Objective To study the effect of vein-occlusion on the replanted limb survival in SD rats at different stages. Methods Twenty-five adultSD rats were randomly divided into 5 groups according to the time of the femoral vein occlusion after the replanted limbs:2- ,3- ，4 -，6-，and 8- day groups. The limbs were observed through naked eye, measurement of dermal temperature and angiography. Results No formation of collateral veinlet was found, and necrosis wasseen in the replanted limbs of 2- , 3- day groups. Reflux-vein was gradually increased in the replanted limbs of 4，6，and 8 day groups. Angiographic score of capillary density and dermal temperaturein the thigh muscles were greater in groups 4-，6-，and 8- day than in groups 2 and 3 day. Conclusion Within 2 and 3 days，the replanted limbs of SD rats will necrose because of vein-occlusion; and 4 days later the replanted limbs can survive depending on the reflux-vein of new collateral veinlet.
rough the ultramicroscopic observation on muscle and microcirculation, Group A,where a largeamount of DXM combined with heporin was given svstematically and locally into the femoral artery of the severed limb before replantation, and in Group B only heporin was given, and Group C and D ascontrol.The results showed that if the hormone and heparin were administred in large dosage, it wasadvantageous to reduce the tissues from reperfusion injury during delayed replantation.
Objective To evaluate the early effectiveness of navigation-free robot-assisted total knee arthroplasty (TKA) compared to traditional TKA in the treatment of knee osteoarthritis combined with extra-articular deformities. Methods The clinical data of 30 patients with knee osteoarthritis combined with extra-articular deformities who met the selection criteria between June 2019 and January 2024 were retrospectively analyzed. Fifteen patients underwent CORI navigation-free robot-assisted TKA and intra-articular osteotomy (robot group) and 15 patients underwent traditional TKA and intra-articular osteotomy (traditional group). There was no significant difference in age, gender, body mass index, affected knee side, extra-articular deformity angle, deformity position, deformity type, and preoperative knee range of motion, American Knee Society (KSS) knee score and KSS function score, and lower limb alignment deviation between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications of the two groups were recorded and compared. The knee range of motion and lower limb alignment deviation were recorded before operation and at 6 months after operation, and the knee joint function was evaluated by KSS knee score and function score. Results There was no significant difference in operation time between the two groups (P>0.05); the intraoperative blood loss in the robot group was significantly less than that in the traditional group (P<0.05). Patients in both groups were followed up 6-12 months, with an average of 8.7 months. The incisions of all patients healed well, and there was no postoperative complication such as thrombosis or infection. At 6 months after operation, X-ray examination showed that the position of the prosthesis was good in both groups, and there was no loosening or dislocation of the prosthesis. The knee joint range of motion, the lower limb alignment deviation, and the KSS knee score and KSS function score significantly improved in both groups (P<0.05) compared to preoperative ones. The changes of lower limb alignment deviation and KSS function score between pre- and post-operation in the robot group were significantly better than those in the traditional group (P<0.05), while the changes of other indicators between pre- and post-operation in the two groups were not significant (P>0.05). Conclusion Compared to traditional TKA, navigation-free robot-assisted TKA for knee osteoarthritis with extra-articular deformities results in less intraoperative blood loss, more precise reconstruction of lower limb alignment, and better early effectiveness. However, long-term effectiveness require further investigation.
ObjectiveTo explore the value of recombinant inferior vena cava filter (IVCF) in the prevention of perioperative pulmonary embolism in patients with lower limb or pelvic fracture combined with deep venous thrombosis (DVT).MethodsThe clinical data of 168 patients with lower limb or pelvic fracture combined with DVT were analyzed retrospectively.ResultsThe filters were successfully implanted in 168 patients, and the recoverable filters were removed after (48.3±4.8) d (14–97 d). The filters were removed successfully in 159 cases, and the removal rate was 94.6%. Sixty-one cases were found to have thrombus on the filter after contrast examination or removal of vena cava filter, that is, the thrombus interception rate was 36.3%.ConclusionFor patients with lower limb or pelvic fracture combined with DVT, the rechargeable vena cava filter can effectively stop thrombosis and avoid pulmonary embolism.
OBJECTIVE: To study the clinical result of treating firearm-wound with the vessel pedicel tissue flap. METHODS: From May 1992 to October 2000, 21 cases of firearm-wound of upper limbs underwent transplantation with the vessel pedicel tissue flap. Of them, the locations of the wound were upper arm in 11 cases, forearm in 7 cases, hand in 3 cases. The size of wound was 1.0 cm x 0.5 cm to 8.0 cm x 6.5 cm; the wound course was 3 minutes to 8 hours with an average of 3 hours and 30 minutes. The patients were followed up 3 months to 2 years. RESULTS: In 21 cases, the results were excellent in 19 cases and poor in 2 cases. The good rate was 90.5%. CONCLUSION: Treatment of firearm-wound with vessel pedicel tissue flap has the good effect.
ObjectiveTo investigate effectiveness of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs.MethodsBetween January 2015 and October 2018, 7 patients with soft tissue defects of the lower limbs were repaired with the anteromedial thigh perforator flaps. The patients were males, aged 8-30 years (median, 23 years). There were 5 cases of traffic accident injuries (the time from injury to admission was 1-4 hours, with an average of 1.5 hours), 1 case of scar formation after traffic accident, and 1 case of scar deformity after burn. The defect located in calf in 5 cases, foot in 1 case, and thigh in 1 case. The area of soft tissue defects ranged from 12 cm×4 cm to 21 cm×7 cm; and the area of flaps ranged from 14 cm×5 cm to 24 cm×8 cm. The donor sites were sutured directly.ResultsThe flaps survived completely after operation in 6 cases, and the wounds healed by the first intention; the partial necrosis of flap occurred and healed after skin graft repair in 1 case. One incision partially ruptured in the donor site and healed after dressing change; the other incisions healed by the first intetion. All patients were followed up 6 months to 2 years with an average of 9 months. Except 1 case complained of edema of the flap, the other patients had good shape, good color, and no swelling.ConclusionFor patients with soft tissue defects of lower limbs that cannot be repaired with anterolateral thigh perforator flap, the anteromedial thigh perforator flap can be used for good results.
Objective To investigate clinical significanceand surgical protocols about the balance of the lower limb lengths in the total hip arthroplasty. Methods Forty-eight patients undergoing the unilateral primary total hip arthroplasty from March 2000 to October 2004 were retrospectively studied. In 12 hips, the prostheses were of the cement type; in 36 hips, of the mixture type. Thirty patients with an equal limb length had a fractured femoral neck, 10 patients had a shortened (1.0-2.0 cm) limb, 6 patients had a shortened (2.0-4.0 cm)limb, and 2 patients had a shortened (4.0-6.0 cm) limb. Based on the clinical measurement and radiographic examination, the surgical protocols were designed, the hip prosthesis type was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the wearing of the acetabula properly, the best rotation point was found out during the operation. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations. The neck length was readjusted after the insertion of the prosthesis so as to achieve an intended limblength equalization. Results All the patients were followed up for 3-42 months.According to the Harris scoring system, clinical results were excellent in 30 patients, good in 12, fair in4, and poor in 2. Of the 30 patients with an equal limb before operation, 5 were lengthened 1.0-2.0 cm in their lower limbs, and 1 lengthened 2.5 cm postoperatively. Of the 18 patients with shortened limbs before operation, 10 returned to the same lengths in their lower limbs, 6 were lengthened 1.0-2.0 cm in their lower limbs, but 2 with seriously-shortened lower limbs for congenital dysplasia of the hipjoint were still shortened 2.0-3.0 cm in the limb length after operation. The Harris hip scores revealed an average of 92.3 points in the patients with an equal limb length, and 88.6 points in the patients with shortened limbs. 〖WTHZ〗Conclusion Many factors, such as surgical protocols, prosthesis type designs, and the management techniques during the operation, can affect the limb length after operation. As the limb length discrepancy will make the patients feel disappointed, the clinical measurements are very important before operation. Application of the comprehensive appraisal methods during the operation, use of the soft tissuebalance method, and skills for obtaining an equal limb length during the total hip arthroplasty are also important for improving the surgical result further.
Objective To investigate the efficacy of minimally invasive osteotomy with preservation of blood supply to the transversely transported bone segment in the treatment of chronic ischemic lower limb diseases using tibial transverse bone transport. Methods A retrospective analysis was conducted on the clinical data of 12 patients with chronic ischemic lower limb diseases who met the selection criteria and were treated between June 2016 and December 2023. The cohort included 7 males and 5 females, aged 26-87 years (mean, 61.2 years). Among them, 7 patients had diabetic foot (DF), including 2 cases complicated by arteriosclerosis obliterans (ASO), with a DF duration ranging from 1.7 to 23.0 months (mean, 9.6 months) and ulcer sizes ranging from 3.2 cm×2.4 cm to 10.0 cm×6.6 cm. Three patients had ASO with a disease duration of 1.7-23.0 months (mean, 10.4 months) and ulcer or post-amputation wound sizes ranging from 2.2 cm×2.1 cm to 12.0 cm×7.7 cm. Additionally, 2 patients with thromboangiitis obliterans (TAO) had a disease duration of 7 and 12 months, respectively. Preoperatively, the mean foot skin temperature was (27.63±0.34)℃, and the visual analogue scale (VAS) score was 8.5±0.7. All patients underwent tibial transverse bone transport using minimally invasive osteotomy while preserving the blood supply to the transported bone segment. Postoperative complications and foot ulcer healing were observed. The effectiveness of tibial transverse bone transport was evaluated by comparing preoperative and postoperative foot skin temperature, VAS scores, as well as through CT angiography (CTA).Results One DF patient with ASO was lost to follow-up, while the remaining 11 patients were followed up 10-29 months (mean, 20.5 months). One DF patient had a displaced fracture at the site of tibial transport due to trauma, which healed after plaster immobilization; 1 DF patient had a small amount of pigmentation in the skin of the donor site, but the blood circulation was good; no complication such as pin tract infection, skin necrosis, or osteomyelitis occurred in the donor site of all patients. At 2-3 weeks postoperatively, the foot skin temperature was (34.21±0.65)℃, and the VAS score was 0.3±0.1, both significantly improved compared to preoperative ones (t=?31.578, P<0.001; t=49.000, P<0.001). Two TAO patients experienced recurrent, persistent, intolerable pain at 7-10 days postoperatively, with no reduction in ulcer size or necrotic areas; 1 underwent toe amputation, and the other required a mid-leg amputation. The remaining patients achieved complete ulcer healing, with healing time ranging from 5.1 to 9.2 weeks (mean, 6.8 weeks). CTA showed no new vascular occlusions or embolisms. X-ray films at 4 months postoperatively demonstrated proper repositioning and good healing of the transported tibial bone segment. ConclusionThe application of minimally invasive osteotomy with preserved blood supply to the transversely transported bone segment in tibial transverse bone transport for the treatment of chronic ischemic lower limb diseases effectively minimizes extensive soft tissue dissection, reduces surgical soft tissue damage, and better maintains local blood supply. This approach lowers the risk of postoperative infection and skin necrosis while accelerating postoperative recovery.
ObjectiveTo investigate the effects of early rehabilitation on function of patients undergoing complex lower limb amputation caused by injuring in "4·20" Lushan earthquake. MethodsFrom April 20th to June 30th, 2013, we carried out comprehensive rehabilitation intervention for two patients who had undergone complex lower limb amputation, including physical treatment, exercise treatment, psychological treatment, wound dressing, rehabilitation program, and multiple rehabilitation nursing care. ResultsThrough early comprehensive rehabilitation intervention, patients' pain was relieved, and their muscle strength, activities of daily living (ADL), and balance function had been improved greatly, achieving the goal of installing artificial limb. ConclusionEarly rehabilitation intervention treatment is effective in relieving pain in patients undergoing lower extremities amputation, and improving their muscle strength, ability of ADL and balance function, which can make the patients return to society much better and faster.
he fascia lata substitute valve operation was performed for curing the supperficial varieositycaused by the deep vein incompotence of the lower extremity basing on the study of the sources ofblood supply and the vascular distribution features of the fascia lata. The fascia lata subetitute vein valve operations were done on three males with the age rangingbetween 22 and 44 years old, and the rerelts were satisfactory 2 and 6 months after oporation.