摘要:目的:比较不同人群踝肱指数（ABI）的测量值,探讨糖尿病大血管病变的多发性及相关性 。方法: 对2007年2月至2009年5月间在本院住院的49名经冠状动脉造影和/或心肌损伤三项及心电图临床证实心肌梗死的糖尿病患者,及50名经冠状动脉造影和/或心肌损伤三项及心电图临床证实无冠脉病变的糖尿病患者,并另选取50名无糖尿病及冠心病的对照50人共149例行下肢检查,分析各组ABI的特点。结果: 三组间ABI比较均有差异,两两比较有统计学差异(Plt;0.05),且糖尿病并冠心病患者的ABI值较对照组明显下降,两组ABI值比较有统计学差异(Plt;0.01)。 结论: 糖尿病合并冠心病与糖尿病足的发病有相关一致性,ABI降低最明显。Abstract: Objective: To explore the multiplicity and correlation of macroangiopathy in type 2 diabetes,we compared the ankle brachial index(ABI) in different populations. Methods: We analyzed the ankle brachial index(ABI) of lower extremity of 149 people in our hospital from February,2007 to May, 2009:A group,49 diabetes with myocardial infarction diagnosed by coronary angiography and / or myocardial damage check and ECG.B group,50 diabetes without myocardial infarction diagnosed by the same methods. Control group, 50 people without diabetes or coronary heart disease. Results: There were significant differences among three groups, respectively (Plt;0.05). And there was decreased ankle brachial index(ABI)in diabetes with coronary heart disease compared with the control group, with significant difference(Plt;0.01). Conclusion: There was a relation between diabetes with coronary heart disease and the incidence of diabetic foot, with obvious reduction of ankle brachial index(ABI)
ObjectiveTo analyze the safety and effectiveness of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran (ASO). MethodsThe clinical data of patients with femoropopliteal ASO were collected and analyzed. The patients were treated by ultrasound-guided endovascular intervention in the Xijing Hospital of Air Force Military Medical University, from March 2015 to June 2021. The endovascular intervention methods included the arterial balloon dilation (ABD) alone, stent implantation (SI), Rotarex mechanical thrombus removal (Abbreviationas: Rotarex), and thrombolytic catheter implantation (CDT), etc. ResultsAll 112 patients (121 affected extremities) who met the research criteria were collected. Among them, there were 13, 68, and 40 affected extremities by the Rutherford classification of 2, 3, and 4, respectively, while 41, 39, and 41 affected extremities by the Trans-Atlantic Inter-SocietyConsensus Ⅱ classification of A, B, and C, respectively. Among 121 affected extremities, 61 underwent the ABD alone, 27 underwent ABD plus Rotarex, 12 underwent ABD plus SI, 6 underwent ABD plus SI plus Rotarex, 3 underwent ABD plus SI plus CDT, 7 underwent ABD plus CDT plus Rotarex, and 5 underwent ABD plus CDT. The ultrasound-guided endovascular treatments were completed successfully in 118 affected extremities (the success rate was 97.5%), and 3 affected extremities were not completely completed by ultrasound guidance. After operation, 5 affected extremities had pseudoaneurysm and 7 affected extremities had hematoma at the puncture site, which were cured after conservative management. The ankle-brachial index (ABI) of the affected extremities immediately after surgery was statistically higher than that before surgery [0.89±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.36 (0.34, 0.38), paired t-test (t=–25.17), P<0.001]. After a follow-up of 12 months, one patient had a metatarsal amputation and one patient died (acute myocardial infarction). The restenosis rate and reintervention rate of the target lesions were 25.0% (30/120) and 15.0% (18/120) at 12 months postoperatively, and the late loss of diameter was (0.88±0.25) mm. The ABI was still higher than before surgery [0.78±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.25 (0.22, 0.27), paired t-test, t=–17.61, P<0.001]. ConclusionFrom analysis results of this data, it can be seen that, ultrasound-guided endovascular intervention is a safe and effective treatment for selective femoropopliteal ASO.
ObjectiveTo investigate the short-term effectiveness of INBONETM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis. MethodsThe clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONETM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups (P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences (P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared. ResultsAll patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased (P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased (P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up (P<0.05); but there was no significant difference in plantarflexion range of motion (P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups (P>0.05); there was a significant difference in the difference of other radiographic parameters (P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found (P>0.05). ConclusionTAA using the INBONETM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.
【Abstract】 Objective To explore the cause of the perioprative period compl ication of scandinavian total anklereplacement(STAR) and to summarize the experience in the treatment and prevention. Methods From March 1999 toNovember 2006, 35 patients were given total ankle replacement(TAR) with STAR system. There were 19 males and 16 femaleswith an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15cases of rheumatoid arthritis. All patients had pain of ankle joint, swell ing and l imitation of joint motion. The disease coursewas 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle scorewas 29(6-48); the mean pain score was 18.3(0-35); the mean function score was 11.7(6-18); and the mean activity score was9.2(3-12). The type of all compl ications were record, and its cause, prevetion and treatment were analyszed. Results Thirtythreepatients achieved heal ing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients werefollowed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in2 cases, l imitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5thmetatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle scorewas 85.5 (58-95); the mean pain score was 48.3(35-50); the mean function score was 20.7(18-30); the mean activity score was17.2(16-20). There were statistically significant differences when compared with preoperative score(P lt; 0.01). The cl inical resultswere excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence ofprosthesis. Conclusion Although STAR can retain the functions of the operated joint, it has its special compl ications. It isimportant to obey operation principle with proficient operative technique, to strictly control surgical indication and to intensifyperioperative period treatment so as to decrease the compl ications.
Objective To summarize the clinical effects of the repairing methods for deep wounds of the foot and ankle. Methods From March 2002 to June 2006, 49 patients with skin and deep tissue defects of the foot and ankle underwent the repairing treatment. Of them, 36 were males and 13 were females, aged 16 to 67 years( 39 years on average). The causes of injuries included mangled injury in 24 cases, high fall injury in 9 cases, cut injury in 7 cases, malignant soft tissue tumor in 5 cases, decubital ulcer in 2 cases, and electric burn in 2 cases. Of the 49 cases, 19 were in left side and 30 in right side. The defect size of skin ranged from 3 cm×2 cm to 20 cm×15 cm and deep tissue injuries were accompanied by defects of tendon and ligament in 24 cases, by damage of joint in 12 cases, and by bone defect in 9 cases, and 35 of them had infections, and 2 of them had diabetes of stage 2. The time between the injury and surgery ranged from 4 hours to 1 year.The wounds were repaired separately by local flap(3 cm×3 cm to 6 cm×4 cm) in 15 cases, local island flap(8 cm×5 cm to 12 cm×7 cm) in 25 cases, free flap(15 cm×11 cm to 24 cm×17 cm) in 4 cases, and cross leg flap(5 cm×4 cm to 8 cm×6 cm) in 5 cases. In 24 cases of defects of tendon and ligament, 15 underwent the reconstruction in one-stage operations,9 in two-satge operation.In 9 cases accompanied by bone defect, twostage bone grafting (12-64 g) was given after wound healed. Results All of the 49 flaps survived. Fortysix healed by the first intention and 3 with distal edge necrosis healed after skin grafting. Two patients with sinus formation healed after 68 months of dressing change. All the cases were followed up 6 months to 3 years, and all the flaps were well developed, the functions of the foot and ankle were satisfactory. Conclusion It can get an excellent result of appearance and function recovery repairing deep wounds of the foot and ankle with proper flaps in earlier time.
ObjectiveTo observe the changes of plasma homocysteine (Hcy) and brachial ankle pulse wave velocity (baPWV) in patients with subclinical hypothyroidism, and discuss the relationship between subclinical hypothyroidism and arterial stiffness. MethodSeventy-three patients with subclinical hypothyroidism who were not treated before were divided into two groups according to thyroid stimulating hormone (TSH) level between January 2013 and June 2014. There were 35 patients in group A (4 mU/L < TSH < 10 mU/L) and 38 in group B (TSH ≥ 10 mU/L). Another 30 healthy individuals were selected as controls. Hcy and baPWV were determined in all subjects. ResultsCompared with the controls, patients had significantly higher level of TSH, Hcy and baPWV in group A, and had significantly higher TSH, triacylglycerol (TG), low density lipoprotein cholesterol (LDL)-C, Hcy, and baPWV in group B (P<0.05). Compared with group A, TSH, TG, LDL-C, Hcy, and baPWV in group B patiens were significantly higher (P<0.05). Pearson correlation analysis showed that Hcy was positively correlated with TSH (r=0.353, P<0.01) and baPWV was positively correlated with TSH (r=0.416, P<0.01). ConclusionsHcy level and peripheric arterial stiffness increase in patients with subclinical hypothyroidism. Both of them are correlated positively with TSH.
Objective To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries (SIEA) for repairing the large soft tissue defects on the foot and ankle. Methods The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females; the age ranged from 25 to 62 years, with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases, cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels, tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement (the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm, with an average of 6.0 cm; the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. Results One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair; the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. Conclusion The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.
ObjectiveTo investigate clinical application of the free peroneal artery perforator flap in soft tissue defect of foot and ankle.MethodsThe clinical data of 18 patients with soft tissue defects of foot and ankle who were repaired with free peroneal artery perforator flaps between March 2019 and March 2020 were retrospectively analyzed. Among them, there were 11 males and 7 females; the age ranged from 21 to 58 years, with an average age of 45 years. The defect was located in the ankle in 2 cases, in the hindfoot in 4 cases, in the midfoot in 5 cases, and in the forefoot in 7 cases. The causes of injury included 11 cases of traffic accident, 4 cases of machine injuries, 3 cases of infection and necrosis after internal fixation. The time from injury to flap repair was 12-48 days, with an average of 24 days. The range of wound was 3 cm×3 cm to 15 cm×8 cm, and the range of skin flap was 4 cm×3 cm to 16 cm×9 cm. The flap harvesting time, operation time, intraoperative blood loss, and complications were recorded; the flap survival and patient satisfaction were observed during follow-up; and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was used to evaluate the foot function.ResultsThe flap harvesting time was 15-33 minutes (mean, 22 minutes); the operation time was 120-160 minutes (mean, 150 minutes); the intraoperative blood loss was 90-180 mL (mean, 120 mL). There were 3 cases of vascular crisis after operation, including 2 cases of arterial crisis, which survived after vascular exploration and vein graft repair; 1 case of venous crisis, partial necrosis of the skin flap, and skin grafting to cover the wound after repeated debridement. The remaining 15 skin flaps survived completely. All patients were followed up 6 months. The skin flaps were in good shape without obvious bloat. According to the AOFAS foot function score, 5 cases were excellent, 10 cases were good, and 3 cases were fair. The excellent and good rate was 83.3%.ConclusionThe free peroneal artery perforator flap is easy to harvest, the shape and size of the flap are easy to design, and it does not damage the main blood vessels of the limb. The appearance and function of the limbs are satisfactory after operation. It can be widely used in the repair of soft tissue defects of the foot and ankle.
Objective To review the current research progress of three-dimensional (3-D) printing technique in foot and ankle surgery. Methods Recent literature associated with the clinical application of 3-D printing technique in the field of medicine, especially in foot and ankle surgery was reviewed, summarized, and analyzed. Results At present, 3-D printing technique has been applied in foot and ankle fracture, segmental bone defect, orthosis, corrective surgery, reparative and reconstructive surgery which showed satisfactory effectiveness. Currently, there are no randomized controlled trials and the medium to long term follow-up is necessary. Conclusion The printing materials, time, cost, medical ethics, and multi-disciplinary team restricted the application of 3-D printing technique, but it is still a promising technique in foot and ankle surgery.
ObjectiveTo investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle.MethodsBetween June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly.ResultsDuring the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months.ConclusionThe abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.