Clinical Observation On The Treatment Of Severe Diabetic Foot With Transverse Tibial Bone Movement

Objective:The clinical characteristics of 15 patients with severe diabetic foot treated with lateral tibial bone transfer were analyzed in the Department of Bone Trauma,second Hospital of Shanxi Medical University.The curative effect was evaluated by WIFi grade 、 VAS 、Wagner grade and the change of foot skin temperature,and the treatment mechanism was further explored by using ELISA to determine the content of VEGF、HIF-1α and b-FGF.Methods:15 patients with severe diabetic foot were selected from September 2015 to September2017 in the group of external fixation and limb lengthening reconstruction in the second Hospital of Shanxi Medical University.After admission,all patients were given basic knowledge of diabetic foot、comprehensive medical treatment and surgical management.The surgery of Transverse Tibial Bone Movement is operated under intraspinal anesthesia or general anesthesia when complete relevant examination is done.Professional guidance is necessary for patients and their families on the transversal removal of bone mass after operation.Collection、statistics and analysis of general data of patients、WIFi grade、VAS、Wagner grade and skin temperature before and after treatment.The content of VEGF 、HIF-1α and b-FGF were measured by Elisa in three stages(before treatment,during bone mass moving,at the end of migration).Results:There were 11 male and 4 female diabetic foot patients in this professional group,the average age was 66.07±15.29 years,the average course of diabetes was about 11.00±9.16 years,and the mean blood glucose control was poor.The average course of disease of diabetic foot was 14.73 ±17.94 weeks,in which 11 cases were more than 4 weeks old,and 8 cases were without systemic complications,among which hypertension was the mostcommon disease.Up to 8 patients had undergone toe amputation.There were 2 cases of coronary heart disease and 2 cases of cerebral infarction.53% of the patients with BMI≤23/L and 87% of the patients with albumin<30g/L.The most common causes were scalds、sharp instruments、wear and tear.13 cases were located at the toe,and others ulers located at the back of foot、foot bottom、foot side and foot side.The results of this study showed that the WIFi grade、the Wagner grade and skin temperature were statistically significant(p < 0.05)before and after the treatment of severe diabetic foot with Transverse Tibial Bone Movement,which indicated that it could significantly promote wound healing、control the infection of diabetic foot ulcer、alleviate the pain of patients and improve the blood supply of lower extremity and microcirculation of foot.The results of this study showed that the content of VEGF and b-FGF was significantly higher during bone mass moving and the end of migration than before operation(p<0.05),but there was no significant difference between during bone mass moving and the end of migration.The change of HIF-1α was not significant among the before operation、during bone mass moving and the end of migration(p>0.05).Conclusion:It is difficult to treat for severe diabetic foot which often occurs in elderly men with poor nutrutions and with diabetes more than 10 years and the blood sugar are poorly controlled recent months.The treatment of severe diabetic foot with transverse bone transfer technique can significantly reduce the pain of patients,promote wound healing and infection control,and can improve the microcirculation of the lower limbs and feet.It is closely related to the high expression of VEGF and b-FGF stimulated by bone fragments.