ABSTRACT
Objective To explore the impact of arterial injury on distal limb blood supply in lower limb trauma. Meth?ods Retrospective analysis of 93 patients with different levels of lower limb arterial injury admitted to our hospital from June 2014 to August 2017. There were 84 males and 9 females aged 43.54±9.90 years (ranging 25-65 years). Revascularization was performed through open reduction. Patients were divided into three groups according to their arterial injury locations. Proximal ves?sels were along the superficial femoral artery, from its beginning to the point where it was divided into the descending genicular ar?tery and direct periosteal branches. Intermediate vessels were from the dividing point on the superficial femoral artery to the popli?teal artery before it was divided into the medial inferior genicular artery. Distal vessels were from the dividing point on the poplite?al artery to the distal end of the peroneal artery. The duration from injury to revascularization in the three groups were 13.67±5.99 h, 11.15±4.43 h, and 11.92±5.48 h, respectively. There was no significant difference between groups (F=1.564, P=0.215). ISS in the three groups were 13.00±3.74, 12.77±3.81, and 11.50±3.99, respectively. There was no significant difference between groups (F=1.445, P=0.241). The following items were compared among the three groups, postoperative creatine kinase, arterial blood lac?tate and limb compartment cut. Results Creatine kinase of the intermediate vascular group was 8 743.15±6 968.48 u/L, proximal vascular group 1 467.67±1 810.27 u/L, distal vascular group 2 893.51±1 304.56 u/L. The data of intermediate vascular group were higher than those of proximal and distal vascular groups with significant difference among the groups (F=22.587,P=0.000). The lactate of the intermediate vascular group was 3.20 ± 1.51 mmol/L, proximal vascular group 1.63 ± 0.46 mmol/L, distal vascular group 1.85±0.69 mmol/L with significant difference among the groups (F=20.612,P=0.000). The compartment cut of the intermedi?ate vascular group was incised in 24, but not in 15. The proximal vascular group was not incised in 18, while 15 was incised and 21 not incised in distal vascular group. The rates of compartment cut were 61.5%, 0 and 41.7%, respectively with significant differ? ences (χ2=19.156, P=0.000). Conclusion In lower limb injuries, the intermediate vascular (from the superficial femoral artery after it is divided into the descending genicular artery and direct periosteal branches to the popliteal artery before it is divided into the medial inferior genicular artery) injury leads to the most severe distal limb ischemia.
ABSTRACT
Objective To summarize and analyze the clinical features,diagnostic methods and treatment measures of patients with advanced spontaneous esophageal rupture. Methods Retrospective analysis of clinical characteristics of 10 patients with advanced spontaneous esophageal rupture was conducted. Results The average age of the patients was 49. 3 years old. The average time of diagnosis was 82. 6 hours. The cause of onset was drastic vomiting except for one case falling down. The main clinical manifestations were chest pain,abdominal pain,and shortness of breath,fever and elevation of hemogram,pleural effusion appeared in all patients,1 case was not treated in time,and 9 cases of the first checks were delayed for diagnosis and treatment in other specialties. Conservative treatment(closed thoracic drainage,gastrointestinal decompression,enteral nutrition support and antimicrobial therapy) was given to all patients. All 10 cases were cured by conservative treatment,the average time of hospitalization was 49. 4 days,followed up for 2 years, no chronic empyema, stricture of the esophagus and reflux esophagitis were observed. Conclusion Late spontaneous rupture of the esophagus is caused by delays in the diagnosis and treatment of the esophagus,the effect of comprehensive conservative treatment is satisfactory.
ABSTRACT
Objective To explore the relation between lower extremity deep venous thrombosis and knee injury.Methods 100 knee injury patients were operated on in our department.The difference of incidence rates of DVT,the thrombus location and incidence rates of DVT before and after operation in the two groups was compared.There were no fatal pulmonary embolism occurring in either group.Results The incidence rate of DVT in tibial plateau fracture group was 52％,that in patellar fracture was 30％ (P ＜ 0.05).DVT incidence rate of popliteal,pretibial,posterior tibial vein thrombosis in group of tibial plateau fracture was higher than that in group of patellar fracture (P ＜ 0.05),while there was no significant difference in postoperative thrombosis between the two groups(P ＞ 0.05).Conclusions There is a high incidence rate of DVT in knee joint injury.Which is closely related to the position of fracture and limb immobilization.
ABSTRACT
Objective To investigate the relationship between lipocalintype prostaglandin dsynthase(L-PGDS) and visfatin in the lower extremity atherosclerotic plaque. Methods Collected from February 2014 to February 2016 in vascular surgery of our hospital 40 cases of femoral artery atherosclerotic plaque intima specimens (observation group), 20 cases of splenic artery, superior mesenteric artery samples (control group), the expression of visfatin and L-PGDS protein were detected by immunohistochemical staining, and the expression of visfatin and L-PGDS mRNA were determined by RT-PCR. Results The observation group visfatin protein expression was (121.42±11.07), significantly higher than the control group (72.07±12.81), and L-PGDS protein expression was (87.93±9.73), significantly lower than the control group (107.04±10.58), the difference was statistically significant (P<0.05). The relative expression of visfatin mRNA in the observation group was (0.321±0.024), which was significant higher than that of the control group (0.217±0.031), while L-PGDS mRNA was (0.203±0.018), significantly lower than the control group (0.314±0.029), the difference was statistically significant (P<0.05); The expression of L-PGDS protein was negatively correlated with the expression of visfatin protein in the plaque tissue (r=-0.617, P<0.05), visfatin mRNA and L-PGDS mRNA were negatively correlated (r=-0.645, P< 0.05). Conclusion Visfatin and L-PGDS in lower extremity atherosclerosis occurrence and development have an important relationship, both of them may play an antagonistic role.
ABSTRACT
Objective To investigate methods and results of endovascular treatment in TASC (Ⅱ) D-type femoral artery occlusion. Methods From January 2012 to May 2013, 26 cases (26 branches) of superficial femoral artery occlusion with endovascular treatment of TASC (Ⅱ) D-type superficial femoral artery occlusion were retrospectively reviewed. The effi-cacy was evaluated through ABI, CTA, DSA and symptoms improved. Results 26 branches were treated with endovascular methods. Technical success rate was 80.7%(21/26), including 13 branche with stent implantation, 6 branches with Silver-hawk atherectomy and 2 branches with Viabahn stent implantation. All patients were followed up for a mean period of (10.3 ± 1.2)months, primary patency rates at 6 months were 69.2%in stent group, 66.7%in Silverhawk atherectomy group and 100%in Viabahn stent group. Conclusion Endovascular treatment of TASC (Ⅱ) D-type femoral artery occlusion can lead to satisfactory short term patency rates, and Viabahn stent is the latest treatment.