ABSTRACT
Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.
ABSTRACT
Objective To study the impact of different insulin levels on the conversion from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM),through analysis of different glycometabolism condition among quinquagenarian population.Methods Subjects enrolled were Beijing habitants who received annual physical examination [ including oral glucose tolerance test (OGTI) ] in the Chinese PLA General Hospital from 2005-2007.According to the OGTT results,the subjects were divided into three groups,including normal glucose tolerance-non-hyperinsulinemia group (NGT-NHIns),IGT-hyperinsulinemia group (IGT-Hins) and IGT-non-hyperinsulinemia group (IGT-NHINS).The prognosis between the year 2009 and 2010 of the three groups was observed.Hyperinsulinemia was diagnosed with fasting serum insulin ≥ 15 mU/L and/or 2-hour serum insulin ≥ 80 mU/L after glucose loading.Results The rate of case number of conversion to T2DM in IGT-NHIns group (42/133) was higher than that in IGT-Hins group (24/154) or NGT-NHIns group (12/126).The HOMA insulin resistance index (HOMAIR) of individuals with IGT-NHIns was lower than that of IGT-Hins [ 0.96 (0.40,3.53 ) vs 2.04 (0.59,23.20),P ＜ 0.05 ],while whole body insulin sensitivity index (WBISI) was higher than that of IGT-Hins [ 7.48 (3.20,31.35 ) vs 3.28 ( 0.86,7.67 ),P ＜ 0.05 ].Modified β-cell function index ( MBCI ) and insulin secretion index (ISI) in IGT-NHIns was poorer than that of IGT-Hins respectively [ 2.57 (0.58,10.98) vs5.17(1.04,65.09); 7.66 (0.99,28.40) vs 17.56 (4.18,96.46),allPvalues ＜0.01].Conclusions The risk of IGT-NHIns progressing into T2DM is higher than that of IGT-Hins. For the prevention of T2DM,individuals with IGT-NHIns should be paid more attention than keeping an eye on IGT-Hins patients.Early control of risk factors could protect β cell function and prevent the progression to T2DM.