Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
Objective To determine the clinical effect of sequence and cross bypass or combined with endovascular procedure for mutilevelarterial occlusive disease of lower extremity so as to investigate the credibletreatment for mutilevel arterial occlusive disease of lower extremity. Methods Between April 2004 and July 2005， 11 patients （14 limbs）underwent sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure. Among of them, 10 cases were male and 1 case was female, aging 62-79 years(mean 70.5 years), and including 8 cases of intermittent claudications (Fontaine stage Ⅱ), 3 cases of rest pain (Fontaine stage Ⅲ) and 1 case of toe ulcerwith gangrene (Fontaine stage Ⅳ). Colour Doppler ultrasonography showed that 14 lower limbswere diagnosed as having multilevel arterial occlusive disease and the preoperation and ankle brachial index(ABI) was 0.36±0.11 . Lower limb digital subtraction angiography(DSA) showed 3 cases of bilateral iliac artery stenosis，extrailiac artery occlusion and bilateral superficial femoral artery occlusions，1 case of right common iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions and 8 cases of unilateral extrailiac artery stenosis and superficial femoral artery occlusions. Postoperation tests of DSA,colour Doppler ultrasonography and ABI were done to observe cumulative patency rate after operation. Results The follow-up period was from 3 to 26 months(mean 14.5 months ). All patients survived. The symptoms of intermittent claudication and rest pain disappeard in all patients. ABI was improved by0.89±0.13 after procedure（Ｐlt;0.01）. The overall salvage rate of limb was 100%. DSA was performed from 3 to 280 days after operation, the overall primary graft patency rate was 92.86%（13/14）.Conclusion Sequence and cross bypass， thromboendarterectomy or combined with endovascular procedure in treatment of mutilevel occlusive disease of lower extremity was effective, less invasive and safe.
Objective To compare the immediate therapeutic effects between endovenous laser treatment and conventional surgery for lower extremity varicosity. Methods Data of 350 limbs of 275 patients treated by endovenous laser treatment (endovenous laser treatment group) and 310 limbs of 210 patients by traditional surgery (traditional surgery group) were analyzed and compared in terms of operation time, number of the incision, postoperative pain, complications, postoperative hospitalized duration and 1-year recurrence rate. Results Endovenous laser treatment group had shorter operation time, fewer incisions, less postoperative pain and shorter postoperative hospitalized duration than traditional surgery group (Plt;0.05). The complications and 1-year recurrence rate had no significant differences between two groups (Pgt;0.05). Conclusion As a safe and effective new treatment for lower extremity varicosity with minimal invasiveness and no left scars, endovenous laser treatment has the potential to replace conventional surgery and extend the surgical indications for lower extremity varicosity treatment.
Objective To provide the anatomic basis for defect repair of the knee, leg, foot and ankle with great saphenous venosaphenous neurocutaneous vascular island flaps. Methods The origin, diameter, branches, distribution and anatomoses of the saphenous artery and saphenous neurocutaneous vascular were observed on 20 sides of adult leg specimens and 4 fresh cadaver voluntary legs. Another4 fresh cadaver voluntary legs were radiogeaphed with a soft X-ray system afterthe intravenous injection of Vermilion and cross-sections under profound fascial, otherhand, micro-anatomic examination was also performed in these 4 fresh cadaver legs. The soft tissue defects in lower extremity,upper extremity, heel or Hucou in handwere repaired with the proximal or distal pedicle flaps or free flaps in 18 patients(12 males and 6 females,aging from 7 to 3 years). The defect was caused by trauma, tumour, ulcer and scar.The locations were Hucou (1 case), upper leg(3 cases), lower extremity and heal (14 cases). Of then, 7 cases were complicatedby bone exposure, 3 cases by tendon exposure and 1 case by steel expouse. the defect size were 4 cm×4 cm to 7 cm×13 cm. The flap sizes were 4 cm×6 cm to 8 cm×15 cm, which pedicle length was 8-11 cm with 2.-4.0 cm fascia and 12 cm skin at width. Results Genus descending genicular artery began from 9.33±0.81 cm away from upper the condylus medialis, it branched saphenous artery accompanying saphenous nerve descendent. And saphenous artery reached the surface of the skin 7.21±0.82 cm away from lower the condylus medialis,and anastomosed with the branches of tibialis posterior artery, like “Y” or “T” pattern. The chain linking system of arteries were found accompanying along the great saphenous vein as saphenous nerve, and then a axis blood vessel was formed. The small artery of only 00-0.10 mm in diameter, distributed around the great saphenousvein within 58 mm and arranged parallelly along the vein like water wave in soft X-ray film. All proximal flaps,distal pedicle flaps and free flaps survived well. The appearance, sensation and function were satisfactory in 14 patientsafter a follow-up of 6-12 months. Conclusion The great saphenous vein as well as saphenous neurocutaneous has a chain linking system vascular net. A flap with the vascular net can be transplanted by free, by reversed pedicle, or by direct pedicle to repair the wound of upper leg and foot. A superficial vein-superficial neurocutaneous vascular flap with abundance blood supply and without sacrificing a main artery is a favouriate method in repair of soft tissue defects in foot and lower extremity.
In order to improve the motion fluency and coordination of lower extremity exoskeleton robots and wearers, a pace recognition method of exoskeleton wearer is proposed base on inertial sensors. Firstly, the triaxial acceleration and triaxial angular velocity signals at the thigh and calf were collected by inertial sensors. Then the signal segment of 0.5 seconds before the current time was extracted by the time window method. And the Fourier transform coefficients in the frequency domain signal were used as eigenvalues. Then the support vector machine (SVM) and hidden Markov model (HMM) were combined as a classification model, which was trained and tested for pace recognition. Finally, the pace change rule and the human-machine interaction force were combined in this model and the current pace was predicted by the model. The experimental results showed that the pace intention of the lower extremity exoskeleton wearer could be effectively identified by the method proposed in this article. And the recognition rate of the seven pace patterns could reach 92.14%. It provides a new way for the smooth control of the exoskeleton.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.
Objective To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities. Methods The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases, including arterial occlusive disease (AODs,62 patients) and thromboangiitis obliterans (TAOs,28 patients). By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients, the immediate and the longterm surgical outcomes were summarized. Results During the hospitalization, 88 patients achieved a remarkable surgical effectiveness, with an immediate surgical effectiveness rate of 97.7% (88/90), but 2 patients failed in the operation and had to undergo amputation of the lower limb. Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation, 64 could have a sufficient blood supply to the lower extremities, with a longterm effectiveness rate of 88.9% (64/72); however, 8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb. Conclusion The one-stage arteriovenous shunt performedon the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.
Objective To explore the treatment of thromboangitis obliterans (TAO) of lower extremities. Methods From March 1994 to February 2009, 24 cases (26 limbs) affected by chronic ischemia were diagnosed as TAO by Doppler ultrasound and DSA, CTA or MRA. According to the different levels of the extensive and diffuse arterial occlusion, the revascularization was performed in the ways: 19 cases (21 limbs) underwent venous arterialization, 3 cases (3 limbs) underwent endovascular therapy, and 2 cases (2 limbs) underwent thrombectomy. Results After the venous arterialization, 19 cases (21 limbs) were followed up for 1 to 14.5 years. Apart from the 5 limbs amputation (23.8%), the postoperative results of the most limbs were satisfactory (61.9%). The ABI before therapy (0.38±0.11) was significantly lower than that 6 months after therapy (0.79±0.08), Plt;0.05. In 3 cases (3 limbs) underwent endovascular therapy, one case failed and then received the venous arterialization. Two cases (2 limbs) finished thrombectomy successfully. After endovascular therapy and thrombectomy, these 4 cases were followed up for 1 to 4 years without the amputation. ConclusionIn order to improve the curative effect, it is important to choose the suitable therapeutic strategy according to the different levels of the extensive and diffuse arterial occlusion. The venous arterialization is an effective treatment for TAO of lower extremities.
Objective
To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line.
Methods
Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 ± 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21° valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.
Results
All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed lt; 2° knee deviation angle in the others except 1 case of 2.9° knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 ± 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00).
Conclusion
The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.
ObjectiveTo discuss the diagnosis, treatment and clinical characteristics of open vascular injuries in the lower extremities and summarize our experiences. Methods To review the records of patients sustained an open injuries to the lower extremities vessel between 1999 and 2001 retrospectively. The clinical, operative findings and prognosis were collected and studied.ResultsAll 25 patients received emergency surgical treatment to repair the vascular injuries. It included 18 with isolated arterial injuries and 7 with combined arteriovenous injuries. Saphenous vein grafts were placed in 5 patients and vascular prostheses were placed in 5 patients with arterial injuries.Twentyfour patients were cured (96%), and 1 graft obstruction occurred (could not be contacted 40 days after operation). ConclusionOpen vascular injuries in the lower extremities should be diagnosed and treated as early as possible. The aim of the operation is to repair or reconstruct the injured vessel and to lower the mortality and morbidity rate.
