Application of Transverse Tibial Bone Transfer in Diabetic Foot Patients: A Comprehensive Evaluation of Postoperative Prognostic Factors and Risk Factors.

Abstract

Objective: Diabetic foot is a serious complication of diabetes, often leading to poor prognosis and increased risk of amputation. Transverse tibial bone transport (TTT) has emerged as a promising limb salvage technique. However, some patients still experience adverse postoperative outcomes. This study aimed to analyze the influencing factors for poor prognosis after TTT and explore the correlations and clinical significance of key risk factors.

Methods: A retrospective analysis was conducted on the clinical data of 120 diabetic foot patients treated with TTT at the Department of Hand and Foot Surgery, our hospital, from January 2016 to May 2024. The incidence and types of adverse outcomes were recorded. Independent sample t-tests were employed for comparing continuous variables between two groups. Univariate and multivariate logistic regression analyses were used to identify significant prognostic factors. Pearson or Spearman correlation analysis was applied depending on data distribution, and Receiver Operating Characteristic (ROC) curves were constructed to assess diagnostic performance.

Results: Among the patients, 95% retained their feet, 81.67% maintained functional feet, and 5% underwent amputation. Complications included osteotomy margin necrosis (8.33%), lower limb venous thrombosis (5.83%), and pin tract infection (2.5%). A total of 26 patients experienced adverse outcomes. Univariate analysis showed significant differences in foot temperature, VAS score, resting pain, transcutaneous oxygen pressure, blood glucose, calcium, and CRP levels (p < 0.05). Multivariate analysis identified foot temperature, transcutaneous oxygen pressure, blood glucose, and CRP as independent risk factors. Correlation analysis revealed that foot temperature was positively correlated with transcutaneous oxygen pressure and negatively correlated with blood glucose and CRP. Blood glucose was positively correlated with CRP. ROC analysis showed good diagnostic performance for foot temperature (AUC = 0.891), transcutaneous oxygen pressure (AUC = 0.954), blood glucose (AUC = 0.850), and CRP (AUC = 0.908), with a combined AUC of 0.998 (Sensitivity = 100.00%, Specificity = 96.81%).

Conclusion: This study suggests that foot temperature, transcutaneous oxygen pressure, blood glucose, and CRP are significant risk factors for poor postoperative prognosis in diabetic foot patients undergoing tibial transverse osteotomy. These factors are interrelated and have high diagnostic value for predicting adverse outcomes, especially when used in combination. Clinically, monitoring changes in these factors can help predict the occurrence of poor postoperative outcomes in diabetic foot patients, thereby supporting the development of personalized treatment plans.