先天性胫骨假关节45年的治疗经验

目的总结45年期间,3个阶段、3种方法、20例先天性胫骨假关节(CPT)患儿的治疗经验。方法我们医院对CPT先后采用了单纯植骨融合术(1956～1977年,5例),游离带血管蒂腓骨移植手术(1977～1990年,7例)和Ilizarov技术和外固定器(1990～2007年,8例)3种方法。结果 20例患儿中15例假关节愈合,治愈率为75%,有2例为愈合后再骨折,治疗后重新愈合。结论对CPT的治疗效果,以游离带血管蒂腓骨移植手术与Il-izarov技术和外固定器较好,两者均较早期的单纯植骨融合方法疗效提高。但3种方法结合应用效果最佳。目前为止,对CPT的治疗仍有很多问题需要解决,例如膝外翻、踝外翻、胫骨再骨折、治疗时间过长等。     

Ilizarov技术在急性胫骨缺损合并软组织缺损治疗中的应用

目的观察Ilizarov技术在急性胫骨缺损合并软组织缺损治疗中的应用效果。方法急性胫骨骨缺损合并软组织缺损20例,18例胫骨缺损〈5 cm者行一期清创、腓骨截骨、胫骨缺损端加压,2例胫骨缺损〉5 cm者行一期清创、骨运输—骨延长术,均于患肢安置Ilizarov外固定架。结果术后随访12～26个月,患者创面均闭合,骨缺损均获得重建,骨折愈合,患肢与健侧肢体长度差〈2 mm;创面经游离皮片植皮成活2例,经皮瓣修复覆盖创面1例,余均未经额外手术修复。结论 Ilizarov技术用于治疗急性胫骨缺损合并软组织缺损安全、有效。     

髓内腓骨移植结合Ilizarov技术治疗胫骨感染性骨不连及骨缺损（附7例报告）

目的探讨髓内腓骨移植结合Ilizarov技术治疗胫骨感染性骨不连及骨缺损的效果。方法选择胫骨感染性骨不连及骨缺损7例,骨感染情况根据Ciemy—Mader分型,Ⅲ型局限型5例,Ⅳ型弥漫型2例;患者均有窦道形成,2例存在皮肤缺损及骨外露。7例均采用髓内腓骨移植结合Ilizarov外固定骨延长治疗。结果患者均获得随访,随访时间平均20．8个月。7例最终全部愈合,延长段或搬移段长度平均5．7cm,骨折端愈合时间平均19．6周。采用ASAMI标准评价治疗效果,骨愈合优良率100％,功能恢复优良率85．7％。结论髓内腓骨移植结合Ilizarov技术是治疗胫骨感染性骨不连及骨缺损的有效方法。     

Ilizarov技术治疗儿童膝关节屈曲畸形

目的探讨Ilizarov技术在儿童膝关节屈曲畸形的应用及方法。方法 1999年8月～2011年12月在我院住院治疗的膝关节屈曲患者15例(23膝),其中先天性多发性关节挛缩症9例,双膝关节先天性脱位2例,单肢畸形1例,先天性脊柱侧凸、脊膜膨出合并双膝屈曲1例,股骨远端截骨术后双膝屈曲1例,左膝化脓性关节炎所致膝关节屈曲1例。应用Ilizarov技术进行手术治疗,术后定期复查。结果术后随访检查显示膝关节屈曲得以矫正,患者术后无因伊氏架延长牵拉引起的神经症状。结论膝关节屈曲畸形见于多种原因,临床治疗难度大,应用Ilizarov技术对于治疗膝关节屈曲畸形取得了很好的治疗效果。     

Ilizarov胫骨横向骨搬移技术联合介入方法治疗糖尿病足严重下肢动脉血管病变的疗效分析

［摘要］　目的　分析Ilizarov胫骨横向骨搬移技术联合介入方法治疗糖尿病足严重下肢动脉血管病变的临床疗效。方法　选择2015-09～2019-01漯河医学高等专科学校第二附属医院收治的糖尿病足溃疡患者21例。应用Ilizarov胫骨横向骨搬移技术联合介入方法进行治疗。记录患者创面愈合时间,术前及术后6个月踝肱指数、下肢血管直径及血流速度,评估临床疗效。结果　术后2周,患者的溃疡面均开始缩小,术后4周时均达到植皮或皮瓣移植术条件,所有创面未做特殊处理。所有患者溃疡面愈合,创面愈合时间（57.76±12.3）d。术后2个月超声复查结果显示患肢外周新生血管网丰富,患肢功能达到日常生活需要。术后6个月时,多普勒血流探测仪检测到患足踝肱指数增大,血管超声检测到患足胫前及胫骨后动脉血流速度加快,血管内径增大,与术前比较差异均有统计学意义（P<0.05）。1例因严重并发症死亡。结论　对于下肢膝关节以上大动脉严重狭窄甚至闭塞的糖尿病足患者,可先采用介入方法打通大血管,再用Ilizarov胫骨横向骨搬移技术改善微循环,加快创面修复,降低小截肢及大截肢发生率。     

Ilizarov支架在小儿下肢短缩合并成角畸形矫正中的应用

目的 探讨Ilizarov支架矫正儿童下肢成角伴短缩畸形安全性与可行性.方法 应用矫形外科原则,对2004年8月～ 2008年7月收治的8例儿童下肢成角伴短缩畸形病例采用Ilizarov支架一期手术、渐进矫形方法 治疗.术前测量患肢短缩和成角畸形的程度并确定成角旋转中心的位置.术中支架铰链安置在成角旋转中心水平.术后7d开始通过调整支架螺杆,逐步同时矫正成角和短缩畸形.随访观察肢体长度、畸形有无复发、关节活动范围、肌力;X线片观察下肢力线、关节水平线与机械轴线角度以及新生骨塑形情况.结果 8例患儿中6例利用微创截骨部位完成矫形与延长,2例于骨折畸形愈合部位截骨矫形、临近骨段延长.术后平均矫正成角畸形33°,平均延长5.2cm.所有病例下肢机械力线恢复,相关关节角度恢复至正常范围,双下肢等长.最后随访时X线片显示延长骨痂愈合良好,无再骨折.无神经血管损伤发生.结论 Ilizarov支架矫正儿童下肢成角伴短缩畸形是安全可行的,能精确恢复下肢长度与力线,手术并发症少,矫形效果好,避免了多次手术,不足之处在于支架治疗时间长.     

现代骨外固定技术——传统的继承、发展与突破

骨外固定的历史远早于内固定,1840年法国外科医生Malgaigne首先使用骨外固定技术治疗胫骨骨折.二次世界大战时,在挽救战争中的骨折伤员及创伤后肢体残缺的过程中,一度促进了外固定器械、技术与基础研究的发展.但在Ilizarov生物学理论、外固定技术没有在世界传播之前,外固定技术的临床应用、作用原理类似于内固定,主要应用于治疗骨折及完成有限的肢体延长和畸形矫正,这个阶段可将其称为"传统骨外固定技术".2006年6月～ 2010年10月,我先后出席了美国巴尔迪摩、俄罗斯库尔干、埃及、西班牙召开的"国际ASAMI(Ilizarov方法研究与应用协会)和世界骨外固定技术大会"[1],深深感到,以Ilizarov技术为代表的现代外固定技术与经典外固定相比,在基础理论、器械性能、医疗理念与治疗范围、学科属性等方面,皆有突破性的发展.     

胫骨横向骨搬移微血管网再生技术在糖尿病足治疗中的临床应用研究

目的研究胫骨横向骨搬移微血管网再生技术在糖尿病足(DF)治疗中的临床应用效果。方法选择该院2019年12月—2020年5月期间收治的糖尿病足40例进行研究,由于治疗措施不同分为两组,各20例,其中对照组实施开放性清创术,研究组采取胫骨横向骨搬移微血管网再生技术治疗,观察两组患者溃疡面积、治疗前后生活质量。结果治疗前两组患者生活质量评分差异无统计学意义(P>0.05),术前两组患者患肢温度差异无统计学意义(P>0.05),治疗前两组患者患肢溃疡面积差异无统计学意义(P>0.05),治疗后研究组生活质量评分高于对照组,术后1周研究温度高于对照组,治疗后研究组患肢溃疡面积少于对照组,差异有统计学意义(P<0.05)。结论对于糖尿病足实施胫骨横向骨搬移微血管网再生技术,可有效提升患者生活质量,并缩小患者溃疡面积,使得踝肱指数、经皮肤测定的动脉血氧张力好转,值得应用。     

中西医结合改良Ilizarov术对下肢感染性骨缺损和肢体短缩的临床疗效

目的探讨中西医结合改良Ilizarov术对下肢感染性骨缺损(LEIBD)和肢体短缩的临床疗效。方法 40例LEIBD患者按照不同疗法分为两组,采用西药结合改良Ilizarov术为对照组18例,在对照组的基础上辅助中医治疗患者22例为中药组。分析两组疗法对骨缺损和肢体短缩的临床疗效。结果经过4~6 w抗感染治疗,随访6~18个月,患者炎症都治愈。10例股骨患者在术后9例两下肢均衡发展等长,可负重行走。30例胫骨患者28例两下肢等长,两下肢短缩0.5 cm,较满意。中药组治疗率高于对照组,但差异无统计学意义(P>0.05),愈合期显著低于对照组(P<0.05),同时手术次数也相对较少。9例股骨患者在术后髋关节功能均正常,7例表现僵硬,3例可以屈伸,其中中药组正常率高于对照组,但差异无统计学意义(P>0.05);30例胫骨患者28例膝关节功能正常,2例轻度屈伸受限,其中中药组正常率高于对照组(P<0.05);3例踝关节融合,15例踝关节功能正常,1例部分屈伸障碍,其中中药组正常率高于对照组,但差异无统计学意义(P>0.05)。中药组钉眼异常、轴向偏移、多发性关节挛缩症及松动均低于对照组,并发症率低。结论采用中西医结合改良Ilizarov术对LEIBD和肢体短缩的临床疗效突出,骨愈合率高,并发症少。     

Ilizarov 技术结合 Taylor 外固定架治疗创伤后胫骨远端缺损合并马蹄内翻足疗效观察

目的：观察Ilizarov技术结合Taylor外固定架一期治疗创伤后胫骨远端缺损合并马蹄内翻足的临床效果。方法创伤后胫骨远端缺损合并马蹄内翻足的患者12例,均采用Ilizarov结合Taylor外固定架一期治疗。术后随访评价疗效,记录不良反应。结果患者手术顺利,骨断端无需植骨。骨性愈合时间6～12个月,平均7个月;随访6～17个月,平均14个月。患者畸形均获满意矫正,截骨处及骨缺损处均临床愈合,足持重行走功能良好,外观满意。术后随访畸形无复发,疗效评价非常满意8例、满意4例。2例发生中度针道感染,对症治疗后均获得痊愈;患者均未并发截骨处骨不愈合、踝关节脱位及血管、神经损伤等严重并发症。结论 Ilizarov结合Taylor外固定架一期治疗创伤后胫骨远端缺损合并马蹄内翻足安全、有效。     

Application of transcutaneous oxymetry in vascular surgery

Our study is aimed at the assessment of transcutaneous oxygen pressure tension measurements (tcpo2) application in relation to evaluation of results of vascular operations upon chronic ischaemic limbs and choice of amputation level if necessary. 269 patients were examined. All measurements were performed with the help of Hellige Oxymonitor SM 361 and a Polish one. A Clark-type electrode was attached to the surface of the skin at the dorsum of the foot and 1/3 upper tibia level (10 cm below lower margin of the patella). In several cases 1/3 lower thigh level was examined too. The clinical status of patients appeared to reflect tcpo2 values. Correct process of healing was observed to start from tcpo2 critical value of 40 mmHg. Tcpo2 method seems very useful for assessment of results of blood-flow reconstruction operations and choice of most advisable level for chronic ischaemic limb amputation.     

Joint bleeding in factor VIII deficient mice causes an acute loss of trabecular bone and calcification of joint soft tissues which is prevented with aggressive factor replacement

While chronic degenerative arthropathy is the main morbidity of haemophilia, a very high prevalence of low bone density is also seen in men and boys with haemophilia. This study investigates bone degradation in the knee joint of haemophilic mice resulting from haemarthrosis and the efficacy of aggressive treatment with factor VIII in the period surrounding injury to prevent bone pathology. Skeletally mature factor VIII knock‐out mice were subjected to knee joint haemorrhage induced by puncture of the left knee joint capsule. Mice received either intravenous factor VIII treatment or placebo immediately prior to injury and at hours 4, 24, 48, 72 and 96 after haemorrhage. Mice were killed 2‐weeks after injury and the joint morphology and loss of bone in the proximal tibia was assessed using microCT imaging. Quantitative microCT imaging of the knee joint found acute bone loss at the proximal tibia following injury including loss of trabecular bone volumetric density and bone mineral density, as well as trabecular connectivity density, number and thickness. Unexpectedly, joint injury also resulted in calcification of the joint soft tissues including the tendons, ligaments, menisci and cartilage. Treatment with factor VIII prevented this bone and soft tissue degeneration. Knee joint haemorrhage resulted in acute changes in adjacent bone including loss of bone density and mineralization of joint soft tissues. The rapid calcification and loss of bone has implications for the initiation and progression of osteoarthritic degradation following joint bleeding.     

A Logarithmic Formulation for Anisotropic Behavior Characterization of Bovine Cortical Bone Tissue in Long Bones Undergoing Uniaxial Compression at Different Speeds

The mechanical properties of bone tissues change significantly within the bone body, since it is considered as a heterogeneous material. The characterization of bone mechanical properties is necessary for many studies, such as in prosthesis design. An experimental uniaxial compression study is carried out in this work on bovine cortical bone tissue in long bones (femur and tibia) at several speeds to characterize its anisotropic behavior. Several samples from different regions are taken, and the result selection is carried out considering the worst situations and failure modes. When considering different displacement rates (from 0.5 to 5 mm/min), three findings are reported: The first finding is that the behavior of bone tissues in radial and tangential directions are almost similar, which allows us to consider the transversal isotropic behavior under static loads as well as under dynamic loads. The second finding is that the failure stress values of the longitudinal direction is much higher than those of the radial and tangential directions at low displacement rates, while there is no big difference at the high displacement rates. The third finding is a new mathematical model that relates the dynamic failure stress with the static one, considering the displacement rates. This model is validated by experimental results. The model can be effectively used in reliability and optimization analysis in prosthesis design, such as hip prosthesis.     

Esmarch tourniquet in orthopaedic surgery

A bloodless field is important in many orthopaedic operations necessitating the use of a pneumatic tourniquet or Esmarch bandage. The outcome of the use of an Esmarch bandage for exsanguination and as a tourniquet in 112 consecutive patients who had elective orthopaedic operations on 131 limbs was evaluated. The setting was at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, from March 2003 to February 2005. The mean age of the patients was 25.7 + standard deviation years (range 1-70 years). The duration of tourniquet application ranged from 20 min to 2 h 35 min. Four limbs (3.1%) developed acute compartment syndrome; four (3.1%) had tourniquet paralysis with ulnar nerve involvement in three limbs. All limbs regained full neurological function following physiotherapy. There was wound infection in two limbs (1.5%). In spite of its drawbacks, the Esmarch bandage is still useful for exsanguination and as a tourniquet in orthopaedic surgery where there is no pneumatic tourniquet.     

Protective effect of melatonin against fractionated irradiation-induced epiphyseal injury in a weanling rat model

The effects of melatonin, a free-radical scavenger and a general antioxidant, on radiation-induced growth plate injury have not been studied previously. The purpose of this study was to determine the potential benefits of sparing longitudinal bone growth by fractionated radiotherapy alone compared with pretreatment with melatonin that provides differential radioprotection of normal cells. Weanling 4-wk-old (75-100 g) male Sprague-Dawley rats were randomly assigned to one of three groups: Group R received fractionated radiation alone (n = 8); groups M5 (n = 8) and M15 (n = 7) received 5 or 15 mg/kg melatonin prior to fractionated radiation, respectively. The distal femur and proximal tibia in the right leg of each animal were exposed to a therapeutic X-irradiation dose (25 Gy total in three fractions) with the contralateral left leg as the non-irradiated control. Melatonin was administered intraperitoneally to the animals 30 min before radiation exposure. Six weeks after treatment, the rats were killed and the lower limbs disarticulated, skeletonized, radiographed, and bone growth was calculated based on measurement of the bone lengths. Fractionated radiation resulted in a mean percent overall limb growth loss of 41.2 +/- 9.5 and a mean percent overall limb discrepancy of 11.2 +/- 2.2. The administration of 5 or 15 mg/kg melatonin before each of the three fractions of radiotherapy reduced the mean percent overall limb growth loss to 33.9 +/- 5.8 and 32.2 +/- 4.5, respectively, and the mean percent overall limb discrepancy to 9.4 +/- 1.6 and 8.9 +/- 1.1, respectively; these values were significantly different compared with irradiation alone (range: P = 0.01-0.04). When compared with Group R, the growth arrest recovered by 5 or 15 mg/kg melatonin was 19.7 and 24.1% for the tibia, 7 and 18.6% for the femur, and 17.7 and 21.8% for the total limb, respectively. These results support further investigation of melatonin in combination with fractionation for potential use in growing children requiring radiotherapy to the extremity for malignant tumors.     

Prevention of limb amputation in patients with limbs ulcers by autologous peripheral blood mononuclear cell implantation

There are many cases of amputation of ischemic limbs of dialysis patients due to diabetes, despite the availability of medicine therapy and vascular by-pass operations. As there is extensive ruin of the vascular bed due to diabetes, vascular regeneration therapy by stem cell implantation is effective. Thirty patients with ischemic limbs due to diabetes (not including type-I) and on dialysis for chronic renal failure (19 cases), diabetes (5 cases), dialysis patients without diabetes (4 cases), and arteriosclerosis obliterans (ASO, 2 cases) were treated by autologous peripheral blood stem cell (PBSC) implantation where imminent amputation was under consideration. Granulocyte Colony Stimulate Factor (G-CSF: 5 microg/kg/day) was administered subcutaneously for 4 days before PBSC collection, that was carried out using a centrifuge (Spectra and/or CS3000) via the vein. The collected PBSC, containing 4.2 x 10(7) of CD 34 positive cells, was divided into units of 0.5-1.0 mL and implanted, without any purification, to the ischemic area of the limbs in about 65 points. In 21 cases, normalization of limb temperature was observed by thermograph, and symptoms also improved. The result of this first attempt of PBSC implantation is that we were able to save 22 ischemic limbs. This is the first large report of the application of regenerative medicine to peripheral ischemic limbs.     

DSA下肢体动脉切开取栓术在急性肢体缺血疾病中的临床应用效果探讨

目的探讨数字减影血管造影(DSA)下行肢体动脉切开取栓手术治疗急性肢体缺血的临床应用效果。方法收集该院2012-09~2019-06接受DSA下肢体动脉切开取栓手术的74例急性肢体缺血患者(共79条患肢)的临床资料,回顾性分析保肢率、手术方式、膝下动脉开通比例、并发症及随访结果,用以评价手术疗效。结果所有74例急性肢体缺血患者均顺利完成手术,术中均未发生与操作相关并发症,61例患者(共64条患肢)成功保肢,保肢率为81.01%(64/79)。其中59例下肢手术患者中,胫前动脉总开通率为83.05%(49/59),胫后动脉总开通率为72.88%(43/59),腓动脉总开通率为84.75%(50/59)。有效随访的61例患者无手术并发症导致死亡的病例。结论DSA下肢体动脉切开取栓手术治疗急性肢体缺血,有利于提高保肢成功率,减少操作相关并发症发生。     

单纯主动脉缩窄的外科治疗

目的总结单纯主动脉缩窄外科治疗的经验,评价手术时机和方法。方法1990年6月至2005年8月,手术治疗单纯主动脉缩窄17例,其中行主动脉缩窄切除对端吻合术5例,人工血管移植术3例,补片成形术7例,Vosschulte成形术1例,左锁骨下动脉-降主动脉人工血管转流术1例。结果术毕上下肢平均动脉压的压差<10mmHg者13例,上肢平均动脉压仍高于下肢10～30mmHg者4例。术后早期高血压者14例。随访5个月至10年,下肢血压高于上肢者13例,无明显差异者3例,下肢血压仍明显低于上肢者1例,仍有高血压者5例;成形部位动脉瘤样扩张1例,再缩窄1例。结论早期诊断、早期治疗是提高生存率和减少术后高血压的关键。手术方法应根据患者年龄、病理特征和术者经验选择。     

Bone properties and muscle strength of young haemophilia patients

PURPOSE: To evaluate bone properties, muscle strength and the relationship between the two, in young (7.0-17.7 years) haemophilia patients (h) and healthy boys (c). SUBJECTS: Twenty-seven boys with severe haemophilia and 33 healthy boys, of similar age, body mass, height, (mean +/- sd for h and c, respectively: 11.2 +/- 3.2 vs. 11.4 +/- 2.9 years, 42.6 +/- 16.6 vs. 41.6 +/- 17.3 kg, 145 +/- 18 vs. 146 +/- 17 cm) and pubertal stage according to secondary sex characteristics, volunteered for the study. all subjects were physically inactive (as determined by questionnaire). METHODS: Subjects performed isokinetic elbow and knee extension and flexion tests at two angular velocities (biodex system ii dynamometer). Bone properties were evaluated by qualitative ultrasound (sunlight omnisense), at the distal radius and tibial mid-shaft. H subjects received prophylactic factor viii treatment within the 24 h preceding testing. No test was performed in the presence of haemorrhage. RESULTS: Muscle strength was consistently higher in c compared with h, especially in the lower limbs (e.g. knee extension: 1.80 +/- 0.44 vs 1.48 +/- 0.53 N x m x kg(-1) body mass, respectively, p = 0.01). No differences were observed in tibial or radial speed of sound between groups. Correlations between muscle strength and bone properties were observed only in the lower limbs and only in c (r = 0.37-0.48). CONCLUSION: Muscle strength, especially lower limbs' strength, was lower in haemophilia patients compared with a matched, similarly inactive population of healthy boys. Nevertheless, at this age range, this relative weakness is not associated with inferior bone properties.