| Objective: To evaluate the value of CT perfusion in the treatment of diabetic foot with Ilizarov bone transport,and to explore the therapeutic mechanism and optimal removal time of Ilizarov bone transport in the treatment of diabetic foot.Methods: Forty New Zealand white rabbits were randomly divided into group A,group B and group C.Group A was a diabetic foot external fixation bone transport group,a total of 18(18 rabbits were divided into 3 groups,6 in each group);Group B 4: diabetic foot did not do any treatment group.Group 18 in group C: normal ischemic foot external fixation bone transport group(in which 18 rabbits were divided into 3 groups,6 in each group).In the first step,rabbits in group A and group B were fed with high-fat and high-sugar diet,and then blood glucose was detected.The fasting blood glucose was ?7.0 mmol/L and the insulin resistance was confirmed as T2 DM.In the second step,the successful T2 DM rabbits(group A and group B)were surgically ligated to remove the full length of the right femoral artery and all its branches.The clinical manifestations were lameness or muscle atrophy,and the CT perfusionvalue of BV was lower than that of the healthy side.P<0.05 was confirmed as successful modeling of diabetic foot model.Group C was simultaneously treated with femoral artery ligation.In the third step,group A and group C were treated with bone transport.The three groups in group A and group C were moved for 2weeks,4 weeks,and 6 weeks,respectively.Group B did not perform bone transport.After the bone window is initially healed,the fixing frame is removed.All groups were followed by CT perfusion scans.Immediately after the end of the scan,the anesthesia was overkilled and the foot muscles were taken for pathological examination.The images acquired by CT were post-processed by Siemens VPCT Body software to obtain a perfusion pseudo-color map,and the region of interest was selected in the plantar muscle group to measure the perfusion parameters.The body weight and blood glucose of the experimental group and the control group were measured from the first day of the experiment,and then every 2 weeks,and the fasting blood glucose,insulin,total cholesterol,triglyceride,high-density lipoprotein,and the test group and the control group were tested every 4 weeks.Low-density lipoprotein and calculate the insulin resistance index until the end of week 16.The vascular endothelial growth factor(VEGF)was transportred to the transport group and the control group(group B)weekly during the transport until the end of the transport process.Using Excel data entry,statistical analysis was performed using SPSS25.0software,and the data of the experiment were all measurement data.Body weight,blood glucose,biochemical index,insulin resistance index and VEGF value: the data between the experimental groups were analyzed by one-way analysis of variance,and the independent sample t test(normal distribution)between the experimental group and the control group,non-normal distributionThe data was tested using a nonparametric test.CT perfusion measurement and microvessel density: Data from each experimental group were analyzed by one-way analysis of variance.Before and after the operation,the experimental group and the control group were analyzed by independent sample t test(normal distribution),non-normal distribution.The data was tested using a nonparametric test.Result: After the experimental animals were fed with high-fat and high-sugar,the body weight,fasting blood glucose,insulin and high-density lipoprotein increased slightly in the experimental group,and there was no significant difference between the control group and the control group.The total cholesterol and triglyceride increased significantly.There was a significant difference between the control group and the control group.The low-density lipoprotein was stable from the high-fat and high-sugar feeding,and there was no significant difference from the control group.After the successful modeling in the 12 th week,the fasting blood glucose,triglyceride,total cholesterol and high-density lipoprotein were statistically significant in the experimental group and the control group.There was a significant difference between the experimental group and the control group insulin resistance index(HOMA-IR).They were 34.29±9.30,5.47±1.92(t=-3.083,p=0.022).There was no significant difference between the experimental group and the control group in body weight,insulin and low density lipoprotein.CT perfusion results showed that the BV of the diabetic foot transport group and the diabetic foot control group were statistically different when they were moved for 6 weeks.The BF of the diabetic foot transport group and the diabetic foot control group were statistically different between 4 weeks and 6weeks.There were significant differences between BV and BF in the diabeticfoot transport group before and after 6 weeks of operation.There was a significant difference in BV and BF between the normal ischemic foot transport group and the postoperative 6 weeks.There was no significant difference in MTT between the preoperative and postoperative 6-week shifts in the diabetic foot transport group.There was a significant difference between the normal ischemic foot transport group and the 6-week PMB before the shift.HE staining results showed that there was a significant difference in the microvessel density of the foot at the three shifting time points of the diabetic foot transport group(F=7.427,0.012).At 6 weeks,the microvessel density in the diabetic foot shift group was significantly higher than that of the shift 2weeks and the shift 4 weeks,and the difference was statistically significant at 6weeks and 2 weeks,6 weeks and 4 weeks.The diabetic foot transport group and the diabetic foot control group had a significant difference in microvessel density at 6 weeks(T=3.154,P=0.003).There was a significant difference between the two groups in the diabetic foot transport group before and after the6 W movement(T=-2.906,P=0.044).The vascular endothelial factor in the experimental group increased rapidly after the start of the transport.During the transport,VEGF was maintained at a high level with an average of 190.85 pg/ml,while the control group(Group B)remained at a relatively low level with an average of 117.82 pg/ml.There were significant differences in VEGF between the 2nd and 6th week of the transport group and the control group(P<0.05).Conclusion: 1.This experiment confirmed that the T2 DM rabbit model can be successfully established by high-fat and high-sugar diet combined with lowdose alloxan.In this case,the ascending femoral artery ligation can establish an animal model of long-term chronic ischemia of diabetic foot.2.This experiment found that blood flow,blood volume and capillary permeability were increased after bone transport,and no significant change was observed in the mean transit time.There was no significant change in blood flow and blood volume at 6 weeks after bone transport and bone transport for 2 weeks and 4 weeks.3.This experiment found that bone transport can promote microvascular enlargement of the plantar muscles.4.This experiment confirmed that bone transport can stimulate the body to produce VEGF,and it is continuously expressed in the process of moving. |
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