Limp Research Articles

Vascular intervention joint foot plastic surgery in the treatment of diabetic foot

Objective To evaluate the chnical value of intervention therapy combined with the foot plastic surgery in the treatment of diabetic foot.Methods 67 patients who accepted the intervention therapy combined with the plastic surgery for occlusive lesion of lower limbs arteries were selected.The clinical symptom,ankle brachial pressure index and hemodynamics were observed before and after treatment.All clinical indicators were compared between the therapeutic group and the control group.Results Among 67 patients,63 cases were successful in clinical treatment (the success rate:94.0％).One month,three months,six months after operation,the skin temperature,anklebrachial index,limp distance,clinical symptom,ankle brachial pressure index and hemodynamics were increased.Compared with preoperation,all above-mentioned indicators were improved obviously (P ＜ 0.05,P ＜ 0.01).Conclusion Intervention therapy for diabetic foot has the merits of less trauma,higher effectiveness of treating diabetic foot ulcers,defect repair,maximally reserved limbs and better shapes of limbs,which made both doctors and patients satisfied.It is a new direction for minimally invasive therapy. Key words: Angioplasty ; Surgery, plastic ; Diabetic foot

Fever and a limp

Fever and a limp

The limb with a limp

The limb with a limp

Clinicopathological and immunohistochemical characteristics of CHILD syndrome

A 9-year-old girl was born with cutaneous erythema and plaques on the left side of the body as well as deformity of the left lower limb.Physical examination revealed limp,obvious shortening of the left lower limb,deformity of the second,third and fourth toes of the left foot.Both muscle tone and muscle strength were decreased in the left lower limb compared with the right lower limb.Cutaneous examination showed erythematous hypertrophic plaques in the left posterior neck,buttock,perineum,leg,and foot.Histopathologic examination of the skin lesions showed epidermal hyperkeratosis,a small number of foamy cells infiltrating the dermal papillae,as well as focal lymphocyte and plasma cell infiltrates in the superficial dermis.Moreover,the foamy cells in the dermal papillae stained strongly positive for CD68 and CD163,but negative for S100.A diagnosis of CHILD syndrome was made. Key words: CHILD syndrome ; Pathology; Immunohistochemistry

Limping through Life

Limping through Life

Endovenous laser ablation versus conventional surgery for great saphenous varicose veins:meta-analysis of randomized trials

To review the available data of randomized controlled clinical trials (RCT) to compare endovenous laser therapy (EVLT) with conventional surgery of high ligation and stripping (HL/S) for the treatment of great saphenous varicose veins. A systematic review of Pubmed, Cochrane Library, Embase, Web of Science, Ovid database, China National Knowledge Infrastructure (CNKI) database and Wanfang database was performed to retrieve RCT studies on the effectiveness of EVLT versus HL/S up to January 1999. The rates of postoperative recurrence at 1 year, 2 years and major complications were analyzed by Review Manager 5.1 software. Eight retrieved RCT studies and 1743 limps were evaluated. The ratios of recurrence were the same for EVLT and HL/S at 1 and 2 years post-operation. For the ratios of major postoperative complications, there was no statistical difference between EVLT and HL/S in thrombosis, wound infection and phlebitis. But EVLT could reduce the ratio of paresthesia. Compared with HL/S, EVLT shows no significant difference in the 1/2-year recurrence rate or the rates of thrombosis, wound infection and phlebitis. However, it can decrease the rate of paresthesia.

To limp, or not to limp, is that the question?

To limp, or not to limp, is that the question?

Effects of ischemia postconditioning in reducing ischemia reperfusion injury in acute limp ischemia

Objective To study the effects of ischemia postconditioning(IPC) in reducing ischemia-reperfusion injury(IRI) in acute limp ischemia(ALI) and investigate the mechanism.Methods 45 New Zealand rabbits were treated with the method that combined high lipid diets and femoral intima injury by balloon inflation to build up limp atherosclerotic stenosis model,then they were randomly divided into three groups( each group 15 rabbits):control group;IR group and IPC group.Serum creatine phosphate kinase(CK),malondialehyde(MDA),superoxide dismutase (SOD) in three groups were measured before occlusion and 2 hours after sustaining reperfusion.The histological changes of limp skeletal muscle of experimental rabbits were analyzed and TUNEL method was used to access apoptosis of skeletal muscle cells.Results The levels of CK,M DA in IPC group were lower than IR group [ (7.49 ± 0.84)vs (8.19 ± 1.06),P＜0.05],[ (3.67 ±0.36) vs (4.06 ±0.55),P ＜0.05] while SOD level was higher than IR group [ (420.40 ± 30.94 ) vs ( 384.73 ± 44.12),P ＜ 0.05 ] ; The injury of skeletal muscles in I PC group was lighter than IR group and the apoptosis index of skeletal muscle cells was significantly decreased compared with that in IR group[(12.27+2.11)％ vs (16.62 ± 1.44)％,P＜0.01].Conclusion Applying IPC in acute limp ischemia could alleviate IRI and protect skeletal muscles.The mechanism was associated with oxidation resistance enhancing and the effects in reducing apoptosis of skeletal muscles induced by IRI. Key words: Ischemia reperfusion injury ; Postconditioning; Skeletal muscle; Apoptosis

Greater trochanteric transfer for the treatment of coxa brevis in children and adolescents

Objective To evaluate the effect of greater trochanteric transfer for the treatment of coxa brevis in children and adolescents.Methods From August 2005 to January 2011,twenty patients (22 hips)with coxa brevis underwent greater trochanteric transfer.Among them 18 patients (20 hips) were available for evaluation,including 4 boys and 14 girls,with an average age of 11.4 years (range,7.5-15.0 years) at operation.Five cases (6 hips) were caused by Perthes disease,and 13 cases (14 hips) were caused by developmental dysplasia of hip.Four patients (4 hips) had undergone greater trochanteric epiphyseodesis ever before.All patients were fixed with tension screw after the deformity was corrected during the operation.After operation,the human plaster spica was used for 6 weeks in all patients.Results All patients were followed up for 14 to 79 months (average,31 months).At the last follow-up,fatigue or pain in the hips disappeared or improved in 13 patients.Sixteen patients had limping and positive Trendelenburg sign preoperatively,at the last follow-up 9 patients got improvement.Twelve patients (13 hips) had limitation of abduction of the hip,the average range of abduction was 25.38°±1.20°,which was improved to 45.38°±1.05° at the last follow-up.The average articulotrochanteric distance and ratio of the distance from the greater trochanter tip to femoral head center and the radius of the femoral head at the last follow-up was (17.47+3.14)mm and 2.10±0.21,respectively,there were statistical differences compared with those before operation [(-2.89±4.62) mm and 1.59±0.22,respectiovely].The average leg-length discrepancy at the last follow-up was (0.78t±0.26) cm,which had on statistical differences compared with that [(0.83 ±0.33) cm]before operation.Conclusion Greater trochanteric transfer for the treatment of coxa brevis in children and adolescents could improve the clinical symptom,recover the normal anatomy of the proximal femoral,restore the hip biomechanics environment,but could uot improve the leg-length discrepancy. Key words: Hip dislocation, congenital; Osteotomy; Child

Control of hemorrhage during the operation of old pelvic fractures by temporary balloon occlusion of the common iliac artery

Objective To discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.Results The mean time of operations was 290 min (range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.Conclusion The effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer. Key words: Pelvis; Fractures, bone; Hemorrhage; Hemostasis, surgical

AKT Question Relating to Causes of Childhood Limp

AKT Question Relating to Causes of Childhood Limp

AKT Answer Relating to Causes of Childhood Limp

AKT Answer Relating to Causes of Childhood Limp

Variable-frequency electroacupuncture for elderly patients with knee osteoarthritis

Objective To investigate the therapeutic effects of variable-frequency electroacupuncture treatment for elderly patients with knee osteoarthritis. Methods One hundred and twenty patients with knee oste-oarthritis were randomly divided into a treatment group and a control group. The treatment group was treated with variable-frequency electroaeupuncture, while the control group was treated with muscle strength training. Before treatment and after 8 weeks of treatment, the motor function of their knee joints was evaluated according to Lysholm' s knee scoring scale, quadriceps muscle strength was evaluated according to the maximum load capacity of knee ex-tension, and postural stability was evaluated using a static balance function test. Results Lysholm scores in the treatment group improved significantly compared with those before treatment, except for the item assessing support-ing. While in the control group, compared with before treatment, there were significant differences in the items as-sessing limp, inter-locking, instability, pain and stair activity. There were significant differences in the items as-sessing inter-locking, pain, swelling, stair activity and.squatting between the two groups after treatment. The maxi-mum knee extension load improved significantly in both groups. Static balance with the eyes both open and closed also improved significantly in both groups. There were significant difference in the length, covered area, rectangle-area and length/area of the sway traces of the two groups after treatment. Conclusions Variable-frequency elec-troacupuneture can effectively improve knee function, quadriceps muscle strength and postural stability in elderly patients with knee osteoarthritis. Key words: Knee; Osteoarthritis; Electroacupuncture

Application of subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip

Objective To observe the effect of transveme subtrochanteric femoral shortening osteoto-my in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods From February 2001 to February 2007, 12 patients with Crowe type Ⅳ DDH were performed primary THA combined with transverse subtrochanteric femoral shortening osteotomy. There were 3 males and 9 females,with the average age of 54 years(ranged, 45-65 years). Five hips were left, 7 hips were right and both sides for 1 patient. The average leg length discrepancy were 3.5 cm (ranged, 1.8-5.0 cm). There were 4 patients with moderate limp and 8 patients with servere limp. Clinical and radiographic data were retrospectively re-viewed at the 3rd, 6th, 12th month after operation, and then it was done every year. The bone union, pros-thesis subsidence, leg limp and the hip Harris score were evaluated. Results The average follow-up was 3.0 years (2-7 years), and the average length of shortening osteotomy was 2.2 cm (1.5-4.2 cm). No nerve injury and nonunion occurred. At ther final follow-up, there were 3 cases of mild limp, 4 cases of moderate limp and no severe ones. The mean Harris score improved from 36 (30-60) before operation to 83 (75-95). The mean union time was 5.3 months after operation (3-24 months after operation). The prosthesis subsidences were found in 1 case at the 5th year after operation and 1 case at the 7th year after operation, and with the subsiding height of 3 mm and 6 mm respectively. No loosening and infection were found in all patients.Conclusion Transverse subtrochanteric shortening osteotomy for Crowe type Ⅳ DDH is easy to performe. It can help to expose the true actabulum and fix the socket precisely, and also facilitate to improve the diame-ter of the prosthesis, correct the anterversion, and prevent nerve injury. Key words: Hip dislocation; congenital; Arthroplasty; replacement; hip; Osteotomy

Treatment of developmental dysplasia of the hip with periacetabular osteotomy.

Objective To report the preliminary results of treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy. Methods From February 2002 to February 2008, 53 patients (55 hips) with DDH were treated with periacetabular osteotomy. 51 patients were females, 2 were males, with the average age of 25.5 years (ranged, 13 to 51 years). The hip pain period before surgery varied from 1 month to 6 years (mean 16 months). 6 patients had the history of hip surgery. The mean Wiberg CE angle was 3°(range, -20°to 15°). According to Tonnis osteoarthritis classification, there were 16 cases in grade Ⅰ, 1 in grade Ⅱ. 25 patients had Shenton's line broken. The ilioinguinal approach was used in former 13 cases. The modified Smith-Petersen approach was used in later 40 cases. Intertrachanteric varus osteotomy was done simultaneously in 6 cases. Results The mean follow-up period was 28 months (ranged, 12 to 60 months). Bone union was achieved in 3 months after surgery. The pain relieved in most of patients. The Har-ris hip score increased from 77.4 points (ranged, 68 to 87 points) preoperatively to 94.6 points (ranged, 70 to 100 points) post-operatively. The range of motion of the hip decreased 20°-60° after surgery. The mean CE angle increased to 29°(ranged, 20° to 50°) postoperatively. 5 patients had limp after surgery, mostly due to dysfunction of gluteus medius, and recovered after 6 months of exercises. 18 patients got lateral femoral cu-taneous nerve injury. Two patients suffered pelvic ring broken and healed without affecting on hip function.No complication such as infection, vascular injury, sciatic neve injury happened in this series. Conclusion Satisfactory results can be obtained through periacetabular osteotomy in young patients with DDH. Periac-etabular osteotomy can correct the acetabular deformity in multiplanar. No vascular impair in acetabular fragment. The stability of the pelvic can be reserved. Early rehabilitation is allowed after surgery. Key words: Hip dislocation; congenital; Osteotomy; Acetabulum

The realize of the both point anesthetic method of the epidural space used to negativeway hysterectomy

Objective To used to negative way hysterectomy with the both paint negative way method of the epidural space. Methods 40 patients of the negative way anesthetic hysterectomy, all were used to the both point anesthetic method of the epidural space, the small pipe was towards the head at the L1～2 space and the small pipe was towards the tail at the L3～4 space. Results The myometrium uterus ligaments and the cervix were good limp. It is merrier of the topical anesthetic has keeped longer time and the dragging pain has lighter and lesser effect in the operation. Conclusion It has certainly worth of the clinical used to about the both point anesthetic method of the epiduralspace used to negativeway hysterctomy. Key words: Epiduralspace bothpain; Negativeway; Hysterectomy

Minimally invasive tibiotalocalcaneal arthrodesis with a retrograde locking nail

Objective To discuss the therapeutic effect of tibiotalocalcaneal arthrodesis for severe painful ankle diseases using a locked retrograde intramednllary nail. Methods From January 2003 to November 2007, 12 patients with severe painful ankle diseases underwent tibiotalocalcaneal arthrodesis with a retrograde locking nail in our department. Their mean age was 47.2 (range, 25 to 68) years. The preoper-ative diagnoses of the 9 male and 3 female patients included posttraumatic osteoarthritis (n=7), rheumatoid arthritis (n=3) and eqninovarus (n=2). The mean interval between the primary disease and the operation was 13.6 (range, 5 to 25) years. All patients were evaluated clinically and radiographically by means of clinical examination, questionnaire, weight-bearing radiographic assessment and the American Foot and Ankle Society(AOFAS) ankle-hindfoot scale. Results All patients were available for the follow-up with an average duration of 18.3 (range, 10 to 36) months. Complications, such as damage to neurovascular struc-tures, non-union and infection, were not seen. Solid fusion was achieved in all ankles after a mean time of 17 (range, 12 to 21) weeks. At the latest follow-up, 8 patients reported no pain and 4 mild pain; 7 patients had no limitation in recreational or daily activities while 5 had limitation in recreational but not in daily activities; 7 patients experienced no difficult walking on any surface but 5 did on uneven terrain and stairs. No patient showed obvious limp. The preoperative mean AOFAS score was 47.3 (range, 40 to 57), and the postoperative one 74.2 (range, 50 to 87) . Conclusion Locked retrograde intramedullary nailing is a minimally in-vasive, effective and safe technique in tibiotalocalcaneal arthrodesis for severe painful ankle diseases. Key words: Arthrodesis; Bone nails; Osteoarthritis

The Child With a Limp

The Child With a Limp

Limp in an 11-Year-Old Male

Limp in an 11-Year-Old Male

Anatomical and clinical study of reconstruction of the pateller ligament with vascularized medial tenden of gastrocnemius muscle

Objective To provide a clinical method in the treatment of patellar ligament defect. Methods Based on morphologic observation and blood supply of the medial tenden of gastrocnemius muscle on 30 adult cadaverous lower limp specimens. Then transferring of sural arteries medial tendon of gastrocnemins muscle was designed and used in 4 patients clinically. Results The period of follow-up in all cases was 2-8 months. The knee joint recovered well with satisfactory function. Conclusion The operation is a simple and ideal procedure. The vascularizod adductor magnus tendon is a good donor in the reconstruction of patellar ligament defect. Microsurgical repair of patellar ligament defect is a effective method. Key words: Patellar ligament; Gastrocnemius muscle; Reconstruction; Microsurgical operation