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。
Objective To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE). Methods The related literatures on ASOLE detection means adopted clinically were reviewed, and their advantages and disadvantages were compared.Results Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI), which was a good index for arterial function assessment of lower extremity. Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI, and therefore more suitable for screening of a large sample. ASI was an index to assess arterial structure and function, and it had a good correlation with PWV. Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell; Pulse wave measurement was simple, sensitive, and its result was reliable. Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time. Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography, but its inherent shortcomings, such as nephrotoxicity of contrast agent, was still need to be resolved. 3D-contrast enhancement magnetic resonance angiography (CEMRA) had little nephrotoxicity, but a combination of other imaging methods was necessary. Microcirculation detections required high consistency of the measurement environment, but they were simple, sensitive and noninvasive, and therefore could be used for screening of ASO. Conclusion Publicity and education of highrisk groups, and reasonable selection of all kinds of detection means, are helpful to improve the early diagnosis of ASOLE.
【摘要】 目的 〖JP2〗评价腔静脉滤器植入联合足背静脉溶栓在下肢深静脉血栓（DVT）治疗中的疗效。 方法 2006年12月-2009年10月，对26 例下肢深静脉血栓患者行下腔静脉滤器植入术，并结合足背静脉溶栓治疗。 结果 26例患者均未出现大出血和致死性肺动脉栓塞等严重并发症，彩色多普勒超声显示17例患者下肢DVT 完全溶解，11例部分溶解。 结论 介入性综合治疗下肢DVT 是一种安全可行、疗效好的方法。【Abstract】 Objective To evaluate the therapeutic effect of filter planting combining thrombolysis therapy through the dorsum pedis vein on patients with deep veins thrombosis of lower limb. Methods The clinical data of 26 patients from December 2006 to October 2009 were retrospectively analyzed. All the patients underwent filter planting combining thrombolysis therapy through the dorsum pedis vein. Results There was no serious complication such as hemorrhea or fatal pulmonary embolism. The phlebothrombosis was fully dissolved in 11 patients and partial dissolved in 17 patients. Conclusion Interventional combined therapy is safe and effective for deep venous thrombosis of lower limb.
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 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 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 investigate the effect of Navio robot-assisted unicompartmental knee arthroplasty (UKA) on the biomechanics of knee joint during sitting-up movement, and to determine whether UKA can maintain the biomechanical characteristics of knee joint. Methods The clinical data of 8 patients with medial compartment osteoarthritis treated with medial fixed platform of Navio robot-assisted UKA between January 2018 and January 2019 and had the complete follow-up data were retrospectively analyzed. There were 4 males and 4 females; the age ranged from 58 to 67 years, with an average of 62.3 years. The disease duration was 6-18 months, with an average of 13 months. The varus deformity ranged from 4° to 6°, with an average of 5°; the knee flexion range of motion was 0°-130°, with an average of 110°. All patients had no extension limitation. The imaging data of bilateral knees during sitting-up movement were collected by biplane C-arm X-ray machine at 3 weeks before operation and 7 months after operation. The three-dimensional models of femur and tibia were established by dual-energy CT scanning, and the three-dimensional models of femur and tibia were matched and synchronized with the femur and tibia in X-ray film by automatic matching tracer software. The biomechanical parameters of femur and tibia were measured, including internal rotation/external rotation, varus/valgus, forward/backward displacement of medial and lateral tibia contact center, and lateral compartment joint space. Results Eight patients were followed up 5-7 months, with an average of 6.4 months. In the comparison of the affected side before and after operation, except for the difference of varus/valgus which was significant (t=4.959, P=0.002), the differences in other indicators was not significant (P>0.05). There were significant differences in varus/valgus and internal rotation/external rotation between healthy and affected sides at 3 weeks before operation (P<0.05), and the differences in other indicators was not significant (P>0.05). At 7 months after operation, the difference in the forward and backward displacement of medial tibia contact center was significant (t=3.798, P=0.007), and the differences in other indicators was not significant (P>0.05). Conclusion UKA can effectively correct the varus and valgus of the knee joint, and restore the rotational biomechanical characteristics of the affected knee joint. It does not affect the establishment of the lateral compartment joint space, but the medial and lateral tibia contact center still changes.
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.
In the process of lower limb rehabilitation training, fatigue estimation is of great significance to improve the accuracy of intention recognition and avoid secondary injury. However, most of the existing methods only consider surface electromyography (sEMG) features but ignore electrocardiogram (ECG) features when performing in fatigue estimation, which leads to the low and unstable recognition efficiency. Aiming at this problem, a method that uses the fusion features of ECG and sEMG signal to estimate the fatigue during lower limb rehabilitation was proposed, and an improved particle swarm optimization-support vector machine classifier (improved PSO-SVM) was proposed and used to identify the fusion feature vector. Finally, the accurate recognition of the three states of relax, transition and fatigue was achieved, and the recognition rates were 98.5%, 93.5%, and 95.5%, respectively. Comparative experiments showed that the average recognition rate of this method was 4.50% higher than that of sEMG features alone, and 13.66% higher than that of the combined features of ECG and sEMG without feature fusion. It is proved that the feature fusion of ECG and sEMG signals in the process of lower limb rehabilitation training can be used for recognizing fatigue more accurately.