Analysis Of Influencing Factors Of Wound Healing Time After Transverse Bone Transfer Of Tibia In Patients With Severe Diabetic Foot

Objective:We investigated the clinical data of Wagner grade 3-5 diabetic foot(DF)patients treated via transverse tibial bone graft in order to analyze factors affecting wound healing time.The aim is to provide a theoretical basis for the evaluation of wound dynamic and nursing intervention.Methods:A total of 56 severe DF patients who underwent transverse tibia bone grafting between January 2018 to February 2019 in the Department of Bone and Joint Surgery of the First affiliated Hospital of Guangxi Medical University were selected for this study.The collected clinical data included: sex,age,cultural degree,residence,nationality,smoking and drinking history,cardiovascular and cerebrovascular diseases,hospitalization time,antibiotic use time,height,weight and body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP).Specialist indexes: diabetes course,DF course,lower extremity peripheral neuropathy,lower extremity blood vessel lesion,wound site,Wagner grade and pain(VAS)score,etc.Metabolic indexes: fasting plasma glucose(FPG),2 hours postprandial blood glucose(2h-PG),glycosylated hemoglobin(Hb A1c),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholestrol(LDL-C)and so on.Inflammatory cytokine indicators: White blood cell count(WBC),neutrophil percentage(NEU),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),CD4/CD8 and other laboratory indicators: Hemoglobin(HB),Albumin(ALB),prealbumin(PAB),Blood platelets count(BPC),Fibrinogen(FIB),Alanine transaminase(ALT),Alanine transaminase(AST),Blood urea nitrogen(BUN),Serum creatinine(Scr),Blood uric acid(BUA),Microalbuminuria(MAU)and so on.Postoperatively,the patients were followed up every month at the outpatient department,via social media(Wechat)and via direct telephone contact in order to collect relevant data such as blood glucose control status and state of wound healing,and to record the wound healing time.The patients were followed up for a total of 12 months.The data collected were analyzed using SPSS 20.0 statistical software.Spearman rank correlation was used to analyze the correlation,while multiple linear regression was used to analyze the factors affecting postoperative wound healing.The vif function in the car package of R3.6.1 software was used for collinear diagnosis,and the variance inflation factor(VIF)was calculated.Results:A total of 56 subjects were included in this study.3 patients died of non-DF causes during the follow-up period(1 patient died of renal failure,1 patient died of complications of diabetic cardiopathy,1 patient drowned).The rate of loss of follow-up was 5.36%.During the follow-up,2 patients developed recurrence of foot ulcers,and then healed due to active wound change.Finally,53 patients were included for statistical analysis,with an average age of 60.32 ±9.98 years,including 42 males and 11 females.(1)Distribution of wound healing time: The average healing time of 53 patients was 4.8 months,the standard deviation was 1.5 months,the minimum was 2.5 months,the maximum was 10.0 months,the median was 4.5 months,and the quartile interval was 2.0 months.(2)Analysis of single factors affecting wound healing:The age,Wagner grade,anemia,peripheral neuropathy,course of diabetes and the Postoperative blood glucose control compliance had significant effects on the wound healing time of severe DF patients after transverse tibial bone transfer.Other indexes such as gender,residence,occupation,nationality,smoking history,drinking history,complicated with cardiovascular and cerebrovascular diseases,VAS score,wound site,DF course,hospital stay,duration of antibiotic use,BMI,SBP,DBP,HDL-C,LDL-C,TG,TC,ALB,WBC,PCT,CD4/CD8,IL-6,NEU,and hs-CRP had no effect on wound healing time.There was no significant difference(P > 0.05).(3)Analysis of multiple factors affecting wound healing : The lower limb angiopathy,anemia,hypoproteinemia,Postoperative blood glucose control is not good and peripheral neuropathy were the factors affecting wound healing time after transverse tibial bone grafting in patients with severe DF.Among them,vascular lesion of lower extremity was the risk factor of healing time(B=0.170,P = 0.020),anemia was the risk factor of healing time(B=1.692,P<0.001),;hypoproteinemia was a risk factor affecting the healing time(B=-0.173,P=0.004);Peripheral neuropathy was a risk factor affecting the healing time(B=0.554,P=0.019);However,good postoperative blood glucose control status was a protective factor of wound healing time(B=-0.917,P=0.024).(4)Collinear analysis:The results showed that the VIF of lower extremity angiopathy,anemia,hypoproteinemia,postoperative blood glucose is up to the standard and peripheral neuropathy were all less than 10,indicating that there was no collinearity among the independent variables.Furthermore,the residual diagnosis of the multiple linear regression model shows that there was no significant correlation between them,and the residual values obeyed approximate normal distribution.The above results therefore shows that the multiple linear regression model in this study was of a high accuracy.Conclusions:(1)Transverse tibial bone grafting can be used to effectively treat severe DF.And the wound healing time following transverse tibial bone grafting can be affected by many factors.(2)The main influencing factors of wound healing time after transverse tibial bone grafting in patients with severe DF were: lower limb peripheral neuropathy,lower limb angiopathy,serum albumin,hypoproteinemia and postoperative blood glucose control.(3)Active regulation of blood glucose,serum albumin and improvement of anemia before and after transverse tibial bone transfer can shorten the wound healing time of patients.