| Background: The latest data research and analysis indicate that the global diabetics account for 9.3% of the total population,and there is a trend of increasing year by year,and the domestic prevalence rate is slightly higher than this figure,about 10.9%.Diabetic foot is one of the most dangerous complications of diabetes.In China,a quarter of diabetes patients will likely suffer from diabetic foot.According to the push,there may be 29 million diabetic foot patients in China.Therefore,how to treat this part of the patient is a worldwide challenge.The lateral tibial bone grafting derived from Ilizarov technology is a significant method for the treatment of diabetic foot.In summing up the experience of diagnosis and treatment,we observed that part of the diabetic feet with simultaneous ulceration of both lower extremities can effectively promote the healing of the other side by simply lifting the bone on one side of the tibia.Reviewing the relevant data shows that there is currently no diabetic foot for both lower extremities in the world.Treatment research.Methods: Collect and sort out all patients who underwent lateral tibial transposition in our hospital due to diabetic foot between June 2014 and June2019,and screen out all of them with simultaneous onset of both sides and the Wagner stage of both feet are above grade 2 Patients,it is planned to conduct clinical efficacy analysis(basic information,improvement of infection indicators)and follow-up follow-up(whether healed,time to heal,whether there are complications,amputation rate)for these patients;One month after treatment,the wound margin tissues of both limbs were planned to undergo SDF-1,CXCR4 and HIF-1 immunohistochemistry experiments,and then the difference between before and after treatment was analyzed by positive cell count;20patients were collected before and after informed consent.Peripheral blood serum at 1 month after surgery was planned to perform ELISA test of SDF-1 and VEGF,and data analysis was performed based on the results of microplate reader.Results: 1.A total of 356 patients with DF were collected,including 31 patients with DF in both lower limbs,27 males and 4 females,aged 43-82 years,average(60.5 ± 9.7)years,and the course of diabetes was 1-20 years,(7.3 ± 6.1)years,the duration of diabetic foot disease is 1 ～ 48 months,(6.5 ± 11.5)months,in this study,DF patients with both lower extremities simultaneously accounted for 8.7% of the total.The BMI of this group of patients was 17.48-27.68,average(22.7 ± 3.0);HbA1 c level was 5.1%-13.8%,average(9.4 ± 2.2)%.The total average healing time was(3.5 ± 2.2)months.The wound healing rate was100% and the salvage rate was 100%.There was no recurrence and recurrence.2.The number or rate of positive cells of SDF-1,CXCR4 and HIF-1 in the tissues before treatment were(3.1 ± 2.3),(56.8 ± 10.2)and(8.8 ± 2.9)%,respectively.The number or rate of positive cells of SDF-1,CXCR4 and HIF-1 in wound tissues after 1 month of transplantation treatment were(9.1 ± 3.7),(149.8 ±17.8),(39.7 ± 12.7)%,obviously It was higher than before tibial lateral movement,and the change trend of both feet was the same,the difference was statistically significant(P <0.05).3.The levels of SDF-1 and VEGF in the serum of the patients before treatment were(247.3±48.5)pg / ml and(444.2±167.0)pg / ml,respectively,and the SDF-1 was treated with unilateral tibial lateral transport for 1 month The expression levels of VEGF and VEGF were(313.7±58.2)pg / ml and(2419.9±706.1)pg / ml,which were significantly higher than before treatment,and the difference was statistically significant(P <0.05).Conclusion: 1.The lateral tibial lateral transposition can effectively treat diabetic feet with simultaneous ulceration of both lower extremities.The wounds of 31 patients healed completely,and there was no statistically significant difference in healing time between the surgical side and the contralateral side,as well as the left and right sides.2.Lateral tibial movement can promote the high expression of SDF-1,CXCR4,HIF-1 and VEGF in the body.It is initially confirmed that this effect is acting on the whole body,so it can promote the healing of bilateral DF wounds and may also treat other parts of the body.Complex wound surface. |
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