OBJECTIVE The purpose of this study was to find the best material for valvular wrapping operation of deep vein of lower limb and to study the diagnostic value of colored Ultrasonic-Doppler for valvular incompetency of the deep vein and the function of the popliteal valve. METHODS Strips of autogenous saphenous vein, autogenous fascia lata and pieces of polytetrafluroethylene artificial vessel were used respectively as the wrapping material for narrowing the valve in 30 dogs. The results of three different wrapping material were obtained by colored Ultrasonic-Doppler and transpopliteal venography in 78 patients. The hemokinetics of the popliteal valve was examined in 20 normal persons. RESULTS In the saphenous vein and fascia lata groups, diffuse fibrosis and marked narrowing of the femoral vein were found, while in the group of artificial vein graft, the graft was intact without prominent fibrosis and narrowing of the vein. In comparing with the result of venography, the accuracy of diagnosis by colored Ultrasonic-Doppler was 91.86%. The femoral and popliteal venous valves closed at the same time when holding the breath, but the popliteal venous valve opened more widely than the femoral venous valve when the calf muscles of the leg contracted. CONCLUSION It was suggested that the graft was the best material for valvular wrapping operation, and colored Ultrasonic-Doppler was an important and non-invasive method for the diagnosis of incompetency of deep vein. The popliteal venous valve was the important barrier for protection of the function of deep vein.
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.
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.
ObjectiveTo report the preliminary clinical results and analyze the prognostic factors of prosthetic failures with non-cemented modular prosthetic reconstruction after tumor resection in lower extremities.MethodsA clinical data of 150 patients with lower extremity tumors treated with MEGASYSTEM-C non-cemented modular prosthetic reconstruction between October 2011 and September 2016 was retrospectively analyzed. There were 88 males and 62 females, aged from 12 to 81 years, with a median age of 24 years. According to World Health Organization (WHO) classification of bone tumors, 120 cases were primary malignant tumors, 27 cases were intermediate tumors, and 3 cases were metastatic tumors. Among them, 134 cases underwent primary operation and 16 cases underwent reoperation after recurrence. Eighty-seven patients with malignant tumors received chemotherapy before and after operation, and no patient received local radiotherapy during perioperative period. Proximal femur was reconstructed in 32 cases, distal femur in 83 cases, and proximal tibia in 35 cases. The postoperative follow-up time, the results of oncology (survival status and tumor recurrence), and prosthesis failure (prosthesis survival rate, reasons for failure, treatment plan after failure) were recorded. The reason of the prosthesis failure was classified into 5 types according to the classification defined by Henderson et al. Kaplan-Meier survival analysis and Log-Rank test were used to analyze patient and prosthesis survival. Lower extremity function was assessed by using the Musculoskeletal Tumor Society (MSTS) scoring system and MSTS scores were compared for patients with different reconstruction sites.ResultsAll patients were followed up 5-84 months, the median follow-up time was 39 months. During the follow-up period, there were 116 cases of tumor-free survival, 10 cases of tumor-bearing survival, and 24 died of lung metastasis or multiple metastases. The 3-year and 5-year survival rates of 120 patients with primary malignant tumors were 83.1% and 76.6%. There was no significant difference in survival rate between different reconstruction sites (P=0.851). Seven cases (4.7%) had local recurrence at 7-21 months after operation. The 3-year and 5-year survival rates of the prosthesis in 150 patients were 94.4% and 92.5%. There was no significant difference in survival rate between different reconstruction sites (P=0.765). There were 26 failures in 24 patients (16.0%) during the follow-up period. There were 9 cases of type 1 failure, 1 case of type 2 failure, 3 cases of type 3 failure, 5 cases of type 4 failure, and 8 cases of type 5 failure. At last follow-up, 120 of the 126 patients survived without prosthetic failure. Except that the influence of different parts of prosthesis on the incidence of type 4 failure (P=0.029), the influence of chemotherapy on the incidence of type 5 failure (P=0.002) were significant, the influence of other types of failure on different reconstructed parts of prosthesis, initial operation, and perioperative chemotherapy had no significant difference (P>0.05). There were 5 cases of amputation (4 cases of type 5 failure, 1 case of type 4 failure), 3 cases of prosthesis removal (1 case of type 2 failure, 1 case of type 3 failure, 1 case of type 4 failure), 3 cases of revision while keeping the original prosthesis (2 cases of type 1 failure, 1 case of type 5 failure). The overall MSTS score was 24±3. The MSTS scores were 24±3, 25±3, and 23±3 in patients whose reconstruction sites located in proximal femur, distal femur, and proximal tibia, respectively, showing no significant difference (F=3.014, P=0.052).ConclusionThe short-term follow-up showed a lower incidence of complications and good function for MEGASYSTEM-C non-cement modular prosthesis system in treatment of bone defects after lower limb tumor resection. The main factors affecting the early survival of prosthesis were tumor progression and infection.
ObjectiveTo explore the rehabilitation effect of a domestic lower limb rehabilitation robot on patients with chronic stroke.MethodsChronic stroke patients who were hospitalized in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Chongqing Medical University from September 2017 to August 2019 were collected. These patients underwent A3 robot-assisted gait training for 6 weeks. The differences of gait parameters, spatiotemporal asymmetries, total score and score of each item of Barthel Index were analyzed before and after 6 weeks training.ResultsA total of 15 patients were included, and 12 patients finally completed the trial. After the training, the gait parameters of patients with chronic stroke were significantly improved. Comparing with the baseline data, the cadence, stride length, velocity, step length of the affected leg, and step length of the healthy leg significantly increased (P<0.05) after the training; the stride time and the double-support time were significantly shorter (P<0.05); the stance phase of the affected leg was shortened (P<0.05); the swing phase of the affected leg was prolonged (P<0.05); While no significant difference in the stance phase or swing phase of the healthy leg was found (P>0.05). The spatiotemporal asymmetries had no significant change compared with the baseline data, including the ratio of step length [(1.26±0.23) vs. (1.13±0.10); t=1.816, P=0.097] and the ratio of swing phase of both lower limbs [1.14 (0.23) vs. 1.10 (0.38); Z=−0.153, P=0.878]. The activities of daily living were improved after the training, and the total score of Barthel Index [(72.92± 13.05) vs. (85.42±14.38); t=−6.966, P<0.001] was significantly higher than that before the training. Among the items, the scores of bathing [0.00 (3.75) vs. 5.00 (5.00); Z=−2.000, P=0.046], walking on the flat ground [10.00 (3.75) vs. 15.00 (5.00); Z=−3.000, P=0.003], and going up and down stairs [5.00 (5.00) vs. 7.50 (5.00), Z=−3.000, P=0.003] were higher than the baseline data, and the differences were statistically significant.ConclusionsA3 robot-assisted gait training can effectively improve the walking ability and activities of daily living of patients with chronic stroke but not the spatiotemporal asymmetries. Whether the spatiotemporal asymmetries can be improved by adjusting the robot equipment parameters needs to be further studied.
Objective To analyze the effectiveness of free vascularized fibula grafts (FVFG) for extensive bone defects after resection of lower limb malignant bone tumors. Methods Between November 2015 and July 2018, 15 cases of lower limb malignant bone tumors were treated. There were 12 males and 3 females with an average age of 12.3 years (range, 9-21 years). There were 11 cases of osteosarcoma and 4 cases of Ewing’s sarcoma. The tumor located at middle femur in 8 cases, lower femur in 4 cases, and middle tibia in 3 cases. The disease duration was 2-6 months (mean, 3.2 months). The tumor was completely removed, and the length of the bone defect was 8-23 cm (mean, 17.7 cm). The bone defect was repaired by FVFG, and combined inactivated tumor bone was used in 8 cases of femoral bone defect. Results The average operation time was 280 minutes (range, 180-390 minutes). The average blood loss was 310 mL (range, 200-480 mL). All incisions healed by first intention. All patients were followed up 2-24 months with an average of 14.5 months. Bone healing achieved in all patients at 9-18 months (mean, 12.3 months) after operation except 1 patient which was followed up only 2 months. The fibula grafts had active metabolism and the average bone metabolism score was 184 (range, 111-257) in effected side and 193 (range, 127-259) in contralateral side. There was no difference between bilateral sides. The average Enneking score was 24.6 (range, 20-30) at last follow-up. No ankle instability or paralysis of common peroneal nerve occurred. Conclusion FVFG appeared very efficient in repair of extensive bone defect after resection of lower limb malignant bone tumor.
Objective To explore clinical effect and safety of rivaroxaban in treatment of acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs. Methods The clinical data of 60 patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, collected from January 2010 to March 2017 in Hunan Provincial People’s Hospital, were retrospectively analyzed. According to the different treatment, these patients were randomly divided into a rivaroxaban group and a control group (traditional warfarin anticoagulation), with 30 patients in each group. The clinical effect and safety were compared between two groups on the 10th day, 20th day and 30th day after treatment. Results Compared with the control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and main pulmonary artery diameter measured by CTPA and echocardiography in the rivaroxaban group were not significantly different on the 10th day, 20th day and 30th day after treatment. However, the intragroup differences were statistically significant at different timepoint (P<0.05). Levels of N-terminal-pro-brain natriuretic peptide of two groups after treatment were significantly reduced on the 10th day, 20th day and 30th day after treatment, and the values of PO2 were significantly increased on the 10th day and 20th day after treatment (P<0.05), but no significant differences were found in the values of PO2 on 20th day and 30th day after treatment. D-dimer in the two groups was obviously increased on the 10th day after treatment but significantly declined on the 20th day and 30th day after treatment (all P<0.05). These changes were predominant in the rivaroxaban group. Conclusion Rivaroxaban is effective and safe for acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, and worthy of clinical implementation and application.
ObjectiveTo investigate the surgical method and preliminary effectiveness of Ilizarov technique in the treatment of lower limb deformity caused by achondroplasia. MethodsThe clinical data of 38 patients with lower limb deformity caused by achondroplasia treated by Ilizarov technique between February 2014 and September 2021 were retrospectively analyzed. There were 18 males and 20 females, the age ranged from 7 to 34 years, with an average of 14.8 years. All patients presented with bilateral knee varus deformity. The preoperative varus angles was (15.2±4.2)°, and knee society score (KSS) was 61.8±7.2. Nine of these patients underwent tibia and fibula osteotomy, 29 cases underwent tibia and fibula osteotomy and bone lengthening at the same time. Full-length bearing position X-ray films of bilateral lower limbs were taken to measure the bilateral varus angles, analyze the healing index, and record the occurrence of complications. KSS score was used to evaluate the improvement of knee joint function before and after operation. Results All 38 cases were followed up 9-65 months, with an average of 26.3 months. Needle tract infection occurred in 4 cases and needle tract loosening occurred in 2 cases after operation, which were improved after symptomatic treatment such as dressing change, Kirschner wire change, and oral antibiotics, and no neurovascular injury occurred in all patients. The external fixator was worn for 3-11 months after operation, with an average of 7.6 months, and the healing index was 43-59 d/cm, with an average of 50.3 d/cm. At last follow-up, the leg was 3-10 cm longer, with an average of 5.5 cm. The varus angles was (1.5±0.2)° and the KSS score was 93.7±2.6, which significantly improved when compared with those before operation (P<0.05). ConclusionIlizarov technique is a safe and effective method for the treatment of short limb with genu varus deformity caused by achondroplasia, which can improve the quality of life of patients.
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
Lower extremity movement is a complex and large range of limb movement. Arterial stents implanted in lower extremity are prone to complex mechanical deformation, so the stent is required to have high comprehensive mechanical properties. In order to evaluate the mechanical property of different stents, in this paper, finite element method was used to simulate and compare the mechanical properties of six nitinol stents (Absolute Pro, Complete SE, Lifestent, Protégé EverFlex, Pulsar-35 and New) under different deformation modes, such as radial compression, axial compression/tension, bending and torsion, and the radial support performance of the stents was verified by experiments. The results showed that the comprehensive performance of New stent was better than other stents. Among which the radial support performance was higher than Absolute Pro and Pulsar-35 stent, the axial support performance was better than Complete SE, Lifestent and Protégé EverFlex stent, the flexibility was superior to Protégé Everflex stent, and the torsion performance was better than Complete SE, Lifestent and Protégé Everflex stent. The TTR2 type radial support force tester was used to test the radial support performance of 6 types, and the finite element analysis results were verified. The mechanical properties of the stent are closely related to the structural size. The result provides a reference for choosing a suitable stent according to the needs of the diseased location in clinical applications.