Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method f...Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.展开更多
目的观察超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果。方法选取择期行糖尿病足手术患者80例,随机分为坐骨神经及股神经阻滞组(PF组)和单次蛛网膜下腔阻滞组(SA组),每组40例。观察2组患者麻醉前(Tb...目的观察超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果。方法选取择期行糖尿病足手术患者80例,随机分为坐骨神经及股神经阻滞组(PF组)和单次蛛网膜下腔阻滞组(SA组),每组40例。观察2组患者麻醉前(Tb)以及麻醉后5(T5)、10(T10)、15(T15)、30(T30)min的心率、收缩压及舒张压。观察2组患者感觉神经阻滞的起效时间(T1)、完全阻滞时间(T2)及完全消退时间(T3),术后首次排尿时间(Tm)。比较2组患者术后6、12、18、24 h的疼痛视觉模拟量表(VAS)评分。观察2组患者麻醉满意度,麻醉不良反应、并发症发生情况。结果血流动力学指标比较:2组Tb的收缩压、舒张压、心率比较差异均无统计学意义(均P>0.05),SA组在T5、T10、T15、T30的收缩压、舒张压较Tb下降(均P<0.05),且低于PF组T5、T10、T15、T30(均P<0.05)。PF组T1、T2、T3长于SA组(均P<0.05),Tm短于SA组(P<0.05)。PF组术后12、18、24 h VAS评分低于SA组(均P<0.05)。SA组与PF组不良反应发生率分别为72.5%、7.5%,组间比较差异有统计学意义(P<0.05)。结论超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果确切,血流动力学稳定,且不良反应少,患者满意度高。展开更多
文摘Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.
文摘目的观察超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果。方法选取择期行糖尿病足手术患者80例,随机分为坐骨神经及股神经阻滞组(PF组)和单次蛛网膜下腔阻滞组(SA组),每组40例。观察2组患者麻醉前(Tb)以及麻醉后5(T5)、10(T10)、15(T15)、30(T30)min的心率、收缩压及舒张压。观察2组患者感觉神经阻滞的起效时间(T1)、完全阻滞时间(T2)及完全消退时间(T3),术后首次排尿时间(Tm)。比较2组患者术后6、12、18、24 h的疼痛视觉模拟量表(VAS)评分。观察2组患者麻醉满意度,麻醉不良反应、并发症发生情况。结果血流动力学指标比较:2组Tb的收缩压、舒张压、心率比较差异均无统计学意义(均P>0.05),SA组在T5、T10、T15、T30的收缩压、舒张压较Tb下降(均P<0.05),且低于PF组T5、T10、T15、T30(均P<0.05)。PF组T1、T2、T3长于SA组(均P<0.05),Tm短于SA组(P<0.05)。PF组术后12、18、24 h VAS评分低于SA组(均P<0.05)。SA组与PF组不良反应发生率分别为72.5%、7.5%,组间比较差异有统计学意义(P<0.05)。结论超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果确切,血流动力学稳定,且不良反应少,患者满意度高。
