Objective To explore the effective method and the feasibil ity of the accurate l imb length equal ization in patients undergoing total hip arthroplasty (THA). Methods From September 2006 to September 2008, 52 patients underwentunilateral THA, including 36 males and 16 females, with an average age of 61.5 years (range, 46-76 years). Among these cases, there were 22 cases of avascular necrosis of the femoral head, 12 cases of hip osteoarthritis, 11 cases of femoral neck fracture, 4 cases of congenital dislocation of hip, and 3 cases of acetabular dysplasia. Forty cases had leg length discrepancy, and the shortened length of the legs was in the range of 10 mm to 35 mm with an average of 20 mm. The mean Harris score before operation was 45 points (range, 36-58 points). Based on the cl inical measurement and radiographic examination, the surgical protocols were designed, the type of the hip prosthesis was chosen, and the neck length of the femoral prosthesis, and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. 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 intended leg-length equal ization. The discrepancy of the leg length was measured and evaluated after operation. Results The incision healed by first intention in all patients. One patient had ischiadic nerve palsy and achieved full restoration after 5 months of symptomatic management. Forty-four patients were followed up 16 months on average (7-32 months). The mean Harris score was 87.5 points (80-91 points), showing significant difference (P lt; 0.05) whencompared with that before operation. The l imb length equal ization were got in 35 patients (equal ization rate was 79.5%). Seven patients had the prolong leg (from 10 mm to 18 mm), 2 patients had the shortened legs (15 mm and 25 mm, respectively). Conclusion By measurement of leg-length and radiographic examination before and during operation, the problem of unequal leg - length can be solved during the THA.
【摘要】 目的 探討2型糖尿病合并下肢血管病變血管內介入治療的臨床意義。 方法 2009年1-5月對4例2型糖尿病合并下肢血管病變患者，根據血管狹窄情況選擇不同介入治療方式，行下肢動脈造影及動脈球囊擴張或支架成形術。 結果 4例患者均有表現靜息痛及間歇性跛行，下肢血管超聲顯示糖尿病下肢動脈有不同程度的斑塊、狹窄與血栓形成，病變累及下肢股動脈、髂動脈及脛前、足背動脈。介入治療后患者下肢血管灌注得到明顯改善，靜息痛及間歇性跛行明顯改善，皮溫改善，需要截肢患者截肢平面顯著降低。 結論 通過下肢血管DSA造影檢查，準確了解糖尿病患者下肢血管的阻塞部位及程度，在保守治療基礎上選擇不同方式的介入治療，有助于下肢血管病變的明顯改善。【Abstract】 Objective To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities. Methods From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy. Results Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased. Conclusion It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.
目的:通過踝肱指數 (ABI)檢查,探討2型糖尿病患者下肢動脈病變 (PAD)的患病率及其影響因素。方法:采用血管多普勒診斷儀對120名 2型糖尿病患者進行 ABI測定,ABIlt;0. 9為 PAD組,ABI≥0. 9為非PAD組,分析比較2組患者的代謝參數。結果:檢出ABIlt;0.9者31例,占總例數的25. 8%。與非 PAD組比較, PAD組患者年齡大、病程長,餐后2h血糖、SBP 、DBP、TG、LDL C、HbA1c均明顯升高,有顯著性差異 (Plt;0.05)。結論:ABI在診斷2型糖尿病下肢動脈病變中具有重要意義;年齡、病程、高 LDLC、高TG、高血糖、高血壓為下肢動脈病變的主要危險因素。
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.
目的:探討磁共振血管造影(MRA)以及計算機斷層掃描血管成像(CTA)對地震擠壓傷下肢血管病變的臨床價值。方法:對5·12汶川大地震中我院收治的已確診為地震擠壓傷致雙下肢橫紋肌溶解癥3例患者進行雙下肢MRA檢查,并對嚴重擠壓傷及下肢毀損,并行截肢的另三名患者進行術后CTA檢查。對MRA圖象雙下肢動脈進行回顧性分析,總結MRA征象,同時總結截肢術后患者CTA表現及臨床價值,并評價二者檢查在擠壓傷所至橫紋肌溶解癥的臨床診治中的作用。結果:3例未行截肢患者MRA雙下肢主要動脈未見確切狹窄及閉塞征象,管腔內未見充盈缺損影。3例已行截肢患者可見殘余肢體的明顯腫脹,雙側髂血管以及部分截斷肢體遠端血管內見止血彈簧鋼圈影像,部分截斷肢體遠端動脈分支變細。截斷血管未見再通,周圍無滲血改變。結論:MRA、CTA能直觀顯示雙下肢動脈損傷及術后情況,在臨床應用中各有優勢和局限性。對二者的合理選擇能為臨床診治提供有利信息。
Objective To investigate the cl inical results of the flap pedicled with collateral branch of descendingrarus of lateral circumflex femoral artery with digital three-dimensional reconstruction technique for lower l imb soft tissue defects. Methods Between March 2009 and January 2010, 7 patients with lower l imb soft tissue defects were treated with free flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery. There were 6 males and 1 female with an age range from 6 to 51 years. They were injured by traffic accident (4 cases), or by object hit from height (3 cases). The locations were foot in 2 cases, ankle in 2 cases, and anterior tibia in 3 cases. The disease duration was 8 hours to 40 days (mean, 20 days). All the cases compl icated by exposure of tendons or bones. The areas of soft tissue defect ranged from 12 cm × 7 cm to 20 cm × 14 cm. Free flaps were transplanted at 4 to 16 days after symptomatic treatment. Before operation, all the flaps were designed with digital three-dimensional reconstruction technique. The size of flaps ranged from 15 cm × 9 cm to 22 cm × 16 cm The donor sites were closed directly in all cases. Results All the flaps survived. The wounds and incisions at donor sites healed by first intention. All the patients were followed up 6 to 12 months. The texture, appearance, and function of the flaps were satisfactory, and no compl ication occurred. All the flaps had protective sensation, which could meet the requirement of the daily l ife. The function of ankle was satisfactory with normal walk; the extension was 19-22° and the flexion was 30-36°. No obvious scar formed at donor sites. Conclusion The flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery has rel iable blood supply, easy operation, l ittle influence on the donor site, and high success rate with digital three-dimensional reconstruction technique. It is an excellent option for repairing lower l imb soft tissue defects.
Objective To observe the effect of autologous peripheral blood stem cells(PBSC) transplantation in the treatment of ischemic lower extremity disorders. Methods Therapeutic group:fortyfive patients received recombinant human granulocyte colony-stimulating factor 450 to 600 U/d by hypodermic injection for 5 days to mobilize stem cells.On the 6th day,PBSC were collected by COBE 6.1 Spectra Version and were injected into ischemic lower extremity. Control group:33 patients were treated with dilating vessels drugs. After operation some indexes were evaluated. Results After operation, these indexes were improved. Skin temperature and TcpO2 were improved obviously, being statistically significant difference(P＜0.05). Conclusion Autologous PBSC transplantation might be a safe and effective method for treating lower extremity ischemic disorder. It could improve the quality of life of many patients as amputation of lower extremity of foot might be avoided or reduced.
This article presents the design of a motion control system for seated lower-limb rehabilitation training. The system is composed of lower limb exoskeleton, motor drive circuit, program of motion control, and so forth. The power of lower limbs joints is provided by six motors. The PCI-1240 motion control card is used as the core. This study achieved repetitive rotation training and gait trajectory training of lower limbs joints, of which the velocity, angle and time can be accurately controlled and adjusted. The experimental results showed that the motion control system can meet the requirement of repetitive rehabilitation training for patients with lower limb dysfunction. This article provides a new method to the research of motion control system in rehabilitation training, which can promote industrial automation technique to be used for health care, and conducive to the further study of the rehabilitation robot.
目的：探討綜合康復治療體系對54例地震致下肢骨折患者功能恢復的影響。方法：采用綜合康復治療方法治療“5·12”汶川大地震所致54例下肢骨折患者，臨床觀察患者傷口的愈合情況和骨折的復位情況，有無骨折并發癥，分析比較治療前后患者下肢功能恢復情況及日常生活活動能力的改善。結果：康復治療后關節活動度明顯改善，由入院時的平均218.61°增加至出院時的237.5°（P＜0.001）。Barthel指數由入院時的平均55.4增加至出院時的70.8（P＜0.001），日常生活活動能力有較大幅度提高。結論：綜合康復治療體系對于地震傷致下肢骨折患者的功能恢復至關重要，一套完善的體系應包括：①康復治療早期介入，功能鍛煉長期堅持；②發揮大型綜合性醫院的優勢，多學科交叉，多部門合作；③功能康復和心理康復并重；④專業人士與社會團體共同參與。