[Analysis of the efficacy and mechanism of antibiotic-loaded bone cement in the treatment of diabetic foot ulcers in patients with tpye 2 diabetes mellitus].

<b>Objective:</b> An exploration of the efficacy and mechanism analysis of antibiotic-loaded bone cement in patients with diabetic foot ulcers (DFU) in patients with type 2 diabetes mellitus. <b>Methods:</b> A retrospective analysis was conducted on the clinical data of 78 patients with type 2 DFU who were treated at Henan Provincial People's Hospital between June 2020 and October 2022, including 54 males and 24 females, with a mean age of (63.0±7.9) years. According to the treatment modality, patients were divided into the bone cement group (<i>n</i>=49) and the gel group (<i>n</i>=29). Clinical data were collected. All patients underwent bacterial culture and antibiotic susceptibility testing prior to enrollment, and antibiotics were selected based on susceptibility results. In the bone cement group, antibiotics were mixed with bone cement at a standard ratio for local application, while in the gel group, a 2% antibiotic gel was used topically. Both groups received standardized wound care based on basic treatment. The primary outcomes included wound healing status after 4 weeks, wound healing time, amputation rate, and bacterial clearance rate. Secondary outcomes included microvessel density (MVD) and the relative expression levels of growth factors [vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), fibroblast growth factor-2 (FGF-2), and epidermal growth factor (EGF)] in wound tissues. <b>Results:</b> There were no significant differences between the two groups regarding gender, age, duration of diabetes, glycated hemoglobin levels, ankle-brachial index, toe brachial index, diabetic complications, comorbidities, history of lower limb vascular interventions, Wagner grade, wound duration, infection markers, or bacterial culture positivity rates (all <i>P</i>>0.05). After 4 weeks of treatment, the total effective wound healing rate was higher in the bone cement group than in the gel group [85.7% (42/49) vs 65.5% (19/29), <i>P</i>=0.033], the wound healing time was shorter [(65.5±5.1) vs (80.0±4.3) d, <i>P</i><0.001], and the major amputation rate was significantly lower [8.2% (4/49) vs 20.7% (6/29), <i>P</i>=0.033], while there was no significant difference in minor amputation rates [42.9% (21/49) vs 37.9% (11/29), <i>P</i>=0.669]. There was no statistically significant difference in bacterial clearance rates between the two groups(<i>P</i>=0.141). The MVD value in the wound tissue of the bone cement group was higher than that in the gel group [(30.73±3.77) vs (20.43±3.74) vessels per high-power field, <i>P</i><0.001].The relative expression levels of VEGF, TGF-β1, FGF-2, and EGF in wound tissues were significantly higher in the bone cement group compared to the gel group (all <i>P</i><0.001). <b>Conclusions:</b> Antibiotic-loaded bone cement is an effective treatment method for infected DFU. Its mechanism of action may be related to promoting angiogenesis and upregulating growth factor expression.