Clinical Observation Of Ilizarov's Tibial Transverse Bone Transfer In The Treatment Of Diabetic Foot

Objective To analyze the clinical effects of Ilizarov tibial transverse bone transfer in the treatment of diabetic foot(DF).Methods Twenty-three patients with Wagner stage 2,3,and 4 diabetic foot admitted to the Department of Orthopaedics and Traumatology of the People's Hospital of Inner Mongolia Autonomous Region from December 2017 to June 2019 were randomly selected as the subjects of this clinical research.There were 13 males and 10 females.There were 8 cases of left foot and 15 cases of right foot.There were 3 cases of Wagner stage 2,9 cases of stage3,and 11 cases of stage 4.All surgical patients were admitted to the hospital for diabetes education,strictly controlled blood sugar,standardized medical treatment of related comorbidities,improved preoperative related auxiliary examinations and tests,excluded surgical contraindications,and performed Ilizarov tibial transverse bone transfer surgery after signing informed consent.Before Ilizarov's tibial transverse bone transfer,three patients underwent vaccum sealing drainage(VSD)and two underwent necrotic toe amputation.All patients started to implement the bone transfer plan on the 7th day after surgery(1mm/day,divided into 4 times,once every 6 hours),laterally moving the bone mass for 3 weeks,and then pressing the moving bone mass back to the original position in the opposite direction for3 weeks.After 4 weeks,X-rays of the affected limb were taken and the external fixation frame was removed.Patients with large wounds were treated by repeatedly pulling the pre-moved bone mass for the longest lateral pulling distance of 2 cm.Patients with large foot wounds,severe infections,and severe skin lesions should be treated with negative pressure closed drainage(VSD)after wound debridement.Autologous skin grafts were given to protect the wounds after the operation according to the wound condition.During the treatment,the wounds should be kept clean to avoid aggravation of infection.Relevant observation indicators were regularly followed up after surgery to evaluate the effect of surgery.Observed indicators are:ulcer healing,inflammatory indicators(blood cell count,erythrocyte sedimentation,C-reactive protein),changes in glycated hemoglobin,dorsal foot artery pulsation,and skin temperature of the foot(dual foot back,midpoint of the foot respectively Skin temperature measurement)changes in toe end blood oxygen saturation,cold feeling score,pain score,VAS score before and after treatment,toronto clinical scoring systwm(TCSS score),vascular CTA comparison before and after tibial transverse bone transfer,and foot magnetic resonance imaging before and after surgery.Results All 23 patients were followed up,with an average follow-up time of 6.5 months.The foot wounds of 9 patients healed within 8 weeks after the Ilizarov tibial transverse bone transfer,and the remaining 13 patients had foot wound healing within 7.5 months after.One patient underwent necrotic toe amputation 2 weeks after surgery,and the limb salvage rate reached 96%.Two diabetic foot patients had a recurrence of foot ulcers within 1 year,and the ulcer recurrence rate was 9%within 1 year.Follow-up None of the patients had needle and eye infections;WBC before surgery(14.0±3.3)×10~9,3 months after surgery(8.3±1.3)×10~9,ESR before surgery(64.4±16.7)mm/h,and 3 months after surgery(14.6±3.9)mm/h,(73.18±17.79)mg/L before CRP,(14.21±7.71)mg/L 3 months after surgery,Hb A1c(8.7±1.1)%before surgery,and 3 months after surgery(5.3±0.7)%.The data of the above groups were statistically significant before and after operation(P<0.05).After tibial transverse bone transfer surgery compared with before treatment,the skin temperature of the foot increased significantly,and the oxygen saturation of the toe end increased significantly.CTA angiography of the lower extremity showed a large number of microvascular networks in the bone migration area and the affected foot.22 patients dorsal foot artery recanalization,dorsal foot arterial pulsation is enhanced to different degrees than before surgery;and the comparison of T2 MRI before surgery and MRI T2 during ulcer healing showed that 23 cases of foot bone and soft tissue inflammation and edema improved in different degrees,and 12cases of DF patients basically recovered foot osteopathy when ulcer heal Normal;postoperative patients'clinical symptom scores,VAS scores,and TCSS scores were all lower than those before surgery.The differences before and after treatment were statistically significant(P<0.05).Conclusion 1.Ilizarov transverse tibia transfer can effectively reduce bone marrow and soft tissue edema and inflammatory lesions,and reduce the risk of foot osteonecrosis and soft tissue necrosis in diabetic foot patients;2.Ilizarov's tibial transverse bone transfer can improve lower limb blood circulation and effectively promote healing of diabetic foot wounds;3.Ilizarov's tibial transverse bone transfer combined with internal medicine for diabetic foot has obvious clinical effects,simple and convenient operation,fewer complications,and significantly improved Limb salvage rate of patients;4.Ilizarov's tibial transverse bone transfer can improve the clinical symptoms of patients with diabetic foot and improve the quality of life of patients.