Limb-sparing surgery with reinnervated free-muscle transfer following radical excision of soft-tissue sarcoma in the extremity.

Limb-sparing surgery is the preferred approach in the management of patients with high-grade soft-tissue sarcomas when local disease can be completely resected. However, conventional treatment focuses only on restoration of basic functions to the remnant limb. Lost functions are not restored to normal, leaving the patient with variable degrees of functional disabilities. This in turn may necessitate further massive reconstructive procedures. Transferred reinnervated free muscles were used to reconstruct functions lost after radical resection of malignant soft-tissue sarcoma of the extremities in 17 patients. The long-term functional outcome included survival of transplanted muscle, speed of neural recovery, and muscle strength and disabilities. All muscles survived. Postoperative follow-up ranged from 27 to 106 months. All muscles except those in a 75-year-old patient were successfully reinnervated. Powerful strength and almost normal limb functions were obtained. Functional scoring of the patients according to the rating system of the Musculoskeletal Tumor Society was 87 percent for the lower extremity and 93 percent for the upper extremity. All patients are presently disease-free. Use of the reinnervated free-muscle transfer in limb-sparing surgery after resection of soft-tissue sarcoma in the extremity may be indicated in the young adult when radical excision of the tumor will result in severe motor functional loss, provided adequate clearance can be obtained and that there is no presence of distant metastasis.     

Anatomic contribution to the study on the variety of fibrous formations of the arm in humans

The authors have examined an anatomical preparation of a human upper limb preserved in the Anatomical Museum in Bologna. The specimen was formed by bone, fibrous formations, musculus biceps brachii and musculus coracobrachialis. The soft parts were kept in situ and dried by mummification. The humerus showed abnormalities at its proximal extremity (Fig. 1) and the muscles displayed fibrous varieties: a) a fibrous sheet (Fig. 1, 2) connected the caput brevis of the musculus biceps brachii to the articular capsule of the shoulder joint; b) an aponevrosis (Fig. 1, 3) connected the musculus coracobrachialis to the same articular capsule and the humerus. These observations were discussed from an evolutionary and functional point of view.     

Comparison of Biomechanical Characteristics during the Second Landing Phase in Female Latin Dancers: Evaluation of the Bounce and Side Chasse Step

Research on dance lower extremity joint motion has been limited. Thus, the purpose of this study was to investigate the lower limb biomechanics differences between the side chasse step (SCS) and the bounce step (BS) of the second landing phase in Jive. Thirteen female recreational Latin dancers (Age: 22 ± 2.5 years; Height: 1.65 ± 0.05 m; Weight: 50 ± 4.5 kg; Dance experience: 4 ± 2 years) were involved in the experiment. The same music was used throughout the data collection period. We intended to determine whether these two steps generate different kinematic and kinetic data. The ankle, hip, and knee joint angle, moment, velocity, and ground reaction force were calculated for each step. Results demonstrated that the lower limb biomechanics of the two different steps showed significant differences. As a result, strengthening the lower limb muscles (gastrocnemius, Tibialis muscle, and quadriceps) is significantly important to balance the joint strength and prevent foot injury. According to the training time reasonably increasing the heel height should be recognized as important. The current study could provide new insights into reducing lower extremity injuries and improving dance performance.     

肢体负压对犬后肢动脉闭塞病影响的实验研究

目的为研究肢体负压疗法的疗效及探讨其作用机理,我们对犬后肢进行实验研究。方法。实验犬分三组,治疗组为左后肢缺血模型犬并行患者肢负压治疗;对照组同治疗组但不做治疗：自身对照组为双后肢缺血模型犬,左侧行负压治疗,右侧作为对照。     

2型糖尿病患者肝损伤标志物与下肢动脉病变的相关性分析

目的：探讨2型糖尿病患者肝损伤标志物水平与其下肢动脉病变的相关性,为2型糖尿病并发症的防治提供参考依据。方法：选取我院收治的2型糖尿病患者946例,根据下肢动脉内膜中层厚度分为以下3组,即无动脉硬化组（276例）、单纯性动脉硬化组（598例）和动脉硬化伴管腔狭窄或闭塞组（72例）。分析和比较三组之间肝损伤标志物谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（GGT）水平的差异,及其与2型糖尿病患者下肢动脉硬化程度的相关性。结果：随着动脉硬化程度的加重,2型糖尿病患者的ALT水平逐渐升高,三组之间两两比较差异均有统计学意义（P〈0．05）。动脉硬化伴管腔狭窄或闭塞组AST水平显著高于非动脉硬化组和单纯性下肢动脉硬化组,而动脉硬化组和非动脉硬化组之间AsT水平比较无显著差异（P〉0．05）。三组之间γ-谷氨酰转肽酶水平比较无显著性差异（P〉0．05）。Spearman等级相关分析显示ALT与糖尿病下肢动脉硬化的相关系数为0．30484。结论：2型糖尿病患者ALT水平与其下肢动脉硬化程度显著相关。     

The ability of oxygenated fluorocarbon solution to minimize ischemic skeletal muscle injury

The amputated canine limb was used to create a devascularized skeletal-muscle-containing model. The extremity was perfused with one of several solutions or merely cooled as a preservative measure during the devascularized period and then replanted. Perfusion of the limb with oxygenated fluorocarbon solution minimized edema formation and leakage of skeletal muscle enzymes into the serum following revascularization as compared to the other perfusates or to mere cooling. Histopathologic changes within the revascularized muscle were also minimized by the oxygenated fluorocarbon perfusion. It is probable that these findings will correlate with improved function of replanted extremities or free muscle flaps. The applicability of these findings to human extremity replantation and free-flap transfer is postulated. However, long-term human studies will be necessary to assess the function of extremities and flaps perfused with this solution prior to its general use in extremity replantation and free-flap transfer.     

2 型糖尿病患者肝损伤标志物与下肢动脉病变的相关性分析

目的：探讨2 型糖尿病患者肝损伤标志物水平与其下肢动脉病变的相关性,为2 型糖尿病并发症的防治提供参考依据。方 法：选取我院收治的2 型糖尿病患者946 例,根据下肢动脉内膜中层厚度分为以下3 组,即无动脉硬化组(276 例)、单纯性动脉硬 化组(598 例)和动脉硬化伴管腔狭窄或闭塞组(72 例)。分析和比较三组之间肝损伤标志物谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)水平的差异,及其与2型糖尿病患者下肢动脉硬化程度的相关性。结果：随着动脉硬化程度的加重,2 型糖尿病患者的ALT 水平逐渐升高,三组之间两两比较差异均有统计学意义(P<0.05)。动脉硬化伴管腔狭窄或闭塞组AST 水平显著高于非动脉硬化组和单纯性下肢动脉硬化组,而动脉硬化组和非动脉硬化组之间AST 水平比较无显著差异(P>0.05)。三组之间γ-谷氨酰转肽酶水平比较无显著性差异(P>0.05)。Spearman 等级相关分析显示ALT 与糖尿病下肢动脉硬化的相关系数为0.30484。结论：2型糖尿病患者ALT 水平与其下肢动脉硬化程度显著相关。     

Pulmonary VO2 dynamics during treadmill and arm exercise in peripheral arterial disease.

Slowed pulmonary O(2) uptake (Vo(2)) kinetics in peripheral arterial disease (PAD) have been attributed to impaired limb blood flow and/or peripheral muscle metabolic abnormalities. Although PAD results from atherosclerotic occlusive disease in the arteries to the lower extremities, systemic abnormalities affecting whole body O(2) delivery or vascular function in PAD could also partially explain the exercise impairment. To date, the effects of these systemic abnormalities have not been evaluated. To test the hypothesis that the slowed pulmonary Vo(2) kinetics in PAD reflects local and not systemic abnormalities, Vo(2) kinetics were evaluated after the onset of constant-load exercise of the upper and lower limbs in PAD patients and healthy controls (Con). Ten PAD patients and 10 Con without significant cardiopulmonary dysfunction performed multiple transitions from rest to moderate-intensity arm ergometry and treadmill exercise to assess their Vo(2) kinetic responses. Reactive hyperemic (RH) blood flow was assessed in the arms and legs as a measure of endothelial function. Compared with Con, PAD Vo(2) kinetic phase 2 time constants were prolonged during treadmill exercise (PAD 34.3 +/- 9.2 s vs. Con 19.6 +/- 3.5 s; P < 0.01) but not arm exercise (PAD 38.5 +/- 7.5 s vs. Con 32.5 +/- 9.0 s; P > 0.05). RH blood flow was significantly reduced in the legs (PAD 20.7 +/- 8.3 vs. Con 46.1 +/- 17.1 ml.100 ml(-1).min(-1); P < 0.01) and arms of PAD subjects (PAD 34.0 +/- 8.6 vs. Con 50.8 +/- 12.2 ml.100 ml(-1).min(-1); P < 0.01) compared with Con, but RH limb flow was not correlated with arm or treadmill Vo(2) kinetic responses in either group. In summary, slowed pulmonary Vo(2) kinetics in PAD patients occur only with exercise of the lower limbs affected by the arterial occlusive disease process and are not slowed with exercise of the unaffected upper extremities compared with controls. Furthermore, the slowed pulmonary Vo(2) kinetics of the lower extremity could not be explained by any abnormalities in resting cardiac or pulmonary function and were not related to the magnitude of reduction in limb vascular reactivity.     

Partial regeneration of the above-elbow amputated rat forelimb. II. Electrical and mechanical facilitation.

This investigation was undertaken to examine the observations of Becker ('72) pertaining to the electrical facilitation of partial limb regenerative responses by means of Ag-Pt wire couples applied to the limb stumps of young, forelimb-amputated white rats. Additionally, in order to examine the possible role of mechanical effects of such device implantations, we have employed uncoupled devices delivering no current or potential difference. In the present experiments, in response to coupled device implantation, cartilage and bone were actively formed in the vicinity of the Pt electrode tip. These tissues contributed to the lengthwise extension of the limb and to the partial restoration of the distal humeral extremity. In limbs bearing the uncoupled electrical devices, qualitatively similar responses were noted, but osteogenesis was diminished in extent compared to that seen in limbs bearing the active or coupled devices. It is therefore necessary to consider the role of mechanical factors in the elicitation of the observed regenerative responses. Myogenesis was enhanced in electrically stimulated limbs, but not in those rats bearing uncoupled devices.     

Emergency free-flap transfer for reconstruction of acute complex extremity wounds.

Nine patients with complex extremity injuries were treated with emergency free-flap transfers over a 3 1/2-year period. The transferred emergency free flaps were performed to cover exposed vital structures. All flaps survived without infection. Complete and careful assessment of the systemic condition of the patient and the nature of the injured extremity is mandatory. Emergency free-flap transfers may salvage the limb or finger and may improve the functional and aesthetic results with the shortest possible hospital stay.     

The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis

In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3–1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1–1.4]) and hip/groin (RR 1.9 [95% CI 1.3–2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1–3.2]; youths RR 1.5 [95% CI 1.26–1.67]; professionals RR 1.3 [95% CI 1.14–1.46]). Both males (RR 1.5 [95% CI 1.33–1.68)] and females (RR 1.5 [95% CI 1.14–1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.     

Differential heating of trunk and extremities. Effects on thermoregulation mechanisms

Experiments in which the whole human body was heated or cooled are compared with others in which one extremity (arm or leg) was simultaneously cooled or heated. With a warm load on the rest of the body resulting in general sweating, a cold load on one extremity did not evoke local shivering; with general body cooling, heating one limb did not stop the shivering. Skin temperatures of the other parts of the body were not influenced by warming or cooling one extremity. Evaporative heat loss was influenced by local, mean skin and core temperature, whereas shivering did not depend on local temperature, and vasomotor control seemed to be controlled predominantly by central temperatures. A cold load on an extremity during whole body heating in most cases induced an oscillatory behaviour of core temperature and of the evaporative heat loss from the body and the extremity. It is assumed that local, mean skin and core temperatures influence the three autonomous effector systems to very different degree.     

Acquisition of the lateral inconsistency in involuntary behaviour of upper limbs in 12-year-old children during walking at moderate speed.

The aim of this work was to investigate possible lateralisation in the behaviour of periodic motion of the human upper limb, during normal walking at a comfortable speed of locomotion. Ten healthy pre-adolescent, strongly right-handed, 12-year-old males participated in the experiment. Participants were walking on a treadmill with a standardised velocity of 1.1m/s (comfortable speed for all of them). A video analysis system with Silicon software was used to synchronically measure various angles of arms and forearms. The initial, final and interim angular positions of both arms and forearms in 10 cycles of each participant were compared in terms of variations (cycle to cycle) between both upper extremities at corresponding phases of each cycle for distal and proximal segments, respectively. We compared the coefficients of variation in relation to the spatial and temporal data of both limbs and their angular velocities. In addition we investigated the level of cycle-to-cycle regularity (constancy) of behaviour in relation to various positions, periods and velocities of movement of upper extremities (specifically arms and forearms) using the Eta non-linear method of correlation. All participants exhibited a lower level of regularity for the distal segments. The spatial and temporal variations in the dominant limb were also greater than the non-dominant limb for all participants. This may be due to a larger contribution from the right-sided muscles that are considered to be the main contributing factor to the motion of the dominant upper limb during walking, rather than simply gravity force acting alone. A possible practical application of this information may be useful in the objective clinical identification of the level of dominance of the upper extremity (arm plus forearm), in addition to 'traditional' handedness.     

Scaling of long bones in ruminants with respect to the scapula

The significance of the scapula for locomotion is becoming more and more established. Studies of locomotion in small and medium‐sized mammals show a considerable amplitude of the scapula and a large contribution to step length. Taking this into account, long bone studies of forelimb movement restricted to the ‘arm’ miss one important segment. A regression model (reduced major axis) was used for analysis of a sample of 77 species of ruminants. This sample was divided according to (1) phylogenetic relationships and (2) habitat. The proximal elements of the limbs, scapula and humerus in the anterior extremity, femur in the hindlimb, show a similar scaling in the different analyses. The changes to limb proportions in the different subsamples are caused by the variability of the distal segments. The anterior extremity scales with a higher coefficient than the hindlimb in all analyses. Concepts like elastic or geometric similarity are inadequate for long bone scaling when the full range of body size in the sample is used. Taking all analyses into account, the differences in limb proportions are due more to phylogenetic relationships than to habitat.     

Composite in situ vein bypass for upper extremity revascularization

Chronic upper extremity arterial insufficiency is rare. Consequently, major reports specifically limited to the topic are scarce, and the clinical experience is small. In addition, symptomatology, diagnostic criteria, and guidelines for surgical management remain ill-defined. In the lower extremities, however, in situ vein bypass has been attempted for nearly three decades. This technique offers many advantages over traditional revascularization methods. Although the procedure has become popular for the lower extremity, no report of its use in the upper extremity is found in the literature. We report what may be the first case in which in situ bypass was used in the upper extremity for a threatened limb secondary to diabetic occlusive vascular disease complicated by a previous shunt used for hemodialysis. Revascularization of the upper extremity using the in situ vein bypass technique may offer a new alternative to traditional methods of revascularization.     

胎儿肢体畸形的超声诊断与染色体异常的相关性分析

目的：总结肢体畸形胎儿的超声诊断与染色体核型诊断结果,分析胎儿肢体畸形时超声诊断与染色体异常的相关性。方法：以孕18—32周的健康自愿者作为对照组（A组）,以同期超声诊断异常者作为观察组（B组）,两组均行超声及染色体检查。对比其染色体核型的检出情况;并以胎儿的超声诊断结果为自变量,以各染色体核型为因变量进行logistic回归分析。结果：A组染色体异常的检出率为2．1,与之相比,B组染色体异常检出率有明显升高,且染色体核型异常以47,XY,＋18、47,XX＋21和47,XXX为主,差异有统计学意义,P〈0．05;logistic分析结果显示,染色体核型异常与胎儿肢体比例失调、四肢短小、肢体非功能位的OR值分别为6．332、7．404、5．98l,P〈0．05,差异显著。结论：胎儿肢体畸形患者染色体异常的诊出率较健康人群明显增高,染色体核型异常与超声诊断为胎儿肢体比例失调、四肢短小、肢体非功能位的比例呈正相关。     

Control of dynamic foot-ground interactions in male and female soccer athletes: Females exhibit reduced dexterity and higher limb stiffness during landing

Controlling dynamic interactions between the lower limb and ground is important for skilled locomotion and may influence injury risk in athletes. It is well known that female athletes sustain anterior cruciate ligament (ACL) tears at higher rates than male athletes, and exhibit lower extremity biomechanics thought to increase injury risk during sport maneuvers. The purpose of this study was to examine whether lower extremity dexterity (LED) – the ability to dynamically control endpoint force magnitude and direction as quantified by compressing an unstable spring with the lower limb at submaximal forces – is a potential contributing factor to the “at-risk” movement behavior exhibited by female athletes. We tested this hypothesis by comparing LED-test performance and single-limb drop jump biomechanics between 14 female and 14 male high school soccer players. We found that female athletes exhibited reduced LED-test performance (p=0.001) and higher limb stiffness during landing (p=0.008) calculated on average within 51 ms of foot contact. Females also exhibited higher coactivation at the ankle (p=0.001) and knee (p=0.02) before landing. No sex differences in sagittal plane joint angles and center of mass velocity at foot contact were observed. Collectively, our results raise the possibility that the higher leg stiffness observed in females during landing is an anticipatory behavior due in part to reduced lower extremity dexterity. The reduced lower extremity dexterity and compensatory stiffening strategy may contribute to the heightened risk of ACL injury in this population.     

Identification of passive elastic joint moment-angle relationships in the lower extremity

The purpose of this study was to develop a method for identifying subject-specific passive elastic joint moment-angle relationships in the lower extremity, which could subsequently be used to estimate passive contributions to joint kinetics during gait. Twenty healthy young adults participated in the study. Subjects were positioned side-lying with their dominant limb supported on a table via low-friction carts. A physical therapist slowly manipulated the limb through full sagittal hip, knee, and ankle ranges of motion using two hand-held 3D load cells. Lower extremity kinematics, measured with a passive marker motion capture system, and load cell readings were used to compute joint angles and associated passive joint moments. We formulated a passive joint moment-angle model that included eight exponential functions to account for forces generated via the passive stretch of uni-articular structures and bi-articular muscles. Model parameters were estimated for individual subjects by minimizing the sum of squared errors between model predicted and experimentally measured moments. The model predictions closely replicated measured joint moments with average root-mean-squared errors of 2.5, 1.4, and 0.7 Nm about the hip, knee, and ankle respectively. We show that the models can be coupled with gait kinematics to estimate passive joint moments during walking. Passive hip moments were substantial from terminal stance through initial swing, with energy being stored as the hip extended and subsequently returned during pre- and initial swing. We conclude that the proposed methodology could provide quantitative insights into the potentially important role that passive mechanisms play in both normal and abnormal gait.     

Altered lower extremity joint mechanics occur during the star excursion balance test and single leg hop after ACL-reconstruction in a collegiate athlete

The effects of ACL-reconstruction on lower extremity joint mechanics during performance of the Star Excursion Balance Test (SEBT) and Single Leg Hop (SLH) are limited. The purpose of this study was to determine if altered lower extremity mechanics occur during the SEBT and SLH after ACL-reconstruction. One female Division I collegiate athlete performed the SEBT and SLH tasks, bilaterally, both before ACL injury and 27 months after ACL-reconstruction. Maximal reach, hop distances, lower extremity joint kinematics and moments were compared between both time points. Musculoskeletal simulations were used to assess muscle force production during the SEBT and SLH at both time points. Compared to the pre-injury time point, SEBT reach distances were similar in both limbs after ACL-reconstruction except for the max anterior reach distance in the ipsilateral limb. The athlete demonstrated similar hop distances, bilaterally, after ACL-reconstruction compared to the pre-injury time point. Despite normal functional performance during the SEBT and SLH, the athlete exhibited altered lower extremity joint mechanics during both of these tasks. These results suggest that measuring the maximal reach and hop distances for these tasks, in combination with an analysis of the lower extremity joint mechanics that occur after ACL-reconstruction, may help clinicians and researchers to better understand the effects of ACL-reconstruction on the neuromuscular system during the SEBT and SLH.     

How close to a pendulum is human upper limb movement during walking?

The aim of this work was to investigate how close to pendulum-like behaviour the periodic motion of the human upper limb (or upper extremity) is, during normal walking at a comfortable speed of locomotion. Twenty-five healthy young persons (males and females) participated in the experiment. Biomechanical testing was undertaken (mass and centre of mass of each segment of the total upper extremity). Participants were walking on a treadmill with a standardised velocity of 1.1 ms(-1) (comfortable speed for all of them). A video analysis system with Silicon software was used to measure the different angles of the arm and forearm. The theoretical period of motion and maximal angular velocity were computed for the centre of mass of the total upper limb from the measured phases of the arm swing and associated positional potential energies. Actual measured periods of motion, in comparison, represented a level of similarity to a lightly damped simple pendulum. Using this assumption, the "damping factor" was calculated from the ratio between theoretical and measured values. A vast majority of people exhibited an actual angular velocity exceeding the expected theoretical angular velocity calculated for a virtual pendulum of similar mass and length characteristics. This may be due to muscle forces that are contributing to the motion of the upper limb during walking rather than simple gravity force acting alone. The observed positional potential energy of the dominant limb was greater than that of the non-dominant limb for the vast majority of participants.