OBJECTIVE: To investigate the efficacy of minimally invasive osteotomy with preservation of blood supply to the transversely transported bone segment in the treatment of chronic ischemic lower limb diseases using tibial transverse bone transport. METHODS: A retrospective analysis was conducted on the clinical data of 12 patients with chronic ischemic lower limb diseases who met the selection criteria and were treated between June 2016 and December 2023. The cohort included 7 males and 5 females, aged 26-87 years (mean, 61.2 years). Among them, 7 patients had diabetic foot (DF), including 2 cases complicated by arteriosclerosis obliterans (ASO), with a DF duration ranging from 1.7 to 23.0 months (mean, 9.6 months) and ulcer sizes ranging from 3.2 cm×2.4 cm to 10.0 cm×6.6 cm. Three patients had ASO with a disease duration of 1.7-23.0 months (mean, 10.4 months) and ulcer or post-amputation wound sizes ranging from 2.2 cm×2.1 cm to 12.0 cm×7.7 cm. Additionally, 2 patients with thromboangiitis obliterans (TAO) had a disease duration of 7 and 12 months, respectively. Preoperatively, the mean foot skin temperature was (27.63±0.34)℃, and the visual analogue scale (VAS) score was 8.5±0.7. All patients underwent tibial transverse bone transport using minimally invasive osteotomy while preserving the blood supply to the transported bone segment. Postoperative complications and foot ulcer healing were observed. The effectiveness of tibial transverse bone transport was evaluated by comparing preoperative and postoperative foot skin temperature, VAS scores, as well as through CT angiography (CTA). RESULTS: One DF patient with ASO was lost to follow-up, while the remaining 11 patients were followed up 10-29 months (mean, 20.5 months). One DF patient had a displaced fracture at the site of tibial transport due to trauma, which healed after plaster immobilization; 1 DF patient had a small amount of pigmentation in the skin of the donor site, but the blood circulation was good; no complication such as pin tract infection, skin necrosis, or osteomyelitis occurred in the donor site of all patients. At 2-3 weeks postoperatively, the foot skin temperature was (34.21±0.65)℃, and the VAS score was 0.3±0.1, both significantly improved compared to preoperative ones ( t=-31.578, P<0.001; t=49.000, P<0.001). Two TAO patients experienced recurrent, persistent, intolerable pain at 7-10 days postoperatively, with no reduction in ulcer size or necrotic areas; 1 underwent toe amputation, and the other required a mid-leg amputation. The remaining patients achieved complete ulcer healing, with healing time ranging from 5.1 to 9.2 weeks (mean, 6.8 weeks). CTA showed no new vascular occlusions or embolisms. X-ray films at 4 months postoperatively demonstrated proper repositioning and good healing of the transported tibial bone segment. CONCLUSION The application of minimally invasive osteotomy with preserved blood supply to the transversely transported bone segment in tibial transverse bone transport for the treatment of chronic ischemic lower limb diseases effectively minimizes extensive soft tissue dissection, reduces surgical soft tissue damage, and better maintains local blood supply. This approach lowers the risk of postoperative infection and skin necrosis while accelerating postoperative recovery.
Humans ; Osteotomy/methods* ; Middle Aged ; Male ; Female ; Aged ; Tibia/surgery* ; Minimally Invasive Surgical Procedures/methods* ; Retrospective Studies ; Adult ; Bone Transplantation/methods* ; Aged, 80 and over ; Diabetic Foot/surgery* ; Treatment Outcome ; Arteriosclerosis Obliterans/surgery* ; Ischemia/surgery* ; Lower Extremity/blood supply*

OBJECTIVE: To report the clinical experience of using Ilizarov wrist joint distraction technique in the treatment of a case of rheumatoid arthritis of the wrist. METHODS: In January 2019, a 49-year-old female patient with rheumatoid arthritis of the left wrist, complicated by ulnar impaction syndrome, was admitted for treatment. Preoperatively, the active range of motion of the left wrist was as follows: extension 0°-flexion 0°, pronation 65°-supination 35°, and grip strength of 4.0 kg. The visual analogue scale (VAS) score was 9, and the Cooney wrist function score was 15, indicating poor function. As conservative treatment failed to achieve symptom relief, Ilizarov wrist joint distraction surgery was performed. Postoperatively, joint distraction was applied at 2 mm increments on postoperative days 2 and 7, in 4 separate sessions. RESULTS: Postoperative X-ray film examination at 7 days revealed a distraction of 3.6 mm in the affected wrist joint compared to the contralateral side. The external fixator was removed 2.5 months postoperatively. At 22 months postoperatively, X-ray film and MRI examinations revealed that the joint space of the left wrist had returned to near-normal, with significant reduction in joint effusion and synovial proliferation. The active range of motion of the left wrist improved to extension 15°- flexion 30°, pronation 90°-supination 90°, with a grip strength of 18.0 kg. The wrist pain VAS score decreased to 0, and the Cooney wrist function score improved to 90, indicating excellent function. At 50 months postoperatively, follow-up X-ray film, MRI, and functional assessments showed the results similar to those at 22 months. CONCLUSION Ilizarov wrist joint distraction may be a viable treatment option for rheumatoid arthritis of the wrist.
Humans ; Female ; Middle Aged ; Wrist Joint/physiopathology* ; Arthritis, Rheumatoid/physiopathology* ; Range of Motion, Articular ; Ilizarov Technique ; Treatment Outcome ; Osteogenesis, Distraction/methods*

Objective:To explore the timing for removal of the external fixator without retraction of elongation zone during the mineralization stage in SD rat models of distraction osteogenesis (DO).Methods:Forty-two 12-week-old male Sprague-Dawley rats were randomly divided into 6 groups (groups A to F, n=7). The external fixator was removed at 1 to 6 weeks during the mineralization stage in groups A to F, respectively. To establish SD rat models of DO, after 4 threaded needles were inserted into the left femur horizontally and vertically, an external fixator was installed after osteotomy. A Kirschner wire was next inserted into the medullary cavity. After the incubation period (5 days), bone elongation lasted for 14 days until 7.0 mm was extended. Three rats were randomly selected from each group and sacrificed. After decalcification of the elongation zone, histological hematoxylin-eosin staining was performed. Radiographs were taken before removal of the external fixator and 5 weeks after removal of the external fixator for the remaining 4 rats in each group. The HE staining results, length of initial elongation zone, and retraction length of elongation zone were compared between groups. Results:HE staining showed large patches of fibrous tissue and a few immature small blood vessels in the elongation zone in group A, a small number of hypertrophic chondrocytes and fibrous junctions in the elongation zone in group B, some chondrocytes, osteocytes and fibrous tissue in the elongation zone in group C, a large number of chondrocytes on both sides of the elongation zone and fibrous connection in the center of the elongation zone in group D, a decreased number of mature hypertrophic chondrocytes and partial bone marrow in the elongation zone in group E, and a small number of chondrocytes and a partially recanalized medullary cavity with bone marrow in the elongation zone in group F. The lengths of initial elongation zone in groups A, B, C, D, E and F were, respectively, (6.98±0.14) mm, (7.02±0.18) mm, (7.02±0.08) mm, (7.02±0.11) mm, (7.01±0.18) mm and (7.00±0.12) mm, showing no statistically significant differences ( P>0.05). The lengths of retraction of elongation zone in groups A and B [(4.34±0.78) mm and (3.45±0.57) mm] were significantly longer than those in groups D, E and F [(0.16±0.17) mm, (-0.02±0.14) mm, and (0.03±0.82) mm] ( P<0.05). The timing for removal of the external fixator without retraction of elongation zone was the 4th week during the mineralization stage (group D); the healing index was 87 d/cm and the non-retraction index 67 d/cm in group D. Conclusion:In the SD rat models of DO, removal of the external fixator at 4 weeks and later during the mineralization stage may not lead to retraction of the elongation zone.

Objective:To explore the timing for removal of the external fixator without retraction of elongation zone during the mineralization stage in SD rat models of distraction osteogenesis (DO).Methods:Forty-two 12-week-old male Sprague-Dawley rats were randomly divided into 6 groups (groups A to F, n=7). The external fixator was removed at 1 to 6 weeks during the mineralization stage in groups A to F, respectively. To establish SD rat models of DO, after 4 threaded needles were inserted into the left femur horizontally and vertically, an external fixator was installed after osteotomy. A Kirschner wire was next inserted into the medullary cavity. After the incubation period (5 days), bone elongation lasted for 14 days until 7.0 mm was extended. Three rats were randomly selected from each group and sacrificed. After decalcification of the elongation zone, histological hematoxylin-eosin staining was performed. Radiographs were taken before removal of the external fixator and 5 weeks after removal of the external fixator for the remaining 4 rats in each group. The HE staining results, length of initial elongation zone, and retraction length of elongation zone were compared between groups. Results:HE staining showed large patches of fibrous tissue and a few immature small blood vessels in the elongation zone in group A, a small number of hypertrophic chondrocytes and fibrous junctions in the elongation zone in group B, some chondrocytes, osteocytes and fibrous tissue in the elongation zone in group C, a large number of chondrocytes on both sides of the elongation zone and fibrous connection in the center of the elongation zone in group D, a decreased number of mature hypertrophic chondrocytes and partial bone marrow in the elongation zone in group E, and a small number of chondrocytes and a partially recanalized medullary cavity with bone marrow in the elongation zone in group F. The lengths of initial elongation zone in groups A, B, C, D, E and F were, respectively, (6.98±0.14) mm, (7.02±0.18) mm, (7.02±0.08) mm, (7.02±0.11) mm, (7.01±0.18) mm and (7.00±0.12) mm, showing no statistically significant differences ( P>0.05). The lengths of retraction of elongation zone in groups A and B [(4.34±0.78) mm and (3.45±0.57) mm] were significantly longer than those in groups D, E and F [(0.16±0.17) mm, (-0.02±0.14) mm, and (0.03±0.82) mm] ( P<0.05). The timing for removal of the external fixator without retraction of elongation zone was the 4th week during the mineralization stage (group D); the healing index was 87 d/cm and the non-retraction index 67 d/cm in group D. Conclusion:In the SD rat models of DO, removal of the external fixator at 4 weeks and later during the mineralization stage may not lead to retraction of the elongation zone.