摘要
目的 中药配合胫骨横向骨搬运治疗气阴两虚挟瘀证糖尿病足(Diabetic foot, DF)患者的临床疗效观察。方法 选取2020年1月—2021年10月期间榆林市中医医院骨伤三科收治的84例DF患者作为研究对象,采用随机数字表法分为对照组和治疗组,每组各42例。两组患者均行胫骨横向骨搬运术治疗,治疗组在此基础上联合益气养阴活血方治疗。治疗8周后,观察比较两组患者中医证候疗效、手术并发症、创面愈合时间,同时比较手术前及术后8周证候积分、患足远端血供、患足皮温、踝肱指数及血清血管生成因子[血管内皮生长因子(Vascular endothelial growth factor, VEGF)、碱性成纤维细胞生长因子(Basic fibroblast growth factor, bFGF)、血小板衍生因子(Platelet-derived factor, PDGF)、表皮细胞生长因子(Epidermal cell growth factor, EGF)]水平变化。结果 (1)证候疗效:治疗后治疗组证候疗效总有效率90.48%(38/42)明显高于对照组71.43%(30/42),差异有统计学意义(P<0.05)。(2)证候积分:治疗后两组患者证候积分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组低于对照组,差异有统计学意义(P<0.05)。(3)患足远端血供:治疗后两组患者足部动脉、胫后动脉血流量均较治疗前升高,差异有统计学意义(P<0.05);且治疗组高于对照组,差异有统计学意义(P<0.05)。(4)患足皮温及踝肱指数:治疗后两组患者患足皮温、踝肱指数均较治疗前升高,差异有统计学意义(P<0.05);但组间比较,差异无统计学意义(P>0.05)。(5)血管生成因子:治疗后两组患者血清血管生成因子VEGF、bFGF、PDGF、EGF水平均较治疗前升高,差异有统计学意义(P<0.05);且治疗组高于对照组,差异有统计学意义(P<0.05)。(6)并发症:治疗后治疗组并发症发生率4.76%(2/42)低于对照组19.05%(8/42),差异有统计学意义(P<0.05)。(7)愈合时间:治疗后治疗组平均愈合时间较对照组短,差异有统计学意义(P<0.05)。结论 中医辅助胫骨横向骨搬运治疗DF效果显著,有利于改善患足远端血供,降低术后并发症发生率,促进足溃疡早期愈合,且可能与上调血管生成因子表达有关。
Objective To observe the clinical effect of traditional Chinese medicine(TCM)combined with trans-verse bone transport of the tibia in the treatment of diabetic foot(DF)qi and yin deficiency with blood stasis syndrome.Methods A total of 84 DF patients admitted to the Third Department of Orthopedics and Traumatology of Yulin Tradition-al Chinese Medicine Hospital from January 2020 to October 2021 were selected as the research objects,and they were di-vided into a control group and a treatment group by random number table method,with 42 cases in each group.Both groups were treated with transverse bone transport of the tibia.On this basis,the treatment group was treated with Yiqi Yangyin Huoxue Recipe for eight weeks.After that,the curative effect on TCM syndromes,surgical complications,and wound healing time were compared between the two groups.At the same time,the changes in syndrome score,distal blood supply of the af-fected foot,skin temperature of the affected foot,ankle-brachial index,and serum angiogenic factors,including vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),platelet-derived factor(PDGF),and epidermal cell growth factor(EGF)were compared before and 8 weeks after the operation.Results(1)Curative effect on syn-dromes:The total effective rate of the treatment group was 90.48%,which was higher than that of the control group(71.43%),indicating that the difference was statistically significant(P<0.05);(2)Syndrome score:after treatment,both groups decreased,and the treatment group was lower than the control group(P<0.05);(3)Distal blood supply of af-fected foot:The blood flow of foot artery and posterior tibial artery in the two groups were higher than those before treat-ment,and the treatment group was higher than the control group(P<0.05);(4)Skin temperature of affected feet and an-kle-brachial index:Both groups increased after treatment(P<0.05),but there was no difference between the groups(P>0.05);(5)Angiogenic factors:Both groups increased after treatment(P<0.05),and the treatment group was higher than the control group(P<0.05);(6)Complications:the incidence rate of the treatment group was 4.76%,lower than that of the control group(19.05%)(P<0.05);(7)Healing time:The treatment group was shorter than the control group(P<0.05).Conclusion The medically assisted transverse bone transport of the tibia is effective in the treatment of DF,which is beneficial to improve the distal blood supply of the affected foot,reduce the incidence of postoperative complica-tions,and promote the early healing of foot ulcers,and it may be related to the up-regulation of the expression of angio-genic factors.
作者
张德林
胡彦伟
ZHANG De-lin;HU Yan-wei(The Third Department of Orthopedics and Traumatology of Yulin Traditional Chinese Medicine Hospital,Yulin Shaanxi 719000)
出处
《世界中西医结合杂志》
2023年第5期1001-1006,共6页
World Journal of Integrated Traditional and Western Medicine
基金
2020年榆林市科协青年人才托举计划项目(20200226)。
关键词
糖尿病足
胫骨横向骨搬运
益气养阴活血方
气阴两虚挟瘀证
血管生成因子
创面愈合
Diabetic Foot
Transverse Bone Transport of the Tibia
Yiqi Yangyin Huoxue Recipe
Qi and Yin Deficiency with Blood Stasis Syndrome
Angiogenic Factors
Wound Healing
