| Background: Diabetic foot refers to foot ulcers and infections caused by vascular and neuropathy of lower limbs of diabetic patients.It is one of the most serious complications of diabetes.According to latest report of The International Diabetes Federation(IDF),there are about 463 million diabetic patients(20-79 years old)around the world in 2019,it means that 1 out of 11 people with diabetes averagely.however,China accounts for about 1/4 of them(116.4million).It is expected that there will be 578.4 million and 700.2 million diabetic patients in the world by 2030 and 2045 respectively.Now there are many treatment methods of diabetic foot ulcers,they include medical treatment(control of blood sugar,blood pressure and renal failure and antibiotic treatment),dressing change,surgical debridement,amputation,VSD,vascular interventional therapy,hyperbaric oxygen and local oxygen therapy and stem cell therapy and many more.Of course,there is also comprehensive treatment combining two or more treatment methods.However,none of the above treatments achieved the desired results,and many patients were eventually forced to amputate or even die.We used Ilizarov proximal tibial cortex transverse distraction to treat diabetic foot patients,and it can cure wounds effectively.But the mechanism of curing wounds is still unknown.Many researchers believed that the healing process of wounds need regulation of tissue or cytokines.Although they are little,they are indispensable in healing process.Some researchers believed that acute or chronic non-healing wounds are caused by the unbalanced inflammatory cells and cytokines of local or whole body,and it was call inflammatory unbalanced status.Inflammatory reactions that are overmuch or too little will affect the local environment of the wounds,and then affect the wound healing.Ilizarov proximal tibial cortex transverse distraction can regulate the whole body and local inflammation and make it easy to get balanced status,so that the diabetic foot ulcers can heal smoothly.Methods: 1.Calculate and collect the diabetic foot patients who were hospitalized in the Department of Bone and Joint Surgery of the First Affiliated Hospital of Guangxi Medical University from July 2014 to January 2019 and performed Ilizarov tibial lateral bone transfer surgery during the hospitalization,and recorded their basic data(mainly there are Name,gender,age,course of diabetes,main treatment plan during hospitalization,etc.),and follow-up,during the follow-up process to observe the relief of local redness and heat pain,record wound healing,healing time,amputation,recurrence,surgical complications The situation was compared with the changes in the three major infection indicators(white blood cell count,erythrocyte sedimentation rate,and C-reactive protein)before and after the operation,and the initial evaluation of the efficacy of using Ilizarov tibial lateral bone transfer to treat diabetic foot.2.After obtaining the patient’s consent,draw peripheral blood before and 1 month after the operation,and use enzyme-linked immunosorbent assay(ELISA)to measure the concentration of IL-1β,IL-6,and TNF-α in the patient’s peripheral blood.There were 10 cases in each group and one month after operation,and the changes of the above three factors before and after operation were compared.3.After obtaining the patient’s consent,take the tissue at the edge of the ulcer wound to make a tissue section with the preoperative and one month after the operation,observe the internal structure under the microscope after H&E staining,and quantitatively analyze the content of the three inflammatory factors by immunohistochemical stainingResults: 1.Of the 263 patients with diabetic foot,a total of 9 patients had amputation,and the salvage rate was 96.6%.The reasons for the amputation were analyzed.Two patients had acute arterial embolism after operation,and the remaining 7 patients had amputation due to arteriosclerotic occlusion and calcification.;There were 20 patients with postoperative recurrence,the recurrence rate was 7.6%;the average wound healing time was 4.77 ± 3.66 months.There were 115 patients with local swelling and heat pain before surgery,which were significantly relieved in 1 month after surgery.There were206 patients with local purulent secretions before surgery,and no purulent secretions existed in 1 month after surgery.The white blood cell count,erythrocyte sedimentation rate,and C-reactive protein before and after surgery were {(13.57±3.48)vs(7.95±1.37)} × 109/L,{(85.06±14.71)vs(39.56±10.58)}mm / h,{(66.30±27.57)vs(11.87±6.60)} mg/L,the difference was statistically significant(P<0.05).2.The concentration of IL-1β,IL-6 and TNF-α in 10 patients were:(92.63±81.91)pg/ml、(49.26±28.26)pg/ml、(99.92±70.95)pg/ml;1month after operation(3.46±4.72)pg/ml、(11.66±5.39)pg/ml、(49.25±10.76)pg/ml,the differences are statistically significant(P<0.05)3,before H&E staining No obvious skin structure was seen in the slices,and a large number of inflammatory cells infiltrated;the skin structure was clearly seen one month after surgery.Conclusion: 1.The lateral tibial bone migration can effectively promote the healing of diabetic foot wounds and is an effective surgical method for the treatment of diabetic foot.2.Lateral tibial bone transfer can effectively reduce the content of inflammatory factors in the whole body and relieve the inflammation in the whole body.3.Tibial lateral bone migration can effectively reduce the content of inflammatory factors in the local wounds of diabetic foot ulcers,so that it can reach the state of inflammation balance,thereby promoting wound healing. |
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