| OBJECTIVE:To evaluate the efficacy of CT perfusion in the treatment of diabetic foot with lateral tibia removal.METHODS:1.Diabetic foot patients admitted to the first affiliated hospital of guangxi medical university from May 2017 to January 2018 were collected,And by the Ilizarov external fixator for the treatment of tibia lateral move.A total of 12subjects were included in the study(5 males and 7 females),All the 12 diabetic foot patients had unilateral ulcer,including 8 in the left,4 in the right,and lateral tibia removal in the ulcer.GE-Revolution256 row CT volume scan was performed before and 12 weeks after surgery.According to the foot ulcer,there were three groups:non-ulcer group,ulcer group and diabetic bipedal group.2.Introduce that dynamic scan data of the 32-period into the perfusion imaging software own by the CT machine(CT Perfusion 4D,ADW4.7),the obtained 1.25mm image was postprocessed,motion artifact after correction,the perfusion tissue threshold range was defined as-50-150 Hu.The posterior tibial artery about 7cm above the bifurcation of the external and internal arteries of the ulcerated foot was selected as the input artery,a time-density plot of target blood vessels was obtained,introduce a mathematical model of deconvolution,get a double foot tissue perfusion.In respectively abductor muscle of the champions league,axis of a central location selection interested area(ROI),area about 10mm~2,each measure 5 times,the mean value of each infusion parameter was measured 10 times.3.SPSS22.0 statistical software was used to analyze the experimental data,and paired test was used for the preoperative and postoperative data of each group.P<0.05 was considered statistically significant,and P<0.01 was considered statistically significant.RESULTS:1.A total of 12 cases of diabetic foot treated with Ilizarov external fixator tibia lateral displacement:The clinical use was based on the grading of the degree of the diabetic foot ulceration with Wagner grade,includingⅡ4、Ⅲ6、IV2.The operation was reviewed after 12 weeks,In 12 case,11 patients were subject to ulcer foot healing(One of the patients with ulcerated foot had a tarsal bone fracture),one patient’s foot was still ulcerated,but it was better than before.2.Diabetic foot Ilizarov external fixator after lateral tibia removal ulcerated foot abductor muscle:The BF and PS increased compared with those before surgery,Statistically significant(P=0.040、0.036);The BV、MTT and TTP increased compared with those before surgery,Statistically no difference(P>0.05)。3.Diabetic foot Ilizarov external fixator after lateral tibia removal ulcerated foot abductor muscle:The BF and BV increased compared with those before surgery,Statistically significant(P=0.046、0.030);PS increased compared with those before surgery,The MTT and TTP decreased compared with those before surgery,Statistically no difference(P>0.05).4.Diabetic foot Ilizarov external fixator after lateral tibia removal biped mus-cle:The BF、BV and PS increased compared with those before sur-gery,Statistically significant(P=0.011、0.042、0.033);TTP increased compared with those before surgery,MTT decreased compared with those before surgery,Statistically no difference(P>0.05).CONCLUSION:1.The parameters of BF,BV and PS in CT perfusion have certain value in evaluating the effect of Ilizarov external fixation frame tibia lateral displacement on diabetic foot.2.The blood flow,blood volume and capillary permeability of the ulcerated foot and non-ulcerated foot of the external fixation frame of Iizarov increased after lateral tibia removal,suggested that tibia transposition can increase the perfusion of ischemic skeletal muscle,improve biped microcirculation,at the same time removal is performed on the ulcer side but on both sides. |
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