Clinical Application Of Color Doppler Imaging In Evaluating The Grade Of Diabetic Foot

BackgroundDiabetes mellitus is a chronic disease, which is the result of both genetic and environmental factors. Diabetic foot is one type of chronic complications, about 15-20% patients take place feet ulcers or gangrenes at least one time, therefore diabetic foot is the most common reason which causes the low and distal amputation, and results in burdens from economy or physiology. During 1992, the investigation dates from Chinese Diabetic Foot Unit showed that the patients of diabetic foot accounted 12.4%, and the patients of amputation accounted 7.3% . Lots of researches showed that lumens and haemodynamics of lower extremity's arteries had great changes between the patients of diabetic foot and control group, but there aren't articles intending to find the differences between the grades among the patients of diabetic foot. This clinical research tries to explore the significance of noninvasive testing, which can be an early diagnosis and intervention to decrease the ratio of amputation among the patients of diabetic foot.ObjectiveTo determine risk factors and the value of low extremity artery Color Dopplerimaging between patients with severe ulcers (Wagner gradedIV) and those with unsevere ulcers (Wagner grade< IV).MethodsA retrospective study of diabetes patients of foot ulcers from August 1997 to August 2003 had come out, sixty patients got treatments in the department of endocrinology, the first affiliated hospital of Zhejiang. According to the ranking of Wagner, theses patients were divided into gangrene group (n=24) and non-gangrene group (n=36). Clinical outcomes concluded diseased region, age, sex, course of disease, length of stay, type of operation, ratio of hypertension, biochemical indicator, and secretion culture. Using color Doppler, it observed inner diameter and blood flow rate of lower extremity artery, which contained left and right common femoral arteries, superficial femoral arteries, deep femoral arteries, popliteal arteries, anterior tibial arteries, posterior tibial arteries and dorsal pedal arteries. Besides, nerve conduction velocity of common peroneal nerve and sural nerve were also recorded.Results1. Between gangrene group and non-gangrene group, age^ blood HDL-C had significant deviation. According to the result of secretion culture, the number of Gram-positive bacteria nearly equaled to the number of Gram-negative bacteria, and the drug fast ration of quinolones were low in both groups.2. Color Doppler showed:Between the two groups, rate of arterial occlusion had differences of statistics sense (PO.05), inner caliber below popliteal artery the inner caliber of left femoral artery, right popliteal artery, left anterior tibial artery, right anterior tibial artery, left posterior tibial artery and left dorsal pedal artery had differences of statistics sense (P<0.05). Besides, the inner caliber of left popliteal artery, right posterior tibial artery had differences of significant statistics sense (P<0.01).Between the two groups, systolic phase peak flow rate of lower extremity arteries had no significant deviation.3. In gangrene group, nerve conduction velocity of common peroneal nerve and sural nerve were both slower than corresponding figures in non-gangrene group.ConclusionsBetween the group of gangrene and the other one of non-gangrene, inner caliber below popliteal artery (including popliteal artery, not including right dorsal pedal artery) was significant deviation. Therefore, low extremity artery Color Doppler is an excellent method, which can monitor the grade of diabetic foot sensitively.