Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo explore the value of potaried technique with Trivex system in treatment for venous skin ulcer with deep venous thrombosis sequelae (DVTS) of lower limbs. MethodsTotal 166 patients with venous skin ulcer with DVTS of lower limbs were included in this study. The patients of operation group (94 patients involving 94 legs) were treated by using potaried technique with Trivex system. The patients of nonoperation group (72 patients involving 72 legs) were treated by using nonoperative method. The clinical indexes of skin infection rate, skin necrosis rate, shrinkage rate of wound area, skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were used to assess the clinical curative effect between two groups on 5, 20, 120 and 360 d after operation or treatment, respectively. ResultsThere were no skin infection and skin necrosis in two groups on 5 d after operation or treatment. The rate of shrinkage of wound area and skin depigmentation of patients in operation group were significantly higher than those in nonoperation group on 20 d after operation or treatment 〔(95.8±2.138)% vs. (68.7±3.125)%，P=0.048; (87.6±1.263)% vs. (12.3±1.324)%， P=0.018〕. The rate of the ulcer healing of patients in operation group was significantly higher than that in nonoperation group on 120 d after operation or treatment (97.9%vs. 8.3%， P=0.014). The rate of the ulcer recurrence of patients in operation group was significantly lower than that in nonoperation group on 360 d after operation or treatment (5.3% vs. 97.2%， P=0.015). ConclusionThe potaried technique with Trivex system can be used as one of the surgical treatment methods for venous skin ulcer with DVTS of lower limbs.
Objective To explore the effect and evaluation criterion of the transplantation of autologous peripheral blood stem cells(PBSC)for blood flow remodeling in the critical limb ischemia (CLI).MethodsThirty six patients with 39 limbs suffered from CLI at Yunnan Provincial Center of Vascular Surgery and Department of Vascular Surgery of The First Affiliated Hospital of China Medical University from March 2003 to January 2007 were included in this study.These patients were divided into two groups. One groupconsisted of 20 cases in all 22 limbs used the transplantation of autologous PBSC,and another group included 16 cases in all 17 limbs were not use this technique.Multifunction monitoring device,dopplor ultrasound monitoring device,per cutem oxygen partial pressure monitoring device and digital subtraction angiography were used to measure effect degree of limbs regional blood flow from cutaneous covering,blood vessel and blood on the preoperative and postoperative days and the follow-up time was six months.ResultsThe effect indexes of limbs regional blood flow of the case by transplantation of autologous PBSC was as follows:skin temperature index(STI)was(1.5±0.3) ℃， per cutem oxygen partial pressure monitoring device(TcPO2)was(36.6±9.3)mm Hg,ankle-brachium index(ABI)was0.7±0.1,photoplethysmograpy index(PPGI) was0.8±0.1,saturation of blood oxygen(SaO2)was(78.3±15.9)%,digital subtraction angiography score was1.5±0.3,the rate of limbs salvage was 82%,the distance of intermittent claudication was(150.3±41.1)meters,and the change of index was consistent with ameliorative tendency of symptom(0.415＜r＜0.592, P＜0.05).ConclusionThe transplantation of autologous PBSC can promote blood flowremodeling in limbs ischemia,and the effect indexes of limbs regional blood flow can objectively reflect the degree of blood flow remodeling.
Objective To analyze the femoral head collapse and the operation of osteonecrosis of the femoral head (ONFH) in different Japanese Investigation Commitee (JIC) types, in order to summarize the prognostic rules of each type of ONFH, and explore the clinical significance of CT lateral subtypes based on reconstruction of necrotic area of C1 type and verify their clinical effect. Methods A total of 119 patients (155 hips) with ONFH between May 2004 and December 2016 were enrolled in the study. The total hips consisted of 34 hips in type A, 33 in type B, 57 in type C1, and 31 in type C2, respectively. There was no significant difference in age, gender, affected side, or type of ONFH of the patients with differenct JIC types (P>0.05). The 1-, 2-, and 5-year femoral head collapse and operation of different JIC types were analyzed, as well as the survival rate (with femoral head collapse as the end point) of hip joint between different JIC types, hormonal/non-hormonal ONFH, asymptomatic and symptomatic (pain duration >6 months or ≤6 months), and combined preserved angle (CPA) ≥118.725° and CPA<118.725°. JIC types with significant differences in subgroup surgery and collapse and with research value were selected. According to the location of the necrotic area on the surface of the femoral head, the JIC classification was divided into 5 subtypes in the lateral CT reconstruction, and the contour line of the necrotic area was extracted and matched to the standard femoral head model, and the necrosis of the five subtypes was presented by thermography. The 1-, 2-, and 5-year outcomes of femoral head collapse and operation in different lateral subtypes were analyzed, and the survival rates (with collapse of the femoral head as the end point) between CPA≥118.725° and CPA<118.725° hip in patients with this subtype were compared, as well as the survival rates of different lateral subtypes (with collapse and surgery as the end points, respectively). ResultsThe femoral head collapse rate and operation rate in the 1-, 2-, and 5-year were significantly higher in patients with JIC C2 type than in patients with other hip types (P<0.05), while in patients with JIC C1 type than in patients with JIC types A and B (P<0.05). The survival rate of patients with different JIC types was significantly different (P<0.05), and the survival rate of patients with JIC types A, B, C1, and C2 decreased gradually. The survival rate of asymptomatic hip was significantly higher than that of symptomatic hip, and the survival rate of CPA≥118.725° was significantly higher than that of CPA<118.725° (P<0.05). The lateral CT reconstruction of type C1 hip necrosis area was selected for further classification, including type 1 in 12 hips, type 2 in 20 hips, type 3 in 9 hips, type 4 in 9 hips, and type 5 in 7 hips. There were significant differences in the femoral head collapse rate and the operation rate among the subtypes after 5 years of follow-up (P<0.05). The collapse rate and operation rate of types 4 and 5 were 0; the collapse rate and operation rate of type 3 were the highest; the collapse rate of type 2 was high, but the operation rate was lower than that of type 3; the collapse rate of type 1 was high, but the operation rate was 0. In JIC type C1 patients, the survival rate of the hip joint with CPA≥118.725° was significantly higher than that with CPA<118.725° (P<0.05). In the follow-up with femoral head collapse as the end point, the survival rates of types 4 and 5 were all 100%, while the survival rates of types 1, 2, and 3 were all 0, and the difference was significant (P<0.05). The survival rate of types 1, 4, and 5 was 100%, of type 3 was 0, and of type 2 was 60%, showing significant difference (P<0.05). Conclusion JIC types A and B can be treated by non-surgical treatment, while type C2 can be treated by surgical treatment with hip preservation. Type C1 was classified into 5 subtypes by CT lateral classification, type 3 has the highest risk of femoral head collapse, types 4 and 5 have low risk of femoral head collapse and operation, type 1 has high femoral head collapse rate but low risk of operation; type 2 has high collapse rate, but the operation rate is close to the average of JIC type C1, which still needs to be further studied.
Objective To evaluate the efficiency and safety of combinative use of radiofrequency and transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Methods Three hundred and twenty-one cases of varicose veins of lower extremity were randomly divided into three groups: group A (102 cases)： endovenouser whole range closure in situ for great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; group B (97 cases)： endovenouser whole range closure in situ for upper leg part of great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; 122 conventional treatment cases, which high ligation and stripping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used, were selected as controlled group (group C). Consequences and complications of operation were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness and infirmity disappeared within one month after operation, skin pigmentation was alleviated within one month after operation, and disappeared gradually within three months. Contrasting three groups in complications of skin numbness of legs, ecchymosis of upper leg, wound hematoma, and swelling below ankle, there was no statistical difference between group A and B, and there was statistical difference between group A and C, and B and C. There were more complications in conventional group than those in mini-invasive groups. There was no statistical difference in leg ecchymosisa between group B and C. No deep vein thrombosis of lower extremity and incision infection was detected in all cases. Conclusion It is simple and definitely efficient to combine radiofrequency with transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.
Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity. Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity， who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009, were analyzed. Three hundred cases were randomly divided into potaried group and transfixion group. In potaried group, there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system. In transfixion group, 110 cases involving 110 legs treated with percutum transfixion. The clinical indexes of skin infection rate and skin necrosis rate, shrinkage rate of wound area and skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5, day 20, day 120 and day 360 after operation respectively. Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P＜0.05), the rates of shrinkage of wound area and skin depigmentation were significantly increased in potaried group compared with transfixion group on day 20 (P＜0.05). The ulcer healing rate was not significantly different between the two groups on day 120 (Pgt;0.05). Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P＜0.05). Conclusion It can be concluded that percutem transilluminated with negatived pressured on the potaried technique with TRIVEXTM Ⅱ potaried system can efficiently promote the healing of venous ulcer in the lower extremity, and at the same time it has an ascendancy in lessening skin infection and skin reinjury.
Objective To establish finite element models of different preserved angles of osteonecrosis of the femoral head (ONFH) for the biomechanical analysis, and to provide mechanical evidence for predicting the risk of ONFH collapse with anterior preserved angle (APA) and lateral preserved angle (LPA). Methods A healthy adult was selected as the study object, and the CT data of the left femoral head was acquired and imported into Mimics 21.0 software to reconstruct a complete proximal femur model and construct 3 models of necrotic area with equal volume and different morphology, all models were imported into Solidworks 2022 software to construct 21 finite element models of ONFH with LPA of 45°, 50°, 55°, 60°, 65°, 70°, and 75° when APA was 45°, respectively, and 21 finite element models of ONFH with APA of 45°, 50°, 55°, 60°, 65°, 70°, 75° when LPA was 45°, respectively. According to the physiological load condition of the femoral head, the distal femur was completely fixed, and a force with an angle of 25°, downward direction, and a magnitude of 3.5 times the subject’s body mass was applied to the weight-bearing area of the femoral head surface. The maximum Von Mises stress of the surface of the femoral head and the necrotic area and the maximum displacement of the weight-bearing area of the femoral head were calculated and observed by Abaqus 2021 software. ResultsThe finite element models of ONFH were basically consistent with biomechanics of ONFH. Under the same loading condition, there was stress concentration around the necrotic area in the 42 ONFH models with different preserved angles composed of 3 necrotic areas with equal volume and different morphology. When APA was 60°, the maximum Von Mises stress of the surface of the femoral head and the necrotic area and the maximum displacement of the weight-bearing area of the femoral head of the ONFH models with LPA<60° were significantly higher than those of the models with LPA≥60° (P<0.05); there was no significant difference in each index among the ONFH models with LPA≥60° (P>0.05). When LPA was 60°, each index of the ONFH models with APA<60° were significantly higher than those of the models with APA≥60° (P<0.05); there was no significant difference in each index among the ONFH models with APA≥60° (P>0.05). Conclusion From the perspective of biomechanics, when a preserved angle of ONFH is less than its critical value, the stress concentration phenomenon in the femoral head is more pronounced, suggesting that the necrotic femoral head may have a higher risk of collapse in this state.
Objective To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering mechanical evidence for preventing internal displacement of the lower limb force line in conjunction with knee varus in patients with knee osteoarthritis (KOA) and reducing bone mass under the tibial plateau. Methods A healthy adult was selected as the study subject, and X-ray film and CT imaging data were acquired. Mimics 21.0 software was utilized to reconstruct the complete knee joint model and three models representing low-density areas under the tibial plateau with equal volume but varying shapes. These models were then imported into Solidworks 2023 software for assembly and verification. Five KOA finite element models with 22%, 33%, 44%, 55%, and 66% bone mass reduction in the low-density area under tibial plateau and 5 KOA finite element models with 81%, 90%, 100%, 110%, and 121% times of the low-density area model with 66% bone mass loss were constructed, respectively. Under physiological loading conditions of the human lower limb, the distal ends of the tibia and fibula were fully immobilized. An axial compressive load of 1 860 N, following the lower limb force line, was applied to the primary load-bearing area on the femoral head surface. The maximum stress within the tibial plateau, as well as the maximum displacements of the tibial cortical bone and tibial subchondral bone, were calculated and analyzed using the finite element analysis software Abaqus 2022. Subsequently, predictions regarding the alteration of the lower limb force line were made based on the analysis results. Results The constructed KOA model accorded with the normal anatomical structure of lower limbs. Under the same boundary conditions and the same load, the maximum stress of the medial tibial plateau, the maximum displacement of the tibial cortical bone and the maximum displacement of the cancellous bone increased along with the gradual decrease of bone mass in the low-density area under the tibial plateau and the gradual increase in the volume of the low-density area under tibial plateau, with significant differences (P<0.05). ConclusionThe existence of a low-density area under tibial plateau suggests a heightened likelihood of knee varus and inward movement of the lower limb force line. Both the volume and reduction in bone mass of the low-density area serve as critical initiating factors. This information can provide valuable guidance to clinicians in proactively preventing knee varus and averting its occurrence.