BACKGROUND:Tibial cortex transverse transport (TTT) surgery has become an ideal treatment for patients with type 2 severe diabetic foot ulcerations (DFUs), while conventional treatments are ineffective. Based on our clinical practice experience, the protective immune response from TTT surgery may play a role against infections to promote wound healing in patients with DFUs. Therefore, this research aimed to systematically study the specific clinical efficacy and the mechanism of TTT surgery. MATERIALS AND METHODS:Between June 2022 and September 2023, 68 patients with type 2 severe DFUs were enrolled and therapized by TTT surgery in this cross-sectional and experimental study. Major clinical outcomes, including limb salvage rate and antibiotics usage rate, were investigated. Ten clinical characteristics and laboratory features of glucose metabolism and kidney function were statistically analyzed. Blood samples from six key time points of TTT surgery were collected for label-free proteomics and clinical immune biomarker analysis. Besides, tissue samples from three key time points were used for spatially resolved metabolomics and transcriptomics analysis, as well as applied to validate the key TTT-regulated molecules by reverse-transcription quantitative PCR. RESULTS:Notably, 64.7% of patients did not use antibiotics during the entire TTT surgery. TTT surgery can achieve a high limb salvage rate of 92.6% in patients with unilateral or bilateral DFUs. Pathway analysis of a total of 252 differentially expressed proteins from the proteomic revealed that the immune response induced by TTT surgery at different stages was first comprehensively verified through multiomics combined with immune biomarker analysis. The function of upward transport was activating the systemic immune response, and wound healing occurs with downward transport. The spatial metabolic characteristics of skin tissue from patients with DFUs indicated downregulated levels of stearoylcarnitine and the glycerophospholipid metabolism pathway in skin tissue from patients with severe DFUs. Finally, the expressions of PRNP (prion protein) to activate the immune response, PLCB3 (phospholipase C beta 3) and VE-cadherin play roles in neovascularization, and PPDPF (pancreatic progenitor cell differentiation and proliferation factor), LAMC2 (laminin subunit gamma 2), and SPRR2G (small proline-rich protein 2G) to facilitate the developmental process mainly keratinocyte differentiation were statistically significant in skin tissues through transcriptomic and reverse-transcription quantitative PCR analysis. CONCLUSION:TTT surgery demonstrates favorable outcomes for patients with severe type 2 DFUs by activating a systemic immune response, contributing to anti-infection, ulcer recurrence, and the limb salvage for unilateral or bilateral DFUs. The specific clinical immune responses, candidate proteins, genes, and metabolic characteristics provide directions for in-depth mechanistic research on TTT surgery. Further research and public awareness are needed to optimize TTT surgery in patients with severe type 2 DFUs.

ObjectiveThe transverse tibial transfer technique is employed primarily to treat diabetic foot ulcers (DFUs), aiming to enhance leg circulation and promote new blood vessel growth. This technique is also beneficial for various conditions associated with poor blood flow in the lower extremities. However, there is no clear molecular mechanism to explain the relationship between the transverse tibial transfer technique and angiogenesis in patients with diabetic foot. This study aims to preliminarily explore the change of IL‐6 and related cytokines in promoting angiogenesis during transverse tibial transplantation, providing a direction for future research.MethodsWe retrospectively assessed a study from April 2022 to November 2023 on 76 patients with severe DFUs at Wagner stages 3–4. Flow cytometry was used to detect the levels of 12 cytokines in serum before the operation and 3, 7, 14, 21, and 35 days after the operation. Ankle‐brachial index (ABI), transcutaneous oxygen tension (TcPO2), and glycosylated hemoglobin (Hba1c) were recorded at admission and discharge. We examined the variations in cytokine levels, wound healing duration, amputation rates, infection incidence, and other key outcomes.ResultsIn our investigation, a total of 76 individuals participated, comprising 49 males and 27 females. These subjects had an average age of 64.7 years, with a standard deviation of 13 years. The mean ulcer healing time was 74 ± 31 days, amputation occurred in 3 patients, pin tract infection occurred in one patient (1.3%), and incision infection occurred in one patient (1.3%). By day 35 following the surgery, both the ABI and TcPO2 values showed a significant increase from their preoperative levels. HbA1c significantly improved compared with presurgery (p < 0.001), IL‐6 levels were significantly increased compared with presurgery (p < 0.05), and then decreased.ConclusionThe transverse tibial transfer (TTT) technique is safe and efficient for managing DFUs. The wound healing time in patients who smoke or consume alcohol is statistically significant compared with that of nonsmoking and nondrinking patients. IL‐6 exhibited substantial changes at various postoperative time points. Future research could investigate the role of IL‐6 in tibial transverse translation.

To compare clinical outcomes of high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) for anterior medial osteoarthritis (AMOA) as well as offer surgical recommendations through age stratification. Between May 2019 and May 2021, 68 cross-indicated AMOA patients were analyzed. The patients were divided into HTO and UKA groups and further into two age groups of 55–60 and 60–65 years. Additionally, general data, visual analog scale (VAS) score, and Hospital for Special Surgery knee score (HSS) were analyzed. All the patients were followed up for 18 months. Knee joint HSS significantly improved, and VAS score decreased in both groups (P < 0.05). In the 55–60 age group, HTO showed superior knee HSS at 1 and 3 months (P < 0.05), with no significant difference at 6, 12, and 18 months. HTO had a significantly lower VAS score at one month, and the VAS scores of the two groups decreased gradually with no significant difference. In the 60–65 age group, the UKA group showed superior knee joint HSS at one month, with no significant difference at 3, 6, 12, and 18 months. The UKA group had a significantly lower VAS score at one month, and both groups’ VAS scores decreased gradually with no significant difference. Both methods yield satisfactory results for AMOA cross-indications, improving knee joint function. The observed recovery trends have implications for personalized surgical recommendations, guiding interventions based on age-specific considerations for optimal outcomes in anterior medial osteoarthritis cases.

目的 探讨内侧开放胫骨楔形高位截骨术(open-wedge high tibial osteotomy,OWHTO)和Oxford单髁置换术(unicompartmental knee arthroplasty,UKA)治疗处于交叉适应证的膝关节前内侧骨关节炎(anteromedial osteoarthritis,AMOA)的临床疗效.方法 回顾性分析2020年6月至2022年4月绵阳市中心医院骨科收治的37例AMOA患者的临床资料.经同一位医师向患者讲解术式特点后,患者自行选择手术方式.其中Oxford UKA组17例,男7例,女10例;年龄55～65岁,平均(60.2±1.1)岁;左膝9例,右膝8例.OWHTO组20例,男8例,女12例;年龄55～65岁,平均(58.7±2.3)岁;左膝11例,右膝9例.比较两组手术时间、术中出血量、术后至完全负重行走时间、牛津膝关节评分(Oxford knee score,OKS)、疼痛数值评估量表(numerical pain rating scale,NPRS)、膝关节活动度(range of motion,ROM)、胫股角和患者满意度.结果 两组患者均接受了 12～18个月随访,平均随访时间(13.2± 3.5)个月.UKA组的手术时长、术后出血量、术后至完全负重行走时间均优于OWHTO组,差异有统计学意义(P＜0.05).术后各时间节点UKA组OKS评分均优于OWHTO组,差异有统计学意义(P＜0.05).术后1周UKA组NPRS评分及ROM均优于OWHTO组,差异有统计学意义(P＜0.05).术后1周UKA组胫股角均值高于OWHTO组,但差异无统计学意义(P＞0.05).末次随访时UKA组患者满意度高于OWHTO组,但差异无统计学意义(P＞0.05).结论 对处于Oxford UKA和OWHTO交叉适应证内的AMOA患者,就近期疗效而言更推荐UKA,对于中长期疗效还需要更多研究予以证实.

Purpose To analyze the clinical effects of different positions of the weight-bearing axis (WBA) after high tibial osteotomy (HTO). Methods The clinical data of 90 patients who underwent HTO in the Department of Orthopedics at our hospital from June 2018 to June 2021 were retrospectively analyzed. Patients were divided into groups A and B ( n = 45 per group) according to different post-HTO WBA positions of the affected side. WBAs in both groups were at 50–60% and 62–66% of the tibial plateau, from inside to outside, respectively. American Hospital for Special Surgery Knee Score (HSS), visual analog scale (VAS) score, femorotibial angle (FTA), and medial proximal tibial angle (MPTA) were recorded and analyzed. Results All patients were followed up with for 12 months. HSS scores increased gradually and VAS scores decreased gradually in both groups preoperatively, and at 3 months, 6 months, and 1 year postoperatively ( P < 0.05). Compared to group A, group B had better HHS scores at 6 months and 1 year postoperatively ( P < 0.05). There was no significant between-group difference in VAS scores at all aforementioned timepoints ( P > 0.05). Postoperative MPTA and FTA were 89.56° ± 2.18° and 177.11° ± 2.63° in group A, and 89.07° ± 1.98° and 177.07° ± 2.36° in group B, respectively, with no significant between-group difference ( P > 0.05). Conclusion Patients with post-HTO WBA ranges of 50–60% and 62–66% achieved knee joint function improvement and pain relief. Half a year later, those with a WBA range of 62–66% had better knee joint function scores. However, a comparison of long-term effects warrants further investigation.

胫骨横向搬移技术通过诱导血管生成来治疗糖尿病足、动脉硬化闭塞症和血栓闭塞性脉管炎等下肢缺血性疾病.然而,尚未有明确的分子机制可以解释胫骨横向搬移技术与糖尿病足患者血管再生的关系.血管生成是一个重要的生物学过程,新血管形成对于糖尿病足患者伤口修复意义重大.胫骨横向搬移技术通过许多生物学机制来促进血运重建,如分泌促血管生成相关因子,诱导新血管形成;重建巨噬细胞极化平衡,以M2型为主,加速血管再生;激活相关细胞因子通路,促进骨髓间充质干细胞向血管生成-成骨耦合等.本文将对当前关于胫骨横向搬移技术的临床应用以及其直接或间接刺激血管生成的潜在驱动因素进行综述.

目的 探讨关节镜下Mason-Allen技术修复肩胛下肌腱损伤的临床疗效.方法 回顾性分析2015年5月至2018年12月我院于关节镜下采用Mason-Allen技术修复肩胛下肌腱损伤的98例病人的临床资料,其中男75例,女23例,年龄为(56.4±9.6)岁.采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、Constant-Murley肩关节评分评估手术前后的肩关节功能,比较手术前后的肩关节活动范围,通过术前及术后6个月的MRI评估肩胛下肌腱的完整性.结果 病人随访(12.5±4.0)个月.末次随访时,Constant-Murley肩关节评分由术前的(42.11±4.53)分提高至(88.76±6.11)分,ASES评分由(54.70±15.89)分提高至(83.36±11.07)分,VAS评分由(4.92±1.30)分降低至(1.51±1.13)分,肩关节前屈上举由87.26° ±16.30°提高至151.28° ±17.65°,外展外旋由52.18°±11.41°提高至75.76°±8.68°,内旋由12.30°±4.51°提高至40.50°±3.30°;手术前后数据比较,差异均有统计学意义(P<0.05).术后6个月,7例(7.1％)经MRI检查确认存在再撕裂.结论 关节镜下应用Mason-Allen技术治疗肩胛下肌腱损伤,临床疗效改善明显,肌腱完整性良好,是关节镜下修复肩胛下肌腱的一种有效方法.