| Objective:Through counting the preoperative situation of diabetic foot patients, the situation after PTA treatment and comparison with the patients simply treated by surgical treatment, explore and analyze the clinical value of PTA in the surgical treatment of diabetic foot patients.Methods:①We selected 83 cases patients and 95 diseased limbs, which had approximate condition and fit the diagnostic criteria of diabetic foot(DF), from First Affiliated Hospital of Zhengzhou University, burn reconstruction Division from September 2011 to September 2014. Foot ulcers were graded by Wagner classification method. After the patient turned into our department from medical department, we controlled the blood sugar by the basic medicine method, dilated the peripheral vascular and nourished the nerve. We treated the wound with conventional surgical debridement and dressing. We recorded routine and specific laboratory examination indicators, assessed lower limbs blood supply disturbance such as ankle- arm blood pressureratio(ABI), rest pain and so on, and analyzed CTA results of the patients. We counted the rate and extent of the vascular embolism.② Selecting 40 patients further after getting their families consent, they all accepted the PTA treatment. Before the treatment and one week, two weeks, three weeks and 1 month after the treatment, we observed ABI, the temperature of lower limb skin, the pulse of dorsalis pedis, and ultrasound examination of limb artery.③We divided the 84 patients into experimental group and control group according to whether they accepted PTA treatment or not. Experimental group patients were recorded from the beginning of the PTA treatment, and the control group patients were recorded after they turned into our department from medical department, respectively noting the situation of wound dressing and the preparation days of wound before skin grafting / osteotomy. After skin grafting/ osteotomy, every time when changing fresh dressing for the wound, we recorded the healing rate of Skin grafting and sectional bone suture, according to Wagner classification grading. When the patients leaved the hospital, we counted the total hospitalization time, number of operation and total cost of hospitalization of all patients from two groups.After discharged from hospital, every month the patient should come to the burn reconstruction division of our hospital, recording the rest pain degree and the pulse of dorsalis pedis of patients in two groups. After making the limb in horizontal for15 min, ABI were recorded by the same doctor; skin temperature was measured by measuring instrument. We counted the monthly recurrence rate of wounds.Results:①By the statistical study, we found that after patients turned into our department from medical department, the systemic basis situation was adjusted to good condition, and infection index all increased at different degree according to the specific inspection. The lesion degree of anterior tibial artery and posterior tibial artery was more serious than other artery by comparing the results of CTA, most of which were occlusion and completely blocking. Some patients appeared the bilateral lower limbs’ ischemia at the same time. In this study, including 258 pairs of blood vessels in 83 cases, after comparing lesion extent, we found that the lesion extents of almost 70% patients were consistent or not obvious different, which illustrated that bilateral limb artery of diabetic peripheral artery disease shown the characteristics of symmetry development. About 90.6% diabetic foot patients appeared that 32 blood vessels in single limb appeared severe stenosis, which illustrated that diabetic foot lower limb artery stenosis invaded several arteries at same time.②In this study, the result of CTA and angiography displayed that 44 limbs had visible serious stenosis, above 90% shown a plurality of artery disease,and vascular stenosis degree was bigger than 75%. After receiving a new type of long balloon and PTA treatment, distal blood flow velocity obviously increased, 41 vessels reached to the success standard, which accounted 92.2% of pretherapy, and no severe intraoperative intimal tear appeared. After treatment of PTA, stenosis degree descended(from(96.28 ±4.15)% to(29.28 ±12.35)%). Long balloon pressure and long time PTA treatment was consistent with the characteristics of diabetic lower extremity arterial disease, reduced intraoperative complications, and improved the success rate of operation.③No significant difference between the experimental group and the control group in growth conditions of the granulation of dressing wound in the four days from the third day to the sixth day after patients entered the hospital. But we found difference from the ninth day, and the experimental group was better than the control group. Through the classification comparison by the Wagner classification method, we found that survival rate of grafting skin in the experimental group was bigger than 75%; the survival condition of suture stitches was passable, so patients did not need the second time surgery. While in the control group, most patients showed the grafting skin did not survive, and suture occurred skin necrosis. It illustrated that after the treatment of PTA, lower limb perfusion in patients significantly increased, achieving the purpose of successful limb preservation. The hospitalized time of the experimental group was significantly shorter than the control group; patients in the control group equally accepted 3.9±0.7 times surgery, which prolonged the duration of hospitalization. Total cost of hospitalization in experimental group decreased than the control group, so the burden of patients did not increase.After discharged, in each period, the experimental group were better than the control group in ABI, lower limb skin temperature, rest pain and the pulse of dorsalis pedis and so on; six months after hospital discharge, the experimental group did not appear the foot ulcer, but the control group both had new cases of foot ulcer in the fifth month and sixth month after discharging. It proved that PTA treatment had positive effect in half a year, and compared with the control group, lower extremity arterial blood supply increased significantly in the experimental group. The success rate of surgical treatment of diabetes greatly improvedHowever, from the third month after discharged, the date of all aspects in the experimental group were fall, some patients presented the original symptoms again(such as intermittent claudication, rest pain and so on), and the gap between the experimental group and the control group in lower extremity arterial blood supply evaluation was fall, which indicated that after the PTA treatment limb blood supply situation was better at short term, but at long-term the blood vessel of limb may appeared straitness again. So it is a problem we still need to solve to maintain the blood supply of vascular lesions better at long-term after the PTA treatment. |
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