下肢动脉造影评分系统对慢性下肢缺血截肢平面选择的价值

目的：对35例下肢慢性缺血性截肢患者进行病例分析，探讨下肢动脉造影评分系统对慢性下肢缺血患者截肢平面选择的指导价值。 方法：首都医科大学宣武医院血管外科自2001-06／2004-08采用下肢动脉造影评分系统指导完成35例下肢慢性缺血性患者进行截肢。对因慢性下肢缺血需行截肢的患者术前行双下肢动脉造影检查，根据首都医科大学血管外科研究所制定的动脉造影评分系统选择截肢平面（膝上截肢分数〈12分，膝下截肢12～19分，半足截肢20～25分，截趾〉25分），术中均按预定平面完成截肢。术后根据截肢残端一期愈合率对下肢造影评分系统进行评价。 结果：按实际处理分析，实验纳入35例患者，33例进入结果分析，2例脱落，1例术后4d死于急性心肌梗死；另1例术后出现缝线反应。①下肢慢性缺血性截肢患者残端一期愈合率：33例截肢患者中，31例患者伤口达一期愈合，2例患者伤口未达一期愈合，患者截肢残端一期愈合率为93．94％。②下肢慢性缺血性截肢患者残端未达一期愈合的原因：2例患者伤口未达一期愈合，其中1例为人工血管搭桥术后截肢患者，残端反复破溃2年以上，人工血管去除后残端愈合；另1例因残端渗出较多，皮瓣下积液引流不畅，行残端切开引流后伤口愈合。 结论：本实验无因缺血造成的伤口延期愈合或再截肢患者，说明这项新的截肢平面判断标准是行之有效的，提示可利用下肢动脉造影评分系统进行截肢平面预测。     

旁路搭桥治疗下肢动脉缺血25例临床分析

目的探讨下肢动脉缺血的诊断方法和旁路搭桥的疗效。方法对25例确诊的下肢动脉缺血患者的临床资料进行回顾性分析。结果全组无手术死亡病例，所有切口均Ⅰ期愈合，肢体疼痛均减轻或消失，趾端溃疡术后3周痊愈，1例开放性截趾于术后6周愈合。本组25例（100％）均获随访，最长2年，随访期间截肢1例，1例术后1个月人工血管有血栓形成，再次手术取栓，1例术后1年因患胃溃疡停用华法林，出现人工血管堵塞，再次行人工血管旁路搭桥术。结论下肢缺血行动脉旁路搭桥手术，有着重要的临床价值，可以使大多数患者得到有效治疗，从而挽救肢体或降低截肢平面。     

Wagner3级严重缺血性糖尿病足的介入治疗

目的 探讨介入治疗Wagner3级严重缺血性糖尿病足患者的临床效果.方法 21例Wagner3级严重缺血性糖尿病足患者接受介入治疗,测量术前、术后1月、术后12月踝肱指数(ABI).结果 17例患者严重狭窄或闭塞动脉经介入治疗后动脉造影显示血管通畅,侧枝循环增多,临床症状明显改善,溃疡愈合,ABI术后1月(0.81±0.25)、12月(0.75±0.17)均比术前(0.23±0.16)明显增高(t=8.057,10.244;P均＜0.001);4例患者膝下动脉未能开通,其中2例溃疡愈合,2例膝下截肢.结论 介入治疗可以改善严重缺血性糖尿病足下肢动脉的血液灌注,促进溃疡愈合,避免截肢或降低截肢平面,其治疗的近期疗效令人满意.     

132例下肢动脉血管损伤的诊断与治疗体会

目的探讨下肢动脉损伤的诊治。方法 132例患者根据典型病史初步诊断为下肢动脉血管损伤,术中明确诊断。治疗采用加压止血同时行手术治疗:股总动脉修补8例,股总动脉大隐静脉旁路转流1例;股浅动脉修补42例,股浅动脉大隐静脉旁路转流15例,股浅动脉人工血管重建2例;腘动脉修补32例,腘动脉大隐静脉旁路转流9例,腘动脉人工血管旁路转流6例,动脉结扎18例。术后随访3个月至2年。结果 82例动脉损伤修补患者术后患肢血供正常,未见间歇性跛行及其他缺血症状;25例大隐静脉旁路转流患者中6例术后一年出现血栓形成及下肢缺血症状,8例人工血管旁路转流患者中4例腘动脉损伤者由于下肢严重缺血症状而行二期手术截肢,2例出现移植物感染而取出血管。18例结扎分支患者随访无特殊不适。结论下肢动脉损伤应首选动脉吻合,万不得已不采用人工血管重建。妥善的术后处理是下肢血管损伤术后顺利愈合的保障。     

自体外周血干细胞移植降低下肢缺血性疾病患者截肢率及截肢平面:30例报告

目的:观察自体外周血干细胞移植对下肢缺血性疾病截肢率及截肢平面的影响。方法:选择2003-11/2004-07解放军第四六三医院30例下肢缺血性疾病患者,已行单侧下肢截脚术3侧,均经药物治疗疼痛及创面无改善,经彩色超声多普勒和血管造影检查显示有不同程度的下肢血管闭塞,临床已诊断以闭塞部位确定截肢平面。施行自体外周血干细胞移植治疗,观察移植治疗后截肢率和截肢平面的降低情况,以及经自体外周血干细胞移植治疗后足部皮温,踝脓比、经皮氧分压、疼痛的改善及创面愈合情况。结果:按实际处理分析,30例患者均进入结果分析。①降低截肢率情况:27例患者移植后截肢8例,截肢率为30%(8/27),截肢率降低了70%。②截肢患者降低截肢平面情况:3例已截肢患者行再次截肢,8例移植后截肢,移植术后截肢患者11例中拟截肢平面为大腿6例、小腿2例、足3例,实际截肢平面为大腿3例、小腿4例、足趾3例、趾1例。降低截肢平面者8例。③移植前后患足皮温和经皮氧分压变化情况:移植后患者皮温较移植前明显升高[(325±1.3],(28.1±1.5)℃,P<0.011,移植后经皮氧分压测定较移植前明显增高[(4.0±0.80),(3.2±0.53)kPa,P<0.01]。④移植后3个月局部疼痛及创面愈合情况随访;疼痛消失、剖面愈合11例;疼痛减轻,创面面积减少5例;疼痛减轻,创面面积无明显变化7例;无效7例。结论:外周血干细胞移植治疗下肢缺血性血管病,可促进剖面愈合,降低截肢率和降低截肢平面,无明显副作用及并发症,可望成为一种简单的、有效的治疗下肢动脉缺血性疾病的方法。     

外科手术治疗急性下肢缺血24例分析

目的：探讨急性下肢缺血的救治方法。方法：24例急性下肢缺血患者均行急诊Fogarty导管取栓术。7例患肢术后行CTA评估，2例行人工血管腹主双股动脉转流术，1例行人工血管股股动脉转流术，3例行髂动脉支架置入球囊扩张术，1例胸主动脉夹层放弃治疗。结果：16例取栓成功，1例截肢，6例行二次手术后血供恢复良好。结论：急诊Fogarty导管取栓术是急性下肢缺血的首选治疗。取栓失败应行术后评估，选择相应的对症处理。     

自体外周血干细胞移植降低下肢缺血性疾病患者截肢率及截肢平面：30例报告

目的：观察自体外周血干细胞移植对下肢缺血性疾病截肢率及截肢平面的影响：方法：选择2003—11／2004—07解放军第四六三医院30例下肢缺血性疾病患者，已行单侧下肢截脚术3例，均经药物治疗疼痛及创面无改善，经彩色超声多普勒和血管造影检查显示有不同程度的下肢血管闭塞，临床已诊断以闭塞部位确定截肢平面。施行自体外周血干细胞移植治疗，观察移植治疗后截肢率和截肢平面的降低情况，以及经自体外周血干细胞移植治疗后足部皮温、踝眩比、经皮氧分压、疼痛的改善及创面愈合情况。结果：按实际处理分析，30例患者均进入结果分析。①降低截肢率情况：27例患者移植后截肢8例，截肢率为30％(8／27)，截肢率降低了70％。②截肢患者降低截肢平面情况：3例已截肢患者行再次截肢。8例移植后截肢，移植术后截肢患者11例中拟截肢平面为大腿6例、小腿2例、足3例，实际截肢平面为大腿3例、小腿4例、足趾3例、趾1例。降低截肢平面者8例。③移植前后患足皮温和经皮氧分压变化情况：移植后患者皮温较移植前明显升高[(32．5&;#177;1．3)，(28．1&;#177;1．5)℃，P&;lt;0．01]，移植后经皮氧分压测定较移植前明显增高[(4．0&;#177;0．80)，(3．2&;#177;0．53)kPa，P&;lt;0．01]。④移植后3个月局部疼痛及创面愈合情况随访：疼痛消失、创面愈合11例；疼痛减轻，创面面积减少5例；疼痛减轻，创面面积无明显变化7例；无效7例。结论：外周血干细胞移植治疗下肢缺血性血管病，可促进创面愈合，降低截肢率和降低截肢平面，无明显副作用及并发症，可望成为一种简单的、有效的治疗下肢动脉缺血性疾病的方法。     

人工血管旁路术治疗下肢动脉闭塞症的护理

目的:探讨下肢动脉闭塞症人工血管旁路术后护理方法。方法:82例下肢动脉闭塞症患者均在腰硬联合麻醉下,52例行膝上人工血管旁路术,19例行膝下人工血管旁路术,6例行左右股动脉人工血管转流术,5例行腹主动脉、双股动脉人工血管旁路术,术后均给予精心护理。结果:无手术死亡,66例治愈,14例好转,2例截肢;随访0.5~4年,76例生活质量正常,2例复发。结论:人工血管旁路术是治疗下肢动脉闭塞症安全、有效的治疗手段,术前全面准备和术后精心护理是保证手术成功、降低致残率的关键。     

自体外周血干细胞移植治疗下肢动脉缺血性疾病16例围术期护理

目的:探讨自体外周血干细胞移植治疗下肢动脉缺血性疾病患者的围术期护理方法。方法:对16例下肢动脉缺血性疾病患者行自体外周血干细胞移植治疗,并做好术前护理、术后护理,观察患者症状改善情况。结果:本组9例肢端小溃疡在6个月内愈合;2例半年后愈合;1例血栓闭塞性脉管炎截趾后切口愈合良好;1例糖尿病足溃疡经干细胞移植治疗1个月溃疡愈合出院。结论:自体外周血干细胞移植治疗下肢动脉缺血性疾病有效而安全,加强围术期护理可有效减少并发症发生,提高移植治疗效果。     

糖尿病足血管内介入治疗临床意义

目的:评价下肢血管介入治疗糖尿病足的临床价值及预后情况.方法:将56例2型耱尿病伴糖尿病足并有外科截肢手术指征患者分为2组.观察组(21例)给予下肢动脉血管成形术+药物治疗+局部换药;对照组(35例)给予药物治疗+局部换药.分别在术后第5,30,60,90天观察并评价2组患者临床症状、下肢动脉血管内径及足部渍疡愈合情况、溃疡愈合时间、住院天数、截肢率.结果:观察组临床症状、下肢动脉血管内径、溃疡愈合情况、溃疡愈合时间、住院天数及截肢率明显优于对照组(P＜0.05).结论:糖尿病足患者行下肢血管介入手术治疗效果满意,可以降低患者病残率.     

Recurrent lower extremity pseudocellulitis

The term "Pseudocellulitis" can be used to describe an uncomplicated nonnecrotizing inflammation of the dermis and hypodermis from a noninfectious etiology. Chemotherapeutic agents have been associated with a variety of cutaneous reactions, including radiation recall dermatitis, hypersensitivity reactions, and erysipeloid reactions. Gemcitabine (2,2-difluorodeoxycytidine) is currently being used for treatment of a variety of solid malignancies, including carcinoma of the lung. The dermatitis involved with gemcitabine is typically a radiation recall reaction whereby an inflammatory reaction occurs in the area previously treated with radiotherapy. We describe here a case of Gemcitabine-induced pseudocellulitis that was unrelated to radiation exposure and manifested in an area of lymphedema. The pseudocellulitis in such cases could be related to the drug's pharmacokinetics and may last until the drug is displaced from the subcutaneous tissue of the affected area. Antibiotics have no role in the treatment, and diphenhydramine with nonsteroidal anti-inflammatories may be used for symptomatic management.     

Duplex sonography of lower extremity arteries

Although indirect noninvasive tests continue to play a role in the evaluation of patients with lower extremity arterial disease, the direct approach of duplex scanning provides both anatomic and physiological information directly from the involved arterial sites. Experience has shown that the results of duplex scanning are comparable with those of arteriography. The addition of color Doppler imaging to standard duplex scanning expedites the examination by helping to identify vessels and localize flow disturbances. However, precise classification of disease severity still requires spectral waveform analysis. Initial screening of patients with duplex scanning can determine the severity of arterial occlusive disease, the location of the lesions, and which interventional techniques are most appropriate. Arteriography can then be reserved for those patients who are being considered for therapeutic interventions. Duplex scanning has become the primary diagnostic test for follow-up of patients after radiological or surgical procedures and should be considered as an essential component of care for patients with infrainguinal bypass grafts. It has also proven to be valuable for intraoperative assessment and the initial evaluation of suspected vascular trauma in the extremities. Finally, new applications such as compression therapy for pseudoaneurysms continue to evolve and expand the role of duplex scanning in the management of patients with vascular problems.     

Basic biomechanics of the lower extremity

This article describes common principles of biomechanics for running, jumping, and kicking. These activities form the basis for much of sports activity. Understanding human movement allows the physician to prescribe appropriate prevention, treatment, and rehabilitation to patients.     

Functional capabilities of lower extremity amputees

One hundred thirty-four lower extremity amputees were evaluated from six months to 12 years postamputation by means of retrospective questionnaires. Patient population was similar to that of the "Amputee Census" in terms of sex, amputation level and cause of amputation. Information was gathered on activities generally considered essential for daily living, vocation and recreation, living arrangements and adjustments therein, as well as feedback on the patients' beliefs concerning what rehabilitation personnel should be doing to improve amputees' lifestyle. The relationship of functional outcome to age, amputation level, and cause of amputation was also evaluated. Results showed that most amputees did not resume a completely normal lifestyle and many modifications were made. The most popular recreational activities were fishing and swimming. Activities that amputees found most difficult were running and walking long distances. Patients requested better communication between professional staff and themselves. Below-knee amputees were significantly more independent than above-knee and bilateral amputees, but the differences between above-knee and bilateral amputees were statistically insignificant. Tumor patients did better than the other three etiologic groups. As age increased, functional independence decreased.     

Postoperative management of lower extremity amputations

Postoperative management of the lower extremity amputation continues to evolve as a crucial first step in amputee rehabilitation. Although the major goals of early rehabilitation remain fairly constant, external forces continually pressure the rehabilitation team to complete these goals within shorter time frames. The atmosphere of rapid rehabilitation for amputees stresses return to normal function as quickly as possible. Early ambulation is the obvious goal for most new amputees.     

Deforming lipoblastomatosis of the lower extremity

OBJECTIVE: Lipoblastomatosis is a rare disorder in infants and children and nonexistent in adults. We discuss a case of a newborn child with lipoblastomatosis extensively involving the pelvis and lower extremities. The clinical and radiological characteristics of the disorder are discussed. CLINICAL FEATURES: A 2-month-old male had an enlarging deformity of the pelvis and lower extremities with progression of the condition from birth. There was no family history related to the disease. No other clinical abnormalities were present. INTERVENTION AND OUTCOME: Lipoblastomatosis is initially treated with surgical excision of the lipomatous neoplastic tissue. The postsurgical outcome is satisfactory; however, the likelihood of recurrence has been reported. CONCLUSION: We present the features of lipoblastomatosis, an uncommon disorder affecting infants and children. The clinical and radiologic manifestations of the disease are assessed with emphasis on magnetic resonance imaging.     

Soft-tissue injuries of the lower extremity

A diverse set of conditions affect the lower extremities in athletes. Good history taking and knowledge of the anatomy of the affected areas can aid in accurate diagnosis. Most conditions can be treated conservatively with great success. Familiarity with rehabilitation strategies can assist physicians in working with physical therapists. New advances, especially in the therapy of plantar fasciitis, may aid physicians in more rapid treatment of conditions of overuse. Surgery can provide definitive relief from symptoms for athletes with whom conservative measures have failed.