The Clinical Application Of Tibial Transverse Bone Transfer In The Treatment Of Diabetic Foot

Objective:To observe the clinical effect of tibia transverse bone transfer technique in the treatment of diabetic foot(DF).Methods:Thirteen patients with DF who were hospitalized in the Sports Medicine Department of Arthritis and Osteopathy in the Lengshuitan District of Yongzhou Central Hospital from April 2018 to October 2020 were selected,and their Wagner classification was 3-4,as the research object of this clinical project.Among them,there are 7 males and 6 females.There were 5 cases on the left foot and 8 cases on the right foot.There were 3 cases of Wagner level 3 and 10 cases of Wagner level4.All patients are admitted to the hospital,complete the preoperative examinations,monitor and control blood sugar,control infections,and comprehensively treat complications related to internal medicine.It is clear that there are no contraindications to the operation,and the is performed after signing the informed consent of the opertibial transverse bone transfer operationation.Among them,2 patients underwent vaccum sealing drainage during the preoperative debridement of the affected foot,and 3 patients underwent necrotic toe amputation during the preoperative debridement.All patients started to move the bone window on the 5th day after the operation,and moved 1mm a day in 4 times,once every 6 hours,21 days after moving the bone window laterally,maintained in the original position for 3 days,and then moved in the opposite direction in the same way.Move the bone window back until the bone window returns to its original position.The tibia X-ray was reviewed for 6 weeks,and the external fixation frame was removed.Postoperative debridement or skin grafting of the wound is performed according to the condition of the foot ulcer.Regular follow-up observation indicators to evaluate clinical efficacy.Observation indicators include wound healing of the affected foot,skin temperature of the affected limb,ankle-brachial index(ABI),visual analogue score(VAS),10 g nylon wire test,and changes in lower limb CTA.Results:The 13 patients with DF who were treated with transverse tibial bone transfer in this research group were followed up.The follow-up time was 3-12 months.Among them,3 patients underwent postoperative debridement.For necrotic toe amputation(small amputation),1 patient received amputation above the ankle joint(large amputation)due to enlarged foot wounds and increased infection 11 months after the operation.The limb salvage rate was 92.3%;1 patient was in Foot ulcer recurrence occurred in the 8th month after operation,and the wound healed after dressing change.The recurrence rate of foot ulcer was 15.4%.One patient had a tibial fracture due to a fall one month after surgery.The fracture healed after being fixed with an external fixator.During the postoperative follow-up period,all patients had no complications such as nail-way infection,skin necrosis in the transfer area,nonunion of fractures,loosening of external fixators and other complications.Observation index changes before and after surgery: 1month after surgery,3 months after surgery,the skin temperature of the affected limb,ABI,VAS,10 g nylon wire test,lower limb blood vessel CTA,and ulcer healing were significantly better than those before surgery.The differences were statistically significant(P<0.05).Conclusion:Transverse tibia bone transfer has a significant clinical effect in the treatment of diabetic foot,which can improve the circulation of the affected limb,improve peripheral nerve function,promote the healing of foot ulcers,and greatly reduce the risk of DF amputation.