| Diabetic foot(DF)is one of the most serious and most expensive chronic complications of diabetes.It is one of the main causes of disability and death in diabetic patients,causing a heavy burden on society.Transverse bone movement of the tibia is based on the Ilizarov's law of tension stress(LTS)for the treatment of ischemic diseases of the lower extremities.The research team took the lead in applying the lateral humeral movement technique to DF treatment.This study intends to provide a better guidance for the treatment of clinical DF patients by analyzing the clinical efficacy of tibia lateral bone transfer and the effects of DF on glucose metabolism,C-peptide and inflammatory markers.Therefore,the study is divided into the following three parts:1.The clinical evaluation of DF lateral bone transfer treatment for DF;2.The effect of transverse bone transfer of the tibia on the levels of glucose metabolism,C-peptide and inflammatory markers in patients with type 2 diabetic foot.3.An example of a special case:a transverse bone transfer of the tibia for the treatment of type 1 diabetes with DF.Part 1.Clinical effect of lateral bone transfer of the humerus in the treatment of diabetic footObjective:To evaluate the clinical efficacy of lateral bone transport of the tibia in the treatment of diabetic foot.Methods:From September 2016 to June 2018,50 patients with DF who underwent transverse bone movement of the humerus in the Department of Bone and Joint Surgery,the First Affiliated Hospital of Guangxi Medical University.There were 36 males and 14 females with an average age of(63±13)years and a course of diabetes(6.88±5.72)years.Compared the pain score,cold sensation score and TCSS score before and after treatment(Toronto clinical scoring system),IWGDF infection staging,bipedal skin temperature.Results:Thirty-two patients successfully completed the relevant observation indicators.Pain score,cold sensation score,TCSS score,and IWGDF infection stage were lower than the pre-treatment before the treatment,and the skin temperature of the limb was moved[after treatment(33.42±2.02)? vs before treatment(32.18±2.53)?],the contralateral limb Skin temperature[before treatment(33.51±2.29)? vs before treatment(32.50±2.78)?]is higher than before treatment,and the difference was statistically significant(p<0.05).Conclusion:Transverse bone movement of the tibia can relieve clinical symptoms,improve blood supply and peripheral nerve function of the lower extremities,and promote the control of foot infection.Part 2.Effect of lateral bone transport of tibia on glucose metabolism,C-peptide and inflammatory markers in type 2 diabetes mellitus complicated with diabetic footObjective:To investigate the effects of transverse bone transport of the tibia on the levels of glucose metabolism,C-peptide and inflammatory markers in patients with type 2 diabetes mellitus complicated with diabetic foot.Methods:From September 2016 to June 2018,71 patients with type 2 DF admitted to the Department of Endocrinology and Osteoarthritis,the First Affiliated Hospital of Guangxi Medical University,were treated with routine treatment in the external hospital or our hospital for 5-21 days.I agreed to enter the transfer group,including 49 cases in the transfer group(12 in Wagner 2,20 in Wagner 3,17 in Wagner 4),and 22 in the control group(1 in Wagner 1 and 8 in Wagner 2,Wagner 3)10 cases,Wagner 4 grade 3 cases).The control group was given conventional treatments for controlling blood sugar,controlling infection,controlling blood pressure and blood lipids,improving circulation,nourishing nerves,debridement and dressing change,and the shifting group was treated with transverse bone movement of the tibia in the control group.Comparison of fasting blood glucose(FPG)before and after treatment,2 hours postprandial blood glucose(2h-PBG),glycosylated hemoglobin(HbAlc),fasting C peptide,postprandial 2hC peptide,inflammation indicators such as white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)levels.Results:1.71 patients with type 2 diabetes mellitus complicated with DF,including 49 patients in the transfer group(12 in Wagner class 2,20 in Wagner class 3,17 in Wagner class 4),and 22 in control group(1 in Wagner class 1 and Wagner 2)8 cases,10 cases of Wagner 3,3 cases of Wagner 4).After treatment,the levels of fasting C-peptide and postprandial 2C peptide in the transfer group were higher than those before treatment,and the levels of HbAlc,WBC,ESR and CRP were lower than those before treatment(P<0.05).FPG before and after treatment.There was no significant difference in 2h-PBG levels(P>0.05).The levels of fasting C-peptide and postprandial 2C peptide in the control group were higher than those before treatment,and the levels of HbAlc and WBC were lower than those before treatment.The difference was statistically significant(P<0.05).FPG,2h-PBG,ESR,CRP before and after treatment.There was no significant difference in levels(P>0.05).After treatment,the levels of fasting C-peptide and postprandial 2C peptide in the transfer group were higher than those in the control group,and the levels of HbAlc,WBC,ESR and CRP were lower than those in the control group,the difference was statistically significant(P<0.05).There was no significant difference in 2h-PBG levels(P>0.05).4.The moving group is divided into Wagner level 2(W2),level 3(W3),and level 4(W4)according to Wagner classification.Compared with W2 group,the difference of W3,4 HbAlc,fasting C peptide,postprandial 2hC peptide,WBC,ESR,CRP before and after treatment was different(P<0.05),and the difference between W2 group before and after treatment was the largest;There was no significant difference between the W3 and 4 groups before and after treatment(P>0.05).There was no difference in the difference between FPG and 2h-PBG before and after treatment(P>0.05).Conclusion:Transverse bone movement of the tibia may have a certain improvement effect on islet 3-cell function and inflammatory state in patients with type 2 diabetes mellitus complicated with DF.The lighter the severity of the foot disease,the more obvious the improvement may be.Part 3.Special caseObjective:Our research group used a lateral humeral shift technique to treat a type 1 diabetes mellitus complicated with DF.Methods:To analyze the clinical data of a patient with type 1 diabetes mellitus complicated with DF.Results:In this patient,the infection was effectively controlled after 1 month of treatment,but because of type 1 diabetes,the islet ?-cell function almost completely disappeared.Although the insulin treatment regimen was given,the glycemic control was poor,and the patient was returned to the hospital after 1 month of treatment,the pain and cold sensation score,TCSS score,infection stage decreased,and bipedal skin temperature increased,and also achieved good clinical results. |
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