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 compare clinical efficacy of tibial transverse transport (TTT) microcirculation reconstruction and periosteal distraction in treating patients with early diabetic foot(DF). METHODS: From June 2021 to June 2024, 60 patients with DF were admitted and divided into bone transport group and stretch group according to different treatment methods. There were 30 patients in bone transport group, including 16 males and 14 females;aged from 48 to 65 years old with an average of (55.59±3.78) years old;the course of disease ranged from 2 to 9 months with an average of(5.95±1.32) months;TTT microcirculation reconstruction surgery was performed. There were 30 patients in distraction group, including 17 males and 13 females;aged from 47 to 67 years old with an average of (55.24±3.81) years old;the course of disease ranged from 2 to 10 months with an average of (5.68±1.54) months;periosteal distraction surgery was performed. The skin temperature of the affected feet, the time of getting out of bed and walking after operation, the time of full weight-bearing, the wound healing time and complications were compared between two groups;the pain was evaluated by visual analogue scale (VAS) before operation and one month after operation respectively;the changes of blood flow velocity of dorsal foot arteries, ankle brachial index(ABI), epidermal growth factor (EGF), and basic fibroblast growth factor (bFGF) before and after operation at 3 months were compared between two groups. RESULTS: All patients were followed up for 3 to 4 months with an average of (3.52±0.12) months. There were no statistically significant differences in comparison of foot skin temperature, postoperative walking time, full weight-bearing time and complications between two groups (P>0.05). The wound healing time of bone transport group (61.26±7.31) days was shorter than that of distraction group (70.17±7.15) days, and the difference was statistically significant (P<0.05). Postoperative VAS at 1 month of bone transport group (2.19±0.21) was lower than that of distraction group (2.55±0.20), and the difference was statistically significant (P<0.05). At 3 months after operation, the blood flow velocity of dorsal foot artery, ankle-brachial index, EGF and bFGF in bone transport group were(34.73±4.18) cm·s^-1, (0.95±0.13), (716.61±71.13) pg·ml^-1 and (175.69±31.28) pg·ml^-1, respectively;which were higher than that of distraction group (31.86±3.23) cm·s^-1, (0.84±0.11), (677.37±70.21) pg·ml^-1, (149.26±30.13) pg·ml^-1, and the differences were statistically significant (P<0.05). There was no recurrence of ulcers in situ or at other sites in both groups during follow-up. CONCLUSION Compared with periosteal distraction, TTT microcirculation reconstruction surgery has a definite effect in the treatment of early DF. It could effectively reduce pain level, improve blood flow indicators and vascular endothelial function of the foot, and has a relatively high safety.
Humans ; Male ; Female ; Middle Aged ; Aged ; Tibia/blood supply* ; Diabetic Foot/physiopathology* ; Microcirculation ; Periosteum/surgery* ; Plastic Surgery Procedures/methods* ; Osteogenesis, Distraction

OBJECTIVETo investigate clinical effect of transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage in treating diabetic foot ulcer.

METHODSFrom November 2015 and December 2016, clinical data of 19 diabetic foot ulcer patients treated with transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage were retrospective analyzed, including 15 males and 4 females aged from 42 to 82 years old with an average of (64.57±7.14) years old;the courses of diabetic ranged was (14.62±6.19) years;12 cases on the left side and 7 cases on the right side;the area of ulcer ranged from 2 cm×3 cm to 8 cm×6 cm. All patients were stage D according to Texas classification, 3 cases were grade 2, 10 cases were grade 3 and 6 cases were grade 4. Ankle-brachial index and Michigan Neuropathy Screening Instrument (MNSI) were used to evaluate recovery of peripheral vessel and nerve before and after operation, the result of angiography and vascular ultrasound were also compared after operation.

RESULTSSeventeen of 19 patients were followed up from 3 to 13 months with an average of 6.9 months. Seventeen patients' surface wound were healed. Ankle-brachial index was increased from (0.51±0.20) before operation to (0.93±0.18) at 3 months after operation, and had significant difference(=13.63, =0.000);MNSI was increased from (4.06±1.36) before operation to(5.76±1.44) at 3 months after operation, and differences were statistically significant (=7.31, =0.000). Postoperative angiography and vascular ultrasound showed satisfied regeneration of micro-vessel and affected foot achieved normal movement and daily life.

CONCLUSIONSTransverse tibial bone transport micro vessels regeneration technology could reconstruct micro-vessel under lower affected limb, promote recovery of peripheral vessel and nerve, while with vacuum drainage could promote wound healing, has advantages of simple operation, obvious clinical effect, and high success rate of limb-salvage, and is one of ideal treatment for diabetic foot ulcer.

Adult ; Aged ; Aged, 80 and over ; Angiography ; Ankle Brachial Index ; Diabetic Foot ; surgery ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Regeneration ; Retrospective Studies ; Tibia ; blood supply ; Treatment Outcome ; Ultrasonography ; Vacuum

OBJECTIVETo assess the effect of muscle contraction on bone capillary permeability.

METHODSThirty female New Zealand white rabbits were randomly divided into the experimental and control groups (n=15). The bone chambers were implanted medially into the right tibiae of the rabbit, and in the experimental group, the rabbits were stimulated by transcutaneous electrical nerve stimulator (TENS) at 4 Hz (1 h/day, 6 days/week) starting from week 2. From week 3, intravital microscopic observation was carried out weekly till week 10, and the vasculature in the tibiae was observed under fluorescent microscope with FITC and RITC staining. All the images were analyzed by Metamorph program.

RESULTSThe bone capillary permeability increased significantly in the experimental group.

CONCLUSIONSkeletal muscle contraction can increase the capillary permeability.

Animals ; Capillary Permeability ; physiology ; Female ; Implants, Experimental ; Muscle Contraction ; physiology ; Muscle, Skeletal ; physiology ; Rabbits ; Random Allocation ; Tibia ; blood supply ; surgery ; Transcutaneous Electric Nerve Stimulation

Child ; Growth Plate ; blood supply ; physiopathology ; surgery ; Humans ; Male ; Popliteal Artery ; pathology ; Salter-Harris Fractures ; Tibia ; blood supply ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed

Adolescent ; Adult ; Bone Diseases, Infectious ; surgery ; Child ; External Fixators ; Female ; Femur ; surgery ; Humans ; Male ; Middle Aged ; Periosteum ; blood supply ; surgery ; Surgical Flaps ; Tibia ; surgery ; Tissue Transplantation

OBJECTIVETo assess the value of perfusion-weighted magnetic resonance (MR) imaging (PWMRI) in monitoring vascularization in tissue-engineered bone graft.

METHODSTibial diaphyseal defect of 20 mm was induced in 25 lower limbs of 13 rhesuses and fixed with an AO reconstruction plate with 7 holes. The monkeys were randomized into 5 groups according to the materials used for defect filling: group A, with beta-tricalcium phosphate (beta-TCP), bone marrow stromal cells (BMSCs) and blood vessel bundles; group B, with beta-TCP and blood vessel bundles; group C, with beta-TCP and BMSCs; group D, with beta-TCP, and group E without filling. PWMRI, X-ray, and radionuclide imaging were carried out at weeks 4, 8, 12 postoperatively. The maximum slope rates of the single intensity-time curve (SS(max)) and the baseline values (SI(baseline)) on the same time points were calculated. Transmittances on the X-ray films and isotope counts in the region of interest (ROI) were assessed and calculated.

RESULTSCompared with other groups, group A showed the highest SS(max) at weeks 4, 8, and 12 postoperatively, and its SS(max) at week 8 was significantly higher than that at week 4 (P=0.003). The SS(max) was positively related to isotope counts in ROI at week 8 after operation (r(s)=0.899, P=0.038), and inversely related to transmittance on X-ray films at week 12 (r(s)=-0.892, P=0.042).

CONCLUSIONThe SS(max) of the single intensity-time curve can accurately reflect the vascularization of the tissue-engineered bone graft, and PWMRI allows sensitive, quantitative, noninvasive and radiation-free vascularization monitoring.

Animals ; Bone Marrow Transplantation ; methods ; Bone Substitutes ; chemistry ; therapeutic use ; Calcium Phosphates ; therapeutic use ; Female ; Macaca mulatta ; Magnetic Resonance Angiography ; Male ; Neovascularization, Physiologic ; drug effects ; physiology ; Random Allocation ; Tibia ; blood supply ; injuries ; surgery ; Tissue Engineering ; methods

OBJECTIVETo compare the mechanical properties of point contact-dynamic compression plate (PC-DCP) and its effects on cortical bone perfusion with that of dynamic compression plates (DCP) in goat tibiae.

METHODSTwenty pairs of matched fresh goat tibiae were used. A transverse fracture model was established. The fractures with a 3mm interspace between the fracture ends were subject to fixations with the DCPs and the PC-DCPs respectively, then the four-points bending tests and the torsion tests were conducted to compare the mechanical properties of the PC-DCP with that of DCP. Another 13 sexually mature goats underwent fixations with the DCPs and the PC-DCPs, respectively, at the mid-shafts of the intact bilateral tibiae. Ischemic zones were observed at four time points (1 day, 2, 6, and 12 weeks after operation) using disulphine blue staining technique.

RESULTSThere were no significant differences in mechanical properties, such as bend- and torsion-resistance, between the DCPs and the PC-DCPs. One day, 2, and 6 weeks after operation, on the side of DCP fixation, outer cortical bone ischemia under the plate persisted, and this condition did not reverse until 12 weeks after operation. However, on the side of PC-DCP fixation, cortical bone ischemia occurred only in the periphery of the screw holes and at the contact sites of the PC NUTs 1 day after operation, and it disappeared at 2 weeks after operation.

CONCLUSIONSThe PC-DCP has similar biomechanical properties of the DCP, but is less detrimental to local bone blood circulation than the conventional plates.

Animals ; Biomechanical Phenomena ; Bone Plates ; Fracture Fixation, Internal ; instrumentation ; Goats ; Staining and Labeling ; Tibia ; blood supply ; Tibial Fractures ; physiopathology ; surgery

OBJECTIVETo study whether tissue engineered bone can repair the large segment bone defect of large animal or not. To observe what character the fascia flap played during the osteanagenesis and revascularization process of tissue engineered bone.

METHODS9 Chinese goats were made 2 cm left tibia diaphyseal defect. The repairing effect of the defects was evaluated by ECT, X-ray and histology. 27 goats were divided into three groups: group of CHAP, the defect was filled with coral hydroxyapatite (CHAP); group of tissue engineered bone, the defect was filled with CHAP + bone marrow stroma cells (BMSc); group of fascia flap, the defect was filled with CHAP + BMSc + fascia flap. After finished culturing and inducing the BMSc, CHAP of group of tissue engineered bone and of fascia flap was combined with it. Making fascia flap, different materials as described above were then implanted separately into the defects. Radionuclide bone imaging was used to monitor the revascularization of the implants at 2, 4, 8 weeks after operation. X-ray examination, optical density index of X-ray film, V-G staining of tissue slice of the implants were used at 4, 8, 12 weeks after operation, and the biomechanical character of the specimens were tested at 12 weeks post operation.

RESULTSIn the first study, the defect showed no bone regeneration phenomenon. 2 cm tibia defect was an ideal animal model. In the second study, group of CHAP manifested a little trace of bone regeneration, as to group of tissue engineered bone, the defect was almost repaired totally. In group of fascia flap, with the assistance of fascia flap which gave more chance to making implants to get more nutrient, the repair was quite complete.

CONCLUSIONSThe model of 2 cm caprine tibia diaphyseal defect cannot be repaired by goat itself and can satisfy the tissue engineering's demands. Tissue engineered bone had good ability to repair large segment tibia defect of goat. Fascia flap can accelerate the revascularization process of tissue engineered bone. And by this way, it augment the ability of tissue engineered bone to repair the large bone defect of goat.

Animals ; Bone Marrow Cells ; cytology ; Bone Marrow Transplantation ; Bone Regeneration ; physiology ; Bone Substitutes ; Cells, Cultured ; Durapatite ; Fascia ; transplantation ; Goats ; Implants, Experimental ; Neovascularization, Physiologic ; Osteogenesis ; Random Allocation ; Stromal Cells ; cytology ; Tibia ; blood supply ; injuries ; surgery ; Tibial Fractures ; surgery ; Tissue Engineering