| Background and Objective:By detecting the changes of blood-related index factors before and after the operation,the wound healing,and the improvement of the skin temperature of the foot,the data is analyzed to analyze the curative effect of the tibia lateral bone transfer for the treatment of diabetic foot Methods:There are 30 patients with diabetic foot hospitalized in the second ward of the orthopedics department of our hospital were selected as the experimental group from December 2018 to December 2020 which contain 16 males and 14 females,aged39-79 years old,with an average of 56.8 years old as well as 12 cases on the left side,18 cases on the right side,according to Wagner classification,10 cases at level 2,12 cases at level 3,and 8 cases at level 4;The inclusion criteria are as follows:1.the patients should have stable blood sugar control,and pre-meal blood sugar needs to be<8mmol/ml,post-meal blood sugar needs to be <11mmol/ml,the arterial embolism of the lower extremities intend not to exceed the popliteal artery 3,the patients intend to have good nutrition,albumin>30g/l,hemoglobin>90g/l,and which can endure anesthesia and surgery,at the same time 30 patients were selected as the control group.According to the inclusion and exclusion criteria,the patients who meet the criteria and receive bone transfer treatment are included in this experiment,and the patients in this experiment are divided into a group as the control group.Complete basic information collection、vital sign measurement、biochemical test(including SDF-1、CXCR4)、clinical examination which confirm diagnosis for patients admitted to hospital.According to the inclusion criteria and exclusion criteria,30 patients were selected for transverse tibial transfer surgery,and with detailed records of personal background characteristics include: age,gender,blood sugar,skin temperature,changes in blood biochemical indicators,etc.Conducting preoperative talks with the patient himself to inform the project related risks and sign the project and surgical informed consent;Preoperative preparation:fasting for 6 hours before the operation,and monitoring the changes in the skin temperature of the patient’s feet and the levels of the blood biochemical indicators SDF-1 and CXCR4 before the operation 7 days before the operation and preventive using of antibiotics half an hour before surgery which is performed by the same experienced doctor,the surgery contained establishing bone transfer block and external fixator in the affected limb then clean up and repair the diabetic foot wound,and use VSD negative pressure suction device on the wound when necessary,After the operation,the external fixation frame and wound bread tying are given,the dressing is changed regularly,and bed rest is strictly avoided to avoid weight bearing on the affected limb.One week after the operation,the external fixation frame was adjusted,and the external fixation frame was adjusted at a speed of 1mm per day to start pulling up the bone to move the block.Every day06:00,12:00,18:00,24:00 was divided into 4 times to complete the For the adjustment of the fixation frame,pull the bone transfer block upward for 2 weeks,stop the adjustment and rest for 1 week,adjust the external fixation frame in the same way,press the bone transfer block down to its original position,and the bone block transfer ends;During the period,the external fixator nail path,skin incisions and foot wounds were treated with dressing changes.Wound debridement was given if necessary.Anti-infective treatment was routinely used with antibiotics to continue to control blood sugar and stabilize blood sugar;and bone removal surgery The record sheet helps the patient to adjust the external fixation frame regularly.Monitoring and recording the changes in the skin temperature of the feet of the patients during the hospitalization,the CTA of the blood vessels of the lower extremities after the operation,the changes in the wound surface,and the changes in the blood indicators in January and March after the operation.In this study,SPSS23.0 statistical software package was used for statistical analysis.Measurement data are expressed as mean ±standard deviation.Differences are compared by paired-sample t test.P<0.05 indicates that the differences are statistically significant.Results:There was no significant difference in the general information of the patients in terms of age,vital signs,biochemical tests,Wagner classification.All 30 patients were followed up for 4-16 months,with an average of 9.2 months.All foot ulcers healed without amputation.The healing time of the ulcer was 6-12 weeks,with an average of(8.6±2.3)weeks;the pain,numbness and infection of the foot disappeared,and the tibia moving bone window was healed,and the healing time was 12-16 Weeks,an average of(13.5±3.1)weeks;CTA after treatment showed that the calf arteries were open,the collateral arteries increased,the dorsal foot arteries were thickened and clearly,and the dorsal foot arteries were palpable;the arterial phase veins showed that blood flow accelerated and improved circulation.The blood biochemical indexes SDF-1 and CXCR4 in the postoperative recheck were significantly higher than those before the operation,with statistical significance(P>0.05)2.There were no obvious complications after tibial removal and needle crossing;the skin temperature,pain score,blood biochemical index SDF-1,CXCR4 of the affected foot were compared with those before the operation,and the difference was statistically significant(P<0.05),which was compared with the contralateral foot Comparison,the difference is not statistically significant(P>0.05)Conclusion:Tibia lateral bone transfer has achieved good results in the treatment of diabetic foot,and the microcirculation has been significantly improved.Under the background that the amputation rate of the current medical treatment of diabetic foot and ulcer remains high,the limb salvage rate of this group of patients reaches 100%,which is very meaningful for the healing of diabetic foot.Among them,the blood biochemical indicators SDF-1,CXCR4 has become an important test standard for observing and evaluating the degree of healing of diabetic foot patients before and after surgery.However,the number of cases and follow-up time in this group are limited,and there is still a lack of observation of large cases and long-term follow-up.The popularity and extensiveness of blood biochemical indicators SDF-1 and CXCR4 need to be discussed together and further improved and perfected. |
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