RESUMEN
First metatarsophalangeal (MTP) arthrodesis is commonly used to treat many end-stage first MTP diseases. The most widely used scale for measuring the clinical outcomes after this procedure, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale, has not been adequately validated and does not measure specific foot functions. Another outcome measure, the patient-reported Foot and Ankle Outcome Score (FAOS) has acceptable construct validity but poor content validity. The FAOS scale has 42 questions, many of which are unrelated to the hallux. We designed a short-form FAOS (sf-FAOS) consisting of 11 questions that are more relevant to first MTP arthrodesis. The sf-FAOS includes a pain subscale and a function subscale, and the score of each subscale ranges from 0 (worst outcome) to 100 (best outcome). Our study has shown that the sf-FAOS scale has acceptable validity, reliability, and responsiveness. In 21 feet (16 patients) with hallux valgus after >1 year of follow-up, the mean sf-FAOS pain score had improved by 44.9 points after surgery (from 51.2 to 96.0; p < .001), and the mean sf-FAOS function score had improved by 22.5 points (from 47.3 to 69.8; p <.001). The improvement in the function score for running and jumping was limited.
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Artrodesis/métodos , Hallux Valgus/cirugía , Articulación Metatarsofalángica/cirugía , Recuperación de la Función , Anciano , Artrodesis/instrumentación , Tornillos Óseos , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/fisiopatología , Humanos , Masculino , Articulación Metatarsofalángica/diagnóstico por imagen , Articulación Metatarsofalángica/fisiopatología , Persona de Mediana Edad , Dimensión del Dolor , Pronóstico , Radiografía/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the surgical treatment results of implant failure after clavicular fracture open reduction and internal fixation (ORIF). METHODS: Fifteen cases from Jan. 2005 to Jan. 2013 were treated surgically according to fracture classification, time of implant failure and implant type. The fracture union, shoulder function and pain were evaluated postoperatively. RESULTS: All the patients had full follow-up for 5 to 101 months (mean: 43.8 months). All the fractures were united well. The constant scores to assess the shoulder function were 82 to 100 (mean: 93.3 in the fracture side) and were 85 to 100 (mean: 96.7 in the uninjured side); statistically significant difference of the constant scores between the two sides was found (P=0.02). Eight cases did not have shoulder pain in the fracture side, while the other 7 cases had mild pain, The visual analogue scale (VAS) scores to evaluate shoulder pain were 1 to 3 in the fracture side, which were statistically different from those in the uninjured side (P=0.03). CONCLUSION: Implant instability causes early implant failure after clavicular fracture ORIF and re-fixation with stable implant is effective. Fracture nonunion leads to late implant failure, and bridging fixation using locking plate associated with bony autograft with iliac crest is a successful method to treat atrophy clavicular nonunion. Surgical treatment can bring good results.
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Clavícula/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Placas Óseas , Humanos , Dolor , Procedimientos de Cirugía PlásticaRESUMEN
BACKGROUND: Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes. METHODS: A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines. RESULTS: Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol. CONCLUSION: Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.
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Tendón Calcáneo , Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Humanos , Rotura/cirugía , Enfermedad Crónica , Traumatismos de los Tendones/cirugía , Traumatismos de los Tendones/rehabilitación , Medicina Basada en la Evidencia , Procedimientos Ortopédicos/métodos , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: To observe the clinical outcome after the surgical treatment of the deltoid ligament injury associated with ankle fractures. METHODS: From January 2005 to December 2009, 16 deltoid ligament ruptures associated with ankle fractures were repaired. According to the AO/OTA system, 2 cases belonged to fracture A, 8 to B, and 6 to C. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analogue scale (VAS) were used for the outcome measurements. RESULTS: The 16 patients were followed up for 30 to 84 months,with the mean follow-up of 47 months. All wounds healed at the first stage. The mean time of bone union was 12.8 weeks (range: 10-14 weeks). The mean AOFAS ankle-hindfoot score in the last follow-up was 93 points (range: 85-100 points). The mean score of VAS was 0.94 points (range: 0-2 points). CONCLUSION: Surgical treatment of ankle fractures associated with deltoid ligament rupture can achieve satisfactory outcomes, but it is important to decide the operation indication.
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Fracturas de Tobillo , Fracturas Óseas/cirugía , Ligamentos Articulares/lesiones , Adulto , Anciano , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Humanos , Ligamentos Articulares/cirugía , Masculino , Persona de Mediana Edad , Rotura , Técnicas de Sutura , Resultado del Tratamiento , Adulto JovenRESUMEN
Treating different diseases by the same method is one of the most important characteristics in Chinese medicine, and as the main principle of treatment it has been widely applied in Chinese clinics. Its clinical effect is clear. The integration of 'differentiation of diseases' and 'differentiation of syndrome' should be the prerequisite and basis of 'treating different diseases by the same method'. Only if different diseases have the same syndrome, the same treatment can be used on them. Replenishing qi and strengthening Shen is a widely used method that carries out 'treating different diseases by the same method'. It is indicated that the method of 'replenishing qi and strengthening Shen' has preferable effects on many diseases. Part of its mechanism is associated with the improvement of function of neuro-endocrine-immune network, and therefore, it has the clinical effect of 'adjustment of the whole and improvement of the part' on partial disorders. Asthma, chronic obstructive pulmonary disease (COPD), uterine bleeding in puberty, anovulatory infertility, Kidney syndrome and aging, although they are attributed to different diseases and states, only if they have the syndrome of Shen deficiency, the principle of 'treating different diseases by the same method' and the method of 'replenishing qi 'and strengthening Shen' can be used effectively.
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Medicamentos Herbarios Chinos/uso terapéutico , Medicina Tradicional China/métodos , Fitoterapia/métodos , HumanosRESUMEN
PURPOSE: In this retrospective study, we evaluated the treatment effect of ankle joint fracture surgery involving the posterior malleolus, and discuss relevant factors influencing the occurrence of traumatic arthritis of the ankle joint. METHODS: A total of 102 cases of ankle joint fractures involving the posterior malleolus in five large-scale skeletal trauma centres in China, from January 2000 to July 2009, were retrospectively analysed in terms of surgical treatment and complete follow-up. Ankle joint mobility, posterior malleolus fragment size, articular surface evenness, Ankle-Hindfoot Scale of the American Orthopedic Foot and Ankle Society (AOFAS) score, and imaging scale score for arthritis were recorded. The degree of fracture pain during rest, active movement, and weight-bearing walking, and satisfaction with treatment were evaluated using a visual analogue scale (VAS). RESULTS: The average AOFAS score was 95.9, excellence rate was 92.2 %, and average VAS scores for degree of fracture pain during rest, active movement, and weight-bearing walking were 0.15, 0.31, and 0.68, respectively. Thirty-six cases showed arthritic manifestations. Ankle joint mobility along all directions on the injured side was lower than that on the unaffected side. There was no obvious difference in treatment effect between the fixed and unfixed posterior malleolus fragment groups for all and for fragment size of < 25 %; between fixing the posterior malleolus fragment from front to back or from back to front; or between elderly patients (≥ 60 years old) and young patients (< 60 years old). There was a distinct difference in the treatment effect between articular surface evenness and unevenness for all and for fragment size of ≥ 25 %. CONCLUSIONS: For all 102 cases of ankle joint fracture involving the posterior malleolus, the treatment effect was satisfactory. Restoration of an even articular surface, especially when fragment size ≥ 25 %, should be attempted during treatment.
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Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Fracturas Óseas/cirugía , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/diagnóstico , Articulación del Tobillo/fisiopatología , Artritis/diagnóstico , Artritis/etiología , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dolor/patología , Dimensión del Dolor , Complicaciones Posoperatorias/etiología , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Caminata , Soporte de Peso , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effect of autograft bone, allograft bone, calcium sulfate bone cement, and calcium phosphate bone cement on the repair of tibial plateau defect in rabbits. METHODS: We used autograft bone, allograft bone, calcium sulfate bone cement, and calcium phosphate bone cement to repair tibial plateau defect in rabbits. Gross and histologic observations, X-ray examination, and biomechanical test were conducted at 1, 2, 4, 8 weeks after operation. RESULTS: X-ray examination found that the bone density was evidently reduced in calcium sulfate group at 8 weeks after operation; there were no marked changes in other groups. The maximal load measurements showed that autograft and allograft groups were greater than calcium sulfate and calcium phosphate groups at 1 and 2 weeks after operation. However at 4 and 8 weeks after operation, no significant difference was found among the four groups. In autograft and allograft groups, there was no significant difference in biomechanical intensity at 2, 4, and 8 weeks, but it was significantly higher than that at 1 week. In calcium sulfate and calcium phosphate groups, the outcome was ranked in descending order as 1 week less than 2 week less than 4 week equal to 8 week. Histologic examination found a great amount of new bones at 8 week in both autograft and allograft groups. In calcium sulfate group, calcium sulfate was almost absorbed and there were numerous bone trabeculations. There was a large amount of unabsorbed calcium phosphate in calcium phosphate group. CONCLUSION: At 1-2 weeks postoperatively, the biomechanical intensity is higher in autograft and allograft groups than calcium sulfate and calcium phosphate groups, but after 4-8 weeks, there is no significant difference among groups. At 1-2 weeks, the biomechanical intensity in all groups is increased, but at 4-8 weeks, there is no significant increase. The rates of absorption and bone formation are quicker in calcium sulfate group than calcium phosphate group.
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Cementos para Huesos , Trasplante Óseo , Animales , Fenómenos Biomecánicos , Articulación de la Rodilla , Tibia , Trasplante AutólogoRESUMEN
OBJECTIVE: To investigate the surgical treatment results of periprosthetic femur fracture after hip arthroplasty. METHODS: In the study, 10 patients from Oct. 2006 to Jan. 2012 were treated surgically according to Vancouver classification, and their fracture union, hip function, pain in fracture site and lower extremity length were evaluated postoperatively. RESULTS: All the patients had full follow-up for 6 to 69 months (mean time: 35.1 months). All fractures were united well with good alignment and no prosthesis loosing or internal fixation failure was discovered. Harris scores to assess hip function were 71 to 90 (mean: 79.8) and the excellent and good rate was 70%. VAS scores to evaluate pain in fracture site when walking were 0 to 3 (mean: 1.4). The lengths of injured lower extremity were shorter by 0 to 2.5 cm than those of the contralateral side preoperatively [mean (1.6±0.9) cm]. The shortened lengths were reduced to 0 to 1.8 cm postoperatively [mean (0.6±0.6) cm], which were statistically different from those of preoperation (P=0.002). CONCLUSION: Although treatment of periprosthetic femur fracture after hip arthroplasty is a hard work, we can make individual therapy regiment based on the patient's age, general condition, function demand and Vancouver classification. Surgical treatment can bring good results.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Prótesis de Cadera/efectos adversos , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/etiología , Fracturas del Fémur/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To observe the clinical effect of biodegradable conduit small gap tublization to repair peripheral nerve injury. METHODS: In the study, 30 cases of fresh peripheral nerve injury in the upper extremities were recruited. After formally informed and obtaining the consent, the recruited patients were divided into the degradable chitin conduit tublization group (experimental group: 15 cases) and traditional epineurial neurorrhaphy group (control group: 15 cases). Their nerve functional recovery conditions were clinically observed according to the standard score methods provided by SHEN Ning-jiang and British Medical Research Council. The excellent and good rates of the overall nerve functional recovery were calculated. The electrophysiologic study was carried out after 6 months. RESULTS: Of the total 30 cases, 28 were followed up, and there were 14 cases in the degradable chitin conduit tublization group and traditional epineurial neurorrhaphy group. The operation procedure was very simple, and the mean suture time [(8.0±0.8) min] was 20% shorter than that of the traditional epineurial neurorrhaphy group [(10.0±0.6) min]. All the wounds in the degradable chitin conduit tublization group healed as expected without rejection, hypersensitive reaction or anomalous draining. Electrophysiology examination results after 6 months displayed that the sensory nerves conduction velocity recovery rate was 77.37% of the normal value, and motor nerve conduction velocity recovery rate was 70.09% in the degradable chitin conduit tublization group. The sensory nerves conduction velocity recovery rate was 61.69% of the normal value, and motor nerve conduction velocity recovery rate was 56.15% in the traditional epineurial neurorrhaphy group. The exact propability methods was applied in the comparison of sensory and motor nerve conduction velocity recovery rate, and there was no statistically significant of two groups(sensory nerve conduction velocity recovery rate P=0.678;motor nerve conduction velocity recovery rate P=0.695). The combinated functional recovery excellent and good rates after repair in the degradable chitin conduit tublization group were 78.57%, while 28.57% in the traditional epineurial neurorrhaphy group. The Fisher's exact probabilistic method was applied in the comparison of combinated functional recovery excellent and good rates, and there was statistically significant of two groups(P=0.021). CONCLUSION: The operation procedure of the degradable chitin conduit tublization is very simple and the clinical recovery effect is much better than that of the traditional epineurial neurorrhaphy. The biodegradable conduit small gap tublization methods to repair peripheral nerve injury has the possibility to substitute the traditional epineurial neurorrhaphy.
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Implantes Absorbibles , Nervio Mediano/lesiones , Regeneración Nerviosa , Traumatismos de los Nervios Periféricos/terapia , Adolescente , Adulto , Anciano , Materiales Biocompatibles , Quitina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Nervio Cubital/lesiones , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of the shoulder. METHODS: Totally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed. All the functional outcome of the involved shoulder were evaluated by ASES, Constant, HSS score and patient self score. The correlations and agreement of three shoulder scales were analyzed with Pearson correlation test and Bland-Altman plot in different age groups and fracture types. RESULTS: (1) The Constant score were lower than other two scores in the same age group and fracture type (F = 13.62 and 4.80, P < 0.05). (2) The correlations between three shoulder scales: ASES and Constant (r = 0.754, P = 0.0003), ASES and HSS (r = 0.755, P = 0.0001), Constant and HSS (r = 0.858, P = 0.0002). The correlations between three shoulder scales and patient self evaluation: ASES (r = 0.602, P = 0.0002), Constant (r = 0.705, P = 0.0001), HSS (r = 0.663, P = 0.0037). The Bland-Altman plot shows three shoulder scales have good agreement. (3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type. CONCLUSIONS: ASES, Constant, HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder, they have good correlation and agreement. Constant score in recommended for its high correlation coefficient with patient self evaluation score. However, its age bias must be paid attention in clinical practice. ASES shoulder score can be used in remote follow-up.
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Fracturas del Hombro/fisiopatología , Articulación del Hombro/fisiopatología , Índices de Gravedad del Trauma , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Fracturas del Hombro/cirugía , Adulto JovenRESUMEN
The expert consensus of the third-generation minimally invasive technical specification for hallux valgus was developed by Foot and Ankle Committee of Orthopaedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, and Foot and Ankle Expert Committee of Orthopedic Branch of Chinese Association of Integrative Medicine. The consensus was drawn from evidence-based medicine and experts' clinical experience to provide an academic guidance of the third-generation minimally invasive technical specification of hallux valgus for the orthopedic surgeons, including definition, indications, osteotomy techniques, post-operative rehabilitation and prognosis.
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Juanete , Hallux Valgus , Ortopedia , Consenso , Hallux Valgus/cirugía , Humanos , Osteotomía/métodosRESUMEN
Lower extremity nerve transposition repair has become an important treatment strategy for peripheral nerve injury; however, brain changes caused by this surgical procedure remain unclear. In this study, the distal stump of the right sciatic nerve in a rat model of sciatic nerve injury was connected to the proximal end of the left sciatic nerve using a chitin conduit. Neuroelectrophysiological test showed that the right lower limb displayed nerve conduction, and the structure of myelinated nerve fibers recovered greatly. Muscle wet weight of the anterior tibialis and gastrocnemius recovered as well. Multiple-model resting-state blood oxygenation level-dependent functional magnetic resonance imaging analysis revealed functional remodeling in multiple brain regions and the re-establishment of motor and sensory functions through a new reflex arc. These findings suggest that sciatic nerve transposition repair induces brain functional remodeling. The study was approved by the Ethics Committee of Peking University People's Hospital on December 9, 2015 (approval No. 2015-50).
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OBJECTIVE: To investigate the clinical results of therapy of periprosthetic femoral supracondylar fractures after total knee arthroplasty (TKA) with open reduction and internal fixation (ORIF) using less invasive stabilization system (LISS). METHODS: Eight cases of periprosthetic femoral supracondylar fractures after TKA were treated with ORIF using distal femoral LISS in our department. They had full follow-up for 3 to 39 months. Their knee functions were evaluated through radiological and clinical checkups and functional evaluations by HSS (The Hospital for Special Surgery) scoring system and Lysholm Questionnaire. RESULTS: None of the fractured patients had any infection or internal-fixation failure. The average knee motion range was 0-94°. There was no statistic difference of the femorotibial angle between pre- and postoperation. At the end of the last follow-up, the average HSS score was 79.38 and Lysholm score 80.25. All the average scores were good and excellent. CONCLUSION: ORIF with LISS is a one of the valuable treatments for periprosthetic femoral supracondylar fractures after TKA.
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Artroplastia de Reemplazo de Rodilla , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fracturas Periprotésicas/cirugía , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Femenino , Fracturas del Fémur/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To investigate function and related impact factors after operation of femoral neck fracture for patients aged less than sixty years. METHODS: In our study,93 patients aged less than sixty years with femoral neck fractures receiving operation from April 2001 to August 2009 and having complete follow-up data were evaluated in terms of age, sex, co-diseases, side of bone fracture, type of bone fracture (Garden classification), time between injury and operation, operation procedures, operation time, time in bed, removal internal fixation and function score during follow-up period. Nonparametric test, rank correlation analysis and Logistic regression analysis were used by SPSS 13.0. RESULTS: Function scores showed non-normal distribution. By nonparametric test, the following variable in function scores was of statistic significance: the Garden classification (H=7.900, P=0.048). By analysis of correlation, the following variable in function scores was of statistic significance: Garden classification (rs=0.206, P=0.048). By Logistic regression analysis, the following variable in function scores was of statistic significance: Garden classification (P=0.030). CONCLUSION: Hip function score is of non-normal distribution, and Garden classification is the most important factor influencing the function after operation for femoral neck fracture for patients aged less than sixty years.
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Fracturas del Cuello Femoral/fisiopatología , Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas , Recuperación de la Función , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: To investigate the clinical features of femoral neck fractures and analyze related causes. METHODS: The clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed. RESULTS: A total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites. CONCLUSIONS: The incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.
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Fracturas del Cuello Femoral/diagnóstico , Fracturas del Cuello Femoral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Fracturas del Cuello Femoral/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot. METHODS: From August 2016 to June 2018, 87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction, inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of (68.9±11.3) years old;2 patients were grade 2, 37 patients were grade 3 and 50 patients were grade 4 according to Wagner's classification;the courses of diabetic were for 10 to 16 years with an average of (13.0±2.2) years;the courses of diabetic feet were for 21 to 48 days with an avergae of (34.2±8.6) days. Postoperative comlications were observed. Skin temperature, visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation. RESULTS: All patients were followed up for 4 to 19 months with an average of (12.6±2.8) months. Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer, and scabed without special treatment. One patient was performed amputation above 5 cm of ankle joint because of severe infection, and 1 patient occurred re-ulceration at 1 year after wound healing, bone transfer was performed again at the same site, and was completely healed at 8 weeks after operation. The healing time of wound ranged from 3 to 24 weeks with an average of (11.9± 3.8) weeks. Foot skin temperature before operation was (28.9±0.91) â, and increased to (31.70±0.32)â at 3 months after operation(t=5.72 P=0.006);VAS score before opertaion was (7.80±0.72), and improved to (2.20±0.13) at 3 months after operation (t=25.38, P=0.000);ABI beforeoperation was(0.48±0.30), increased to(0.98±0.24) at 3 months after oeprtaion(t= 14.68, P=0.000). CONCLUSION: Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg, promote recovery of peripheral blood vessels, and promote wound healing of foot, reduce or avoid amputation. At the same time, the improved osteotomy is one of the effective methods for the treatment of diabetic foot which has advantags of less trauma, simple opertaion.
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Diabetes Mellitus , Pie Diabético , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo , Pie Diabético/cirugía , Femenino , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Tibia , Resultado del TratamientoRESUMEN
OBJECTIVE: Wallerian degeneration is a pathological process closely related to peripheral nerve regeneration following injury, and includes the disintegration and phagocytosis of peripheral nervous system cells. Traditionally, morphological changes are observed by performing immunofluorescence staining after sectioning, which results in the loss of some histological information. The purpose of this study was to explore a new, nondestructive, and systematic method for observing axonal histological changes during Wallerian degeneration. METHODS: Thirty male Thy1-YFP-16 mice (SPF grade, 6 weeks old, 20±5 g) were randomly selected and divided into clear, unobstructed brain imaging cocktails and computational analysis (CUBIC) optical clearing (n=15) and traditional method groups (n=15). Five mice in each group were sacrificed at 1st, 3rd, and 5th day following a crush operation. The histological axon changes were observed by CUBIC light optical clearing treatment, direct tissue section imaging, and HE staining. RESULTS: The results revealed that, compared with traditional imaging methods, there was no physical damage to the samples, which allowed for three-dimensional and deep-seated tissue imaging through CUBIC. Local image information could be nicely obtained by direct fluorescence imaging and HE staining, but it was difficult to obtain image information of the entire sample. At the same time, the image information obtained by fluorescence imaging and HE staining was partially lost. CONCLUSION: The combining of CUBIC and Thy1-YFP transgenic mice allowed for a clear and comprehensive observation of histological changes of axons in Wallerian degeneration.
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Proteínas Bacterianas/genética , Proteínas Luminiscentes/genética , Proteínas Recombinantes/metabolismo , Antígenos Thy-1/genética , Degeneración Walleriana/patología , Animales , Proteínas Bacterianas/metabolismo , Modelos Animales de Enfermedad , Humanos , Proteínas Luminiscentes/metabolismo , Masculino , Ratones , Ratones Transgénicos , Microscopía Confocal , Imagen Óptica , Distribución Aleatoria , Antígenos Thy-1/metabolismo , Degeneración Walleriana/diagnóstico por imagen , Degeneración Walleriana/etiología , Degeneración Walleriana/metabolismoRESUMEN
Peripheral nerves have a limited capacity for self-repair and those that are severely damaged or have significant defects are challenging to repair. Investigating the pathophysiology of peripheral nerve repair is important for the clinical treatment of peripheral nerve repair and regeneration. In this study, rat models of right sciatic nerve injury were established by a clamping method. Protein chip assay was performed to quantify the levels of neurotrophic, inflammation-related, chemotaxis-related and cell generation-related factors in the sciatic nerve within 7 days after injury. The results revealed that the expression levels of neurotrophic factors (ciliary neurotrophic factor) and inflammation-related factors (intercellular cell adhesion molecule-1, interferon γ, interleukin-1α, interleukin-2, interleukin-4, interleukin-6, monocyte chemoattractant protein-1, prolactin R, receptor of advanced glycation end products and tumor necrosis factor-α), chemotaxis-related factors (cytokine-induced neutrophil chemoattractant-1, L-selectin and platelet-derived growth factor-AA) and cell generation-related factors (granulocyte-macrophage colony-stimulating factor) followed different trajectories. These findings will help clarify the pathophysiology of sciatic nerve injury repair and develop clinical treatments of peripheral nerve injury. This study was approved by the Ethics Committee of Peking University People's Hospital of China (approval No. 2015-50) on December 9, 2015.
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As an important tool for assessing musculoskeletal conditions, imaging plays an important role in assessing the risk of disease, judging disease and the progress of disease, and prognosis scores. Accompanied with the rapid development of artificial intelligence(AI) in the field of image detection and interpretation, some AI-assisted recognition studies involving musculoskeletal X-ray imaging have been examined and shown a high potential value, which can enhance various parts of the X-ray imaging value chain and guide clinicians by improving imaging efficiency, imaging quality, and diagnostic accuracy. At present, the development of AI-assisted imaging recognition technology is still at an early stage. AI algorithms need to be further improved and developed. Image data is still insufficient and the qualityis relatively heterogeneous. The long-term accuracy and stability of technical performance require further observation and research.
Asunto(s)
Enfermedades Musculoesqueléticas , Ortopedia , Algoritmos , Inteligencia Artificial , Humanos , Película para Rayos XRESUMEN
Neutrophil peptide 1 belongs to a family of peptides involved in innate immunity. Continuous intramuscular injection of neutrophil peptide 1 can promote the regeneration of peripheral nerves, but clinical application in this manner is not convenient. To this end, the effects of a single intraoperative administration of neutrophil peptide 1 on peripheral nerve regeneration were experimentally observed. A rat model of sciatic nerve crush injury was established using the clamp method. After model establishment, a normal saline group and a neutrophil peptide 1 group were injected with a single dose of normal saline or 10 µg/mL neutrophil peptide 1, respectively. A sham group, without sciatic nerve crush was also prepared as a control. Sciatic nerve function tests, neuroelectrophysiological tests, and hematoxylin-eosin staining showed that the nerve conduction velocity, sciatic functional index, and tibialis anterior muscle fiber cross-sectional area were better in the neutrophil peptide 1 group than in the normal saline group at 4 weeks after surgery. At 4 and 8 weeks after surgery, there were no differences in the wet weight of the tibialis anterior muscle between the neutrophil peptide 1 and saline groups. Histological staining of the sciatic nerve showed no significant differences in the number of myelinated nerve fibers or the axon cross-sectional area between the neutrophil peptide 1 and normal saline groups. The above data confirmed that a single dose of neutrophil peptide 1 during surgery can promote the recovery of neurological function 4 weeks after sciatic nerve injury. All the experiments were approved by the Medical Ethics Committee of Peking University People's Hospital, China (approval No. 2015-50) on December 9, 2015.