Study on characteristics of microvascular perfusion with superb micro-vascular imaging after tibia transverse bone transport for diabetic foot / 中华骨科杂志

ABSTRACT

Objective:To explore the clinical value of super micro vascular imaging (SMI) in evaluating the microvascular perfusion of diabetes foot treated by tibial transverse bone transport.Methods:A retrospective study of 18 diabetic foot patients who underwent tibial transverse bone transport in the Second Hospital of Shanxi Medical University from May 2019 to December 2021 were analysed, including 12 males and 6 females, with an average age of 64.89±14.34 years (range, 30-90 years). All patients had varying degrees of foot ulcer. Before and after the operation, the blood vessels of the patient's lower leg and foot were examined. The display rate of low-velocity blood flow was compared between color Doppler flow imaging (CDFI) and SMI; the blood flow and vascular index at the beginning of the first dorsal metatarsal artery before and after operation under SMI were compared; the number and length of new blood vessels were also compared before and after operation.Results:All patients were followed up for at least 2 months. CDFI blood flow display rate was 73.6% (106/144), and SMI blood flow display rate was 80.6% (116/144), the difference was statistically significant (χ 2=4.68, P=0.031). Under SMI, the blood flow at the beginning of the first dorsal metatarsal artery on the affected side was measured before operation 3.38 (1.33, 7.56) ml/min, 1 week after operation 4.19(2.84, 11.48) ml/min and 1 month after operation 3.72 (2.52, 11.40) ml/min, with statistically significant difference (χ 2=9.46, P=0.009). There were statistically significant differences in blood flow at 1 week and 1 month after operation compared with that before operation ( P=0.033, P=0.003). The vascular index at the beginning of the first dorsal metatarsal artery on the affected side was 3.84±3.60, 6.51±4.92 and 6.82±5.36 before operation, 1 week and 1 month after operation, respectively, and the differences were statistically significant( F=4.35, P=0.031). The vascular index in the first week after operation was significantly higher than that before operation ( P=0.026). Up to the last follow-up, the number of new collaterals in 18 patients was 4.5 (2, 8), which was significantly different from 1 (0, 2) before operation ( Z=-3.57, P=0.001). In total, the length of 18 new blood vessels in 9 patients was longer than that before operation, and the establishment of grade 2 and grade 3 branches were observed in 5 patients. The superficial subcutaneous vessels were showed more clarity than that before surgery, and there was collateral circulation on the opposite side. Conclusion:SMI objectively reflects the changes of hemodynamics and microcirculation of patients after tibial transverse bone transport, and helps clinical preliminary predict the prognosis of patients and adjust individual treatment plan according to blood perfusion in time.