High Frequency Color Doppler Ultrasound Was Used To Evaluate The Treatment Of Diabetic Foot With Transverse Tibial Bone Transfer

OBJECTIVE:High frequency color doppler ultrasound was used to observe the effect of lateral tibial bone transfer in the treatment of diabetic foot(diabetic foot,DF).METHODS:A total of 48 DF patients were divided into block group and non-block group.The number of patients in the occlusion group was 18,including13 males and 5 females,aged 56 to 87 years,with an average age of 72 years,an average duration of diabetes mellitus of 15 years,and an average glycosylated hemoglobin of 19.7%.There were 30 patients in the unoccluded group,including 21 males and 9 females,aged 50-69 years,with an average age of 59 years,an average duration of diabetes of 7 years,and an average hba1 c of12.6%.In the occlusion group,the anterior tibial artery,posterior tibial artery and dorsal foot artery of both lower limbs were occluded,while the common femoral artery,superficial femoral artery and popliteal artery of both lower limbs were not occluded.In the group without occlusion,the common femoral artery,superficial femoral artery,popliteal artery,anterior tibial artery,posterior tibial artery and dorsal foot artery were not occluded.Patients with femoral commonartery,superficial femoral artery and popliteal artery stenosis rate less than 80%were included in the inclusion criteria of transverse tibial bone transfer.Patients with femoral common artery,superficial femoral artery and popliteal artery stenosis rate more than 80% were excluded by two-dimensional ultrasound,and were not included in the group.Transversal-tibial bone transfer was performed in both groups.Color doppler ultrasound was used to evaluate the changes of arterial wall,lumen(including vascular diameter,plaque rate,stenosis rate and occlusion rate)and hemodynamics(including resistance index and blood flow)of both lower limbs of the patients before and one month after surgery.At the same time,combined with the changes of laboratory biochemical indexes(including white blood cell count,esr,and c-reactive protein)before and one month after surgery in the diabetic foot occlusion group and the non-occlusion group,the temperature at the midpoint of the dorsum of the foot was measured with the skin thermometer,and the changes in the skin temperature of the diabetic foot occlusion group and the non-occlusion group before and one month after surgery were compared.RESULTS:(1)the severity of lower limb artery disease in patients with diabetic foot is related to the age,disease course and blood glucose control of patients with diabetic foot.(2)there were no significant changes in the stenosis rate,plaque rate and occlusion rate between preoperative and postoperative month in patients with diabetic foot(occlusion group and non-occlusion group).(3)the lumen diameter,resistance index and blood flow of the common femoral artery,popliteal artery,posterior tibial artery and dorsal foot artery of both lower limbs before and one month after the operation of the patients in the unoccluded group were compared.1 month after removal,the diameter of the lumen increased,and the difference was statistically significant(P < 0.05);Theresistance index decreased,and the difference was statistically significant(P <0.05);Blood flow increased and the difference was statistically significant(P <0.05);The posterior tibial artery and dorsal foot artery showed obvious changes.The lumen diameter,resistance index and blood flow of the common femoral artery,popliteal artery,posterior tibial artery and dorsal foot artery of both lower limbs before and one month after the surgery were compared without removal,and the lumen diameter,resistance index and blood flow showed no significant change one month after the surgery,with no statistically significant difference(all P > 0.05).(4)the lumen diameter,resistance index and blood flow of the common femoral artery and popliteal artery of both lower limbs before and one month after surgery were compared in the patients in the occlusion group.There were no significant changes one month after surgery in the removed side and the unremoved side,and the differences were not statistically significant(all P > 0.05).(5)one month after surgery,the biochemical indexes(including WBC count,esr and c-reactive protein)in diabetic foot occlusion group were lower than those in the preoperative laboratory,and the difference was statistically significant(P < 0.05);In the non-occlusive diabetic foot group,the postoperative biochemical indexes(including WBC count,esr and c-reactive protein)were lower one month after surgery than those before surgery,and the difference was statistically significant(P < 0.05);In the diabetic foot occlusion group,1 month after surgery,there was no significant change in the skin temperature of both feet(removed side and unremoved side),and the difference was not statistically significant(P > 0.05),the skin temperature of patients with diabetic foot in the non-occlusion group increased one month after surgery compared with that before surgery,and the difference was statistically significant(P < 0.05),there was no significant change in skin temperature of thenon-occlusive diabetic foot one month after surgery compared with that before surgery,and the difference was not statistically significant(P > 0.05).CONCLUSION:High-frequency color doppler ultrasonography can objectively reflect the two-dimensional and hemodynamic changes of bilateral lower limb arteries before and one month after transversal-tibial bone transfer in the treatment of diabetes patients.Meanwhile,combined with laboratory indexes and changes of foot skin temperature,the postoperative efficacy of patients was evaluated.