Advances in tibial transverse transport for the treatment of diabetic foot
10.3760/cma.j.cn121113-20231123-00324
- VernacularTitle:胫骨横向骨搬移治疗糖尿病足的研究进展
- Author:
Lupeng WANG
1
;
Wenjun ZHAO
;
Guosheng XING
;
Xiaoyuan DUAN
;
Chengyue YU
;
Weiguo XU
Author Information
1. 天津市天津医院矫形一病区，天津 300211
- Publication Type:Journal Article
- Keywords:
Diabetic foot;
Ulcer;
Bone remodeling;
Review
- From:
Chinese Journal of Orthopaedics
2024;44(24):1633-1640
- CountryChina
- Language:Chinese
-
Abstract:
The difficulty in the treatment of diabetic foot lies in the high rate of recurrence and difficulty in eradicating the disease, and the results of both systemic basic treatment and local surgical treatment are not ideal. In recent years, domestic scholars have applied tibial transverse transport for the treatment of diabetic foot. Tibial transverse transport is suitable for the treatment of severe diabetic foot with a good blood supply of the large and middle arteries. It has the advantages of high healing rate and low recurrence rate, and can effectively reduce the mortality and amputation rate of patients. However, postoperative complications such as tibial osteotomy fracture, pin tract infection, skin necrosis at osteotomy area, tibial deformity and osteomyelitis should be paid attention to. Domestic scholars have improved the operation of tibial transverse bone transport in terms of reducing the surgical incision, osteotomy area, and preserving the blood supply of the osteotomy site. The modified double bone flap transverse tibial bone transport and "door" shaped window technique have been derived, and related surgical instruments have also been improved in the direction of precision. At present, the research on the mechanism of tibial transverse transport in the treatment of diabetic foot mainly focuses on promoting the reconstruction of macrophage polarization balance, stem cell mobilization and angiogenesis. After tibial transverse transport, the polarization of macrophages to classical activated type was decreased, and the polarization of selective activated type was increased. The two mechanisms promoted each other to reconstruct the polarization balance of macrophages. Bone transport activated SDF-1/CXCR4/PI3K/AKT and Wnt signaling pathways to induce stem cell mobilization. At the same time, it stimulates the release of angiogenic factors, activation of endothelial progenitor cells and Ras/Raf/MEK/ERK signaling pathways to promote angiogenesis and ultimately promote the healing of diabetic foot ulcers.
