng)面四周向中心移行,1～3個月時創(chuàng)面愈合50%左右,上皮組織最終覆蓋創(chuàng)面,僅留線性瘢痕。②創(chuàng)面組織形態(tài)觀察結(jié)果。術(shù)前創(chuàng)面邊緣組織表皮結(jié)構(gòu)不完整,壞死結(jié)構(gòu)較多。術(shù)后1個月創(chuàng)面邊緣組織可清晰地觀察到完整表皮結(jié)構(gòu),分為角質(zhì)層、顆粒層、棘層和基底層; 真皮層結(jié)締組織中可觀察到血管及膠原纖維,纖維結(jié)構(gòu)少見。術(shù)前、術(shù)后創(chuàng)面邊緣組織表皮均有大量炎性細(xì)胞浸潤。③術(shù)后1個月時,創(chuàng)面邊緣組織中Ki-67、CD31、VEGF染色陽性細(xì)胞面積百分比均大于術(shù)前[(1.850±1.287)%,(7.480±5.272)%,Z=3.292,P=0.001;(0.395±0.139)%,(1.082±0.636)%,Z=3.403,P=0.001;(0.341±0.217)%,(2.428±1.502)%,Z=3.780,P=0.000]。結(jié)論:脛骨橫向骨搬移術(shù)能有效促進重度糖尿病足創(chuàng)面愈合,治療后創(chuàng)面愈合方式為再生愈合,其機制可能是該手術(shù)能促進創(chuàng)面組織細(xì)胞增殖與毛細(xì)血管再生。
Abstract:
Objective:To explore the pattern and mechanism of action of wound healing of severe diabetic foot after treatment with transverse tibial bone transport surgery.Methods:One hundred and thirty-six patients with severe diabetic feet were recruited from December 2014 to June 2018.According to the Wagner classification criteria,the diabetic feet belonged to grade 3(66),4(60)and 5(10).According to the TEXAS classification criteria,the diabetic feet belonged to grade 2B(32),2C(2),2D(11),3B(13)and 3D(78).All patients were treated with transverse tibial bone transport surgery.The roughly observation on wound healing procedure was performed,and the wound margin biopsies was performed before the surgery and at 1 month after the surgery.The wound tissue morphology and the expressions of Ki-67,CD31 and vascular endothelial growth factor(VEGF)were observed through HE staining and immunohistochemical staining respectively.Results:The results of roughly observation on wound surface showed that(1)the early postoperative wound was in the inflammatory stage,presenting with inflammatory cell infiltration and yellowish-white surface;(2)the fresh granulation tissues formed subsequently and migrated from the periphery to the center of the wound,and the ruddy wound surface demonstated that the wound entered into the hyperplasia stage;(3)the epithelial tissues gradually migrated from the periphery to the center of the wound when wound surface was covered by granulation tissues;(4)about 50% of wound healed within 1-3 months,and the wound surface was covered by epithelial tissues in the end,only the linear scars were found.The results of histomorphology observation on wound surface showed that(1)the epidermal structures of marginal tissues of wound were incomplete and many necrotic structures were found in wound surface before the surgery;(2)the complete epidermal structures,including cuticle,granular layer,spinous layer and basal layer were found in the marginal tissues of the wound at 1 month after the surgery;(3)the blood vessels and collagen fibers were found within the connective tissues of dermis and less fiber structure was found;(4)a large number of inflammatory cell infiltration was found in the epidermis of marginal tissues of wound surface before and after the surgery.The area percentages of positive Ki-67,CD31 and VEGF staining cells in marginal tissues of wound were higher at 1 month after the surgery compared to pre-surgery(1.850+/-1.287 vs 7.480+/-5.272%,Z=3.292,P=0.001; 0.395+/-0.139 vs 1.082+/-0.636%,Z=3.403,P=0.001; 0.341+/-0.217 vs 2.428+/-1.502%,Z=3.780,P=0.000).Conclusion:The transverse tibial bone transport surgery can effectively promote the wound healing of severe diabetic foot by means of regenerative healing,and its mechanisms of action may be that it can promote the cells proliferation and capillary regeneration in wound tissues.

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相似文獻/References:

[1]郜浩凱.Ilizarov脛骨橫向骨搬移技術(shù)治療糖尿病足潰瘍[J].中醫(yī)正骨,2019,31(06):56.
[2]何立環(huán),陳炎,鄺曉聰,等.重度糖尿病足脛骨橫向骨搬移術(shù)治療后創(chuàng)面愈合規(guī)律分析[J].中醫(yī)正骨,2019,31(10):70.

備注/Memo

備注/Memo:
基金項目:廣西自然科學(xué)基金項目(2017GXNSFAA198293); 廣西壯族自治區(qū)醫(yī)療衛(wèi)生重點學(xué)科資助項目(S2017032); 廣西生物醫(yī)藥協(xié)同創(chuàng)新中心研究生創(chuàng)新創(chuàng)業(yè)項目(GCICB-IE-2018007)通訊作者:鄺曉聰 E-mail:[email protected](收稿日期:2019-10-23 本文編輯:李曉樂)
更新日期/Last Update: 2019-12-15