| BACKGROUND There are about 114 million people with diabetes in China.Diabetic foot is the most common complication in this population,and the prevalence rate is about 25%.Diabetic foot is a manifestation of long-term peripheral nerve and microvascular disease of diabetes in the lower extremities and their feet.It is mainly manifested as surface ulcer or deep tissue damage,with multiple infections or more serious complications.At present,diabetic foot adopts comprehensive treatment,but severe diabetic foot healing is not ideal,and even amputation can be caused,and the risk of amputation is extremely high.Therefore,in the treatment of diabetic foot patients,how to improve the wound healing rate and limb salvage has always been a clinical problem.On the other hand,in the cause of chronic wounds,the proportion of lower extremity ulcers caused by diabetes is as high as 33.3%,which solves the problem of wounds in diabetic foot and also contributes to the repair and treatment of chronic wounds.The Ilizarov external fixator bone transfer treatment system established according to the "tension-stress" rule was used for large segmental bone defects caused by trauma and chronic osteomyelitis in the early stage,and good bone defect repair effect was obtained.We used the external fixation of the bone to move the middle tibia lateral bone transfer technique for the treatment of severe diabetic foot,which greatly improved the wound healing rate and greatly reduced the amputation rate.It also found that the wound was regenerative repair.The lateral bone transfer site and the ulcer site of the humerus are not in the same part,even in the contralateral lower limb or foot,but still obtain a very good ulcer healing effect,suggesting that local damage stimulation of the lateral bone movement of the tibia may result in systemic activation and repair effects.Reviewing the classical theory of body repair and combining the lateral bone transfer technique of the tibia to promote the regenerative plumage and phenomenon of ulcer wounds,suggesting that the mechanism may involve the activation and mobilization of relevant growth factors and stem cells.The secretion,activation and multi-directional differentiation of stem cells may be involved in the plasticity and repair of specific tissue structures.Stem cell theory shows that the tissues and organs of the body have different levels of stem cells,and the bone marrow is the largest stem cell bank in the body.Under normal physiological conditions,bone marrow stem cells are mostly in a static state.Only a small number of stem cells exist in peripheral blood and circulation.When tissues and organs are damaged,they can activate and chemotaxis of bone marrow stem cells to damage by stem cell mobilization factors such as SDF-1.The part is induced and adjusted by the microenvironment of the damaged part to repair the damaged part.METHOD 1.Collecting severe diabetic foot patients hospitalized in theDepartment of Osteoarthritis,the First Affiliated Hospital of Guangxi Medical University from June 2016 to March 2019,screening 136 cases,and further confirming the lateral healing of the lower extremity wounds through clinical observation of severe diabetic foot lower limb wound healing.Bone transfer promotes the regenerative repair of severe diabetic foot ulcers,statistical healing rate,amputation rate,etc.At the same time,it analyzes and summarizes the clinical cases of unilaterally moving bilateral lower extremity wound repair and the lateral side of the affected side lower limb wound repair,and passes the blood flow index(The dorsal artery pulsation and foot skin temperature),the peripheral nerve neuropathy index(TCSS score and 10 g nylon silk test)to clarify the systemic regenerative repair effect of lateral bone transport of the tibia.2.After seeking patient consent,2 patients with severe diabetic foot background were selected.Peripheral blood was taken before and 1 month after surgery.Serum was extracted and tested by GSH-CAA-X00 chip to find changes in stem cell mobilization related factors.3.Based on the chip results,after seeking patient consent,10 patients with severe diabetic foot were selected.Heparin anticoagulated peripheral blood was taken before and 1 month after surgery.Peripheral blood mononuclear cells were extracted and mouse anti-human monoclonal CD34 antibody was used.Mouse anti-human monoclonal CXCR4 antibody was co-labeled to explore the changes of CD34+CXCR4+ subpopulation in hematopoietic stem cells.4.Based on the chip results,after seeking patient consent,10 patients with severe diabetic foot were selected,5 of whom were randomized to the flow test,and their heparin anticoagulated peripheral blood was taken before and 1 month after surgery to extract individual blood from the peripheral blood.Thenucleated cells were arranged with a cell suspension of 2×10 4 cells/ml.The cells were cultured in methylcellulose medium for 14 days.The number of colony colonies of different types of hematopoietic stem cells was counted to further clarify the changes of hematopoietic stem cells in peripheral blood.5.After seeking the patient’s consent,40 patients with severe diabetic foot were selected,including the above patients.The wound tissue was taken before and 1 month after operation.The tissue sections were made by HE staining and the postoperative healing was observed under microscope.6.After seeking patient consent,40 patients with severe diabetic foot were selected as above.The wound tissue was taken before and 1 month after surgery.Tissue sections were made and immunohistochemical technique was used to label epidermal stem cells with CK19,labeled with Ki-67.Proliferating cells were used to detect the number and distribution of CK19 and Ki-67 positive cells before and after surgery.2RESUITS Results 1.A total of 136 severe diabetic foot patients except 5cases of acute lower extremity thrombosis emergency amputation,ulcer wound healing rate of 100%,preservation rate of 96.3%,wounds 3 to 8 months regenerative repair healing,original facial skin The lines are basically the same as normal skin,leaving only linear scars.The affected limbs have pain and sensation,and they can walk independently for 2000 m.The patients were followed up for 3-24 months and only 4 recurrences occurred.The pulsation of the dorsal artery of the foot was improved after operation;the skin temperature of the foot was restored,p<0.05,the blood flow of the lower limbs was improved after operation;the postoperative TCSS score was decreased,p<0.05,and the feeling of 10 g nylon wire was tested.The number of points increased,p< 0.05,and the peripheral nerve lesions of the lower limbs were improved aftersurgery.2.The results of GSH-CAA-X00 chip showed that SDF-1,Mip-a and IL-8foldchange>1.2,the results showed up-regulation compared with preoperative stem cell mobilization-related chemokines;stem cell mobilization-related cells Among the factors,G-CSF,GM-CSF,SCF,IL-3,IL-7 foldchange>1.2,the results showed up-regulation.3.Compared with preoperative,the proportion of CD34+CXCR4+subpopulation in peripheral blood hematopoietic stem cells increased,p<0.05.4.The number of colony formation of peripheral blood hematopoietic stem cells increased after operation,p<0.05.5.The preoperative wound edge tissue HE staining microscope showed that the epidermal structure was incomplete and the necrotic structure was more.The intact epidermal layer structure,including the stratum corneum,granular layer,spinous layer and base,was clearly observed in the marginal tissue of the wound in January.At the bottom layer,vascular and collagen fibers were observed under the microscope,and the fibrous structure was rare;there were a large number of inflammatory cell infiltration before and after the wound edge tissue.6.The preoperative Ki-67 positive cells were mainly distributed in the basal layer,and the amount was small.The Ki-67 positive cells increased at the basal layer and were widely distributed in the dermis.The expression of CK19 positive cells was less before operation,and the expression increased after operation,which was distributed in the dermis layer.CONCLUSION Conclusion 1.The humeral traverse technique can promote the regenerative healing of ulcer wounds in patients with severe diabetic foot.2.The technique of humeral traverse may promote the proliferation of wound skin cells by mobilizing and activating body stem cells(such as bone marrow stemcells,epidermal stem cells,etc.),and participate in the wound healing mechanism of severe diabetic foot patients. |
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