Uso tópico de sevoflurano en heridas complejas de miembro inferior / Topical use of sevoflurane in complex lower limb wounds

El dolor crónico asociado a heridas de larga evolución en miembros inferiores constituye una situación de conflicto con características angustiantes que compromete seriamente la calidad de vida e interfiere en el proceso de reparación tisular, estableciendo un cuadro propio en el cual la herida se transforma en un componente más de esta compleja condición y no el motivo en sí de la consulta. Dadas las limitaciones y efectos negativos de las terapias usuales para el alivio del dolor crónico en heridas, se establece una apertura a nuevas propuestas adyuvantes. Motivo de ello es el propósito del presente trabajo, a través del uso de sevoflurano tópico para evaluar el incremento de la analgesia en una población con úlceras en miembro inferior de diverso origen etiológico.

Clinical and genetic analysis of a patient with Desminopathy manifesting initially with myalgia after lower limb activity / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical characteristics and genetic variant of a patient with desminopathy manifesting with atypical symptoms.@*METHODS@#A patient who was admitted to the Department of Neurology of Jing'an District Central Hospital on February 24, 2021 was selected as the study subject. Clinical data, laboratory tests, muscle pathology, muscle magnetic resonance imaging (MRI) and genetic testing of the patient were retrospectively analyzed.@*RESULTS@#The patient had developed myalgia after lower limb activity, and gradually developed asymmetrical muscle weakness and atrophy of the lower limbs. Cardiac examination revealed atrioventricular block and decreased left ventricular diastolic function. Muscle MRI showed that semitendinosus, sartorius, gracilis, fibula, gastronemius and supinator muscles were selectively involved at the early stage. Muscle biopsy confirmed pathological changes of desmin positive myofibrils. Genetic testing revealed that the patient has harbored a c.1024A>G (p.n342d) missense variant in exon 6 of the DES gene. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated as likely pathogenic (PS4_moderate+PM2_supporting+PP3_moderate+PP1).@*CONCLUSION@#Desmin disease has a great clinical heterogeneity. Postexercise myalgia of lower limbs is a rare clinical phenotype. For patients harboring the c.1024A>G (p.n342d) variant of the DES gene, in addition to semitendinosus and fibula, Cardiac involvement is relatively insidious and easy to be ignored in clinic. Timely muscle MRI, muscle biopsy and gene detection will help the early diagnosis of the disease.

Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study

Abstract Background: Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. Methods: Forty-one ASA III-IV patients who underwent SIFIB + PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. Results: Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p < 0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p < 0.001) and during movement (p < 0.001 for the 1st and 3rd hours, and p = 0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p = 0.01). Conclusion: The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.

Dolor y edema de miembros inferiores por dermopatía tiroidea: presentación inusual de la enfermedad de Graves en una paciente adolescente / Lower limb pain and edema due to thyroid dermopathy: an unusual presentation of Graves disease in an adolescent patient

La enfermedad de Graves es un proceso inmunomediado en el que autoanticuerpos se dirigen contra el receptor de tirotrofina. Por su acción estimulante sobre la glándula tiroides, se genera crecimiento glandular difuso y aumento de la hormonogénesis. Se caracteriza por el comienzo subagudo de síntomas constitucionales, neuromusculares, cardiovasculares, gastrointestinales y oculares, seguidos en algunos casos de la aparición de manifestaciones cutáneas como la dermopatía tiroidea o mixedema. En pediatría la enfermedad de Graves es infrecuente (aunque es la causa más frecuente de hipertiroidismo), pero la cronología de aparición de los síntomas está bien descrita; es rara la aparición de dermopatía en ausencia de otros síntomas de hipertiroidismo y sin afectación ocular. Se presenta el caso de una paciente de 15 años con dermopatía tiroidea por enfermedad de Graves sin oftalmopatía ni otros síntomas de hipertiroidismo clínico asociados.

Graves disease is an immune-mediated process characterized by the presence of autoantibodies to thyrotropin receptors. Its stimulating action on the thyroid gland causes diffuse glandular growth and increased hormone production. Graves disease is characterized by a subacute onset of non-specific, neuromuscular, cardiovascular, gastrointestinal, and eye symptoms, sometimes followed by skin manifestations, such as thyroid dermopathy or myxedema. In pediatrics, Graves disease is rare (although it is the most frequent cause of hyperthyroidism). However, the chronology of symptom onset has been well described; the development of dermopathy in the absence of other symptoms of hyperthyroidism and without eye involvement is rare. Here we describe the case of a 15-year-old female patient with thyroid dermopathy due to Graves disease without eye disease or other associated clinical symptoms of hyperthyroidism.

Manejo de tejidos blandos en trauma de miembros inferiores: a propósito de un caso / Soft tissue management in lower limb trauma: about a case

Los miembros inferiores están sujetos frecuentemente a traumas que ocasionan daño de estructuras vitales y que pueden dejar secuelas funcionales y estéticas en las personas. Las lesiones de tejidos blandos son las que asientan en la piel, tejido celular subcutáneo, aponeurosis, músculos, vasos y nervios. Del manejo oportuno y adecuado de las lesiones que se presenten posteriores a un trauma de tejidos blandos dependerá el resultado, el tiempo de recuperación, costos de hospitalización y sobre todo la preservación de las funciones de locomoción y sostén del miembro afectado

The lower limbs are frequently exposed to traumas that cause vital structures damage and can leave functional and aesthetic sequelae in patients. Soft tissue lesions are those that affect the skin, subcutaneous cellular tissue, fascia, muscles, vessels, and nerves. The result, recovery time, hospitalization costs and, above all, the preservation of the locomotion and support functions of the affected limb will depend on the timely and adequate management of injuries that occur after a soft tissue trauma.

Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb / 中国骨伤

OBJECTIVE@#To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.@*METHODS@#Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.@*RESULTS@#Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05).@*CONCLUSION@#DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.

Research progress of lower limb muscle strength training in the treatment of lliotibial band syndrome / 中国骨伤

Iliotibial band syndrome (ITBS), as an overused injury of the lower extremities, has developed into a common cause of lateral knee pain. At present, the treatment of ITBS includes drug therapy, muscle strength training, physical therapy, and surgical treatment. Among these methods, physical therapy, drug therapy, and surgical treatment can only alleviate the symptoms of patients. As a safe and effective treatment, lower limb muscle strength training can improve patients' muscle strength, correct abnormal gait, and reduce the recurrence rate of the disease by paying attention to the dynamic changes of patients' recovery process. At present, the pathogenesis of ITBS remains unclear, and the treatment methods are not unified. It is necessary to further study the biomechanical factors related to the lower extremities and develop more scientific and comprehensive muscle strength training methods.

Analysis of 4 children with DYNC1H1 gene related spinal muscular atrophy with lower extremity predominant 1 / 中华儿科杂志

Objective: To investigate the clinical features and gene variation characteristics of children with dynein cytoplasmic 1 heavy chain 1 (DYNC1H1) gene associated spinal muscular atrophy with lower extremity predominant (SMALED) 1. Methods: The clinical data of 4 SMALED1 children admitted to Peking University First Hospital from December 2018 to May 2021, who were found to have pathogenic variation of DYNC1H1 gene through genetic testing, except for other genes known to be related to motor retardation, were retrospectively summarized to analyze the phenotype and genotype characteristics. Results: There were 3 males and 1 female. The age of onset was 1 year, 1 day, 1 day and 4 months, respectively. The age of diagnosis was 4 years and 10 months, 9 months, 5 years and 9 months, and 3 years and 1 month, respectively. The clinical manifestations were muscle weakness and muscular atrophy of lower limbs, 2 cases with foot deformity, 1 case with early non progressive joint contracture, 1 case with hip dislocation and 1 case with mental retardation. De novo heterozygous missense variations in DYNC1H1 gene were found in all 4 children. According to the rating of American College of medical genetics and genomics, they were all possible pathogenic and pathogenic variations, with p.R598C, p.P776L, p.Y1109D variations had been reported, and p.I1086R variation had not been reported. Conclusions: For those with unexplained lower limb muscle weakness, muscle atrophy, joint contracture and foot deformity, upper limb motor ability related retention, with or without mental retardation, as well as the motor ability progresses slowly, it is necessary to consider the possibility of SMALED1 and the detection of DYNC1H1 gene when necessary.

Application and value of intravascular ultrasound for excimer laser ablation combined with drug-coated balloon in the treatment of lower limb arteriosclerotic obliterans / 中华外科杂志

Objective: To examine the value of intravascular ultrasound (IVUS) for excimer laser ablation (ELA) combined with drug-coated balloon (DCB) in treating lower limb arteriosclerotic obliterans (ASO). Methods: As a prospective case series study, patients who underwent ELA combined with DCB for lower limb ASO with the guidance of IVUS from September 2021 to March 2022 at Department of Vascular Surgery, Zhongshan Hospital, Fudan University were enrolled prospectively. Lesion characteristics, procedure-related outcomes and complications were collected. The therapy outcomes were compared with baseline data by paired t test. Results: There were 8 males and 2 females, aged (72.0±5.9) years (range: 61 to 81 years). Of all the 11 lesions, there were 8 lesions in superficial femoral artery and 3 in popliteal artery. The lesion length was (7.0±2.4) cm (range: 3.2 to 9.8 cm). There were 4 chronic totally occlusion and 7 severe stenosis. All patients underwent the operation successfully. The technical success rate was 10/11. Bailout stenting was performed in one lesion because of flow-limiting dissection. Four lesions were grade 3 to 4 in peripheral artery calcium score system, and 9 lesions with calcification arc≥180°. Larger diameter drug-coated balloons were selected in 5 lesions after measurement of intravascular ultrasound. The follow-up time was (6.0±1.9) months (range: 3 to 9 months). The ankle-brachial index of the patient was significantly improved immediately after surgery (0.97±0.13 vs. 0.48±0.18, t=-7.60, P<0.01) and at 3 months after surgery (0.95±0.12 vs. 0.48±0.18, t=-7.17, P<0.01). The 3-month primary patency rate was 11/11, the target lesion reintervention was 0 and ulcer healing rate was 3/4. Conclusion: IVUS assisted ELA in the treatment of lower limb artery lesions is safe and effective in early stage.

Evaluation and treatment strategy of limb length discrepancy after total hip arthroplasty / 中华外科杂志

Limb length discrepancy(LLD) is a common complication after total hip arthroplasty (THA). Good positioning of the prosthesis and suitable soft tissue tension are essential to ensure hip joint stability. Patients will be more satisfied if almost the same length of both lower extremities is achieved. Preoperative comprehensive evaluation of patients is helpful to prevent the occurrence of LLD after surgery. Therefore, the pelvic spine conditions, as well as type and cause of LLD should be analyzed in detail before surgery. During operation, limb length should be adjusted by touching the position of patella, Kirschner's wires positioning and referring to the relationship between the center of femoral head and the tip of greater trochanter. After surgery, it is necessary to clearly distinguish true LLD from functional LLD, and make a reasonable therapeutic plan according to patient's symptoms and the range of differences in limb length. This article reviews the latest literatures based on clinical practice experience and summarizes the research status of LLD after THA, which helps joint surgeons to have an in-depth understanding of this postoperative complication.

Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty: a randomized controlled trial / 中国针灸

OBJECTIVE@#To investigate the clinical effect of aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty and the influence on hypercoagulation.@*METHODS@#Seventy-three patients of knee osteoarthritis with lower extremity venous thrombosis after total knee arthroplasty (KOA) were randomly divided into an observation group (37 cases, 2 cases dropped off) and a control group (36 cases, 1 case dropped off). The patients in the control group took orally rivaroxaban tablets, 10 mg a time, once a day. On the basis of the treatment as the control group, the aconite-isolated moxibustion was applied to Yongquan (KI 1) for the patients of the observation group, once daily and 3 moxa cones were used in each treatment. The duration of treatment was 14 days in both groups. Before treatment and 14 days into treatment, the ultrasonic B test was adopted to determine the conditions of lower extremity venous thrombosis in the two groups. Before treatment, 7 and 14 days into treatment, the coagulation indexes (platelet [PLT], prothrombin time [PT], activated partial prothrombin time [APTT], fibrinogen [Fib] and D-dimer[D-D]), the blood flow velocity of the deep femoral vein and the circumference of the affected side were compared between the two groups separately, and the clinical effect was evaluated.@*RESULTS@#Fourteen days into treatment, the venous thrombosis of the lower extremity was relieved in both groups (P<0.05), and that of the observation group was better than the control group (P<0.05). Seven days into treatment, the blood flow velocity of the deep femoral vein was increased compared with that before treatment in the observation group (P<0.05), and the blood flow rate in the observation group was higher than that in the control group (P<0.05). Fourteen days into treatment, PT, APTT and the blood flow velocity of the deep femoral vein were increased in the two groups compared with those before treatment (P<0.05); and PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all reduced in the two groups (P<0.05). Compared with the control group 14 days into treatment, the blood flow velocity of the deep femoral vein was higher (P<0.05), PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all lower in the observation group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 85.7% (30/35) in the control group (P<0.05).@*CONCLUSION@#Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban can effectively treat lower extremity venous thrombosis after total knee arthroplasty, relieve hypercoagulation, accelerate the blood flow velocity and alleviate swelling of the lower extremity in the patients with knee osteoarthritis.

Standardized Jin's three-needle therapy for stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of standardized Jin's three-needle therapy on limb motor function and nerve function defect in stroke patients, and to evaluate the placebo control method.@*METHODS@#A total of 66 patients with stroke were randomly divided into a Jin's three-needle group (33 cases, 3 cases dropped off) and a placebo needle group (33 cases, 4 cases dropped off). All the patients were treated with conventional medication and rehabilitation treatment. In addition, the patients in the Jin's three-needle group were treated with standardized Jin's three-needle therapy at temporal three points, spirit four points, hand three points, foot three points, upper extremity spasm three points, lower extremity spasm three points, etc.; while the patients in the placebo needle group were treated with placebo needling at identical points. All the treatments were given once a day, 5 days a week, and 3-week treatment was given with an interval of 2 days between weeks. The scores of Fugl-Meyer assessment scale (FMA) and National Institutes of Health stroke scale (NIHSS) were observed before treatment, 10 d and 21 d into treatment, and the blind evaluation was conducted after treatment.@*RESULTS@#On the 10 d and 21 d into treatment, the FMA scores in both groups were higher than those before treatment (P<0.01), and the NIHSS scores were lower than those before treatment (P<0.01). On the 10 d and 21 d into treatment, the FMA scores in the Jin's three-needle group were higher than those in the placebo needle group (P<0.05); on the 10 d into treatment, the NIHSS score in the Jin's three-needle group was were lower than that in the placebo needle group (P<0.05). There was no significant difference between the two groups on judging the type of treatment (P>0.05), and the consistency with the real situation was poor (Cohen's kappa coefficient<0.20).@*CONCLUSION@#The standardized Jin's three-needle therapy could effectively improve the limb motor function and nerve function defect in stroke patients. The placebo control method used in this study shows good clinical operability and masking effect.

Effects of moxibustion at Yongquan (KI 1) on cognition function and lower limb motor function in patients with post-stroke cognitive impairment of kidney essence deficiency / 中国针灸

OBJECTIVE@#To observe the effects of moxibustion at Yongquan（KI 1） on the cognitive function and lower limb motor function in patients with post-stroke cognitive impairment of kidney essence deficiency.@*METHODS@#Eighty-four patients with post-stroke cognitive impairment of kidney essence deficiency were randomly divided into an observation group（42 cases，1 case dropped off）and a control group（42 cases，1 case dropped off）.The control group was treated with medication，electroacupuncture，rehabilitation training and repetitive transcranial magnetic stimulation（rTMS）；on the basis of the treatment as the control group，moxibustion at bilateral Yongquan（KI 1）was adopted in the observation group.Both groups were treated once a day，5 days a week with 2-day interval，4 weeks were required. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, Fugl-Meyer assessment-lower extremity (FMA-LE) score, Berg balance scale (BBS) score, functional independence measure (FIM) score, modified fall efficacy scale (MFES) score and scale for the differentiation of syndromes of vascular dementia (SDSVD) score before and after treatment were observed in the two groups.@*RESULTS@#After treatment，the MoCA, MMSE, FMA-LE, BBS, FIM and MFES scores were higher than those before treatment in both groups (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). After treatment，the SDSVD scores were lower than those before treatment in both groups (P< 0.05), and the SDSVD score in the observation group was lower than that in the control group (P< 0.05).@*CONCLUSION@#Moxibustion at Yongquan（KI 1） can improve the cognitive function and motor and balance function of lower limbs in patients with post-stroke cognitive impairment of kidney essence deficiency，reduce the risk of fall and improve the quality of life.

Professor LI De-hua's experience in treating facial nerve injury after total parotidectomy with blade needle based on jingjin theory / 中国针灸

The paper summarizes the academic thought and clinical experience of professor LI De-hua in treatment of facial nerve injury after total parotidectomy with blade needle based on jingjin (muscle region of meridian, sinew/fascia) theory. This disease is located at muscle regions of hand-/foot-three yang meridians; and the sinew/fascia adhesion is its basic pathogenesis, manifested by "transversely-distributed collaterals" and "knotted tendons". In treatment, the knotted tendons are taken as the points. Using the relaxation technique of blade needle, the lesions of sinews/fascia are dissected and removed to release the stimulation or compression to the nerves and vessels so that the normal function of sinews/fascia can be restored.

Beneficial Effects and Potential Mechanisms of Tai Chi on Lower Limb Osteoarthritis: A Biopsychosocial Perspective / 中国结合医学杂志

Lower limb osteoarthritis (OA) is a chronic, multifactorial disease characterized by impaired physical function, chronic pain, compromised psychological health and decreased social functioning. Chronic inflammation plays a critical role in the pathophysiology of OA. Tai Chi is a type of classical mind-body exercise derived from ancient Chinese martial arts. Evidence supports that Tai Chi has significant benefits for relieving lower limb OA symptoms. Using a biopsychosocial framework, this review aims to elucidate the beneficial effects of Tai Chi in lower limb OA and disentangle its potential mechanisms from the perspective of biology, psychology, and social factors. Complex biomechanical, biochemical, neurological, psychological, and social mechanisms, including strengthening of muscles, proprioception improvement, joint mechanical stress reduction, change of brain activation and sensitization, attenuation of inflammation, emotion modulation and social support, are discussed.

Effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury / 浙江大学学报·医学版

OBJECTIVES@#To investigate the effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury.@*METHODS@#A total of 80 patients with incomplete spinal cord injury caused by thoracolumbar fracture admitted in Ningbo Yinzhou No.2 Hospital from April 2020 to December 2021 were randomly divided into control group and study group, with 40 cases in each group. In addition to routine training, the control group received torso training on stable surface and the study group received torso training on unstable surface. The gait, lower limb muscle strength, balance function, lower limb function, mobility and nerve function of the two groups were compared.@*RESULTS@#After treatment, the stride length, stride frequency and comfortable walking speed improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05). The muscle strength of quadriceps femoris, gluteus maximus, hamstring, anterior tibialis and gastrocnemius were improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05); the total trajectories of static eye opening and static eye closing gravity center movement in the two groups were significantly shorter (all P<0.05), and the improvements in the study group were more significant (all P<0.05). The dynamic stability limit range and the American Spinal Injury Association (ASIA) lower extremity motor score, Berg balance scale, modified Barthel index scale in the two groups were significantly higher (all P<0.05), and these scores in study group were significantly higher than those in the control group (all P<0.05). Both groups showed a significant improvement in ASIA grade (all P<0.05), and the improvement in the study group was significantly better (P<0.05).@*CONCLUSIONS@#Torso training on unstable surface can effectively improve the gait and lower limb muscle strength of patients with incomplete spinal cord injury and improve the lower limb motor function.

Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism / 中华创伤杂志(英文版)

PURPOSE@#Static progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.@*METHODS@#A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference.@*RESULTS@#In total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy.@*CONCLUSION@#The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.

Research progress of knee meniscal repair techniques / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of meniscus repair in recent years, in order to provide help for the clinical decision-making of meniscus injury treatment.@*METHODS@#The domestic and foreign literature related to meniscal repair in recent years was extensively reviewed to summarize the reasons for the prevalence of meniscal repair, surgical indications, various repair methods and long-term effectiveness, the need to deal with mechanical structural abnormalities, biological enhancement repair technology, rehabilitation treatment, and so on.@*RESULTS@#In order to delay the occurrence of osteoarthritis, the best treatment of meniscus has undergone an important change from partial meniscectomy to meniscal repair, and the indications for meniscal repair have been expanding. The mid- and long-term effectiveness of different meniscal repair methods are ideal. During meniscus repair, the abnormality of lower limb force line and meniscus protrusion should be corrected at the same time. There are controversies about the biological enhancement technology to promote meniscus healing and rehabilitation programs, which need further study.@*CONCLUSION@#Meniscal repair can restore the normal mechanical conduction of lower limbs and reduce the incidence of traumatic osteoarthritis, but the poor blood supply and healing ability of meniscal tissue bring difficulties to meniscal repair. Further development of new biological enhanced repair technology and individualized rehabilitation program and verification of its effectiveness will be an important research direction.

Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee.@*METHODS@#The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb.@*RESULTS@#The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision.@*CONCLUSION@#For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.