自制可控内嵌式双管冲洗引流联合PMMA骨水泥诱导膜技术治疗糖尿病足溃疡创面的疗效分析

Efficacy of a Self-Designed Controllable Dual-Tube Irrigation-Drainage System Combined with the Masquelet Technique for Diabetic Foot Ulcer Wounds

摘要: 目的：探讨抗生素聚甲基丙烯酸甲酯(PMMA)骨水泥联合自制双管冲洗技术在糖尿病足溃疡(DFU)治疗中的临床疗效。方法：选取本院收治的DFU患者32例，根据治疗方法分为对照组(n = 16)和实验组(n = 16)。对照组在清创术后行负压封闭引流(VSD)治疗，并辅以全身抗感染及血糖控制等基础治疗；实验组在基础治疗及清创术后，行自制可调内嵌式双管冲洗引流联合抗生素PMMA骨水泥覆盖治疗。比较两组患者的临床疗效及总有效率、炎症反应指标(治疗前后4周的CRP、ESR、PCT、WBC)、疼痛视觉模拟评分(VAS)、生活质量SF-36评分、细菌检出率、术后恢复情况(手术次数、住院时间、创面愈合情况)以及并发症发生情况(术后出血、感染、溃疡加重、骨髓炎、截肢等)。结果：实验组住院时间、溃疡愈合时间均显著短于对照组(P < 0.05)。治疗4周后，实验组患足VAS评分显著低于组内治疗前及同期对照组(P < 0.05)；实验组SF-36各维度评分均显著高于同期对照组(均P < 0.05)。实验组总有效率为93.8% (15/16)，显著高于对照组的50.0% (8/16) (χ² = 7.58, P < 0.05)。实验组手术次数少于对照组，细菌检出率低于对照组，差异均有统计学意义(均P < 0.05)。实验组创面愈合时间短于对照组，肉芽组织生长厚度高于对照组，创面面积小于对照组，差异均有统计学意义(P < 0.05)。实验组并发症发生率低于对照组(P < 0.05)。结论：自制可调内嵌式双管冲洗联合抗生素PMMA骨水泥治疗DFU具有较好的临床效果，能够缩短患者住院时间、减轻患足疼痛、促进溃疡愈合，并在总有效率方面显示出优于单纯VSD治疗的初步证据，是一项值得进一步验证的保肢治疗优化方案。

Abstract: Objective: To investigate the clinical efficacy of antibiotic-loaded polymethyl methacrylate (PMMA) bone cement combined with a self-made double-tube irrigation technique in the treatment of diabetic foot ulcer (DFU). Methods: A total of 32 DFU patients admitted to our hospital were divided into a control group (n = 16) and an experimental group (n = 16). The control group received negative-pressure wound drainage (VSD) after debridement, along with basic treatments including systemic anti-infection and glycemic control. On the basis of basic treatment and debridement, the experimental group received self-made adjustable embedded double-tube irrigation and drainage combined with antibiotic-loaded PMMA bone cement coverage. The clinical efficacy and overall response rate, inflammatory markers (CRP, ESR, procalcitonin, WBC at baseline and 4 weeks after treatment), Visual Analog Scale (VAS) score, SF-36 quality of life score, bacterial detection rate, postoperative recovery outcomes (number of operations, length of hospital stay, wound healing status), and incidence of complications (postoperative bleeding, infection, ulcer aggravation, osteomyelitis, amputation, etc.) were compared between the two groups. Results: The length of hospital stay and wound healing time in the experimental group were significantly shorter than those in the control group (P < 0.05). After 4 weeks of treatment, the VAS score of the affected foot in the experimental group was significantly lower than that before treatment in the same group and that in the control group at the same time point (P < 0.05); the SF-36 scores in all dimensions in the experimental group were significantly higher than those in the control group at the same time point (P < 0.05). The overall response rate in the experimental group was 93.8% (15/16), significantly higher than 50.0% (8/16) in the control group (χ² = 7.58, P < 0.05). The number of operations and bacterial detection rate in the experimental group were lower than those in the control group, with statistical significance (P < 0.05). The wound healing time in the experimental group was shorter, the thickness of granulation tissue was greater, and the wound area was smaller than those in the control group (P < 0.05). The incidence of complications in the experimental group was lower than that in the control group (P < 0.05). Conclusion: The combination of self-made adjustable embedded double-tube irrigation and antibiotic-loaded PMMA bone cement shows favorable clinical effects in the treatment of DFU, including shortened hospital stay, reduced foot pain, promoted ulcer healing, and superior overall response rate compared with VSD alone. It is an optimized limb-salvage strategy worthy of further validation.