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Objective To compare the differences in lower limb force line between degenerative medial meniscus injuries and lateral meniscus injuries and investigate their correlation.Methods A total of 90 patients who underwent arthroscopic treatment for meniscal injuries between March 2019 and March 2022 were enrolled in the study.They were 45 males and 45 females,at a median age of 52 years(ranging from 40 to 59 years).Of these patients,47 had medial meniscus injuries,while 43 had lateral meniscus injuries.The hip-knee-ankle(HKA)angle was measured on full-length films,and the differences were compared between the 2 groups.Results There were no significant differences in terms of gender,age,lower limb laterality,body mass index,site of injury,and type of injury between the medial meniscus injury group and the lateral meniscus injury group.Statistical difference was observed in the mean HKA angle,with a value of(177.20±2.46)° in the medial meniscus injury group and of(181.05±3.13)° in the lateral meniscus injury group(P＜0.01).Conclusion There is a significant difference in HKA angle between medial meniscus injury group and the lateral meniscus injury group.A correlation is found between lower limb alignment and degenerative meniscus injury.
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Objective:To explore the application value of regional oxygen saturation (rSO 2) level in the prognosis evaluation of patients with acute lower limb ischemia (ALLI). Methods:Retrospective analysis of clinical data of 82 ALLI patients admitted to the ICU of Xinjiang Uygur Autonomous Region People's Hospital from June 2021 to June 2022. The subjects were divided into event group and non-event group according to the incidence of adverse events during the follow-up. The general clinical data of the two groups were compared. Multiple stepwise linear regression was used to analyze the independent related factors of rSO 2. Multivariate Cox regression was used to analyze independent risk factors of adverse events. Receiver operating characteristic (ROC) curve was used to obtain the optimal cut-off value of rSO 2 prediction adverse events. The subjects were divided into high-value group and low-value group according to the optimal cut-off value. Kaplan-Meier curve was used to analyze the difference in survival rate between groups during the follow-up. Results:A total of 82 ALLI patients were included in this study, and the incidence of adverse events during follow-up was 25.6% (21 cases). The rSO 2 of four periods and maximum, minimum, average and ankle-brachial index in the event group were significantly lower than those in the non-event group. The troponin I, troponin T, myoglobin, creatine kinase, C-reactive protein, and lactate in the event group were significantly higher than those in the non event group ( P?0.05). Multiple stepwise linear regression analysis showed that: C-reactive protein ( β=-0.320, P=0.002), lactate ( β=-0.262, P=0.009), troponin Ⅰ ( β=-0.230, P=0.025), and smoking history ( β=-0.211, P=0.034) were all independent predictors of rSO 2. Multivariate Cox regression analysis showed that 24 h rSO 2 (mean) was an independent influencing factor for adverse events in ALLI patients (adjusted HR=0.67, 95% CI:0.54-0.83, P<0.001). The 24 h rSO 2 (mean) was good in predicting the incidence of adverse events at 30, 60, and 90 days in ALLI patients (AUC were 0.934, 0.867 and 0.823), and the corresponding optimal cut-off values of rSO 2 were 59.36, 59.03 and 59.03. The sensitivity and specificity to predict adverse events in ALLI patients were 85.7% and 85.3% when the 24 h rSO 2 (mean) was 59.36 as the best cut-off value. According to the optimal cut-off , the subjects were divided into high value group (rSO 2>59.36%, 59 cases) and low value group (rSO 2≤59.36%, 23 cases), Kaplan Meier survival curve analysis showed that there was significant difference in event free survival between the two groups ( P<0.001), the high value group significantly better than the low value group. Conclusion:The 24 h rSO 2 (mean) is an independent influencing factor for adverse events in ALLI patients, and has good predictive value for prognosis.
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Objective To explore the application effect of new improved 3D printing individualized guidance(3D psi)in total knee arthroplasty(TKA)for knee osteoarthritis(KOA).Methods A total of 100 patients with KOA in 920th Hospital of Joint Logistics Support Force,PLA from January 2021 to January 2022 were selected,and were divided into 2 groups of 50 patients each using the randomized numerical table method.The control group was treated with conventional TKA,and the study group was treated with new improved 3D psi assisted TKA.The operation conditions,postoperative rehabilitation,complications,prosthesis component position deviation,knee range of motion(ROM),lower limb force line parameters[coronal distal femoral mechanical axis lateral angle(mldfa),lower limb mechanical axis angle(HKA)],gait parameters(percentage of support time,stride,pace),knee function(HSS score),quality of life(AIMS2 score)were observed.Results Com-pared with control group,the amount of intraoperative and postoperative blood loss and drainage volume 2 days after operation were less in the study group,and the operation time and hospital stay were shorter(P<0.05).The deviations of LTC Angle,FFC Angle,HKA Angle,LFC Angle and FTC Angle in the study group were smaller than those in the control group(P<0.05).At 3 months,6 months and 12 months after surgery,the percentage of knee ROM,supporting time,stride length and walking speed of the research group were higher than those of the control group,while the coronal-position mLDFA and HKA were lower than those of the control group(P<0.05).The proportion of WBC and PMN in joint fluid at 3 months,6 months and 12 months after surgery was lower than that in control group(P<0.05).The HSS score of the study group was higher than that of the control group at 3 months,6 months and 12 months after operation,and the AIMS2 score was lower than that of the control group(P<0.05).There was no statistically significant difference in the incidence of complications between the study group and the control group(P>0.05).Conclusion The new improved 3D PSI-assisted TKA treatment of KOA can optimize the surgical situation,improve operating accuracy,improve the patient's lower limb alignment,promote limb function recovery,help improve the quality of life,and has high safety.
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Objective:To retrieve, evaluate and integrate the relevant evidence of prevention of lower limb ischemic complications in venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients, and provide reference for the development of scientific and complete prevention and management of lower limb ischemic complications.Methods:According to the evidence-based methodology, clinical decisions, guidelines, expert consensus, evidence summary, systematic review, randomized controlled trials and experimental studies related to lower limb ischemia complications in VA-ECMO patients were searched from CNKI, Wanfang, PubMed, Cochrane Library and other domestic and foreign databases as well as relevant professional websites. The literature search period was from the establishment of the database to August 2023. Two researchers independently evaluated the literature quality, and then extracted and summarized the evidence according to the theme.Results:A total of 27 004 articles were obtained in the preliminary search, and 11 articles were finally included after screening, including 1 guide, 2 expert consensus, 2 systematic reviews and 6 original studies. Through literature reading, evidence extraction and classification, and expert group meetings, a total of 24 best evidences were concluded in four dimensions, including team training and management, VA-ECMO pre-computer evaluation, VA-ECMO catheter selection, and the monitoring and management of lower limb ischemia.Conclusions:This study summarized the best evidence for the prevention of lower limb ischemia complications associated with VA-ECMO patients, and can provide reference for healthcare providers in clinical practice. In order to ensure the safety of VA-ECMO treatment and reduce the incidence of related complications, healthcare professionals should carefully select and apply evidence according to the clinical context and patients′ wishes.
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Objective To explore the role and efficacy of VEGF and HGF gene adenovirus vector in promoting angiogenesis in ischemic tissue.Methods 84 Kunming mice were randomly divided into sham group,control group,VEGF group,HGF group and VEGF+HGF group,and the left lower limb ischemia model was established.The blood supply of ischemic tissue was observed by rheometer,and the expression levels of VEGF and HGF in each group were detected by Western Blot and ELISA.Immunohistochemical staining was used to detect angiogenesis(CD31,SMA)in ischemic tissues.Safety was assessed by side effects during treatment in mice.Results After the successful modeling,the blood flow velocity of the left lower limb in each group decreased significantly.On the 7th day after operation,the blood flow of the left lower limb in each group was significantly better than that on the 0th day after operation(P<0.05),and the blood flow of the left lower limb in Ad-VEGF-HGF group was significantly better than that in other groups(P<0.05).On the 28th day after operation,the blood flow of the left lower limb in Ad-VEGF-HGF group gradually stabilized,the blood flow in Ad-VEGF-HGF group was significantly better than that in other groups,and both VEGF group and HGF group were significantly better than the control group(P<0.05).On the 7th,14th,and 28th days following surgery,HGF and VEGF protein levels in the Ad-HGF,Ad-VEGF,and Ad-VEGF-HGF groups were substantially greater than those in the control group(P<0.05).The expression level in the Ad-VEGF-HGF group peaked on the 14th day(all P<0.001)and subsequently declined to preoperative levels on the 28th day after operation.Conclusion Ad-VEGF-HGF gene injection can effectively boost VEGF and HGF protein expression and rapidly reach the relative peak level,encour-aging angiogenesis after lower limb ischemia,increasing blood flow,and improving lower limb circulation.
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BACKGROUND:Confirming the reliability and validity of the My jump 2 application for measuring lower limb vertical stiffness may offer the possibility of it as an alternative to the Kistler three-dimensional force platform for measuring lower limb stiffness. OBJECTIVE:To verify the reliability and validity of the My Jump 2 application in measuring lower limb vertical stiffness of college students. METHODS:The drop jump data of the participants were collected through the Kistler three-dimensional force platform and the My Jump 2 application,and the vertical stiffness of the participants'lower limb vertical stiffness was calculated.The intraclass correlation coefficient was used to analyze the data measured by the My Jump 2 application and the Kistler three-dimensional force platform,attempting to verify the reliability of the My Jump 2 application.The bias and average between the two devices were drawn into a Bland-Altman diagram to verify the consistency between the two test methods.Finally,the test-retest reliability of the My Jump 2 applications at 30 cm and 40 cm was analyzed using the Cronbach's alpha(α)and coefficient of variation.Pearson product-moment correlation was used to analyze the correlation of My Jump 2 applications. RESULTS AND CONCLUSION:My Jump 2 application has high reliability and validity when measuring the vertical stiffness of the lower limb.At the same time,due to its advantages of low cost,convenient portability and field testing for large samples,it can be used as an alternative to the Kistler three-dimensional force platform to test the vertical stiffness of the lower limb in college students and similar populations.
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BACKGROUND:The risk factors for patellofemoral pain syndrome are still unclear and research on risk factors is gradually becoming a hot topic in order to improve the therapeutic outcome of this disease. OBJECTIVE:To investigate the relationship between lower limb alignment and patellofemoral pain syndrome in young male runners. METHODS:In the same running population,21 patients with bilateral knee pain,29 patients with single knee pain and 20 normal runners were collected from January 2021 to July 2022.Full-length X-ray examination of both lower limbs in standing position was performed in all subjects.The lateral distal femoral angle,medial tibial proximal angle,joint line congruence angle,hip-knee-ankle angle,and knee physical valgus angle were measured and statistically analyzed. RESULTS AND CONCLUSION:There was no significant difference in the parameters between the left and right knees in each group(P>0.05).Compared with the normal group,no significant changes in lateral distal femoral angle,medial tibial proximal angle,joint line congruence angle,and hip-knee-ankle angle were observed in the single knee pain group and double knee pain group,while the knee physical valgus angle was significantly increased in these two groups(P<0.05).To conclude,increased knee physical valgus angle may be a risk factor for patellofemoral pain syndrome.
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BACKGROUND:The basic principle of the design of the robot system used for total knee arthroplasty is to combine three-dimensional surgical planning,early warning of danger areas during surgery,real-time data feedback,robot arm assisted osteotomy and other technologies to achieve precision and personalization of total knee arthroplasty,which is exactly its biggest advantage.Therefore,it has become a hot topic in the field of joint surgery in recent years and attracted much attention. OBJECTIVE:To summarize the development status of robotic-assisted total knee arthroplasty in the field of joint surgery and the comparison of advantages and disadvantages with conventional total knee arthroplasty and to prospect the future development of robotic-assisted total knee arthroplasty. METHODS:Relevant articles were searched from PubMed,CNKI,Wanfang and VIP databases by computer.English key words were"robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR".Chinese key words were"robotic-assisted,computer navigation,total knee arthroplasty".Finally,64 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)The robot system used to assist total knee arthroplasty is divided into active,semi-active and passive according to its degree of freedom.The semi-active system,currently widely used in robotic systems,effectively enhances the accuracy and personalization of total knee arthroplasty.However,its high implementation cost and relatively steep learning curve remain key factors to be balanced when promoting its adoption in joint surgery field.(2)Robotic-assisted total knee arthroplasty can achieve precise osteotomy and correct placement of prosthesis in local three-dimensional space of the knee joint.It has been widely proven that it can provide better accuracy of prosthesis implantation,reduce imaging abnormalities,obtain good soft tissue balance during the operation,and ultimately improve the motion and functional status of the knee joint after the operation.(3)However,the current robotic-assisted system still has objective shortcomings,including the problem of learning curve between different robot devices and operators,additional installation and maintenance costs,and potential complications related to robot surgery.Therefore,whether it can truly benefit the medical system and patients still needs to be proven by long-term research,and the robotic-assisted system also needs to be further improved substantially.(4)Robotic-assisted total knee arthroplasty technique is still in the preliminary research stage in clinical practice and has not been widely applied.To better define the usage of robotic-assisted total knee arthroplasty and enhance its clinical procedural standards and safety,refining these aspects will become a focal point of future research on robotic-assisted total knee arthroplasty.
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BACKGROUND:For early knee osteoarthritis in which total knee arthroplasty fails to achieve satisfactory results,high tibial osteotomy that has been found to promote regeneration of damaged cartilage and alleviate symptoms in patients is considered a classic knee-preserving procedure. OBJECTIVE:To review and discuss the effectiveness,mechanism,and application prospects of high tibial osteotomy in stimulating cartilage regeneration in knee osteoarthritis and to provide a theoretical basis for the use of high tibial osteotomy in the treatment of knee osteoarthritis. METHODS:A computerized search was conducted in PubMed,Web of Science,CNKI and WanFang databases for relevant literature published from 2013 to 2023.The search terms used were"knee osteoarthritis,high tibial osteotomy,limb alignment,chondrocytes,biomechanics,intra-articular"in both English and Chinese.Finally,75 articles were included for review. RESULTS AND CONCLUSION:High tibial osteotomy correcting the lower limb alignment has been found to be effective in alleviating symptoms and potentially delaying or preventing the need for total knee arthroplasty.This is an important aspect of orthopedic step-down treatment in knee osteoarthritis.Maintaining a normal mechanical microenvironment is crucial for the proper functioning and maintenance of chondrocyte phenotype.Abnormal mechanical signals can be converted into intracellular chemical signals through mechanosensors like primary cilia,integrins,cytoskeleton and nucleoskeleton,resulting in disruptions to the balance of matrix metabolism and regulation of inflammatory responses.Chondrocytes after abnormal stress action still have the potential to revert to a normal phenotype under appropriate stress;correction of the mechanical microenvironment by high tibial osteotomy leads to spontaneous cartilage repair and remission of synovial inflammation.The combination of high tibial osteotomy and cartilage regeneration strategy holds promising prospects for patients with early knee osteoarthritis who are not candidates for total knee arthroplasty.
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BACKGROUND:In recent years,computer-assisted navigation has gradually attracted attention in the medical field.Some scholars have reported that the clinical effects of computer navigation in total knee arthroplasty vary.To explore the clinical effect of the new generation of Brainlab Knee 3 navigation system,this study is conducted. OBJECTIVE:To analyze the application effect of computer navigation system(Brainlab Knee 3)combined with gap balance technology in total knee arthroplasty. METHODS:A total of 71 patients received total knee arthroplasty at the Department of Joint Surgery of Dalian Second People's Hospital from November 2020 to May 2021.In the navigation group,35 patients underwent total knee arthroplasty by computer navigation combined with gap balance.In the traditional group,36 patients underwent osteotomy with traditional surgical instruments.The difference between medial and lateral joint spaces,knee range of motion,hospital for special surgery knee score,hip-knee-ankle angle,deviation values of coronal femoral component angle,coronal tibial component angle,and sagittal tibial component angle were compared between the two groups. RESULTS AND CONCLUSION:(1)In the navigation group,the differences of intraoperative medial and lateral joint gap at knee extension 0,1,and 2 mm were found in 19,14,and 2 cases,respectively.The gap difference was 0 mm in 18 cases,1 mm in 15 cases and 2 mm in 2 cases at 90° degree knee flexion.In the traditional group,the gap difference at knee extention was 0 mm in 10 cases,1 mm in 20 cases,and 2 mm in 6 cases.The gap difference at 90 degree knee flexion was 0 mm in 10 cases,1 mm in 15 cases and 2 mm in 8 cases.(2)The operation time in the navigation group was longer than that in the traditional group(P<0.05),and two patients in the navigation group developed lower limb intermuscular vein thrombosis after surgery,and none of the patients in the traditional group had complications.(3)The range of motion between the two groups increased significantly at 6 and 12 months after surgery,and the range of motion in the navigation group was higher than that in the traditional group(P<0.05).(4)At 12 months after surgery,the hospital for special surgery knee scores of both groups increased significantly,and the hospital for special surgery knee score in the navigation group was higher than that in the traditional group(P<0.05).(5)At 6 months after surgery,the deviation values of hip-knee-ankle angle,coronal femoral component angle,coronal tibial component angle,and sagittal tibial component angle of navigation group were significantly lower than those in the traditional group(P<0.05).(6)The results showed that computer navigation technique combined with gap balance in total knee arthroplasty had advantages in postoperative range of motion,lower limb alignment and the accuracy of tibial prosthesis component position,and joint function recovered well.
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Objective To observe the differences between the lymphatic reflux in the lower extremities and near the uterus by interphalangeal and cervical injection of indocyanine green(ICG).Methods A total of 50 patients with early-stage endometrial cancer or cervical cancer admitted to Zhoukou Central Hospital from June 2019 to November 2022 were selected as the research subjects.According to the ICG injection site during the surgery,patients were divided into the interphalangeal injection group(n=20)and the cervical injection group(n=30).The patients in the two groups were injected with ICG at the toes or cervix uteri,respectively.The lower limb lymphatic reflux pathway in the pelvic cavity and the para-uterine lymphatic reflux pathway were observed under fluorescence laparoscopy,and the differences between the two groups were analyzed.Results Among the patients with the interphalangeal injection of ICG(20 patients,40 sides),the lower limb lymphatic reflux was developed on 33 sides of 18 patients but not developed on both sides of 2 patients.Among the 18 patients,26 sides showed the lower limb lymphatic reflux through deep inguinal lymph nodes,circumflex iliac lymph nodes,external iliac lymph nodes,and common iliac lymph nodes;5 sides showed the lower limb lymphatic reflux to deep inguinal lymph nodes,circumflex iliac lymph nodes,obturator lymph nodes,internal iliac lymph nodes,and common iliac lymph nodes;and 2 sides showed the lower limb lymphatic reflux to deep inguinal lymph nodes,obturator lymph nodes,internal iliac lymph nodes,and common iliac lymph nodes.Among the patients with the cervical injection of ICG(30 patients,60 sides),pelvic lymph nodes were developed on 55 sides of 29 patients but not developed bilaterally in 1 patient.In the 29 patients,2 sides showed para-uterine lymphatic reflux to obturator lymph nodes,circumflex iliac lymph nodes,external iliac lymph nodes,and common iliac lymph nodes,in which circumflex iliac lymph nodes were non-sentinel lymph nodes;40 sides showed para-uterine lymphatic reflux to medial iliac lymph nodes(or obturator lymph nodes)and common iliac lymph nodes along the superior paracervical lymphatic reflux pathway;and 13 sides showed para-uterine lymphatic reflux to the internal iliac or presacral lymph nodes along the inferior paracervical lymphatic reflux pathway.The shared pathway of lower limb lymphatic reflux and para-uterine lymphatic reflux was upward reflux from obturator,external iliac and common iliac lymph nodes.The circumflex iliac lymph node developing rates in the interphalangeal and cervical injection groups were 93.94％(31/33)and 3.63％(2/55),respectively.The interphalangeal injection group had a significantly higher circumflex iliac lymph node developing rate than the cervical injection group(P＜0.05).Conclusion The application of ICG under fluorescence laparoscopy intuitively observed the lower limb lymphatic reflux and the para-uetine lymphatic reflux pathway.The difference between the two is that the lower limb lymphatic reflux flows through the circumflex iliac lymph nodes at the distal end of the external iliac lymph nodes,while cervical cancer and endometrial cancer rarely transfer there.
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Walking downstairs and running are common actions in daily life;however,older adults with functional decline are prone to falls or injuries.To cope with various situations and avoid falls,the first neuroprotective motor mechanism activated by the body is the regulation of lower limb stiffness.Hence,this study retrieved and collected relevant research results from databases such as China Knowledge,Wanfang,Google Scholar,and Web of Science,using key words such as elderly and lower limb stiffness,and summarized the similarities and differences in changes in lower limb stiffness in different action tasks.The findings show that interventions on controllable factors can improve changes in lower limb stiffness to prevent falls in older adults.However,owing to the small number of related studies,it is necessary to further investigate the effects of action interventions on lower limb stiffness in older adults to obtain reliable regularity features and references.
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Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of a cerebellar hemisphere on the walking of stroke survivors with lower limb dysfunction, and to explore its possible mechanism.Methods:Thirty stroke survivors with walking dysfunction were randomly divided into an experimental group and a control group, each of 15. Before their daily routine rehabilitation, the control group received fake iTBS while the experimental group was given 600 pulses of iTBS over 200s. The experiment continued 5 days a week for 3 weeks. The Berg Balance Scale (BBS), the Fugl-Meyer lower extremity assessment (FMA-LE), the Modified Barthel Index (MBI) and Functional Ambulation Categories (FAC) were used before and after the treatment to evaluate the subjects′ balance, lower extremity motor function, walking and ability in the activities of daily living. Gait analysis was also performed. The amplitude of motor evoked potentials (MEPs) and the cortical silent period (CSP) were also noted to assess corticospinal excitability.Results:After the treatment, the average BBS, FMA-LE and MBI scores, FAC grading, stride length, stride speed, stride frequency, and the percentage of swing period in the walking cycle, as well as MEP amplitude and latency had improved significantly in the experimental group. All were then significantly better, on average, than in the control group. The control group also demonstrated significant improvement in all of the outcomes except the percentage of swing period in the walking cycle.Conclusion:iTBS of the cerebellum can improve the walking of stroke survivors with lower limb dysfunction. The mechanism may be related to the cerebellar regulation of spinal cord excitation of the cerebral cortex.
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Objective:To explore the effect of low-molecular-weight heparin calcium in preventing lower limb deep vein thrombosis after rectal cancer surgery.Methods:A retrospective case-control study was conducted. The clinical data of 30 rectal cancer patients with postoperative subcutaneous injection of low-molecular-weight heparin calcium in Beijing Hepingli Hospital from February 2018 to February 2022 were retrospectively analyzed, and 30 patients wearing antithrombotic elastic socks during the same period were selected as controls. In the antithrombotic elastic socks group, the appropriate thrombotic elastic socks were selected according to the actual situation of the patients after operation. Low-molecular-weight heparin calcium group was given subcutaneous injection of low-molecular-weight heparin calcium on the 2nd day after operation. The indexes of coagulation function, situation of postoperative lower limb deep vein thrombosis and perioperative indexes were analyzed.Results:The age of patients in the low-molecular-weight heparin calcium group was (62±12) years old, with 17 women and 13 men. The age of patients in the antithrombotic elastic socks group was (63±1) years old, with 18 women and 12 men. Before prevention, there were no significant differences in platelet count (Plt), activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D) levels between the two groups (all P > 0.05). After prevention, the FIB and D-D levels of patients in the low-molecular-weight heparin calcium group [(3.3±0.7) g/L and (341±30) μg/L] were lower than those in the antithrombotic elastic socks group [(4.9±0.6) g/L and (428±40) μg/L] ( t values were 9.51 and 9.61, both P < 0.05), but there were no significant differences in Plt, APTT, TT and PT between the two groups (all P > 0.05). The rate of lower limb deep vein thrombosis in the low-molecular-weight heparin calcium group was lower than that in the antithrombotic elastic socks group [6.67% (2/30) vs. 26.67% (8/30), χ2 = 4.32, P < 0.05]. The drainage flow of anterior sacral drainage tube in the two groups decreased gradually on the 1st, 2nd, 3rd and 4th day after surgery, but there were no significant differences between the two groups (all P > 0.05). The thrombosis time of patients in the low-molecular-weight heparin calcium group was longer than that in the antithrombotic elastic socks group [(84±9) h vs. (73±10) h, t = 4.81, P < 0.05], but there were no significant differences between the two groups in the intraoperative bleeding amount, operation time and postoperative hospital stay (all P > 0.05). Conclusions:Compared with antithrombotic elastic socks, low-molecular-weight heparin calcium is more effective and safer in the prevention of lower limb deep vein thrombosis after rectal cancer surgery.
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Objective:To compare the morphological differences of psoas major muscles between patients with lumbar disc herniation (LDH) of lower limb pain and lumbocrural pain based on CT imaging data.Methods:Sixty patients with LDH admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistic Team from January 2012 to February 2023 were included. According to clinical symptoms, they were divided into lower limb pain group and lumbocrural pain group ( n=30). 3D CT images of the psoas major muscles in the 2 groups were reconstructed; the longest transverse axis perpendicular to the longitudinal axis of the psoas major muscle was chosen as the cross-sectional area, and the maximum psoas major muscle cross-sectional area was calculated; maximum psoas major muscle cross-sectional area index (PI max) was defined as ratio of maximum psoas major muscle cross-sectional area and L 5 vertebral cross-sectional area. PI max difference between lower limb pain group and lumbocrural pain group was compared; PI max difference among patients with different pain degrees (visual analog scale [VAS] scores) or pain courses was further compared in both lower limb pain group and lumbocrural pain group. Pearson correlation was used to analyze the correlations of PI max with pain degree and pain course in the 2 groups. Results:PI max in lower limb pain group was significantly larger than that in lumbocrural pain group (0.62±0.05 vs. 0.54±0.04, t=7.320, P<0.001). PI max in patients with severe pain from both lower limb pain group and lumbocrural pain group was significantly smaller than that in patients with moderate pain (0.61±0.05 vs. 0.65±0.04, t=2.422, P=0.022; 0.53±0.03 vs. 0.58±0.04, t=3.502, P=0.002). PI max in patients with short pain course from both lower limb pain group and lumbocrural pain group was significantly larger than that in patients with long pain course (0.64±0.05 vs. 0.59±0.04, t=2.570, P=0.016; 0.57±0.04 vs. 0.53±0.03, t=2.941, P=0.007). Pearson correlation showed that PI max was negatively correlated with pain degree and pain course in LDH patients from both groups ( P<0.05). Conclusion:Atrophy of psoas major muscles in LDH patients is aggravated with increased pain degree and pain course.
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Objective:To investigate the lower limb muscle strength characteristics in amateur runners with patellofemoral pain(PFP). Method:Thirty PFP amateur runners(20 males and 10 females)were recruited as the knee pain group,and 30 matched non-injured amateur runners were recruited as the non-knee pain group.The hip abductor strength,quadriceps strength,hamstring strength,hamstring/quadriceps ratio,and bilateral limb symmetry index were col-lected for all participants.Independent sample t-tests were used to compare the differences between the groups. Result:The hip abductor strength and bilateral limb symmetry index,quadriceps strength and bilateral limb symmetry index of male PFP amateur runners were significantly lower than those of the non-knee pain group,while the hamstring/quadriceps ratio was significantly higher than that of the non-knee pain group.The hip ab-ductor strength and bilateral limb symmetry index of female PFP amateur runners were significantly lower than those of the non-knee pain group. Conclusion:PFP amateur runners exhibit different lower limb muscle strength characteristics compared to non-knee pain runners,and the lower limb strength characteristics of male and female PFP amateur runners are not consistent.Therefore,functional and gender differences should be considered in the clinical treatment and rehabilitation training of PFP.
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Objective:To study the influence of electromyographic biofeedback therapy(EMGBFT)combined with mirror therapy(MT)on lower limb motor and balance function in stroke patients. Method:Sixty patients with hemiplegia after stroke were randomly divided into two groups:MT based EMG-BFT group and EMGBFT group,30 patients in each group.On the basis of conventional rehabilitation,the patients in the EMGBFT group received sham MT stimulation combined with EMGBFT,and the patients in the MT based EMGBFT group received MT combined with EMGBFT.Before and after treatment,the lower limb motor function of the patients was evaluated using Fugl-Meyer assessment scale-lower extremity(FMA-LE)and surface electromyography-integrated electromyography(iEMG)of knee flexion and ankle dorsiflex-ion,co-contraction ratio(CR).Plantar pressure-symmetry index(SI)of mean pressure and contact area of both feet,elliptical area of body center of gravity,anteroposterior(AP)and mediolateral(ML)displacement distance of body center of gravity under eye-opening and eye-closed states were calculated to evaluate pa-tients'weight-bearing and balance function. Result:After treatment,FMA-LE,CR and iEMG of biceps femoris and rectus femoris under knee flexion,tibialis anterior and medial gastrocnemius under ankle dorsiflexion were markedly ameliorated in the two groups(P＜0.01).After treatment,in the eye-opening state,the SI of mean pressure and contact area of both feet,elliptical area of body center of gravity,AP and ML displacement distances of body center of gravity were greatly enhanced in the two groups(P＜0.05,P＜0.01),in the eye-closed state,the SI of mean pressure and contact area of both feet,ML displacement distances of body center of gravity were observably ameliorat-ed in the two groups(P＜0.05,P＜0.01).Compared with the EMGBFT group,the FMA-LE,iEMG of biceps femoris and tibialis anterior muscles,elliptical area of body center of gravity,AP and ML displacement dis-tance of body center of gravity with eyes open,SI of contact area of both feet with eyes closed had more significant changes in the MT based EMGBFT group after treatment(P＜0.05,P＜0.01). Conclusion:Electromyographic biofeedback therapy combined with mirror therapy can improve lower limb motor and balance function in stroke patients,the underlying mechanism of which may be the activation of lower limb weak muscle motor units,the relief of lower limb spasm,and the improvement of standing static balance ability.
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Lymphoedema of lower extremities,chronic and progressive,will severely deteriorate the quality of life of patients as it progresses.Thus,early diagnosis and treatment to delay the progress of the disease is conducive to improving the prognosis of patients.At present,common techniques for the diagnosis of lower limb lymphedema,whose advantages and disadvantages vary,cannot be applied to individual case comprehensively.CEUS has the advantages of non-invasion,convenience,real-time,and good repeatability for this disease.CEUS can enhance the image of lymph in lymphatics,and has a high sensitivity to superficial lymphatics,gradually applied in lymphedema of lower limbs.This article reviews the application of CEUS in lower limb lymphedema.
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Objective:To explore application value of combined spinal-epidural anesthesia under the assistant of ultrasound location on lower limb fractures.Methods:A total of 80 patients with lower limb fractures who underwent surgical treatment at the 901th Hospital of the PLA Joint Service Support Force from July 2020 to July 2022 were selected,and they were divided into a control group and an observation group according to the random number table method,with 40 cases in each group.The control group received epidural anesthesia under ultrasound,and the observation group received the combined lumbar-epidural anesthesia under ultrasound.The lidocaine dosage,anesthetic block time,anesthesia onset time and dosage of additional analgesic,as well as the changes in vital signs such as diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR),between the two groups of patients were compared.In addition,the thrombelastogram,anesthetic effects and occurrence of adverse reactions also were compared between two groups.Results:The lidocaine dosage,anesthetic block time,anesthesia onset time and dosage of additional analgesic of the observation group were significantly higher than those in the control group,and the differences were statistically significant(t=8.657,23.483,12.785,16.600,P<0.05),respectively.There were no statistically significant differences in DBP,SBP,HR,comprehensive coagulation index(CI),reaction time(R),formation time of blood cell agglutination(K)and incidence of adverse reactions between two groups before anesthesia,at the 30th minute after anesthesia and after the end of anesthesia(P>0.05).Compared with α angle before anesthesia and at the 30th minute after anesthesia,the α angles of the two groups increased significantly after anesthesia(t=6.564,5.783,P<0.05),respectively.The mechanical strength(G)of the blood clot and the maximum amplitude(MA)of chromatogram of the observation group were significantly reduced after completed anesthesia,and the differences of them were statistically significant(t=8.480,4.236,P<0.05),respectively.There were no significant differences between G and MA in the control group(P>0.05).The total effective rate of the observation group was 97.50%,which was significantly higher than 80.00% of the control group,and the difference was statistically significant(x2=4.507,P<0.05).Conclusion:The combined spinal-epidural anesthesia under the assistant of ultrasound location can effectively reduce the amount of anesthetics in patients with lower limb fracture,which has fast block and effect.In addition,it has little influence on circulatory function,and it is less likely to form a hypercoagulable state.It has better clinical anesthesia effect.
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Objective To understand the research status and development trend of TCM in the treatment of lower limb arteriosclerosis obliterans(LLASO);To provide reference for related research.Methods The literature on the treatment of LLASO by TCM was retrieved from CNKI,Wanfang Data and VIP from September 18,1992 to September 18,2022.NoteExpress 3.6.0 was used to manage and remove repetition.Excel 2019 was used to analyze the trend of the number of articles published.VOSviewer 1.6.18.0 and CiteSpace 6.1.R6 were used to analyze the co-occurrence,clustering,timeline and emergence of the included authors,institutions and keywords,and knowledge graph was drawn.Results A total of 1 095 articles were included,and the number of articles published showed an overall upward trend;1 915 authors were involved,and the author with the most articles was Chen Bainan,forming research teams with Xi Jiuyi,Cao Yemin and Ge Jianli as the cores respectively;the main research institutions were Shandong University of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Heilongjiang University of Chinese Medicine and so on,but there was little cooperation among them.High-frequency keywords included arteriosclerosis,diabetes,clinical efficacy,gangrene,hemorheology,etc.,forming 13 clusters such as qi deficiency and blood stasis,Simiao Yong'an Decoction,angiogenesis and so on.The focus of research was external treatment of TCM,clinical efficacy,blood stasis syndrome,medication law,Buyang Huanwu Decoction.Conclusion The research heat of TCM in the treatment of LLASO has gradually increased,and the modern research in this field from 1992 to 2022,such as gene detection and molecular biology based on big data platform,is the research hotspot in this field.The development trend is the combination of internal treatment and external treatment of TCM,as well as the interdisciplinary research of integrated traditional Chinese and Western medicine combined with interventional therapy and other techniques.