OBJECTIVE: To evaluate the short-term effectiveness of Ilizarov technique combined with steel needle internal fixation in treating Charcot neuroarthropathy (CN) of the foot and ankle. METHODS: Between June 2020 and December 2023, 12 patients with Eichenholtz stage Ⅲ CN of the foot and ankle were treated with Ilizarov technique and steel needle internal fixation. There were 9 males and 3 females with an average age of 48.6 years (range, 19-66 years). The disease duration ranged from 1 to 16 months (mean, 6.8 months). Ankle joint involvement predominated in 7 cases, while midfoot involvement occurred in 5 cases; 3 cases presented with skin ulceration and soft tissue infection. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 31.2±9.0, 36-Item Short-Form Health Survey (SF-36)-Physical Component Summary (PCS) score was 32.6±6.8, and Mental Component Summary (MCS) score was 47.8±8.4. Postoperative assessments included wound healing, regular X-ray film/CT evaluations of fusion status, and effectiveness via AOFAS and SF-36-PCS, MCS scores. RESULTS: All operations were successfully completed without neurovascular complication. Two patients experienced delayed wound healing requiring intervention, and the others achieved primary healing. All patients were followed up 15-43 months (mean, 23.3 months). Imaging confirmed successful joint fusion within 13-21 weeks (mean, 16.8 weeks). At last follow-up, the AOFAS score was 72.5±6.4, and the SF-36-PCS and MCS scores were 63.2±8.4 and 76.7±5.3, respectively, all of which improved compared to preoperative levels, with significant differences ( P<0.05). CONCLUSION Ilizarov technique combined with steel needle internal fixation effectively restores walking function and achieves satisfactory short-term effectiveness in CN of the foot and ankle.
Humans ; Middle Aged ; Male ; Female ; Adult ; Ilizarov Technique ; Arthropathy, Neurogenic/surgery* ; Aged ; Ankle Joint/surgery* ; Treatment Outcome ; Needles ; Fracture Fixation, Internal/instrumentation* ; Steel ; Young Adult ; Foot Joints/surgery*

Objective:To investigate value of contrast-enhanced ultrasound(CEUS)in predicting ischemic-type biliary lesions(ITBLs)in patients with thickened hilar bile duct wall at early stage after liver transplantation.Methods:A total of 45 patients,who underwent liver transplantation at the Liver Transplantation Center of Beijing Friendship Hospital Affiliated to Capital Medical University from June 25,2020 to December 28,2022,and occurred hilar bile duct wall thickening at early stage after surgery,were prospectively included.CEUS was performed on biliary tract when the thickened hilar bile duct wall was first detected by routine ultrasound,and the enhanced mode of duct wall at each phase was recorded.Subsequently,according to the results of cholangiography,these patients were divided into ITBLs group(15 cases)and non-ITBLS group(30 cases).The enhanced degree of each phase of CEUS of two groups was qualitatively analyzed and compared,and the diagnostic efficacy of CEUS for ITBLs after liver transplantation was evaluated.Results:There were no significant differences in source of liver donor,biliary anastomosis,autoimmune liver disease,hepatic artery occlusion(HAO),rejection,cytomegalovirus infection and cholangitis between the two groups(P>0.05).The compared results of the enhanced mode of CEUS at arterial phase between the two groups indicated that 25 patients(83.3%)were hyper-enhancement,and 5 patients(16.7%)were iso-enhancement,and 0 patient was hypo-enhancement or non-enhancement in non-ITBLS group.The compared results also indicated that 3 patients(20.0%)were hyper-enhancement,and 4 patients(26.7%)were iso-enhancement,and 8 patients(53.3%)were hypo-enhancement or non-enhancement in ITBLs group.The difference of above results between the two groups was statistically significant(x2=22.946,P<0.000).There was no significant difference between the two groups in the enhanced mode at the late phase(P>0.05).The accuracy,sensitivity,specificity,positively predictive value and negatively predictive value of the prompted hypo-enhancement or non-enhancement at arterial phase of CEUS on biliary tract were respectively 84.4%,53.3%,100%,100%and 84.4%in diagnosing ITBLs.For 8 patients who were diagnosed as ITBLs by CEUS,the diagnostic time of CEUS for ITBLs was 1 to 6 months[3.0(1-5)months]ahead of that of cholangiography.Conclusion:CEUS can more accurately predict ITBLs before the biliary tract occurs significant morphological change,which can significantly advance the diagnostic time for ITBLs.

Single-docking robot-assisted laparoscopic radical nephroureterectomy is difficult to deal with the distal ureter and bladder. Thirty-two patients with ureter carcinoma underwent single-docking robot-assisted nephroureterectomy in rectus rectilinear cannula placement in our hospital. The advantages include lower surgical difficulty, shorter operation time, less surgical bleeding and damage. This surgical method is a safe and effective minimally invasive treatment for ureter carcinoma.

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation.Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed.All 2 cases were male.Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa.The patient was hospitalized due to still recurrent fever with longterm retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery.Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa.The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery.All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty.The operative and postoperative complications were recorded and the postoperative examination data were collected.Results The operation time of the 2 cases were 165min and 189min,and the bleeding amount were 50ml and 100ml respectively.No urinary leakage,renal colic,high fever and other complications occurred.In case 1,nephrostomy tube was removed 8d after operation.The urinary catheters were removed 14d after operation in the 2 cases.The postoperative hospital day was 9d and 6d respectively.CT examination was performed 3 months after surgery.Compared with preoperative,case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved.In case 1,double J tube was removed in 3 months after operation.In case 2,double J tube was replaced in 3 months after operation and was removed after 3 months.2 patients were followed up to 18 months and 14 months after operation,respectively.Nohydronephrosis aggravated.Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation.It has the advantages of small trauma,quick recovery,exact effect and few complications.

This article reported the treatment of 3 cases of frequent recurrent intractable nephrotic syndrome by XIE Chang-sen. On basis of the therapeutic method of invigorating the spleen and kidney, other methods should be used according to individual difference and special clinic signs and symptoms, such as other invigorating qi and consolidation of superficies, nourishing blood and dispersing stagnated liver qi, warming kidney qi to invigorate yang, replenishing essence and dispersing turbid and so on. And partner treatment is the key for cure.