Objective To introduce a new surgical approach to rectify the shortened lower limbs. Methods From March 1985 to October 2000,288 cases of shortened lower limbs were treated and reviewed. Closed fracture at the metaphysis was made by a self-made “needle saw”, and then the “multiple-plane and double-track elongation instrument” was adopted to elongate the fractured bone. There were totally 161 cases of male and 127 cases of female included, with average age 21.3 years old, ranging from 12 to 29 years old, among which there were 268 cases elongated at the proximal metaphysis of the tibia, 16 cases at the distal femur and 4 cases at the distal tibia. All of the cases were followed up for 6 to 8 months before clinical evaluation. Results The lower limbs in 288 cases were elongated for 3.0 to 11.5 cm in 24 to 96 days, averaging 47 days, which fulfilled pre-operative plan. In the second week after the operation, new calculus and periosteum formed obviously in the gap between the fractured parts, and in 6 to 8 months bone union was observed at the fractured site in all cases. There was no nerve or blood vessel injury, or non-union of the metaphysis fracture. The functionof the manipulated knee joints and ankle joints recovered well. Conclusion It is a practical and safe surgical option to rectify the shortened lower limbs by closed fracture at the metaphysis, followed by elongation of the fractured bone,without any complication such as non-union or atrophy of manipulated bone, andwith no need of internal fixation or bone grafting.
Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity. Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity， who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009, were analyzed. Three hundred cases were randomly divided into potaried group and transfixion group. In potaried group, there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system. In transfixion group, 110 cases involving 110 legs treated with percutum transfixion. The clinical indexes of skin infection rate and skin necrosis rate, shrinkage rate of wound area and skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5, day 20, day 120 and day 360 after operation respectively. Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P＜0.05), the rates of shrinkage of wound area and skin depigmentation were significantly increased in potaried group compared with transfixion group on day 20 (P＜0.05). The ulcer healing rate was not significantly different between the two groups on day 120 (Pgt;0.05). Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P＜0.05). Conclusion It can be concluded that percutem transilluminated with negatived pressured on the potaried technique with TRIVEXTM Ⅱ potaried system can efficiently promote the healing of venous ulcer in the lower extremity, and at the same time it has an ascendancy in lessening skin infection and skin reinjury.
Objective To assess the combined management of lower limb chronic venous diseases according to the CEAP classification. Methods One hundred and twenty patients were classified according to the CEAP classification. Based on clinical presentation and image study, all patients were treated with combined management plan including oppression, medication and surgery. Results All 120 patients (135 limbs) were followed up in clinic, the local recurrence rate was 18.52%(25/135). Conclusion CEAP classification expounds the developing process of lower limb chronic venous diseases. With CEAP, we can avoid the blind spot in the treatment and expand the extent of combined therapy. Accordingly, CEAP classification is useful in the treatment and diagnosis of chronic venous diseases.
Objective To evaluate the clinical efficacy of t ransplantation of autologous peripheral blood stemcells ( PBSC) for the t reatment of lower limb arterial ischemic disease. Methods From March 2004 to February2007 , 16 patient s with severe lower limb arterial ischemic disease were t reated with autologous PBSC t ransplantation. Recombinated granulocytecolony stimulating factor ( G2CSF) was used to mobilize the proliferation of bonemarrow stem cells and then the stem cells were released into peripheral blood. Af ter 5 - 6 days , PBSC were collected by CS23000 PLUS blood2cells separator. Such concent rated stem cells fluid was int ramuscularly injected into theischemic areas of the lower limbs. Results The result s of 3 to 242month following2up after the t ransplantation ofstem cells showed that the resting pains of the affected limb were greatly relieved , and ulcers were healed. The distance and duration of intermittent limping became farther and longer. Conclusion Transplantation of autologousPBSC would be a novel and effective method for the t reatment of arterial ischemic disease. However , this method isstill at the stage of initial clinical application , so it still need to be further studied.
Objective To explore the effective autologous bone marrow stem cell dosage for treatment of severe lower limb ischemia. Methods From December 2003 to December 2004, 22 cases of bilateral lower limb ischemia were treated with autologous bone morrow cell transplantation. All the patients were randomly divided into two groups according to ischemia degree. In group A(severe ischemia side), the amount of transplanted autologous bone marrow cells was more than 1×108, and ingroup B(mild ischemia side), the amount was less than 1×105. A series of subjective indexes, such as improvement of pain, cold sensation and numbness, and objective indexes, such as increase of ankle/brachial index (ABI) and transcutaneous oxygen pressure (TcPO2), angiography, amputation rate, and improvement of foot wound healing were used to evaluate the effect of autologous bone marrow stem cells implantation. Results The rates of pain relief were 90.0% in group A and 16.7% in group B (Plt;0.01); the rates of cold sensation relief were 90.5% in group A and 5.3% in group B（Plt;0.01）;the improvement of numbness was 62.5% in group A and 9.1% in group B（Plt;0.01）. Increase of ABI was 31.8% and 0 in groups A and B respectively（Plt;0.01） at 4 weeks after implantation. Increase of TcPO2was 94.4% and 11.1% in groups A and B respectively（Plt;0.01） at 4 weeks after implantation. Twelve cases of angiography showed rich new collateral vessels in 100% of the limbs in group A while no remarkable new collateral vessel in group B. The amputation rates were 4.5% in group A and 27.3% in group B（Plt;0.05） at 4 weeks after implantation. The rate of improvement of foot wound healing was 75% in group A and there was no changein wound healing in group B after 4 weeks of implantation. Conclusion The effectiveness of autologous bone marrow stem cell implantation depends on the number of implanted stem cells. Effectiveness is expected in most patients if the implanted stem cell is more than 1×108, whereas there would be little effect if the cell number is less than 1×105.
Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.
ObjectiveTo investigate the effect of preoperative valgus or varus deformity on the prosthesis installation and alignment restoration in total knee arthroplasty (TKA). MethodsBetween January 2012 and December 2013, 198 patients (245 knees) with osteoarthritis underwent primary TKA, and the clinical data were retrospectively analyzed. There were 23 males and 175 females, with the average age of 67 years (range, 43-90 years). Single knee and double knees were involved in 151 and 47 cases respectively. The disease duration was from 1 month to 30 years (mean, 8.99 years). The anteroposterior X-ray films of whole lower limbs were taken, and the femorotibial angle (FT) was measured before operation and at 1 week after operation; the mechanical femoral angle (MF) and the anatomical tibial angle (AT) at 1 week after operation were measured. The correlation analysis was made for pre-and post-operative FT, MF, and AT. According to the valgus or varus deformity before operation, all patients were divided into 5 groups:≥20° varus (group A), 10-20° varus (group B), ≤10° varus (group C), < 10° valgus (group D), and≥10° valgus (group E), and the above indicators were compared between groups. And the rate of the good limb alignment was recorded after operation. ResultsThe pre-and post-operative FT were (171.53±9.12) and (177.38±3.57)° respectively, and postoperative MF and AT were (89.00±2.68) and (88.62±2.16)° respectively. Preoperative FT was associated with postoperative FT and MF (r=0.375, P=0.000; r=0.386, P=0.000), but it was not correlated with AT (r=0.024, P=0.710). Postoperative FT was associated with MF and AT (r=0.707, P=0.000; r=0.582, P=0.000). Postoperative FT was significantly increased when compared with preoperative FT in each group (P < 0.05). There were significant differences in preoperative FT between groups (P < 0.05). There were significant differences in postoperative FT when compared group A with groups B, C, D, and E (P < 0.05), and when compared groups B and C with groups D and E (P < 0.05), but there was no significant difference between groups B and C, and between groups D and E (P>0.05). The rate of good alignment was 70.2% (172/245); it was 27.8% (5/18), 66.0% (62/94), 74.4% (67/90), 88.9% (32/36), and 85.7% (6/7) in groups A, B, C, D, and E respectively, showing significant differences between groups (P < 0.05). There was no significant difference in postoperative AT between groups (P>0.05). Except for between group D and group E (P>0.05), significant difference in MF was shown between the other groups (P < 0.05). ConclusionThe more severe deformity of lower limb before TKA, the higher risk of deviation for prosthesis installation and poor alignment in TKA.
Objective To compare the effectiveness of autologous implantation between bone marrow stem cells and peripheral blood stem cells for treatment of lower limb ischemia. Methods From December 2004 to December 2005, 42 patients with unilateral lower limb ischemia were treated with both autologous bone marrow stem cell implantation(group A, n=21)and autologous peripheral blood stem cell implantation (group B, n=21). Fortytwo patients included 32 males and 10 females. The age ranged from 34 to 80 years, with a mean of 65.6 years. Of the patients, there were 28, 8 and 6 patients suffered from diabetic lower limb ischemia, Burger’s disese and atherosclotic occlusion, respectively. Ischemic history was from 3 months to 5 years, with amean of 2.1 years. A series of subjective indexes (such as improvement of pain, cold sensation and numbness) and objective indexes such as increase of ankle brachial index (ABI), transcutaneous oxygen pressure (TcPO2), angiography, amputation rate, and improvement of foot wound healing, were used to evaluate the effect. Results After 4 weeks of implantation, the rate of pain relief was 88.2% in group A and 89.5% in group B (Pgt;0.05) ; the rate of cold sensation relief was 94.4% in group A and 94.7% in group B（Pgt;0.05）; improvement of numbness was 69.2% and 66.7% respectively in groups A and B（Pgt;0.05）. Increaseof ABI was 38.1% in group A and 33.3% in group B（Pgt;0.05）; increase of TcPO2 was 85.7% and 90.5% respectively in groups A and B（Pgt;0.05）; angiography was performed in 12 patients (group A) and 9patients (group B), and the new formed collateral vessel rate was 83.3% in group A and 77.8% in group B（Pgt;0.05）; the amputation rate was 9.1% in groups A and B（Pgt;0.05）; the rate of improvement of foot wound healing was 60.0% in group A and 66.7% in group B(P＞0.05). Forty patients were followed up 3-15 months(mean 8 months). The improvement rate of subjective symptoms was 75.0% in group A and 70.0% in group B (Pgt;0.05); increase of ABI was 60.0% in group A and 65.0% in group B; increase of TcPO2 was 80.0% and 75.0% respectively in groups A and B; the new formed collateral vessel rate was 90.0% in group A and 84.6% in group B. All ulcers healed except 1 case in group B. Conclusion Bone marrow stem cell graft and peripheral blood stem cell graft are all effective in treatingower limb ischemia.
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.
Objective To analyze the methods of treating diabetic feet and to evaluate the optimal method. Methods The clinical data of 115 patients (137 legs) with diabetic feet were retrospectively analyzed. Results Seventy-one affected legs were treated with balloon dilation or stenting (11 with additional debridement of local ulcer), 12 legs were treated by femoral-popliteal arterial bypass (5 with additional debridement of local ulcer), and 31 legs were treated by debridement of local ulcer or amputation merely, and another 23 legs were treated by medical therapy. All diabetic feet treated by surgical treatment were improved obviously without death and severe complications, while 2 cases with medicine therapy died. Conclusion Because of the complexion of the diabetic foot, it should be treated individually, and the key point is to deal with the vascular lesions.