CT Perfusion Study On Curative Effect Evaluation Of The Bone Removal With Ilizarov External Fixator In Diabetic Foot Patient

Objective: To explore the value of CT perfusion study on curative effect assessment of the bone removal with Ilizarov external fixator in diabetic foot patient,and to explor the corresponding quantitative evaluation indicators.Materials and methods:1.Patients who had the external fixator of bone removal treatment with applicate Ilizarov tension stress rule to treat diabetic foot between December2015 and February 2017 in the first affiliated hospital of guangxi medical university was collected as the research object.12 cases(10men,2 women)subjects were chosen into the research,12 cases(10left side,2 right side)with a total of 24 diabetes foot which were single foot ulcers,and all of 12 cases of bone removal technique were conducted in canker side.Before surgery and 8 weeks after surgery,all of them underwent shuttle scanning of the second generation of Germany Siemens 64 storey CT scanner(Siemens Somatom definition definition flash).All single diabetic ulcer foot(12feet)were divided into three groups: ulcerated foot group(12 feet),unulcerated foot group(12 feet)and diabetic foot group(ulcerated foot + unulcerated foot,24 foot),and preoperative and postoperative control study were conducted of the three groups.2.The 4 D shuttle scan images were transfered into Siemens VPCT Body software and post-processed with Customized Tumor2.The perfusion organization threshold was defined at the range of-50 Hu to 150 Hu after motion artifact correction.Choosed diabetes ulcerated foot posterior tibial artery which from the distance about 15 cm to bifurcation of plantar medial artery and the lateral plantar artery as input artery.Applied deconvolution method to obtain both sides of the plantar tissue perfusion pseudo color map after targeted blood vessel’s time density curve was obtained.Selected the central of bilateral inside planta pedis medial muscle(Sam abductor muscle)as the region of interest(ROI),which covers an area of about 1.0 square centimeters and each was measured 6 times in coronary and transection respectively.Obtained average value of both sides of the planta pedis perfusion parameters and their relative perfusion which was measured many times on coronary position and transection.3.All the data were inputted by Excel and analysised by SPSS17.0statistical software.All data in the study were measurement data.Compared the difference of preoperative and postoperative groups’ measurement data.We used P-P figure to test data whether follow the normal distribution.Data followed the normal distribution used paired test to compare each group with or without significant difference between mean and standard deviation,whereas data unfollowed adopted none parameter rank and summing test,P ≤ 0.05 wasconsidered statistically difference.Results:1.12 diabetic foot cases which applied external fixator in bone removal with Ilizarov technique to treat were included in the study,and 5 cases in phaseⅡ,7 cases in phase Ⅲ with Wagner classification.11 cases of foot ulcer surface healed,1 case failed to heal because of fracture carelessly after the operation in the review after 8 weeks.2.Postoperative target intravascular contrast agent to peak time slightly delayed compared with preoperative,and postoperative intravascular’s time(EP-ES)between target intravascular contrast medium began enhancing to the concentration in peak time slightly increased compared with preoperative.Preoperative and postoperative target intravascular contrast medium concentration peak time of EP were(26.036 ±7.433)seconds,(26.036± 7.675)seconds respectively,and their difference had statistical significance(P= 0.043);Preoperative and postoperative target blood vessels contrast medium enhancement from the start to its concentration in peak time T(EP-ES)were(19.960±3.894)seconds,(22.970±2.403)seconds,both their difference were significant(P =0.018).3.Diabetic foot cases which applied external fixator in bone removal with Ilizarov technique postoperative double inside planta pedis muscle group value of BV,BF and PMB increased compared with preoperative,and their difference had statistical significance(P = 0.004,P = 0.003,P = 0.037 respectively).The value of TTP,MTT and MIP decreased compared with preoperative and theirdifference had no statistical significance(value of P was greater than 0.05);Diabetic foot cases which applied external fixator in bone removal with Ilizarov technique postoperative double inside planta pedis muscle group value difference of BV and MTT had narrow spread compared with preoperative,and their difference had statistical significance(P = 0.027,P = 0.026 respectively).The value difference of preoperative and postoperative foot BF,MIP,PMB and TTP could not judge(P > 0.05).4.Diabetic foot cases which applied external fixator in bone removal with Ilizarov technique postoperative ulcerated inside planta pedis muscle group value of BF increased from preoperative,and its difference had statistical significance(P = 0.044);the value of postoperative BV and PMB increased compared with preoperative,while postoperative TTP,MTT and MIP decreased compared with preoperative,yet the change difference of BV,PMB,TTP,MTT,MIP between preoperative and postoperative had no statistically significant difference(P>0.05).5.Diabetic foot cases which applied external fixator in bone removal with Ilizarov technique postoperative the no ulcerated inside planta pedis muscle group value of BF,BV increased from preoperative,and its difference had statistical significance(P=0.021,P=0.006 respectively);the value of postoperative PMB increased compared with preoperative,while there was no obvious difference between preoperative and postoperative value of TTP,MTT,MIP,and the difference of PMB,TTP,MTT,MIP between preoperative andpostoperative change had no statistically significant difference(P>0.05).Conclusion:1.The bone removel with Ilizarov external fixator postoperative double planta pedis blood flow,blood volume and capillary permeability increased,and bilateral feet blood volume difference between preoperative and postoperative decreased.The above indicated that the bone removel with Ilizarov external fixator postoperative could increase bilateral planta pedis perfusion,and it was one of the reasons for diabetic foot ulcer surface healing.2.The preoperative and postoperative target intravascular contrast medium concentration peak time of EP were(26.036 ±7.433)seconds,(26.036 ± 7.675)seconds respectively,and their difference had statistical significance(P =0.043);Preoperative and postoperative target blood vessels contrast medium enhancement from the start to its concentration in peak time T(EP-ES)were(19.960±3.894)seconds,(22.970±2.403)seconds,both their difference were significant(P =0.018).Postoperative target intravascular contrast agent to peak time slightly delayed compared with preoperative,and postoperative intravascular’s time(EP-ES)between target intravascular contrast medium began enhancing to the concentration in peak time slightly increased compared with preoperative.