ObjectiveTo summarize the research progress of tibial transverse transport (TTT) in treatment of chronic ischemic diseases of the lower extremities.MethodsThe related literature was systematically searched and the mechanisms, clinical treatment methods, clinical efficacy, indications, contraindications, and complications of TTT were discussed.ResultsBased on the law of tension-stress, TTT is a new method in the treatment of chronic ischemic diseases of the lower extremities. It can relieve the ischemic symptoms, promote the wound healing, and increase the limb salvage rate. The clinical application in recent years has shown good effectiveness, and the scope of application is expanding.ConclusionDue to the current limited clinical application, the sample size of the TTT for the chronic ischemic diseases of the lower extremities is relatively small, and the follow-up time is limited. So its validity, long-term effectiveness, and bone transport standards are need further research.
Objective To evaluate the effectiveness and safety of surgical thrombectomy for acute deep venous thrombosis of lower extremities. Methods Randomized controlled trials of surgery versus conservative treatment were sought from MEDLINE (1966-Jun.2006), EMbase (1974-Jun.2006), The Cochrane Library (Issue 2, 2006), CBM (1989-Jun. 2006) and CMCC (1994-Jun. 2006). Collections of Chinese Congress on Vascular Surgery (1991-Jun.2006) and the journal of Vascular Surgery (2000-Jun. 2006) were handsearched. Two reviewers independently extracted data into a designed extraction form. The guidance in The Cochrane Collaboration’s Handbook was consulted for quality evaluation and data analysis. Results Six potentially eligible studies were identified. Six were included according to the inclusion criteria. The 6-month total patency was significantly higher in the surgical treatment group than in the conservative treatment group with OR 7.26 and 95%CI 2.40 to 21.94, while the 5-year total patency was not different between the two groups with OR 2.59 and 95%CI 0.88 to 7.67. At month 6 and year 5, the incidence of post-thrombosis syndrome (PTS) was significantly higher in the conservative treatment group than in the surgical treatment group with OR 0.11, 95%CI 0.59 to 1.59, OR0.18, 95%CI 0.06 to 0.60 respectively. The incidence of 10-year PTS and the results of valvular function measurements were similar between the two groups. The incidence of pulmonary thrombosis was also comparable between the two groups with OR 1.40 and 95%CI 0.39 to 4.97. Conclusion Surgical thrombectomy may improve the extent of patency and venous valvular sufficiency in the short term, but without increasing the patency rate. There is no enough evidence to assess whether surgical throbectomy improves long-term outcomes. It is safe to preform surgical thrombectomy. The small number of patients randomised and the low quality of the trials decreases the reliability of the current evidence. Therefore, more high quality randomised controlled studies should be done, to determine the long-term outcomes of surgical thrombectomy.
Objective To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities. Methods The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases, including arterial occlusive disease (AODs,62 patients) and thromboangiitis obliterans (TAOs,28 patients). By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients, the immediate and the longterm surgical outcomes were summarized. Results During the hospitalization, 88 patients achieved a remarkable surgical effectiveness, with an immediate surgical effectiveness rate of 97.7% (88/90), but 2 patients failed in the operation and had to undergo amputation of the lower limb. Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation, 64 could have a sufficient blood supply to the lower extremities, with a longterm effectiveness rate of 88.9% (64/72); however, 8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb. Conclusion The one-stage arteriovenous shunt performedon the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.
Objective To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture. Methods The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups (P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups. Results There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group (P<0.05). There was no significant difference in the quality of fracture reduction between the two groups (P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups (P>0.05). ConclusionFor femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal people, and the risk of developing coronary atherosclerosis is much higher than that in other high-risk groups. Numerous studies have confirmed that high systolic and diastolic blood pressures are potential risk factors for coronary artery disease, and it has been demonstrated that the ascending aortic pressure during diastole increases after amputation. However, the relationship between lower limb amputation and coronary atherosclerosis has not been fully explained from the perspective of hemodynamic environment. Therefore, in this study, a centralized parameter model of the human cardiovascular system and a three-dimensional model of the left coronary artery were established to investigate the effect of amputation on the hemodynamic environment of the coronary artery. The results showed that the abnormal hemodynamic environment induced by amputation, characterized by factors such as increased diastolic pressure in the ascending aorta, led to a significant expansion of the low wall shear stress (WSS) region on the outer lateral aspect of the left coronary artery bifurcation during diastole. The maximum observed increase in the area of low WSS reached up to 50.5%. This abnormal hemodynamic environment elevates the risk of plaque formation in the left coronary artery. Moreover, the more severe the lower limb atrophy, the greater the risk of coronary atherosclerosis in amputees. This study preliminarily reveals the effect of lower limb amputation on the hemodynamic environment of the left coronary artery.
Lower extremity atherosclerotic disease (LEAD) is one of the serious chronic diseases globally. In recent years, medical advancements have led to significant progress in LEAD treatment, yet certain challenges remain. Within the diagnostic and therapeutic process for LEAD, a shift from the traditional open surgical model to an endovascular treatment approach has yielded marked success. However, it is necessary to guard against an oversimplified diagnostic and therapeutic mindset. Personalized diagnosis and treatment should be administered based on the patient’s condition and the nature of the lesions. In real-world practice, there is often a disproportionate emphasis on revascularization procedures, overlooking comprehensive assessment and holistic management. Consequently, a recent trend has emerged, shifting the focus from mere revascularization to integrated, full-process management. This paper provides a comprehensive exposition on preoperative diagnosis and holistic assessment, the rational selection of primary treatment methods and surgical techniques, and the optimization of treatment strategies across the full life cycle, while underscoring the importance of whole-process management. It further explores the implications of this transition and its potential for future development.
ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
ObjectiveTo explore the feasibility and technical essentials of soft tissue defect reconstruction of the lower extremity using the distally based anteromedial thigh flap (dAMT) pedicled with perforating vessels from rectus femoris branch. MethodsBetween July 2008 and December 2015, 6 patients underwent defect reconstruction of the lower extremity using the dAMT flap pedicled with perforating vessels from rectus femoris branch. There were 4 males and 2 females with an average age of 34 years (range, 4-55 years). The etiologies included liposarcoma in 1 case, malignant fibrous histocytoma in 1 case, post-burn scar contracture around the ankle in 1 case, and post-burn scar contracture around the knee in 3 cases. The disease duration ranged from 3 to 28 months (mean, 13 months). After resection of lesion tissues, the defect size ranged from 13 cm×7 cm to 24 cm×12 cm. The flap size ranged from 15 cm×8 cm to 24 cm×12 cm. The length of the pedicle ranged from 10 to 25 cm (mean, 19.8 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 8 to 13 cm (mean, 11.3 cm). The donor sites were directly sutured. ResultsAll flaps survived postoperatively without any complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 36 months (mean, 17.8 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the joint were greatly improved in the patients with scar contracture. ConclusionIf the rectus femoris branch gives off cutaneous branch to the anteromedial thigh region and arises from the descending branch of the lateral circumflex femoral artery, a dAMT flap could be raised to reconstruct soft tissue defects of the lower extremity.
In order to improve the motion fluency and coordination of lower extremity exoskeleton robots and wearers, a pace recognition method of exoskeleton wearer is proposed base on inertial sensors. Firstly, the triaxial acceleration and triaxial angular velocity signals at the thigh and calf were collected by inertial sensors. Then the signal segment of 0.5 seconds before the current time was extracted by the time window method. And the Fourier transform coefficients in the frequency domain signal were used as eigenvalues. Then the support vector machine (SVM) and hidden Markov model (HMM) were combined as a classification model, which was trained and tested for pace recognition. Finally, the pace change rule and the human-machine interaction force were combined in this model and the current pace was predicted by the model. The experimental results showed that the pace intention of the lower extremity exoskeleton wearer could be effectively identified by the method proposed in this article. And the recognition rate of the seven pace patterns could reach 92.14%. It provides a new way for the smooth control of the exoskeleton.
Objective To discuss the reconstructive method of the bone defect after resection of the upper extremity bone tumor and to assess the outcome of the autograft to reconstruct the bone defect after the bone tumor resection. Methods From August 1998 to March 2004,16 patients aged 7~45 years suffering from bone tumor of the upper extremity were treated with the wide resection of the bone tumor and the reconstruction of the bone defect by the autograft. The following diagnoses were confirmed by pathological examination:Ewing’s sarcoma and osteosarcoma of theproximal humerus in 1 patient each; Ewing’s sarcoma of the distal humerus in 2 patients;giant cell tumor in 8 patients, highgrade chondrosarcoma in 2, malignant fibrohistiocytoma in 1; and osteosarcoma in 1 of the distal radius. Substitution of the proximal humerus with the clavicle was performed in 2 patients, andthedistal humerus with the fibula in other 2 patients. Of the 12 patients with tumor in the distal radius, 1 was reconstructed with autograft of the iliac bone and 11 with autograft with the fibula. The functional outcome was evaluated by the MSTS score. Results The follow-up for 36 and 12 months respectively revealed that in the 2 patients undergoing the autograft with the clavicle in the proximal humerus, good shoulder functions of flexion and extension were obtained although the function of abduction was poor, with the MSTS scores of 23 and 22 respectively. In the 2 patients undergoing the autograft with the fibular in the distal humerus, good elbow function and bone union were observed according to the followup for 3 and 4 months respectively, with the MSTS scores of 24 and 19 respectively. Of the 12 patients undergoing the autograft in the distal radius, 11 had an excellent or good function with no complication, with the average MSTS score of 22.6 (ranging from 18 to 27), accordingto the follow-up for 6-75 months; only 1 had no bone union 10 months after operation and lost the follow-up afterwards. Conclusion Reconstruction ofthe bone defect with the autograft after the wide resection of the upper extremity bone tumor is an ideal and reliable method for some suitable patients, especially for some children.