| Objective:To preliminarily investigate the feasibility of dynamic enhanced MRI in evaluating the soft tissue perfusion of the foot before and after lateral tibial displacement of external fixator in diabetic foot,and analyze DCE-MRI perfusion parameters to evaluate the clinical efficacy of Ilizarov external fixator lateral tibial displacement in the treatment of diabetic foot.Methods:1.Gathering from June 2018 to January 2020,guangxi medical univer-sity first affiliated hospital of diabetic foot patients joint section,after contro-lling blood glucose,blood pressure,anti-infection treatment plans to mens-truation Ilizarov external fixator for the treatment of tibia lateral move,9cases were included in this study the researchers,among them 4 cases were female,male in 5 cases,9 cases of patients with diabetic foot were unilateral canker,are performed in canker side.Siemens 3.0T superconducting magnetic resonance scanner was used before and 2 months after operation.The relatively normal foot on the other side of the ulcerated foot was non-ulcerated foot,which was divided into three groups according to whether the foot was ulcerated or not,the ulcerated foot group,the non-ulcerated foot group and the diabetic double foot group.preoperative and postoperative control studies were conducted in the three groups.Clinicians were employed to measure the skin temperature of hallux before and 2 months after the operation of diabetic foot and to score the pain of diabetic foot.2.All patients with preoperative and postoperative 2 months after foot DCE-MRI scan lines will be the original image to Siemens syngo workstation,using Tissue-4D software for data processing,generating area of common interest in no time-signal intensity curve and perfusion figure,in the sole abductor muscle area(ROI),manual sketch areas of interest area of about 1cm~2,one foot measuring four times,measuring eight times,and then take the average.It is required that both foot parts should be consistent as far as possible,while avoiding blood vessels,bones and necrotic areas,so as to obtain the vascular functional parameters of the area of interest(Ktrans),reflux constant(Kep),area under initial enhancement curve(i AUC),and extracellular volume ratio of blood vessels(Ve),and preserve the experimental data.3.Spss22.0 statistical software was used to analyze the experimental data.Before and after the operation,the data of each group were paired t-test.P<0.05 was statistically significant,P<0.01 was statistically significant.Results:1.A total of 9 cases of Ilizarov external fixator lateral tibial displacement were treated with diabetic foot:preoperative clinical Wagner classification was used to grade the degree of diabetic foot ulcers,including 6cases of grade 3 and 3 cases of grade 4.According to the review two months after the operation,5cases of wagner’s grade 1,3 cases of Grade 2 and 1 case of Grade 3were examined.Among the 9 patients,8 of them had basic healing of ulcerated feet,and 1 case still had ulcerated feet with severe pre-operation soft tissue defects,but it was significantly better than before,and most of the defect soft tissue wounds healed.2.After surgery for diabetic foot,skin temperature of hallux toe was increased compared with that before surgery,and the pain degree of the affected limb was decreased compared with that before surgery,with statistical significance(P=0.044,0.013).3.The values of Ktrans and Kep at 2months after resection of hallux muscle in the ulnar foot group were significantly higher than those before surgery(P=0.028,0.047).Ve value decreased and i AUC value increased,but there was no statistical significance(P>0.05).4.In the non-ulnerable foot group,Ktrans increased 2 months after surgery compared with that before surgery,showing a statistically significant increase(P=0.040);Kep value and i AUC value increased and Ve value decreased compared with that before surgery,showing no statistical significance(P>0.05).5.Ktrans and i AUC values of hallux muscle in the diabetic bipedal group were increased compared with that before surgery,with statistical significance(P=0.035,0.039).Kep and Ve values were not statistically significant(P>0.05).Conclusions:1.Dynamic contrast enhanced MRI scan perfusion param-eters Ktrans,Kep and i AUC are of certain value in evaluating the efficacy of Ilizarov external fixator lateral tibial displacement in the treatment of diabetic foot.2.Mabductor transport constants of both ulcerated and non-ulcerated feet increased after lateral tibial displacement with Ilizarov external fixator,suggesting that transverse tibial displacement could increase the perfusion volume of bilateral skeletal muscles. |
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