内科

目的比较不同方法治疗Wagner重型糖尿病足患者保肢率的差异，分析患者足踝关节以上大截肢的影响因素，为临床治疗提供参考。方法回顾分析2012年2月至2016年8月在本院住院治疗的糖尿病足患者的临床资料，对符合研究要求的患者进行电话随访0.5～5年，调查患者出现踝关节以上大截肢的情况，采用χ2检验比较不同方法治疗患者的大截肢率，采用二分类Logistic回归方法综合分析患者大截肢的影响因素。结果（1）对Wagner重型糖尿病足患者，采用足部常规换药治疗、创面治疗及Ilizarov技术胫骨横向骨搬移术治疗的大截肢率总体比较差异具有统计学意义（P＜0.05）；常规换药组与创面治疗组患者的大截肢率比较差异无统计学意义（P=0.807，＞0.016 7）；常规换药组及创面治疗组患者的大截肢率分别与Ilizarov技术胫骨横向骨搬移术组患者的大截肢率比较差异均有统计学意义（P=0.010、0.013，＜0.016 7）。（2）二分类Logistic回归分析显示：采用常规换药方法治疗Wagner重型糖尿病足患者的大截肢风险是采用胫骨横向骨搬移术治疗的13.994倍（OR=13.994，95%CI为1.533～127.740）；采用创面治疗方法治疗Wagner重型糖尿病足患者的大截肢风险是采用胫骨横向骨搬移术治疗的11.141倍（OR=11.141，95%CI为1.298～95.630）；中性粒细胞百分比＞75%的Wagner重型糖尿病足患者大截肢的风险是中性粒细胞百分比≤75%患者的5.959倍（OR=5.959，95%CI为1.528～23.246）。结论对Wagner重型糖尿病足患者采用Ilizarov技术胫骨横向骨搬移术治疗并有效控制全身感染状况，可显著提高患者的保肢率。

ObjectiveTo compare the difference in the rate of limb salvage for Wagner patients with severe diabetic foot by different methods, and to analysis of the factors affecting the large amputation above the ankle joint. In order to provide reference for clinical treatment. MethodsThe clinical data of diabetic foot patients hospitalized in our hospital from February 2012 to August 2016 were reviewed and analyzed. Patients who met the requirements of the study were followed up for 6 months to 5 years, and the case of large amputations above the ankle joint was investigated. χ2 test was used to compare the large amputation rate of patients with different methods, and binary Logistic regression analysis is used to analyze the influencing factors of patients with large amputation. Results(1) there was a statistically significant difference in the amputation rate between the patients with Wagner severe diabetic foot treated by foot routine dressing change, wound treatment and transverse tibial bone transport by Ilizarov technique (P＜0.05). There was no significant difference in the rate of amputation between the conventional medicine group and the wound treatment group (P=0.807, ＞0.0167). The large amputation rate in the conventional dressing group and the wound treatment group was significantly different from those in the Ilizarov technology transverse tibial bone transport group (P=0.010, 0.013, ＜0.016 7). (2) the two classification Logistic regression analysis showed that: The risk of large amputation in patients with Wagner severe diabetic foot treated by routine dressing change is 13.994 times that of the transverse tibial bone transport (OR=13.994, 95%CI：1.533-127.740). The risk of large amputation in the treatment of the patients with Wagner severe diabetic foot was 11.141 times that of the transverse tibial bone transport (OR=11.141, 95%CI：1.298-95.630). The risk of large amputation in the treatment of the patients with Wagner severe diabetic foot and percentage of neutrophils＞75% is 5.959 times that of percentage of neutrophils of patients (OR=5.959=75%, 95%CI：1.528-23.246). ConclusionThe treatment of Wagner severe diabetic foot patients with transverse tibial bone transport by Ilizarov technique can effectively control the status of systemic infection, and significantly increase the patient′s limb salvage rate.