Objective To investigate the effectiveness and technical points of shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg. Methods Twelve cases of severe amputation of middle and distal lower leg were treated with shortened replantation at the 1st stage and limb lengthening at the 2nd stage between April 2009 and May 2016. There were 9 males and 3 females with an average age of 28 years (range, 16-32 years). The injury causes included traffic accident injury in 4 cases, heavy pound injury in 6 cases, and machine crush injury in 2 cases. The interval from injuries to treatment ranged from 30 minuts to 6 hours (mean, 3 hours and 12 minutes). All of 12 cases, 6 cases were completely amputated in the right middle and distal lower leg, 4 were not completely amputated in the left middle and distal lower leg, and 2 were ankle amputations. The limbs were 4.0-12.5 cm shorter than the contralateral sides, with an average of 7.3 cm. Limb lengthening was performed at 1.5-8.0 months after replantation and the time of extension was 1.7-5.3 months (mean, 3.1 months). Results All 12 patients recovered the same lengths of both lower extremities after shortened replantation and limb lengthening. The lengthened segments gained good bone mineralization, bony union was achieved at lengthened segments and broken end of fracture at 7-16 months (mean, 11.3 months). All patients were followed up 6 months to 5 years (mean, 2 years and 5 months). The range of motion of the knee joint were 0-5° (mean, 3°) in hyperextension and 110-140° (mean, 120°) in flexion. Except for 2 cases of ankle arthrodesis, plantar flexion angles were 15-45° (mean, 26°) and dorsiflexion angles were 10-25° (mean, 15°) in the other cases. The plantar sensation was restored to the S3+ level in 4 cases, S3 level in 6 cases, and S2 level in 2 cases. At last follow-up, the affected limb function were excellent in 7 cases, good in 3 cases, fair in 2 cases according to Kofoed functional evaluation criteria. Conclusion It expanded indications for replantation of lower limb amputation, reduced the operation difficulty and trauma with shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg.
ObjectiveTo evaluate the quality differences in recommendations generated by large language models (LLMs) and clinical practitioners for sarcopenia-related questions. MethodsA sarcopenia knowledge base was constructed based on the latest domestic and international research and consensus guidelines. Using the Python environment, a locally deployed and sarcopenia-focused hybrid vertical LLM (referred to as LC) was implemented via LangChain-LLM. Eight fixed questions covering etiology, diagnosis, and prevention were selected, along with eight virtual patient cases. The evaluation team assessed the quality of answers generated by LC and written by clinical practitioners. Quantitative analysis was performed on the precision, recall, and F1 scores (harmonic mean of precision and recall) of treatment recommendations. ResultsThe responses were generally perceived as "possibly written by humans or AI", with a stronger inclination toward being AI-generated, although the accuracy of such judgments was low. Regarding answer quality attributes, LC's responses were superior to those of clinical practitioners in guideline consistency (P<0.01), exhibited similar acceptability (P>0.05), showed better practicality (P<0.05), and had a lower proportion of "1–2 errors" (P<0.05). Quantitative analysis of treatment recommendations indicated that LC and GPT-4.0 outperformed clinical practitioners in recall and F1 scores (P<0.05), with minimal differences between LC and GPT-4.0. ConclusionThe locally deployed sarcopenia-focused hybrid vertical LLM demonstrates high accuracy and applicability in addressing sarcopenia-related issues, outperforming clinical practitioners and exhibiting strong clinical decision-support capabilities.