目的 了解老年2型糖尿病动脉僵硬度与踝臂指数（ABI）对评价外周动脉硬化的价值。 方法 2010年1月－3月，应用超声、回声跟踪技术和动脉硬化检测仪检测80例老年2型糖尿病患者（观察组）和40例正常老年人（对照组）的颈总动脉内中膜厚度（IMT）、僵硬系数（β）、脉搏波传导速度（PWVβ）、ABI及动脉斑块情况。 结果 与对照组比较，观察组患者的IMT增厚、β增高、PWVβ增快、ABI降低及动脉斑块发生率增多，差异均具有统计学意义（P＜0.001）。 结论 老年2型糖尿病可导致IMT增厚、动脉僵硬度增高、PWVβ增快、ABI降低及更易发生动脉粥样硬化斑块，这些参数可以预测外周动脉粥样硬化的程度，利用彩色多普勒超声诊断仪和动脉硬化检测仪可以较容易得到这些参数，是评价外周动脉粥样硬化病变一种简便、易行，有临床实际意义的方法和手段。
Objective To summarize the clinical effects of the repairing methods for deep wounds of the foot and ankle. Methods From March 2002 to June 2006, 49 patients with skin and deep tissue defects of the foot and ankle underwent the repairing treatment. Of them, 36 were males and 13 were females, aged 16 to 67 years( 39 years on average). The causes of injuries included mangled injury in 24 cases, high fall injury in 9 cases, cut injury in 7 cases, malignant soft tissue tumor in 5 cases, decubital ulcer in 2 cases, and electric burn in 2 cases. Of the 49 cases, 19 were in left side and 30 in right side. The defect size of skin ranged from 3 cm×2 cm to 20 cm×15 cm and deep tissue injuries were accompanied by defects of tendon and ligament in 24 cases, by damage of joint in 12 cases, and by bone defect in 9 cases, and 35 of them had infections, and 2 of them had diabetes of stage 2. The time between the injury and surgery ranged from 4 hours to 1 year.The wounds were repaired separately by local flap(3 cm×3 cm to 6 cm×4 cm) in 15 cases, local island flap(8 cm×5 cm to 12 cm×7 cm) in 25 cases, free flap(15 cm×11 cm to 24 cm×17 cm) in 4 cases, and cross leg flap(5 cm×4 cm to 8 cm×6 cm) in 5 cases. In 24 cases of defects of tendon and ligament, 15 underwent the reconstruction in one-stage operations,9 in two-satge operation.In 9 cases accompanied by bone defect, twostage bone grafting (12-64 g) was given after wound healed. Results All of the 49 flaps survived. Fortysix healed by the first intention and 3 with distal edge necrosis healed after skin grafting. Two patients with sinus formation healed after 68 months of dressing change. All the cases were followed up 6 months to 3 years, and all the flaps were well developed, the functions of the foot and ankle were satisfactory. Conclusion It can get an excellent result of appearance and function recovery repairing deep wounds of the foot and ankle with proper flaps in earlier time.
To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus. Methods The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were l isted as follows: ① Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; ② Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; ③ Thirty adult lower l imb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site. Results The internal malleolus had a basilar width of (2.6 ± 0.2) cm, a middle thickness of (1.3 ± 0.2) cm, an anterior length of (1.4 ± 1.9) cm and a posterior length of (0.6 ± 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 ± 3.60)°. The fibular head had a middle thickness of (1.8 ± 0.6) cm, a middle width of (2.7 ± 0.4) cm. Its articular facet was toroid, superficial and cavate in shape, and exposed inwardsly and upwardsly, and had a extraversion angel of (39.2 ± 1.3)°. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 ± 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 ±0.2) cm and a outer diameter of (2.0 ± 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 ± 0.5) mm and (2.6 ± 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 ± 1.3) mm at (1.0 ± 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 ± 0.4) mm. Its accompanying veins had outer diameters of (1.3 ± 0.5) mm and (1.1 ± 0.4) mm. Conclusion The blood supply compound flap based on fibular head had a possibil ity to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
Objective To explore the clinical effect of the lower rotating point super sural neurocutaneous vascular flap on the repair of the softtissue defects in the ankle and foot. Methods From May 2001 to February 2006, 24 patients with the soft tissue defects in the ankle and foot were treated with the lower rotating point super sural neurocutaneous vascular flaps. Among the patients, 15 had an injury in a traffic accident, 6 were wringedand rolled by a machine, 1 was frostbited in both feet, 2 were burned, 25 had an exposure of the bone and joint. The disease course varied from 3 days to 22 months; 19 patients began their treatment 3-7 days after the injury and 5 patients were treated by an elective operation. The soft tissue defects ranged in area from 22 cm × 12 cm to 28 cm × 12 cm. The flaps ranged in size from 24 cm × 14cm to 30 cm × 14 cm, with a range up to the lower region of the popliteal fossa. The rotating point of the flap could be taken in the region 1-5 cm above thelateral malleolar. The donor site was covered by an intermediate thickness skingraft. Results All the 25 flaps in 24 patients survived with asatisfactory appearance and a good function. The distal skin necrosis occurred in 1 flap, but healing occurred after debridement and intermediate thickness skin grafting. The follow-up for 3 months to 5 years revealed that the patients had a normal gait, the flaps had a good sense and a resistance to wearing, and no ulcer occurred. The two point discrimination of the flap was 5-10 mm. Conclusion The lower rotating point super sural neurocutaneous vascular flap has a good skin quality, a high survival rate, and a large donor skin area. The grafting is easy, without any sacrifice of the major blood vessel; therefore, it is a good donor flap in repairing a large soft tissue defect in the ankle and foot.
ObjectiveTo explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. MethodsBetween August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. ResultsThe operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. ConclusionA combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.
Objective To evaluate the effectiveness of Ilizarov external fixation and ankle arthrodesis in the treatment of late traumatic ankle arthritis. Methods Between June 2013 and June 2015, 27 patients with late traumatic ankle arthritis were treated with Ilizarov external fixation technique. There were 16 males and 11 females with an age of 27-69 years (mean, 45.7 years). Sixteen cases were on the left side, 11 on the right side. All the patients suffered from traumatic ankle fractures or ligament damages caused by initial traumas. After 6 months of standard conservative treatment, the results was invalid and all patients had ankle joint pain and movement disorders. The disease duration was 3-39 years (mean, 11.5 years). According to Takakura ankle arthritis staging, there were 16 cases in stage 3 and 11 cases in stage 4. The tibial-talar angle before operation was (102.55±4.02) ° measured on conventional double-feet loading anteroposterior and lateral X-ray films. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot joint score was 45.72±6.45, and the visual analogue scale (VAS) score was 8.61±1.96. Results All the patients were followed up 15-42 months (mean, 28.1 months). All ankles achieved bony fusion, the clinical healing time was 12.9 weeks on average (range, 11-18 weeks). No persistent bleeding in the incisions and needle tract occurred during the follow-up. There were 4 cases of mild needle infection, 2 cases of anterior dislocation of talus, and 3 cases with different degree of limited activity. No traumatic bone defect, bone disconnection, and false joint formation was observed. At 12 months after operation, the AOFAS ankle and foot joint score, VAS score, and tibial-talar angle were 80.53±9.14, 2.77±0.82, and (94.36±2.48)°, respectively, which were significantly improved when compared with preoperative ones (t=16.17, P=0.00; t=14.28, P=0.00; t=9.01, P=0.00). The effectivenss was excellent in 9 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 81.5%. Conclusion Satisfactory effectiveness can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of traumatic ankle arthritis, showing certain application prospect, while long-term effectiveness should be comfirmed by large sample randomized controlled trials.
Objective To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods. Methods From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwentthe repairing treatment, of whom 35 were males and 1 was female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defectsranged in area from 5 cm×4 cm to 20 cm×10 cm. The lateral supramalleolar flapwas used in 15 patients (15 flaps) with a flap area of 5 cm×4 cm-15 cm×8 cm,and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm×4 cm20 cm×10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods. Results Of the 36 patients, 15 underwent the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis.The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1. Conclusion The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolarflaps is more suitable for the skin defect of a smaller area over the medial orlateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.