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Objective To explore the significance of comprehensive treatment including anticoagulation,inferior vena cava filter implantation,mechanical thrombectomy,iliac vein angioplasty and stent placement and catheter-directed thrombolysis (CDT) in the treatment of acute iliac femoral vein thrombosis on the basis of left iliac vein compression.Methods In this study 61 patients were enrolled at Beijing Luhe Hospital,Capital Medical University between Mar 2013 and Mar 2019 in anticoagulation combined with CDT group and comprehensive treatment group.Short-term venous recanalization rate scores and long-term proximal valvular function of left femoral vein were compared.The survival curve was drawn using kaplan-meier method,and incidence of PTS was compared with the Log rank test.Results The short-term venous recanalization rate scores of the patients in the comprehensive treatment group were higher than scores of the patients in the traditional treatment group(t =9.872,P ＜ 0.001).16 patients developed PTS.The incidence of PTS in the comprehensive treatment group was lower than that in the traditional treatment group(x2 =7.146,P =0.008).Patients in comprehensive treatment group kept a better function of the proximal valvular of left femoral vein than patients in the traditional treatment group (x2 =23.834,P ＜0.001).Conclusions The comprehensive treatment can effectively reduce the occurrence of long-term PTS in patients with acute iliac femoral vein thrombosis complicated with left iliac vein compression,and improves the quality of patients' life.
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Objective To investigate the clinical value of limited debridement in treating diabetic foot osteomyelitis with incomplete foot gangrene.Methods Retrospective analysis of traditional surgery (complete removal of diseased bone and soft tissue) and limited debridement (limited removal of diseased bone and soft tissue) in patients with incomplete foot gangrenuria foot osteomyelitis from February 2015 to March 2017,There were 38 cases in the traditional operation group and 76 cases in the limited debridement group.Between the two groups,the sex ratio (20/18 vs 41/35),age (64.90±8.40 vs 68.1±8.10),Wagner 3/4 grading ratio (12/26 vs 26/50),the ratio of nerve ulcers/ischemic neurotic ulcers (13/25 vs 24/52),the ulceration ratio of forefoot/middle foot±hind foot (33/5 vs 68/8),arterial ABI (0.71±0.39 vs 0.67±0.33),and lower extremity arterioplasty ratio (52.63％ vs 59.21％),combined with hypertension (78.95％ vs 77.63％),coronary heart disease (71.05％ vs 69.74％),cardiac insufficiency (10.53％ vs 9.21％),renal failure rate (21.05％ vs 22.37％),incidence of hypoproteinemia (10.53％ vs 10.53％),anaemia (15.79％ vs 19.74％) and drug resistance of drug resistant bacteria (26.32 vs 23.68％) had no statistical difference.All the patients received antibiotic after surgery.The incidence of antibiotic related complications,the rate of amputation on the ankle,the average length of hospitalization,the average healing time of the ulcer/wound,the rate of readmission in one year,the rate of recurrent ulcer,the rate of new ulceration,the rate of ulceration and the death rate were collected to evaluate the clinical effects.Results The duration of antibiotic use in the traditional operation group (25.2±12.3 d) and the average hospitalization time (16.9±7.6 d).The average healing time of ulcer/wound (121.6 ±23.7 d) was shorter than that of limited debridement group (32.5± 16.8 d,24.7± 12.5 d,153.2±27.8 d).The amputation rate (1.32％),re-admission rate (1.32％),ulcer recurrence rate (2.63％) and ulcer recurrence rate (1.32％) in the limited debridement group were significantly lower than those in the traditional operation group (10.53％,31.58％,21.05％,28.95％).There was no significant difference in the incidence of antibiotic-related complications and all-cause mortality between the two groups.Conclusion Conservative surgery for diabetic foot osteomyelitis of incomplete foot gangrene is scientific and reasonable,and the quality of life of patients can be improved.The clinical benefit is obvious.It is worth of clinical promotion.
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Objective To observe the clinical effects of open kinetic chain and closed kinetic chain exercise in the early period of anterior cruciate ligament reconstruction rehabilitation,provide the theoretical and clinical experiences for the early rehabilitation of the anterior cruciate ligament reconstructed knee.Methods From February 2009 to June 2010,60 patients undergoing single-bundle anterior cruciate ligament reconstructions by using hamstring tendon allograft were enrolled in the study,and were divided into two groups:open kinetic chain group(30 cases,30 knees)and closed kinetic chain group(30 cases,30 knees).In accordance with the rehabilitation procedures for six months,no statistically significant differences were found between the two groups in Lysholm scores,International Knee Documentation Committee(IKDC)scores and one-leg hop test preoperative.The active and passive range of notion,Lysholm scores,IKDC scores,one-leg hop test and KT-1000 were evaluated three and six months after surgery.Results Three months after surgery,no significant differences were found in passive range of motion,Lysholm scores,IKDC scores,but significant differences were found in active range of motion,one-leg hop test and KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Six months after surgery,no significant differences were found in active range of motion,passive range of motion,one-leg hop test,Lysholm scores,IKDC scores,but significant difference in KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Conclusion Closed kinetic chain exercise is benefit for recovery of muscles strength,proprioception and protect the graft in the early rehabilitation period after anterior cruciate liganent reconstruction.
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Objective To investigate the impact of graft position shift on anterior cruciate ligament reconstruction induced by femoral fixation of interference screw. Methods Nineteen fresh cadaveric knees were used and assigned to three groups. 1) Study of graft position shift: 5 knees were randomly selected, interference screws of 7 mm, 8 mm and 9 mm were used in autologous tendon fixation, then the graft position shift were measured. 2) Study of isometry: 7 knees were randomly divided into the isometric reconstruction group (D group). In the D group, Retrobutton, interference screw and interference screw in location-corrected bone tunnel were used respectively as fixation. The isometry of grafts was evaluated. 3) Study of tibia anterior translation: 7 knees were randomly divided into the anatomic reconstruction group (J group). In the J group,the tibia anterior translation was measured in four different conditions in the same joint: intact knee joint,knee joint without ACL, ACL anatomic reconstruction by interference screw fixation, and ACL anatomic reconstruction by interference screw fixation with corrected bone tunnel location. Results 1) With 7 mm, 8mm and 9 mm interference screw fixation, graft position shift were (2.36±0.11) mm, (2.72±0.06) mm and (3.00±0.06) mm respectively. 2) Graft length change: graft length change in Retrobutton group and corrected bone tunnel group were less than 3 mm, while graft length change in those fixed with interference screw were stretched in more than 3 mm. 3) Study of tibia anterior translation: there was no difference among the intact group, the anatomic group and the corrected group at 0° and 15°. However, the difference was found between the intact group and other groups at 30°、60° and 90° of flexion, as well as between these two reconstructed methods at 20° joint flexion (P＜0.05). Conclusion In both isometric and anatomic ACL reconstruction with interference screw, the graft is pushed tightly toward the femoral tunnel wall, which shifts the graft away from the desired position. In our study we find out that the corrected location of the femoral bone tunnel significantly improves the isometry of ACL reconstruction and anatomic reconstruction.
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[Objective]To explore the "acute angle" of femur,and evaluate the bone tunnel technique in posterior cruciate ligament reconstruction.[Method]Using the porcine flexor digitorum tendon as graft,the author reconstructed posterior cruciate ligament.The bone tunnel was established with the angle of 80?,90?and 100?comparison the tunnel and intercondylar fossa of femur side wall,and press sensitive film was set between the edge of tunnel and graft.The pressure between was used to represent abrasion.The bigger the pressure was,the larger the abrasion was.The difference of pressure between bone tunnel technique group and the control group was compared.[Result]The pressure of angle 100?was lowest(3.55?0.21 MPa).And the pressure of burnishing group(3.29?0.19 MPa)was lower than that of the control group(3.55?0.21 MPa).[Conclusion]The bone tunnel technique can reduce the femoral;"acute angle" of femur in posterior cruciate ligament reconstruction.
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45.0?5.4)was higher than those who underwent omnidistance tourniquet technology.The incidence rate of hematoma and venous thrombus of lower extremity had no obvious difference.[Conclusion]The postoperative blood loss can be reduced and early postoperative clinical effect and affected limb function can be improved by halfway tourniquet technology for patients who underwent TKA.