Objective To discuss the role of the bone suture anchors for repair of avulsed deep radioulnar ligaments in maintaining the rotatory stability of the distal radioulnar joint. Methods Nine upper limbs specimens were selected from fresh adult cadavers to make wrist joint-bone capsular ligaments complex specimen. All the specimens were tested under conditions of intact (normal group), deep radioulnar ligaments injury (injury group), and deep radioulnar ligaments injury repaired with anchoring (repair group). The internal and external rotation torque values were recorded in 45° wrist extension, neutral position, and 45° wrist flexion by AG-IS series MS biomechanical testing system. The statistic software was used to compare difference in rotation torque between groups. Results In 45° wrist extension, neutral position, and 45° wrist flexion, the internal rotation torque values in normal group were (0.83±0.33), (0.86±0.34), and (0.36±0.30) N·m respectively; the external rotation torque values were (0.86±0.38), (0.44±0.22), and (0.25±0.21) N·m respectively. The internal rotation torque values in injury group were (0.18±0.17), (0.22±0.17), and (0.16±0.15) N·m respectively; the external rotation torque values were (0.27±0.26), (0.13±0.17), and (0.04±0.04) N·m respectively. The internal rotation torque values in repair group were (0.79±0.34), (0.73±0.33), and (0.41±0.23) N·m respectively; the external rotation torque values were (0.80±0.39), (0.41±0.22), (0.41±0.40) N·m respectively. In 45° wrist extension, neutral position, and 45° wrist flexion, the internal and external rotation torque values in injury group were significantly lower than those in normal group and repair group (P<0.05), but no significant difference was found between repair group and normal group (P>0.05). Conclusion The deep radioulnar ligaments are important structure for maintaining rotatory stability of distal radioulnar joint. Bone anchoring of the avulsed deep radioulnar ligaments to the ulna fovea is critically important in reconstructing function anatomy of the distal radioulnar joint.
ObjectiveTo explore the causes and management of the complications in diabetic foot treated with tibial transverse transport (TTT). MethodsBetween September 2015 and September 2019, 196 patients with diabetic foot were treated with TTT. There were 109 males and 87 females, with an average age of 67.6 years (range, 45-86 years). According to Wagner’s classification, there were 124 cases of grade 3, 62 cases of grade 4, and 10 cases of grade 5; the course of disease was 1-12 months, with an average of 2.6 months. All patients underwent the minimally invasive tibial osteotomy. The osteotomy site was the middle and lower tibia in 62 cases and the middle and upper tibia in 134 cases. The area of osteotomy was 20 cm2 in 83 cases and 7.5 cm2 in 113 cases. The osteotomy block was moved back and forth once in 92 cases and twice in 104 cases. The complications were recorded, including secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection. ResultsAmong 196 patients, 41 cases (20.9%) had complications. Nine cases (4.6%) had secondary fracture at tibial osteotomy, among which 6 cases (9.6%) of middle and lower segment osteotomies and 3 cases (2.2%) of middle and upper segment osteotomies. The incidence between the patients with different osteotomy sites was significant (χ2=5.354, P=0.021). The area of osteotomy was 20 cm2 in 5 cases (6.0%) and 7.5 cm2 in 4 cases (3.5%). There was no significant difference in the incidence between patients with different areas (χ2=0.457, P=0.499). Skin necrosis occurred in the osteotomy area in 12 cases (6.1%), all of which were moved back and forth once. There was a significant difference in the incidence between patients who were treated with transport once and twice (P=0.001). There were 18 cases (9.1%) with pin tract infection, including 12 cases (6.1%) with mild infection and 6 cases (3.0%) with severe infection. There was no significant difference in the incidence between the patients with mild and severe infections (P=0.107).ConclusionTTT is an effective method to treat diabetic foot, but there are complications such as secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection during transport. Preoperative evaluation of indication, standardization of osteotomy mode, size and position of osteotomy block, establishment of individualized removal plan, and strengthening of pin track nursing after operation can effectively reduce complications.
Objective To investigate the effectiveness of tibial transverse transport (TTT) in treating Wagner grade 3-4 type 2 diabetic foot ulcers and analyze dynamic changes in immunoglobulin levels. Methods The clinical data of 68 patients with Wagner grade 3-4 type 2 diabetic foot ulcers treated with TTT between May 2022 and September 2023 was retrospectively analyzed. The cohort included 49 males and 19 females, aged 44-91 years (mean, 67.3 years), with 40 Wagner grade 3 and 28 grade 4 ulcers. The duration of type 2 diabetes ranged from 5 to 23 years, with an average of 10 years. The number of wound healing cases, healing time, amputation cases, death cases, and complications were observed and recorded. Serum samples were collected at 6 key time points [1 day before TTT and 3 days, 7 days (the first day of upward transverse transfer), 14 days (the first day of downward transverse transfer), 21 days (the first day after the end of transfer), 36 days (the first day after the removal of the transfer device)], and the serum immunoglobulin levels were detected by flow cytometry including immunoglobulin G (IgG), IgA, IgM, IgE, complement C3 (C3), C4, immunoglobulin light chain κ (KAP), immunoglobulin light chain λ (LAM). Results All the 68 patients were followed up 6 months. Postoperative pin tract infection occurred in 3 cases and incision infection in 2 cases. Amputation occurred in 5 patients (7.4%) at 59-103 days after operation, and 8 patients (11.8%) died at 49-77 days after operation; the wounds of the remaining 55 patients (80.9%) healed in 48-135 days, with an average of 80 days. There was no recurrence of ulcer, peri-osteotomy fracture, or local skin necrosis during follow-up. The serum immunoglobulin levels of 55 patients with wound healing showed that the levels of IgG and IgM decreased significantly on the 3rd and 7th day after operation compared with those before operation (P<0.05), and gradually returned to the levels before operation after 14 days, and reached the peak on the 36th day. IgA levels continued to decrease with time, and there were significant differences at all time points when compared with those before operation (P<0.05). The level of IgE significantly decreased at 21 days after operation compared with that before operation (P<0.05), while it was higher at other time points than that before operation, but the difference was not significant (P>0.05). The level of C3 showed a clear treatment-related increase, which was significantly higher on the 7th, 14th, and 21st days after operation than that before operation (P<0.05), and the peak appeared on the 14th day. The change trend of C4 level was basically synchronous with that of C3, but the amplitude was smaller, and the difference was significant at 7 and 14 days after operation compared with that before operation (P<0.05). There was no significant difference in KAP/LAM between different time points before and after operation (P>0.05). Conclusion TTT can accelerate wound healing, effectively treat diabetic foot ulcer, and reduce amputation rate, and has definite effectiveness. The potential mechanisms of TTT in the treatment of diabetic foot ulcers include the dynamic regulation of IgG, IgA, IgM, and IgE levels to balance the process of inflammation and repair, and the periodic increase of C3 and C4 levels may promote tissue cleaning, angiogenesis, and anti-infection defense.
目的 探討游離股外側肌瓣聯合封閉式負壓吸引技術（VSD）修復四肢軟組織缺損的臨床效果。 方法 2009年6月－2011年6月，對25例四肢軟組織缺損患者采用游離股外側肌瓣聯合VSD治療對創面經徹底清創后，先行VSD覆蓋，5～9 d后去除VSD負壓膜。再次清創受區，切取股外側肌瓣修復創面，處理血管危象，二期植皮。 結果 25例均獲得隨訪，時間6～12個月。經負壓封閉引流后，局部創面無明顯感染，肌腱及骨外露區周圍肉芽組織生長良好。出現血管危象3例，經及時處理后3例肌瓣均恢復血液循環。感染控制良好，無竇道形成，患肢功能恢復滿意。 結論 對于嚴重創傷后的肢體軟組織缺損，經徹底清創后，應用封閉式負壓引流及游離股外側肌瓣修復，可明顯縮短治療周期，提高手術成功率，最大限度恢復患肢的功能。
目的 比較克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的臨床療效。 方法 1999年1月－2007年3月，收治肩鎖關節脫位患者29例，分別采用克氏針張力帶聯合喙鎖韌帶重建（克氏針組10例）和鎖骨鉤鋼板（鋼板組19例）治療。其中男18例，女11例；年齡19～50歲，平均38.2歲。患者均為新鮮RockwoodⅢ型肩鎖關節脫位，受傷至手術時間1～16 d，平均3 d。兩組患者性別、年齡、受傷至手術時間等一般資料比較差異無統計學意義（P＞0.05）。進行兩組患者術后臨床及影像學評估比較。 結果 25例患者（克氏針組10例，鋼板組15例）獲隨訪，隨訪時間2～12年，平均6年。術后克氏針組發生克氏針彎曲5例、斷裂1例；鋼板組切口淺表感染2例，經換藥后治愈，其余患者切口Ⅰ期愈合。兩組患者肩鎖關節均獲得良好功能，組間比較差異無統計學意義（P＞0.05）。影像學方面：與克氏針組相比，在患肢負重位時鋼板組喙鎖間隙間距增加了23%（P＜0.05），非負重位兩組間距差異無統計學意義（P＞0.05）。術后8～12周出現喙鎖韌帶鈣化，鋼板組12例、克氏針組2例（P＜0.05）。術后6個月出現肩鎖關節骨性關節炎，鋼板組2例、克氏針組1例（P＞0.05）。肩關節功能與影像學結果無相關性（r=0.096，P＞0.05）。 結論 克氏針張力帶聯合喙鎖韌帶重建和鎖骨鉤鋼板固定治療RockwoodⅢ型肩鎖關節脫位均可獲得良好的臨床功能。與克氏針張力帶相比，鎖骨鉤鋼板固定具有手術操作簡便、療效確切、并發癥少、能夠早期康復鍛煉等優點。
Objective To evaluate the results of open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. Methods From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 caseswere extremely serious (less than 30° extension-flexion arc) and 18 cases were serious (30-60° extension-flexion arc). The range of motion of the elbow stiffness was (32.5 ± 28.9)° and the Mayo score was 51.9±13.1 before operation. All initial fractures were healed according to cl inical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Results Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instabil ity and debil itating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 ± 14.4 and the range of motion of elbow stiffness was (108.8 ± 36.0)°; showing significant differences when compared with preoperation (P lt; 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrol ysis. Conclusion Open elbow arthrolysis and postoperative rehabil itation for patients with elbow stiffness can improve joint function and ensure the stabil ity of elbows.
目的 探討空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折的臨床療效。 方法 2005年6月－2010年9月采用空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折38例，男29例，女9例；年齡32～69歲，平均42.2歲。其中髕骨中份橫行骨折18例，斜行骨折15例，髕骨縱行骨折3例，髕骨下極骨折2例。骨折塊移位0.6～3.2 cm，平均1.7 cm。受傷至手術時間1～7 d，平均2.1 d。末次隨訪時評估雙側膝關節主觀感受、視覺模擬評分（VAS）、患側膝關節活動度（ROM）、Lysholm評分及影像學變化。 結果 患者隨訪13～54個月，平均19.5個月。康復期內未出現皮膚刺痛、滑囊炎、切口延期愈合或不愈合等臨床并發癥。末次隨訪時疼痛VAS評分（1.5 ± 0.9）分，患側膝ROM為健側的85.2%。術后2.1～3.2個月，平均2.8個月達到臨床骨性愈合。 患側Lysholm評分優27例、良8例、可1例、差2例，優良率92.1%；健側膝關節Lysholm評分優35例、良1例、可0例、差2例，兩側比較差異無統計學意義（P＞0.05）。 結論 空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折可獲得較好臨床療效，且術后循序漸進的康復鍛煉是膝關節功能得到最大恢復的關鍵。
【摘要】 目的 評價切開復位Herbert螺釘內固定加外支架治療對亞急性和陳舊性舟狀骨骨折的治療效果。方法 2008年2月—2009年5月,對15例受傷后4周以上(平均7.6周)入院診斷為亞急性和陳舊性舟狀骨骨折的患者均采用Herbert螺釘內固定加外支架治療,術后隨訪5～16個月,平均12.5個月,按Gartland amp; Werley和改良Green amp; O’Brein評分系統進行評價治療效果。結果 15例患者均進行有效隨訪,末次隨訪Gartland amp; Werley評分優8例,良5例,中2例,優良率為86.7％,改良Green amp; O’Brein評分優7例,良5例,中3例，優良率為80％。結論 此方法是治療亞急性和陳舊性舟狀骨骨折的有效措施,值得推廣。
【摘要】 目的 總結應用經皮微創鋼板固定（minimally invasive percutaneous plate osteosynthesis，MIPPO）技術治療2型糖尿病患者脛骨遠端骨折的臨床經驗及治療效果。 方法 2007年5月-2010年11月，采用MIPPO技術治療2型糖尿病合并脛骨遠端骨折15例。其中男9例，女6例；年齡38~70歲，平均60歲。左側脛骨遠端骨折 4例，右側 11例。單發骨折10例，多發骨折5例。根據 AO分型:A1型2例，A2型1例，A3型5例，B1型3例，B3型3例，C1型1例。傷后至手術時間為2~14 d。 結果 15例患者隨訪時間8~12個月，平均10個月。手術時間平均89 min，術中失血量平均285 mL。術后1年采用Johner-Wruhs方法評估療效:優4例，良5例，中3例，差3例；總體滿意率80%。X線片示13例患者骨折均獲骨性愈合，愈合時間4~8個月，平均6個月，無再發骨折。3例發生泌尿系統感染，1例發生呼吸系統感染，感染率26.7%。 結論 MIPPO技術治療2型糖尿病脛骨近端骨折具有對骨折周圍軟組織剝離少、符合生物學固定概念、內固定牢靠、切口較小等優點，降低了切開復位內固定術后并發癥的發生率。【Abstract】 Objective To summarize the clinical experiences and effects of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique for type 2 diabetic patients with fractures of distal tibia. Methods From May 2007 to November 2010, 15 type 2 diabetic patients with distal tibia fractures including 9 males and 6 females were treated with minimally invasive percutaneous plate osteosynthesis. Their age ranged from 38 to 70 years old averaging at 60. Left distal tibia fracture occurred to 4 cases, and right distal tibia fracture occurred to 11 cases. Ten patients had single fracture, and 5 had multiple fractures. According to AO fracture classification, there were two cases of A1, one cases of A2, five cases of A3, three cases of B1 and B3 respectively, and two cases of C1. The time from the occurrence of fracture to operation was ranged from 2 to 14 days. Results The patients were followed up for 8 to 12 months with an average period of ten months. The average operation time was 89 minutes and perioperative blood loss was (285±38) mL. Johner-Wruhs method was used to evaluate the efficacy. Four cases were excellent, 5 were good, 3 were fair, and 3 were poor, with an overall satisfaction rate of 80%. X-ray showed that 13 patients were healed. The healing time was 4 to 8 months, averaging 6 months, and no further fractures occurred. There were 3 cases of urinary tract infection and 1 case of respiratory infection with an infection rate of 26.7%. Conclusion Minimally invasive percutaneous plate osteosynthesis technique for fractures of distal tibia in diabetic patients is a safe method with better mechanical stability, less intervention of blood supply, less soft tissue complications and smaller incisions.