Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of p...Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods.Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed.These patients were treated w让h physeal bar resection and hemi-epiphysiodesis,with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases).Of the 45 cases,the median age was 9.0 years (range:3-14 years) with 28 male and 17 female patients.The median of pre-operation ankle varus angle was 20 degrees (IQR 15-25) and 5 degrees (IQR 0-20) at the time of final follow up,representing a statistically significant difference (P<0.05).No differences were observed with regards to age,gender,and surgical history between effective group and ineffective group (P>0.05).The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05).The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees,respectively (P>0.05).Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia.We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.展开更多
Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population whil...Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups.This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields.The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies,with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates.In line with increasing interest on the impact of obesity in orthopedics,there has been a similar output of publications in the foot and ankle literature.This review article evaluates several foot and ankle pathologies,their risk factors associated with obesity and subsequent management.It provides an updated,comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes,with the ultimate aim of educating both surgeons and allied health professionals about the risks,benefits,and modifiable factors of operating on obese patients.展开更多
Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory re...Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site was noted. It was treated with local care and healed without sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was observed in one case, which required a tibiotalar arthrodesis. At the last follow-up, consolidation of the arthrodesis was effective in all patients. The posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’ activity was normal without assistance in all cases. The walking perimeter was greater than 1 km in six patients. Patient activity was normal without assistance in all cases. Stepping was absent in all patients. No difficulty with footwear was noted. According to the Angus and Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that double arthrodesis associated with posteromedial release and transfer of the posterior tibial in one step in inveterate paralytic varus equines feet, gives satisfactory results. It allows for easy shoeing and plantigrade walking without stepping. Complications are essentially represented by the absence of fusion of the arthrodesis and tibiotalar arthrosis.展开更多
目的:探讨跖骨截骨联合外侧软组织松解治疗拇外翻的效果。方法:选取2018年4月—2022年1月溧阳市中医医院收治的60例拇外翻患者,采用简单随机法将患者分为两组,各30例,参照组采用第一个跖骨Chevron或者Scarf治疗,试验组在第一个跖骨Chev...目的:探讨跖骨截骨联合外侧软组织松解治疗拇外翻的效果。方法:选取2018年4月—2022年1月溧阳市中医医院收治的60例拇外翻患者,采用简单随机法将患者分为两组,各30例,参照组采用第一个跖骨Chevron或者Scarf治疗,试验组在第一个跖骨Chevron或者Scarf截骨基础上采用外侧软组织松解。术后24周,评估患者术后恢复情况[拇外翻角(HVA)、第1、2跖骨间夹角(IMA)],踝功能评分,肿胀值,疼痛程度视觉模拟评分法(VAS)评分,统计患者骨性愈合时间。结果:术前,两组拇外翻患者IMA、HVA比较差异均无统计学意义(P>0.05),术后,两组拇外翻患者IMA、HVA均降低,试验组IMA、HVA均低于参照组(P<0.05)。术后两组拇外翻患者美国骨科足踝外科协会评分(AOFAS)评分均升高,肿胀值均降低(P<0.05);试验组AOFAS评分较参照组高,肿胀值较参照组低(P<0.05)。与术前比较,两组术后1、2、5 d VAS评分均降低(P<0.05),与术后1 d比较,两组术后2 d VAS评分均升高,术后5 d VAS评分均降低(P<0.05),与术后2 d比较,两组术后5 d VAS评分均降低(P<0.05);试验组术后2、5 d VAS评分均低于参照组(P<0.05)。试验组、参照组骨性愈合时间分别为(2.83±0.35)、(3.95±0.27)个月,试验组骨性愈合时间较参照组短(P<0.05)。结论:跖骨截骨联合外侧软组织松解能够促进拇外翻患者术后恢复,缓解术后疼痛及肿胀,有利于跖趾关节恢复,值得在临床中推广与应用。展开更多
目的:探讨Ludloff截骨术和Chevron截骨术治疗足拇外翻(Halluxvalgus,HV)畸形的效果。方法:选取2021年1月-2021年12月在笔者医院行截骨术治疗的HV畸形患者109例,根据不同手术方式分为Ludloff组(行Ludloff截骨术)55例(60足)和Chevron组(行...目的:探讨Ludloff截骨术和Chevron截骨术治疗足拇外翻(Halluxvalgus,HV)畸形的效果。方法:选取2021年1月-2021年12月在笔者医院行截骨术治疗的HV畸形患者109例,根据不同手术方式分为Ludloff组(行Ludloff截骨术)55例(60足)和Chevron组(行Chevron截骨术)54例(58足)。观察并比较两组患者临床疗效优良率,以美国足踝评分系统(American orthopaedics foot and ankle score,AOFAS)评估两组足踝功能,以X线片测定两组患者拇外翻角(Hallux valgus angle,HVA)、第Ⅰ、Ⅱ跖骨间角(Intermetatarsal angle,IMA)及第1跖骨远关节面角(Distal metatarsalarticularangel,DMAA),并统计两组术后并发症发生情况。结果:术后,Ludloff组和Chevron组优良率比较差异无统计学意义(P>0.05);但Chevron组临床疗效为优的比例(89.66%)高于Ludloff组(75.00%),差异有统计学意义(P<0.05)。术后3个月,两组AOFAS评分均显著升高,且Chevron组评分高于Ludloff组,差异有统计学意义(P<0.05);两组HVA、IMA、DMAA指标均显著下降,且Chevron组低于Ludloff组,差异有统计学意义(P<0.05)。两组术后均未发生感染等严重并发症。结论:Ludloff截骨术和Chevron截骨术治疗HV畸形均有良好效果,可改善HVA、IMA、DMAA角度,改善患者足踝功能,且Chevron截骨术的效果更佳,值得临床推广应用。展开更多
文摘Children presenting with partial physeal arrest and significant remaining growth may benefit from physeal bar resection,although the operation is a technique demanding procedure.This study evaluates the treatment of post-traumatic pediatric ankle varus deformity using physeal bar resection and hemi-epiphysiodesis with the assistance of two operative methods.Forty-five patients presenting with a distal tibial medial physeal bridge as well as ankle varus deformity following traumatic ankle physeal injury between 2009 and 2017 were followed.These patients were treated w让h physeal bar resection and hemi-epiphysiodesis,with the assistance of either fluoroscopy (10 cases) or intraoperative three-dimensional navigation (35 cases).Of the 45 cases,the median age was 9.0 years (range:3-14 years) with 28 male and 17 female patients.The median of pre-operation ankle varus angle was 20 degrees (IQR 15-25) and 5 degrees (IQR 0-20) at the time of final follow up,representing a statistically significant difference (P<0.05).No differences were observed with regards to age,gender,and surgical history between effective group and ineffective group (P>0.05).The median of pre-operative ankle varus angles of the navigation and fluoroscopy groups were both 20 degrees (P>0.05).The median correction angle of the navigation and fluoroscopy groups was 10 and 15 degrees,respectively (P>0.05).Our results indicate that physeal bar resection and hemiepiphysiodesis are effective treatments for correcting ankle varus deformity due to traumatic medial physeal arrest of the distal tibia.We observe no difference in outcome between fluoroscopy group and three-dimensional navigation group during the procedures.
文摘Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups.This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields.The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies,with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates.In line with increasing interest on the impact of obesity in orthopedics,there has been a similar output of publications in the foot and ankle literature.This review article evaluates several foot and ankle pathologies,their risk factors associated with obesity and subsequent management.It provides an updated,comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes,with the ultimate aim of educating both surgeons and allied health professionals about the risks,benefits,and modifiable factors of operating on obese patients.
文摘Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site was noted. It was treated with local care and healed without sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was observed in one case, which required a tibiotalar arthrodesis. At the last follow-up, consolidation of the arthrodesis was effective in all patients. The posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’ activity was normal without assistance in all cases. The walking perimeter was greater than 1 km in six patients. Patient activity was normal without assistance in all cases. Stepping was absent in all patients. No difficulty with footwear was noted. According to the Angus and Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that double arthrodesis associated with posteromedial release and transfer of the posterior tibial in one step in inveterate paralytic varus equines feet, gives satisfactory results. It allows for easy shoeing and plantigrade walking without stepping. Complications are essentially represented by the absence of fusion of the arthrodesis and tibiotalar arthrosis.
文摘目的:探究Scarf截骨术与第一跖骨双平面截骨术(Double metatarsal osteotomy,DMO)矫正中重度拇外翻畸形的疗效。方法:随机选取2020年4月-2022年4月于笔者医院就诊且接受DMO治疗的47例中重度拇外翻畸形患者(63患足)纳入对照组,随机选取同期接受Scarf截骨术治疗的51例中重度拇外翻畸形患者(67患足)纳入观察组进行回顾性分析。比较两组患者部分负重和完全负重的时间,评估其术前和术后1个月关节功能[美国足踝协会(American orthopedic foot and ankle society,AOFAS)评分]、形态学指标[拇外翻角(Hallux valgus angle,HVA)、第一跖骨相对长度(Relative length of first metatarsal,RLFM)、第一、二跖骨间角(Intermetatarsal angle,IMA)、关节面固有角(Distal metatarsal articular angle,DMAA)]、疼痛情况[视觉模拟评分(Visual analogue scale,VAS)]的变化,记录两组术后并发症发生情况。结果:观察组部分、完全负重时间显著短于对照组(P<0.05);术后1个月,观察组AOFAS评分、DMAA均显著优于对照组(P<0.05),RLFM、IMA、HVA两组比较差异均无统计学意义(P>0.05);两组术后1个月VAS均明显降低,且观察组低于对照组(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论:Scarf截骨术与DMO均能有效治疗中重度拇外翻畸形,两者形态学改善情况相近,Scarf截骨后能显著缩短患者功能恢复时间。
文摘目的:探讨跖骨截骨联合外侧软组织松解治疗拇外翻的效果。方法:选取2018年4月—2022年1月溧阳市中医医院收治的60例拇外翻患者,采用简单随机法将患者分为两组,各30例,参照组采用第一个跖骨Chevron或者Scarf治疗,试验组在第一个跖骨Chevron或者Scarf截骨基础上采用外侧软组织松解。术后24周,评估患者术后恢复情况[拇外翻角(HVA)、第1、2跖骨间夹角(IMA)],踝功能评分,肿胀值,疼痛程度视觉模拟评分法(VAS)评分,统计患者骨性愈合时间。结果:术前,两组拇外翻患者IMA、HVA比较差异均无统计学意义(P>0.05),术后,两组拇外翻患者IMA、HVA均降低,试验组IMA、HVA均低于参照组(P<0.05)。术后两组拇外翻患者美国骨科足踝外科协会评分(AOFAS)评分均升高,肿胀值均降低(P<0.05);试验组AOFAS评分较参照组高,肿胀值较参照组低(P<0.05)。与术前比较,两组术后1、2、5 d VAS评分均降低(P<0.05),与术后1 d比较,两组术后2 d VAS评分均升高,术后5 d VAS评分均降低(P<0.05),与术后2 d比较,两组术后5 d VAS评分均降低(P<0.05);试验组术后2、5 d VAS评分均低于参照组(P<0.05)。试验组、参照组骨性愈合时间分别为(2.83±0.35)、(3.95±0.27)个月,试验组骨性愈合时间较参照组短(P<0.05)。结论:跖骨截骨联合外侧软组织松解能够促进拇外翻患者术后恢复,缓解术后疼痛及肿胀,有利于跖趾关节恢复,值得在临床中推广与应用。
文摘目的:探讨Ludloff截骨术和Chevron截骨术治疗足拇外翻(Halluxvalgus,HV)畸形的效果。方法:选取2021年1月-2021年12月在笔者医院行截骨术治疗的HV畸形患者109例,根据不同手术方式分为Ludloff组(行Ludloff截骨术)55例(60足)和Chevron组(行Chevron截骨术)54例(58足)。观察并比较两组患者临床疗效优良率,以美国足踝评分系统(American orthopaedics foot and ankle score,AOFAS)评估两组足踝功能,以X线片测定两组患者拇外翻角(Hallux valgus angle,HVA)、第Ⅰ、Ⅱ跖骨间角(Intermetatarsal angle,IMA)及第1跖骨远关节面角(Distal metatarsalarticularangel,DMAA),并统计两组术后并发症发生情况。结果:术后,Ludloff组和Chevron组优良率比较差异无统计学意义(P>0.05);但Chevron组临床疗效为优的比例(89.66%)高于Ludloff组(75.00%),差异有统计学意义(P<0.05)。术后3个月,两组AOFAS评分均显著升高,且Chevron组评分高于Ludloff组,差异有统计学意义(P<0.05);两组HVA、IMA、DMAA指标均显著下降,且Chevron组低于Ludloff组,差异有统计学意义(P<0.05)。两组术后均未发生感染等严重并发症。结论:Ludloff截骨术和Chevron截骨术治疗HV畸形均有良好效果,可改善HVA、IMA、DMAA角度,改善患者足踝功能,且Chevron截骨术的效果更佳,值得临床推广应用。
