ObjectiveTo investigate the effect of virtual scene simulation training combined with midium frequency impulse electrotherapy on upper limb function and daily living ability of hemiplegia patients.MethodsFrom March to October 2019, 50 hemiplegic patients were recruited and randomly assigned to the trial group and the control group, with 25 patients in each group. The control group was given routine rehabilitation training, while the trial group was given virtual scene simulation training and medium frequency impulse electrotherapy on the basis of routine rehabilitation training. The Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Simple Test for Evaluating Hand Function (STEF), and Modified Barthel Index (MBI) were used to assess patients’ upper limb function and daily living ability before treatment and after 8 weeks of treatment.ResultsBefore treatment, the FMA-UE, STEF, and MBI scores of the trial group vs. the control group were 22.88±5.18 vs. 23.44±6.26, 40.12±4.82 vs. 41.44±4.54, and 51.40±7.29 vs. 48.60±7.00, respectively, and none of the between-group differences was statistically significant (P>0.05); after 8 weeks of treatment, the FMA-UE, STEF, and MBI scores of the two groups were 39.48±6.35 vs. 33.52±6.53, 59.08±7.54 vs. 52.52±5.83, and 71.00±8.78 vs. 62.40±9.37, respectively, and all of the between-group differences were statistically significant (P<0.05). After 8 weeks of treatment, the FMA-UE, STEF and MBI scores of the two groups of patients were significantly improved compared with those before treatment (P<0.05), and the improvement of each score of the trial group was significantlybetter than that of the control group (P<0.05). No stroke recurrence, electric burn, or other adverse reactions occurred in the two groups after treatment. ConclusionVirtual scene simulation training combined with midium frequency impulse electrotherapy can effectively improve the upper limb function of patients with hemiplegia and improve their quality of life.
ObjectiveTo compare the efficacy of three surgical approaches, including percutaneous transluminal angioplasty (PTA), PTA+bare metal stent (BMS), and Rotarex+PTA+drug coated balloon (DCB), in treating femoropopliteal artery lesions in arteriosclerosis obliterans (ASO), and to explore the prognostic factors of femoropopliteal artery lesions in ASO. MethodsA retrospective analysis was conducted on 314 patients with femoropopliteal artery lesions in ASO who were treated in the Department of Vascular and Thyroid Surgery in the First Affiliated Hospital of Xinjiang Medical University from March 2018 to March 2024. inverse probability of treatment weighting was used to balance the baseline characteristics of the three groups. The clinical examination, imaging examination, and ankle-brachial index (ABI) results of the three groups at 3 months, 12 months, and 24 months after surgery were compared. Log-rank test was used to compare the incidence of all-cause mortality (ACM) and major adverse limb events (MALEs) among the three groups, and Cox proportional hazards regression model was used to analyze the prognostic factors of femoropopliteal artery lesions in ASO. ResultsA total of 314 patients with ASO femoropopliteal artery lesions were enrolled, comprising 153 cases in the PTA group, 89 cases in the PTA+BMS group, and 72 cases in the Rotarex+PTA+DCB group. After inverse probability of treatment weighting based on propensity scores, baseline characteristics were balanced across all groups (all P>0.05). Postoperative follow-up results demonstrated the following patency rates: at 3 months, 58.4% (87/149) for the PTA group, 79.5% (66/83) for the PTA+BMS group, and 87.5% (63/72) for the Rotarex+PTA+DCB group; at 12 months, 78.0% (60/79), 68.3% (43/63), and 80.0% (44/55), respectively; and at 24 months, 98.1% (52/53), 89.7% (35/39), and 100.0% (43/43), respectively. The Rotarex+PTA+DCB group exhibited significantly superior patency rates, claudication distances, ankle-brachial index (ABI), and Rutherford classification compared to both the PTA and PTA+BMS groups at 3 months (P<0.05). Furthermore, the Rotarex+PTA+DCB group showed lower incidence of ACM/MALEs compared to the other two groups (χ2=18.70, P<0.001). Survival analysis revealed that the Rotarex+PTA+DCB group had significantly better survival outcomes compared to the PTA+BMS group (χ2=14.27, P<0.001) and the PTA group (χ2=3.92, P=0.016). Cox proportional hazards regression analysis identified elevated red cell distribution width (RDW) as an independent risk factor for ACM/MALEs following endovascular therapy in ASO patients, with a relative risk of 1.006 [95%CI (1.002, 1.011), P=0.006]. ConclusionsThe Rotarex+PTA+DCB demonstrate superior outcomes compared to both the PTA and PTA+BMS in terms of patency rate, claudication distance, ABI, and Rutherford classification at 3 months postoperatively, along with the better survival. Furthermore, elevated RDW may serve as a prognostic factor for adverse outcomes in patients with ASO femoropopliteal artery lesions.
ObjectiveTo explore the value of recombinant inferior vena cava filter (IVCF) in the prevention of perioperative pulmonary embolism in patients with lower limb or pelvic fracture combined with deep venous thrombosis (DVT).MethodsThe clinical data of 168 patients with lower limb or pelvic fracture combined with DVT were analyzed retrospectively.ResultsThe filters were successfully implanted in 168 patients, and the recoverable filters were removed after (48.3±4.8) d (14–97 d). The filters were removed successfully in 159 cases, and the removal rate was 94.6%. Sixty-one cases were found to have thrombus on the filter after contrast examination or removal of vena cava filter, that is, the thrombus interception rate was 36.3%.ConclusionFor patients with lower limb or pelvic fracture combined with DVT, the rechargeable vena cava filter can effectively stop thrombosis and avoid pulmonary embolism.
ObjectivesTo investigate the influence of the abduction angle of the upper extremities on the image quality of non-enhanced CT scan and clinical value of the patients who cannot lift with double upper limbs by vehicle accident.Methods60 patients with double upper limbs that could not lift by vehicle accidents were required to receive liver non-enhanced CT scan, the patients were divided into 3 groups according to the abduction angle (group A, B, C), 20 cases in each group, another 20 cases with standard pose as the control group (group D). The CT value and standard deviation of the liver region of interest, the erector and the background air were measured, and the contrast to noise ratio of liver images, image noise value were calculated, together with the assessment of image quality and statistic analysis.ResultsThe liver non-enhanced CT scan were completed successfully. The image quality of group D was significantly better than A, B, C (Z=–10.753, P<0.05;Z=–11.645, P<0.05;Z=–12.281, P<0.05), respectively. Group C was better than A and B (Z=–8.502, P<0.05;Z=–4.068, P<0.05), respectively. Group B was better than A (Z=–5.885, P<0.05). The CNR of the four groups of images increased gradually, group A (0.09±0.77), group B (1.56±0.83), group C (2.51±0.87), group D (2.59±0.97), respectively. There were significant differences between four groups (F=36.323, P<0.05). The image noise decreased systematically, group A (14.84±2.94), group B (13.04±1.59), group C (11.60±1.72), group D (10.44±1.13), respectively. There were significant differences between four groups (H=426.755, P<0.05).ConclusionOn the premise of safety inspection, with the enlargement of angle of the upper limbs of patients who cannot lift with double upper limbs by vehicle accidents, the image noise decreased and image quality is improved with the increase of signal noise ratio.
Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
Motor function was investigated by constant perfusion manometry in the Roux limb of ten patients who had undergone total gastrectomy and Roux-en-Y anastomosis. Results showed that in the fasting state, the migrating motor complex (MMC) was comletely absent, retrograde in direction or bursts of nonphasic pressure activity. Reduced motor activity patterns occurred after the meal in some patients. Four patients failed to convert fasting state into the feeding state. Total gastrectomy with Roux-en-Y anastomoses provakes a relatively severe distubance in motor function, which could contribute to postoperative upper abdominal distress.
ObjectiveTo evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction. MethodsBetween March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25° (mean, 20°), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm × 4 cm to 8 cm × 6 cm; the upper limb free flap from 7 cm × 5 cm to 9 cm × 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting. ResultsAll the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90° (mean, 88°). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered. Conclusion A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.
ObjectiveTo evaluate the dynamic changes of blood flow and blood pressure of acute hindlimb ischemia of rats by laser Doppler flowmetry (LDF) and laser Doppler perfusion imaging (LDPI). MethodsThe acute hindlimb ischemia model of rats was established by resection of rats femoral arteries of left hindlimb. The blood flow and blood pressure between operated and nonoperated hindlimbs were examined by LDF on 2, 7, 14, 28, and 49 d after operation. And the blood flow was evaluated by LDPI on 7 d after operation. ResultsAll rats survived after operation and no hindlimb necrosis occurred. The mean score was 2 on 14 d after operation and 1 on 49 d after operation. The ratio of blood flow between operated and nonoperated hindlimbs on 2 d after operation significantly increased from 1 to 1.31±0.439 (P=0.021). The ratio of blood flow on 7 d (0.82±0.538) and 14 d (0.93±0.294) after operation was significantly lower than that on 2 d after operation (P=0.032 and P=0.019), although the difference between the two former was not significant (P=0.502). Furthermore, the ratio of blood flow on 28 d after operation reached the bottom (0.41±1.970), which was obviously lower than that on 2, 7, and 14 d after operation (P=0.004, P=0.007, and P=0.006). The blood flow of operated hindlimbs recovered approximately the value before operation (0.98±0.093), which was significantly lower than that on 2 d (P=0.010), higher than that on 28 d (P=0.005), but not different from that on 7 d and 14 d after operation (P=0.126 and P=0.382). The ratio of blood pressure between operated and nonoperated hindlimbs on 2 d after operation significantly increased from 1 to 0.47±0.375 (P=0.031). The ratio of blood pressure decreased on 7 d after operation (0.44±0.118), which was not different from that on 2 d after operation (P=0.203). Furthermore, the ratio of blood pressure on 14 d after operation reached the bottom (0.35±0.115), which was obviously lower than that on 2 d and 7 d after operation (P=0.001 and P=0.036). On 28 d after operation, the ratio of blood pressure increased (0.54±0.146), which was significantly higher than that on 14 d after operation (P=0.008), while not different from that on 2 d (P=0.493) and 7 d after operation (P=0.551). The ratio of blood pressure recovered approximately the value before operation (0.97±0.094), which was significantly higher than that on 2, 7, 14, and 28 d (P=0.013, P=0.021, P=0.002, and P=0.031). ConclusionAcute hindlimb ischemia model of rats can be established by resection of rats femoral arteries of left hindlimb and the most serious stage of hindlimb ischemia is on 14-28 d after operation. LDF and LDPI are of importance for monitoring the dynamic changes of rats hindlimb ischemia after operation.
The purpose of this paper was to investigate the effects of wearable lower limb exoskeletons on the kinematics and kinetic parameters of the lower extremity joints and muscles during normal walking, aiming to provide scientific basis for optimizing its structural design and improving its system performance. We collected the walking data of subjects without lower limb exoskeleton and selected the joint angles in sagittal plane of human lower limbs as driving data for lower limb exoskeleton simulation analysis. Anybody (the human biomechanical analysis software) was used to establish the human body model (the human body model without lower limb exoskeleton) and the man-machine system model (the lower limb exoskeleton model). The kinematics parameters (joint force and joint moment) and muscle parameters (muscle strength, muscle activation, muscle contraction velocity and muscle length) under two situations were compared. The experimental result shows that walking gait after wearing the lower limb exoskeleton meets the normal gait, but there would be an occasional and sudden increase in muscle strength. The max activation level of main lower limb muscles were all not exceeding 1, in another word the muscles did not appear fatigue and injury. The highest increase activation level occurred in rectus femoris (0.456), and the lowest increase activation level occurred in semitendinosus (0.013), which means the lower limb exoskeletons could lead to the fatigue and injury of semitendinosus. The results of this study illustrate that to avoid the phenomenon of sudden increase of individual muscle force, the consistency between the length of body segment and the length of exoskeleton rod should be considered in the design of lower limb exoskeleton extremity.
ObjectiveTo analyze the effectiveness of unicompartment allografts replacement for reconstructing bone defect after bone tumor resection around knee.MethodsBetween January 2007 and January 2014, a total of 9 patients received unicompartment allografts replacement to treat bone tumor around the knee, including 6 males and 3 females, with an average age of 25.8 years (range, 17-38 years). There were 7 patients with bone giant cell tumor (postoperative recurrence of bone giant cell tumor in 1 case) and 2 patients with chondromyxoid fibroma. The tumors were located at the distal femur in 7 cases and proximal tibia in 2 cases, and the tumors were almost at the lateral limbs. The symptom duration was 2-5 months (mean, 3.2 months). The size of lesion ranged from 6 cm×2 cm to 9 cm×4 cm by X-ray film and MRI; and the metastasis was excluded by CT. The length of the allograft was 8.0-9.2 cm (mean, 8.6 cm).ResultsThe intraoperative blood loss volume was 400-550 mL (mean, 480 mL); and 0-3 U of erythrocyte was transfused after operation. The continuous exudate of incision occurred in 1 patient, and cured after 3 months; the other incisions healed primarily at 2 weeks after operation. All patients were followed up 3-10 years (mean, 6 years). No operation area infection, allograft bone poor healing or rupture was found. At 1 year after operation, the knee range of motion was 90-110° (mean, 100°); the Musculoskeletal Tumor Society score was 24-29 (mean, 26). Low density area (osteolysis) was found in 6 allografts; no articular surface collapse, hairline fracture, or fracture was found in patients; callus formation was observed in the contact surface between the allograft and the host bone, and the cortical bone showed good continuity.ConclusionUnicompartment allografts replacement can provide good support and function in terms of bone tumor resection, and achieve good effectiveness by biological reconstruction.
