Diabetic foot is a serious chronic complication of diabetes, tibial transverse transport (TTT) technique can promote the regeneration of vascular tissue, improve microcirculation, achieving good results in the treatment of diabetic foot ulcers, but traditional TTT technique has many complications, which needs to be improved to reduce postoperative complications.

To investigate the efficacy of modified TTT technique, that is, bone and periosteum combined transport technique, in the treatment of patients with Wagner grade Ⅲ and Ⅳ diabetic foot.

The clinical data of 117 diabetic foot patients treated with modified TTT technique in the hand and foot surgery of Yantai Yuhuangding Hospital from January, 2018 to May, 2021 were retrospectively analyzed, and the postoperative foot preservation, functional limb preservation, large amputation, ulcer healing time, complication, foot skin temperature improvement, resting pain, preoperative and postoperative CTA results were collected. The follow-up was till to March 31, 2022.

The follow-up time ranged from 5.5 to 24.0 months, with an average of (14.21±4.06) months. The postoperative foot preservation rate (no amputation or amputation below ankle) was 95.73% (112/117) , the functional limb preservation rate (no amputation or minor amputation distal to midfoot) was 83.76% (98/117) , the major amputation rate (amputation above ankle) was 4.27% (5/117) , and the postoperative ulcers healed well in all patients except amputees, with an average time to healing of (9.07±2.02) weeks, ranging from 6 to 14.5 weeks. The postoperative foot skin temperature at 1, 2, 4, and 8 weeks of the patients were significantly improved compared with the preoperative period (P<0.01) ; The postoperative VAS scores of 35 patients with resting pain at 1, 2, 4, and 8 weeks compared with the preoperative period (P<0.01) ; the CTA results showed improved postoperative vascular condition, increased microvascular vessels number and reconstructed vascular network of the foot in 70.34% (94/117) of included patients postoperatively; The incidence of complication during bone handling was 11.97% (14/117) , among which the incidence of osteotomy area skin edge necrosis, deep vein thrombosis, and pin track infection was 5.98% (7/117) , 4.27% (5/117) , and 1.71% (2/117) , respectively.

The modified TTT technique can promote wound healing through the stimulation of lower limb microcirculation reconstruction, to alleviate resting pain and improve foot skin temperature in diabetic foot patients effectively in the short term, with low incidence of complication, providing an effective approach for the treatment of diabetic foot.

糖尿病足是一种严重的糖尿病慢性并发症，胫骨横向骨搬运（TTT）技术可促进血管组织再生，改善微循环，在治疗糖尿病足溃疡中取得良好效果，但传统TTT技术并发症较多，需对该技术进行改良来减少术后并发症。

探讨改良TTT技术即骨与骨膜联合搬运治疗Wagner 3~4级糖尿病足患者的疗效。

回顾性分析2018年1月—2021年5月于烟台毓璜顶医院手足外科应用改良TTT技术治疗的117例糖尿病足患者的临床资料，收集患者术后保足情况、功能性保肢情况、大截肢情况和溃疡愈合时间、并发症、足部皮温改善情况、静息痛情况及术前、术后CT血管造影（CTA）资料。随访时间截至2022-03-31。

随访时间5.5~24.0个月，平均（14.21±4.06）个月。术后保足率（未截肢或踝关节以下截肢）为95.73%（112/117），功能性保肢率（未截肢或中足中段以远部位小截肢）为83.76%（98/117），大截肢率（踝关节以上截肢）为4.27%（5/117），除截肢患者外其余患者术后溃疡愈合良好，愈合时间6.0~14.5周，平均愈合时间为（9.07±2.02）周。患者术后1、2、4、8周足温高于术前（P<0.01）；静息痛患者35例，静息痛患者术后1、2、4、8周视觉模拟评分（VAS）低于术前（P<0.01）；CTA显示70.34%（94/117）的患者术后血管情况好转、微血管数量增加、足部血管网重建；在骨搬运过程中并发症发生率为11.97%（14/117），其中截骨区域皮缘坏死、下肢静脉血栓、钉道感染的发生率分别为5.98%（7/117）、4.27%（5/117）、1.71%（2/117）。

改良TTT技术将骨与骨膜联合搬运可以通过刺激下肢微循环的重建促进创面愈合，短期内有效缓解糖尿病足患者静息痛，改善足部温度，且并发症发生率低，为治疗糖尿病足提供了一种有效手段。