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 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.
目的观察激光腔内闭合联合点式切除治疗下肢静脉曲张的疗效。方法回顾性分析我科2007年5月至2011年1月期间采用激光腔内闭合联合点式切除治疗310例下肢静脉曲张患者的临床资料，其中男121例，女189例，共406条肢体; 平均年龄52.6岁。结果所有患者术后临床症状得到改善，术后第3天查彩超显示所有大隐静脉主干完全闭合。36例合并皮肤溃疡患者中25例术后经换药后溃疡面明显缩小，11例术后3个月溃疡面愈合。术后有110例出现不同程度患肢皮下瘀斑，15例出现大隐静脉行程的皮下血肿，未予特殊处理，术后2~3周后均自行好转。术后出现小腿中下段内侧皮肤麻木及感觉障碍118例，术后3个月均有不同程度好转。所有患者切口一期愈合，无切口感染，未出现皮肤烧灼伤及术后下肢深静脉血栓形成。平均住院时间6.3 d。结论激光腔内闭合联合点式切除是治疗下肢静脉曲张的微创、安全及有效的方法。
Objective To summarize the research about the stability of deep venous thrombosis (DVT) of the lower extremity in recent years. Methods The literatures about the stability of DVT of lower limbs at home and abroad in recent years were reviewed. Results There are few studies on the stability of DVT at home and abroad, which limited on the floating thrombus. Conclusion The stability of DVT can be effectively evaluated by SOMATOM Force CT (The third generation dual source CT).
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.
ObjectiveTo explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery (DCIA) on the repair of lower limb composite defect wounds with cavity. MethodsA retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted, including 4 males and 3 females, aged 24-58 years, with a median age of 37 years. The causes of injury were machine twisting injury in 2 cases, fall from height injury in 2 cases, and traffic accident injury in 3 cases. According to Gustilo-Anderson classification, there were 1 case of type Ⅲa, 4 cases of type Ⅲb, and 2 cases of type Ⅲc (combined with anterior tibial artery rupture); according to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 2 cases of type 42-C3, 2 cases of type 43-A2, and 3 cases of type 43-B1. The time from injury to admission ranged from 2 to 10 hours, with an average of 6 hours. Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement. In the second stage, according to the characteristics of the wound, the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap. The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm, and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm. The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm. The donor site was primarily closed. ResultsAll the flaps survived after operation, except for 1 case of partial necrosis of the flap edge, which healed after secondary skin grafting, and the donor and recipient wounds healed by first intention. All patients were followed up 16-24 months, with an average of 18 months. The broken end of the bone defect healed well, and the healing time was 8-10 months, with an average of 7.3 months. At last follow-up, the shape of the flap was satisfactory, the texture was soft, and there was no abnormal hair growth, pigmentation, and so on. Only linear scar was left in the donor site, and no complication such as abdominal hernia occurred. According to Paley fracture healing scoring system, bone healing was rated as excellent in 5 cases and good in 2 cases. The limb function was satisfactory, and full weight bearing was achieved at 12-16 months after operation. According to the lower extremity functional scale (LEFS), 6 cases were excellent and 1 case was good. Conclusion The iliac myocutaneous flap pedicled with DCIA is flexible in design and highly free in tissue composition, which can repair the composite defect wound of lower limbs with deep cavity in a three-dimensional way, and repair the limb shape and reconstruct weight-bearing function to the greatest extent.
Objective To explore the treatment of thromboangitis obliterans (TAO) of lower extremities. Methods From March 1994 to February 2009, 24 cases (26 limbs) affected by chronic ischemia were diagnosed as TAO by Doppler ultrasound and DSA, CTA or MRA. According to the different levels of the extensive and diffuse arterial occlusion, the revascularization was performed in the ways: 19 cases (21 limbs) underwent venous arterialization, 3 cases (3 limbs) underwent endovascular therapy, and 2 cases (2 limbs) underwent thrombectomy. Results After the venous arterialization, 19 cases (21 limbs) were followed up for 1 to 14.5 years. Apart from the 5 limbs amputation (23.8%), the postoperative results of the most limbs were satisfactory (61.9%). The ABI before therapy (0.38±0.11) was significantly lower than that 6 months after therapy (0.79±0.08), Plt;0.05. In 3 cases (3 limbs) underwent endovascular therapy, one case failed and then received the venous arterialization. Two cases (2 limbs) finished thrombectomy successfully. After endovascular therapy and thrombectomy, these 4 cases were followed up for 1 to 4 years without the amputation. ConclusionIn order to improve the curative effect, it is important to choose the suitable therapeutic strategy according to the different levels of the extensive and diffuse arterial occlusion. The venous arterialization is an effective treatment for TAO of lower extremities.
ObjectiveTo discuss the implantation and conversion technology of convertible inferior vena cava filter and the experience of management.MethodsThe clinical data of 115 patients with convertible inferior vena cava filter implantation admitted to our vascular surgery center from January 2018 to December 2018 was retrospectively analyzed.ResultsAmong the 115 patients with convertible inferior vena cava filter implantation, 74 were males and 41 were females. The ages ranged from 22 to 87 years, with median age 54 years. The successful rate of filter implantation was 100% without any surgical related complications. After implantation surgery, patients were followed up from 4 to 455 days with a median of 90 days and the recurrence rate of adverse events was 7.8% (9/115). The recurrence time were 16 to 104 days after conversion, with a median of 42 days. Twenty-three patients (20.0%) received filter conversion, one of them failed and all the others succeeded. The technical successful rate was 95.7% (22/23). The conversion operative time was 22.8 to 51.4 min, with median time 27.4 min. The intervals between implantation and conversion were from 4 to 455 days, with median time 159 days. Accessory techniques were used in 20 of 22 successful filter conversions and the application rate of accessory technique was 90.9%. The patients were followed-up from 30 to 180 days after conversion with a median time of 90 days and no adverse event was reported.ConclusionConvertible inferior vena cava filter is a significant choice for patients application of inferior vena cava filter due to its high safety of conversion surgery, technical success rate and possibility of conversion after long-term indwelling.
ObjectiveTo summarize the experience of treating lower extremity deep venous thrombosis (DVT) after repair of inguinal hernia. MethodThe clinical data of 1 812 patients who underwent herniorrhaphy from January 2002 to December 2012 were reviewed, and we analyzed such data as age, gender, and the formation of DVT. ResultsFive of them suffered from DVT (0.28%), including 2 cases involving both lower extremities, 1 right and 2 left extremity. All of them were discharged from hospital by anticoagulant therapy and there was no pulmonary embolism and death case. DVT recovered well in 4 cases half a year after being discharged from the hospital. One had a sequela of recurrent swelling of the left lower extremity. ConclusionsReasonable precautions and treatment against DVT are very important even though DVT rate after inguinal hernia repair is low.
目的:着重分析汶川地震中伤员下肢骨折的发生部位、类型及其产生机制和临床意义。方法:对5·12汶川大地震发生后近2个月内先后送至四川大学华西医院治疗的496例下肢骨折伤员,按X线检查结果对骨折部位及类型进行分析。结果:下肢多部位粉碎性骨折而截肢者29例(5.8％),其余467例伤员共584个部位发生骨折。按骨折部位分类:股骨162个(27.7％),胫腓骨275个(47.1％),髌骨19个(3.3％)以及足骨128个(21.9％)。按骨折类型分类:粉碎性骨折244个(41.8％),斜行骨折194个(33.2％),横行骨折53个(9.1％),线性骨折35个(6.0％),螺旋形骨折33个(5.7％),嵌插骨折17个(2.9％),凹陷性骨折2个(0.3％),同一部位(胫腓骨骨干)的多种类型骨折6个(1.0％)。结论:本组汶川地震造成的下肢骨折,部位以胫腓骨为主;类型以粉碎性骨折为主。常规X线检查对下肢骨折伤员具有简便、快速和准确的诊断价值。