ObjectiveTo explore the surgical technique and effectiveness of limited bone and soft tissue surgery combined with Ilizarov technique in the treatment of adolescents severe cerebral palsy with flattened valgus foot and lower leg external rotation deformity. MethodsA retrospective analysis was conducted on 12 patients with severe cerebral palsy with flattened valgus foot and external rotation deformity of the lower leg, totaling 16 feet, admitted between January 2022 and January 2025. There were 5 males with 7 feet and 7 females with 9 feet, the age ranged from 12 to 18 years, with an average of 15 years. There were 10 cases on the left foot, 6 cases on the right foot, and 4 cases on both feet. The preoperative external rotation angle of the lower leg ranged from 20° to 35°, with an average of 26°. The preoperative visual analogue scale (VAS) score was 4.9±0.9, the American Orthopaedic Foot & Ankle Society (AOFAS) score was 68.7±12.0, the calcaneal tilt angle was (12.69±1.78)°, and the hindfoot angle was (18.69±3.55)°. Patients with bilateral lower leg deformities underwent surgery in two phases, with an interval of 3-6 months between surgeries. Select soft tissue surgery (Achilles tendon elongation, release or transposition of joint capsule and ligaments) and bone surgery (joint fusion, calcaneal osteotomy, medial wedge osteotomy, etc.) combined with tibiofibular internal rotation osteotomy and Ilizarov external fixation were selected according to the patient’s condition. At 1 week after operation, the external fixators of the lower leg and ankle were slowly adjusted, and the deformities that were not completely solved in the three-dimensional correction operation were corrected. Postoperative pain relief and functional recovery were evaluated by VAS and AOFAS scores, and the improvement of foot deformity was evaluated by calcaneal tilt angle and hindfoot angle on radiographic data, and the postoperative effctiveness was evaluated according to the International Clubfoot Study Group (ICFSG). Results At 2 weeks after operation, the foot deformity of the patient was basically adjusted. All patients were followed up 6-36 months, with an average of 18 months. The incisions healed by first intention without nerve injury, infection, or other complications. At last follow-up, the patients recovered satisfactorily, the osteotomy sites healed, and the external rotation of the lower leg was corrected. The VAS score was 1.2±0.1 and AOFAS score was 86.7±6.8, which were significantly different from those before operation (P<0.05). The calcaneal tilt angle was (18.38±1.15)° and the hindfoot angle was (10.06±2.93)°, which were significantly different from those before operation (P<0.05). According to the ICFSG scoring standard, 13 feet were excellent and 3 feet were good, and the excellent and good rate was 100%. ConclusionThe combination of bone and soft tissue limited surgery and Ilizarov technique is a safe, minimally invasive, and effective method for treating severe cerebral palsy in adolescents with flattened valgus foot and external rotation deformity of the lower leg. It conforms to biological principles and follows the concept of natural bone reconstruction.
ObjectiveTo evaluate the effectiveness of vascularized fibula reconstruction in treatment of distal tibial malignant and invasive tumors.MethodsBetween March 2012 and January 2018, 11 patients with distal tibial malignant and invasive tumors were treated with vascularized fibula reconstruction. There were 7 males and 4 females with an average age of 20 years (range, 16-39 years). There were 8 cases of osteosarcoma, 2 cases of invasive giant cell tumor of bone, and 1 case of hemangioendothelioma. The tumors were rated as benign stage 3 in 2 cases and malignant stageⅠA in 1 case, stageⅡA in 4 cases, and stage ⅡB in 4 cases according to the Enneking staging. The disease duration was 1-6 months (mean, 2.7 months). The limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score, and the distal and proximal union of the transplanted fibula and the diameter of the fibula were examined by imaging.ResultsAll incisions healed by first intention. All patients were followed up 16-85 months (mean, 41 months). No tumor recurrence or metastasis occurred during the follow-up. The proximal and distal grafts in the 10 cases showed osseous healing, and the healing time was 7-12 months (mean, 10.1 months) at proximal end and 7-12 months (mean, 9.3 months) at distal end. In 1 case, the proximal end did not heal at 19 months, while the distal end healed at 13 months; proximal bone grafting was performed, and the proximal end healed. Among the 4 patients with distal screw fixation, 2 had peri-internal fixation fractures after graft healing, but no skin necrosis or infection occurred. All the 7 patients with distal steel plate fixation had no peri-internal fixation fracture, but 1 patient developed anterior tibial skin necrosis. At 12 months after operation, the diameter of fibula increased 1-5 mm (mean, 2.4 mm) by compared with that before operation. The MSTS score was 17-27 (mean, 22.8).ConclusionReconstruction of ankle joint with vascularized fibula can achieve satisfactory functional results, which is one of the feasible and worthy methods for the distal tibial malignant and invasive tumors.
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.
