【Abstract】 Objective To investigate and evaluate the effectiveness of covering amputated raw surface with freetissue transplantation from damaged limbs. Methods Between August 2010 and June 2011, 5 cases of severe injury of lower extremities were treated, including 4 males and 1 female with an age range of 3 years and 8 months to 43 years. Of them, 3 cases suffered from traffic accident injury and 2 had machine injury. The disease duration was 2-9 hours. Among the 5 cases, 1 suffered from half pelvis destruction and traumatic amputation of hip joint, 1 from comminuted open fracture of proximal femur, and another 3 from thigh destruction with survival soft tissue of legs. All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm × 10 cm to 20 cm × 20 cm in size. Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs. The flap size ranged from 15 cm × 10 cm to 25 cm × 20 cm. The wounds were repaired with free tissue transplantation. Results Five transplanted tissue flaps were survival. Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue, dressing change or vacuumed drainage for 1-2 months. All wounds healed and the patients were followed up 1-3 months. No sinus tract or ulceration was observed. The appearance of stumps was satisfactory. Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory. It is an effective procedure to repair the raw surface of amputated stumps.
【摘要】 目的 觀察綜合康復治療對汶川地震截肢傷員功能障礙的臨床療效。 方法 對5?12汶川大地震22例擠壓傷截肢患者的24條截肢殘端實施護理、擺放良肢位、運動治療、殘端塑形、紫外線療法、紅外線療法、石蠟療法、音頻電療法、經皮電刺激神經療法、關節松動、按摩和拍打、超短波治療、作業療法和心理治療等綜合康復治療，直至截肢傷員出院為止。視覺模擬評分法量表評定幻肢痛疼痛強度、測定膝關節和髖關節活動范圍、Barthel指數評定日常活動。 結果 治療前幻肢痛疼痛強度為2.95±1.33，治療后為0.50±0.96；治療前肘關節活動范圍為（90.0±28.3）o，治療后為（135.0±7.1）o；治療前肩關節屈伸活動范圍為（68.8±27.8）o，治療后為（137.5±9.6）o；治療前肩關節收展活動范圍為（53.8±7.5）o，治療后為（96.3±4.8）o；治療前膝關節活動范圍為（91.0±23.0）o，治療后為（123.0±6.7）o；治療前髖關節屈伸活動范圍為（86.9±25.9）o，治療后為（132.3±13.8）o；治療前髖關節收展活動范圍為（46.9±10.9）o，治療后為（64.6±8.7）o；治療前Barthel指數為57.05±18.69，治療后為78.18±13.85，康復治療前后均有統計學意義（Plt;0.05）。 結論 地震后截肢不良殘肢發生率高，綜合康復治療能促進截肢殘端傷口愈合和消除殘肢疼痛，可明顯改善殘肢條件，有利于地震截肢患者功能恢復和日常生活能力的提高，為后期的假肢安裝及步態訓練創造了條件。【Abstract】 Objective To observe the efficiency of comprehensive rehabilitation therapy on amputation patients after Wenchuan earthquake. Methods Twenty-two amputation patients after Wenchuan earthquake with 24 stumps were treated with postoperative wound care, maintaining the correct position of the limbs, exercise therapy, stump shaping, ultraviolet therapy, infrared therapy, paraffin therapy, audio electrotherapy, transcutaneous electrical nerve stimulation therapy, joint mobilization, massage, beat, ultrashort wave therapy, occupational therapy and psychotherapy and so on until discharged. The results were measured from the following aspects: pain intensity using VAS, rangement of knee joint and hip joint, Barthel index of ADL before and after rehabilitation. Results Pain intensity of phantom limb pain were (2.94±1.53) before rehabilitation,and (0.44±1.03) after; the movement range of elbow was (90.0±28.3)o before and(135.0±7.1)o after; the movement range of shoulder flexion and extension was (68.8±27.8)o before and (137.5±9.6)o after; the movement range of shoulder abduction and adduction was (53.8±7.5)o before and (96.3±4.8)o after rehabilitation; the movement range of knee was (91.0±23.0)o before and (123.0±6.7)o after rahabiliation; the movement range of hip flexion and extension was (86.9±25.9)o before and (132.3±13.8)o after; the movement range of hip abduction and adduction was (46.9±10.9)o before and (64.6±8.7)o after; the score of Barthel index was 57.05±18.69 before and 78.18±13.85 after. The difference between before and after rehabilitation were statistically significant (Plt;0.05). Conclusion The incidence of adverse amputation stumps after the earthquake was high. Integrative rehabilitation has an positive effect on promoting wound healing, by eliminating stump pain and recovering lower limb function, improving daily living function and social ability, and creating conditions for installing prosthesis limbs and gait training in later period.
Objective To explore the effectiveness of QIN Sihe’s surgical strategy combined with Ilizarov technique in treating foot and ankle deformities on the verge of amputation. Methods A retrospective analysis was conducted on the clinical data of 56 patients (62 feet) with foot and ankle deformities on the verge of amputation treated with QIN Sihe’s surgical strategy and Ilizarov technique between May 2010 and December 2020. Among them, there were 39 males and 17 females. The age ranged from 8 to 62 years (median, 27.5 years). QIN Sihe’s surgical strategy: subcutaneous release or open lengthening of contracted Achilles tendons, limited correction of bony deformities through multiple osteotomies during surgery, tendon transfer to balance the power of the foot and ankle, simultaneous percutaneous osteotomy and correction of tibial torsion deformity to restore the weight-bearing line of the lower extremity, and installation of Ilizarov foot and ankle distraction devices for slow distraction and correction of residual foot and ankle deformities. After removal of external fixation, individualized braces were used for protection during exercise and walking. For patients with bilateral deformities, staged surgeries were performed. The effectiveness was evaluated according to the QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction at last follow-up. Results All patients achieved the preoperative expected orthopedic and functional reconstruction goals. The postoperative wearing time of external fixator was 3-7 months, with an average of 5.5 months. The incidence of pin tract infection during the treatment period was 6.5% (4/62). All patients were followed up 25-132 months (median, 42 months). All 56 patients successfully retained their limbs. At last follow-up, foot and ankle deformities were corrected, the weight-bearing line was basically restored, and plantigrade feet were restored. At last follow-up, according to QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, the effectiveness was rated as excellent in 37 cases (39 feet), good in 18 cases (21 feet), and fair in 1 case (2 feet). The excellent and good rate was 96.8% (60/62). Conclusion The combination of QIN Sihe’s surgical strategy and Ilizarov technique in treating foot and ankle deformities on verge of amputation is minimally invasive, safe, and the therapeutic effect is controllable. This combined approach has unique advantages in preserving limb function and restoring biomechanical balance.
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal individuals, but the relationship between lower limb amputation and the episodes of cardiovascular disease has not been studied from the perspective of hemodynamics. In this paper, numerical simulation was used to study the effects of amputation on aortic hemodynamics by changing peripheral impedance and capacitance. The final results showed that after amputation, the aortic blood pressure increased, the time averaged wall shear stress of the infrarenal abdominal aorta decreased and the oscillatory shear index of the left and right sides was asymmetrically distributed, while the time averaged wall shear stress of the iliac artery decreased and the oscillatory shear index increased. The changes above were more significant with the increase of amputation level, which will result in a higher incidence of atherosclerosis and abdominal aortic aneurysm. These findings preliminarily revealed the influence of lower limb amputation on the occurrence of cardiovascular diseases, and provided theoretical guidance for the design of rehabilitation training and the optimization of cardiovascular diseases treatment.
Objective To investigate the effectiveness of tibial transverse transport (TTT) in treating Wagner grade 3-4 type 2 diabetic foot ulcers and analyze dynamic changes in immunoglobulin levels. Methods The clinical data of 68 patients with Wagner grade 3-4 type 2 diabetic foot ulcers treated with TTT between May 2022 and September 2023 was retrospectively analyzed. The cohort included 49 males and 19 females, aged 44-91 years (mean, 67.3 years), with 40 Wagner grade 3 and 28 grade 4 ulcers. The duration of type 2 diabetes ranged from 5 to 23 years, with an average of 10 years. The number of wound healing cases, healing time, amputation cases, death cases, and complications were observed and recorded. Serum samples were collected at 6 key time points [1 day before TTT and 3 days, 7 days (the first day of upward transverse transfer), 14 days (the first day of downward transverse transfer), 21 days (the first day after the end of transfer), 36 days (the first day after the removal of the transfer device)], and the serum immunoglobulin levels were detected by flow cytometry including immunoglobulin G (IgG), IgA, IgM, IgE, complement C3 (C3), C4, immunoglobulin light chain κ (KAP), immunoglobulin light chain λ (LAM). Results All the 68 patients were followed up 6 months. Postoperative pin tract infection occurred in 3 cases and incision infection in 2 cases. Amputation occurred in 5 patients (7.4%) at 59-103 days after operation, and 8 patients (11.8%) died at 49-77 days after operation; the wounds of the remaining 55 patients (80.9%) healed in 48-135 days, with an average of 80 days. There was no recurrence of ulcer, peri-osteotomy fracture, or local skin necrosis during follow-up. The serum immunoglobulin levels of 55 patients with wound healing showed that the levels of IgG and IgM decreased significantly on the 3rd and 7th day after operation compared with those before operation (P<0.05), and gradually returned to the levels before operation after 14 days, and reached the peak on the 36th day. IgA levels continued to decrease with time, and there were significant differences at all time points when compared with those before operation (P<0.05). The level of IgE significantly decreased at 21 days after operation compared with that before operation (P<0.05), while it was higher at other time points than that before operation, but the difference was not significant (P>0.05). The level of C3 showed a clear treatment-related increase, which was significantly higher on the 7th, 14th, and 21st days after operation than that before operation (P<0.05), and the peak appeared on the 14th day. The change trend of C4 level was basically synchronous with that of C3, but the amplitude was smaller, and the difference was significant at 7 and 14 days after operation compared with that before operation (P<0.05). There was no significant difference in KAP/LAM between different time points before and after operation (P>0.05). Conclusion TTT can accelerate wound healing, effectively treat diabetic foot ulcer, and reduce amputation rate, and has definite effectiveness. The potential mechanisms of TTT in the treatment of diabetic foot ulcers include the dynamic regulation of IgG, IgA, IgM, and IgE levels to balance the process of inflammation and repair, and the periodic increase of C3 and C4 levels may promote tissue cleaning, angiogenesis, and anti-infection defense.
Objective To review the progress in amputation technique of diabetic foot. Methods Recent l iterature concerning the amputation technique of diabetic foot was reviewed and analyzed. Results According to the different levels of the amputation, the diabetic foot’s amputation can be classified as major amputation and minor amputation, and differentkinds of methods can derive from these styles. Different factors should be considered when the style and method of amputation are chosen. Conclusion To the diabetic foot amputation, the general rule is to l imit the amputation level on the premise of the good cl inical effect. The health state, the region of the diabetic foot, the tissue perfusion, the susceptibil ity to infection in local tissue, and the abil ity of wound healing are important factors in selecting the styles and methods of diabetes-related amputations. Importance should be attached to the synthesis treatments of diabetes to prevent the higher level amputation.
Objective To explore the feasibility of using biomechanical indicators as supplementary evaluation to the Musculoskeletal Tumor Society Scoring System (MSTS) for amputee patients. Methods Twenty-four patients who underwent hemipelvectomy between September 2018 and January 2025 were enrolled. There were 15 males and 9 females with an average age of 61.4 years (range, 45-76 years). Participants performed gait tests at self-selected speeds using three assistive devices (prosthesis, single crutch, and double crutches). Motion data were analyzed using a customized OpenSim model. Biomechanical indicators of the intact limb exhibiting common characteristics were screened through correlation and sensitivity analyses. Test-retest reliability [interclass correlation coefficient (ICC)] of selected parameters was assessed to evaluate their potential as MSTS score supplements. Results All biomechanical indicators showed significant positive correlations with MSTS scores across assistive devices (P<0.05). Seven indicators demonstrated |Pearson correlation coefficients|>0.8, including walking speed, maximum hip angle, maximum hip moment, peak hip flexion moment, peak hip extension moment, hip flexion impulse, and hip extension impulse. Among these, maximum hip moment, hip flexion impulse, and hip extension impulse exhibited significant between-group differences in adjacent MSTS levels (P<0.05), indicating high sensitivity, along with excellent test-retest reliability (ICC>0.74, P<0.01). Conclusion Biomechanical indicators statistically qualify as potential supplements to MSTS scoring. Maximum hip moment, hip flexion impulse, and hip extension impulse demonstrate particularly high sensitivity to MSTS score variations.
