Study on Different Types of Skin Flap Transplantation to Repair Forefoot Damaged Injury

Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their clinical data were retrospectively analyzed.All the selected patients received skin flap transplantation and repair,of which 26 patients received free myocutaneous flap transplantation and repair,and were treated as group A.The other 36 patients underwent retrograde foot flap transplantation and repair.They were taken as group B,and the clinical treatment methods and curative effects were summarized.Results Among the 26 patients in group A,the skin flaps of 21 patients survived completely,while those of the other 5 patients showed partial necrosis at the edge of the skin flaps.They were treated with free skin grafting and healed after regular dressing change.All the skin flaps survived.Follow-up for at least 6 months showed that 11 patients had mild claudication and skin flap sensation was slightly poor.Among the 36 patients in group B,only 2 cases suffered from distal partial necrosis after the operation,which was caused by large tension after dorsum pedis flap transplantation.After systematic treatment and regular dressing change by doctors,the flaps of 2 patients healed.In addition,venous reflux disorder occurred in 3 patients with medial saphenous nerve nutrient vessel flap of the foot,which was related to swelling factors.The flaps of other patients survived,healed well and did not show infection symptoms.Conclusion According to the actual condition of patients with forefoot damage,the flap repair method is formulated,which has good short-term and long-term therapeutic effects and plays an important role in repairing forefoot damage.

Minimally Invasive Surgery of the Forefoot: Current Concept Review

A minimally invasive surgical technique (MIS) is any procedure that could be less invasive than open surgery used for the same purpose. Though MIS often involves small incisions or percutaneous approaches, its main goal is to achieve good therapeutic results with the least damage to functional anatomic structures. Minimal invasiveness in orthopaedic forefoot surgery, including first ray and lesser toes, with its growth over the last two decade, showed many advantages and good outcomes with the aim to obtain fewer complications due to a contained approach, shorter surgical time and exposure, lesser post-operative risk of infection, lesser pain, hospitalization and post-operative recovery time, compared with traditional open approaches. This appears particularly true for what concerns hallux valgus surgical correction. MIS techniques have proven in the literature to be reliable, providing today comparable results with traditional open approaches.

Treatment Options for Pin Site Infection during Kirschner Wires in Elective Forefoot Surgery

The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years. The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18 - 44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50 Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.

穿着高跟鞋足部组织结构生物力学规律及前掌缓震方式分析研究

本文通过对穿着高跟鞋的女性足部组织结构进行分析,揭示了高跟鞋对足部生物力学的影响。研究结果表明,穿着高跟鞋会导致足部前掌区域承受更大的压力和冲击力,从而增加足部损伤的风险。为了缓解这种压力,本文提出了一种新的前掌缓震方式,通过在高跟鞋的前掌区域加装缓震垫来减轻足部受力,从而降低足部受伤的风险。本文为高跟鞋设计提供了新思路,有望为穿着高跟鞋的女性提供更加舒适、健康的体验。

类风湿前足畸形第5跖骨头是否切除成形的临床对比研究

目的:比较类风湿性关节炎(rheumatoid arthritis,RA)前足畸形重建术第5跖骨头切除成形与不切除的临床疗效。方法:回顾性分析2015年5月至2019年1月收治的50例(76足)女性RA致前足中重度畸形患者,依据第5跖趾关节退变情况,行RA前足重建第5跖骨头保留或切除术,分为第5跖骨头保留组(保留组)和第5跖骨头切除组(切除组)。保留组24例,年龄47~81(60.37±8.60)岁;病程13~22(19.00±3.06)年;身体质量指数(body mass index,BMI)21~28(23.53±2.47)kg·m-2;中度拇外翻畸形6例(6足),重度拇外翻畸形18例(30足);采用第1跖趾关节融合联合第2-4跖趾关节成形及第5跖趾关节清理术治疗。切除组26例,年龄30~80(58.53±13.70)岁;病程8~25(17.94±3.92)年;BMI为20~28(24.60±2.03)kg·m-2;中度拇外翻畸形4例(4足),重度拇外翻畸形22例(36足);采用第1跖趾关节融合联合2-5跖趾关节跖骨头切除成形术治疗。观察并比较两组手术时间、术后并发症情况,比较术前和末次随访时拇外翻角(hallux valgus angle,HVA),第1-2跖骨间角(intermetatarsal angles between the first and the second metatarsals,IMAFS),第1-5跖骨间角(intermetatarsal angles between the first and the fifth metatarsals,IMAFF)变化情况,并采用日本足踝外科协会(Japanese Society for Surgery of Foot,JSSF)评价临床疗效。结果:50例均获得随访,切除组随访时间为14~46(25.30±8.83)个月;保留组随访时间为12~48(24.30±11.12)个月,两组随访时间比较,差异无统计学意义(P>0.05)。两组手术时间、术后并发症比较,差异无统计学意义(P>0.05)。切除组JSSF评分、HVA、IMAFS、IMAFF分别由术前的(45.09±3.35)分、(38.90±13.67)°、(12.88±1.72)°、(32.50±2.99)°改善至末次随访时的(81.60±3.27)分、(15.40±0.96)°、(9.06±2.27)°、(22.20±1.98)°(P<0.05);保留组分别由(47.09±3.96)分、(43.30±12.65)°、(13.99±3.13)°、(33.20±6.14)°改善至(83.10±3.66)分、(15.20±1.54)°、(8.99±1.02)°、(24.70±1.88)°。两组间术前及末次随访时JSSF评分、HVA、IMAFS、IMAFF比较,差异均无统计学意义(P>0.05)。末次随访时,两组JSSF评分中疼痛、畸形比较,差异有统计学意义(P<0.05)。结论:无论是类风湿前足重建术还是前足重建第5跖趾关节清理术,术后临床疗效及影像学结果均明显改善。对比类风湿前足重建术,类风湿前足重建第5跖趾关节清理术治疗类风湿前足中重度畸形,疼痛改善明显,但畸形改善较差。对于类风湿引起的前足中重度畸形,第5跖趾头关节面轻中度退变畸形的患者可考虑使用。

鞋前跷参数设计对步行生物力学特征的影响:综述与展望

为了探讨不同鞋前跷参数设计对人体步行下肢生物力学特征可能产生的影响。通过文献检索的方法,在PubMed、中国知网(核心期刊)等中英文数据库对近30年关于鞋前跷参数对下肢生物力学影响的文献进行了检索。共检索到486篇文献,经过筛选,最终纳入16篇文献进行分析。结果表明,不同鞋前跷参数设计对足底压力、步态稳定性、足踝生物力学产生影响,且影响机制不同:顶点位置通过改变踝关节跖屈阻力臂,影响踝关节跖屈力矩大小,进而影响跟腱应力;前跷角度可以减少跖趾关节背屈角,降低前足足底压力,减弱绞盘效应和缓解足底筋膜应力,但较小的顶点角度会破坏步态稳定性。不同参数的组合对足踝部健康的效果各不相同,因此需要进一步明确各参数之间的相互作用机制,以确保功能性鞋靴设计的应用效果。

不同跑步着地习惯对跟腱形态学及其负荷特征的影响

目的 探究不同着地模式对跟腱形态学和负荷特征的影响。方法 招募习惯后跟着地跑者和习惯前掌着地跑者各14人,利用超声医学影像仪采集受试者的跟腱形态学特征(跟腱长度、横截面积、厚度);利用三维测力跑台采集并计算受试者穿着缓冲跑鞋以10 km/h速度跑步时的跟腱负荷特征(跖屈力矩、跟腱力、负载率、冲量、应力等)。结果 与习惯后跟着地跑者相比,习惯前掌着地跑者踝关节跖屈力矩峰值、跟腱力峰值、平均负载率、峰值负载率均显著增加(P<0.05),但两组跑者跟腱长度、跟腱横截面积和跟腱厚度差异无统计学意义(P>0.05)。结论 长期的前掌着地模式可以适应性地提高跟腱在重复性的“拉长-收缩”循环刺激中的力学特性。

游离腓肠内侧动脉穿支皮瓣修复前足软组织缺损

目的探讨应用游离腓肠内侧动脉穿支皮瓣(MSAP)修复前足软组织缺损的临床疗效。方法2019年5月-2022年5月,应用腓肠内侧动脉穿支皮瓣修复前足软组织缺损11例。一期行VSD覆盖,二期均行MSAP修复创面,皮瓣切取面积4.0 cm×7.0 cm~7.0 cm×10.0 cm。术后2周观察皮瓣成活情况,术后1个月、2个月、3个月、6个月及末次随访观察皮瓣外观、感觉、供区恢复及并发症发生情况。根据曼彻斯特-牛津足部调查问卷(MOXFQ)评价治疗效果。结果11例MSAP均成活,1例出现静脉危象,探查后皮瓣成活。随访时间6~9个月,平均7个月,皮瓣外观良好,质地柔软,穿鞋满意,2例因皮瓣臃肿行皮瓣修整。5例感觉恢复至S3级,5例感觉恢复至S2级,1例感觉恢复至S1级。供区均直接缝合,伤口仅留线性瘢痕,无功能影响。结论MSAP皮下脂肪薄,毛发少,外形美观,穿支较恒定,血管蒂长,供区可直接缝合,是修复前足软组织缺损较好的手术方式。

Osteoid Osteoma of the Second Metatarsal: An Exceptional Localization and Unusual Clinical Features

Osteoid osteoma of the foot can be difficult to diagnose, the clinical presentation may be mimicking other local pathologies leading to a considerable delay in diagnosis. We report an exceptional localization of osteoid osteoma in the second metatarsal in a 30-year-old patient, expressed for 3 years by metatarsalgia, with no clinical and radiological architecture defect of the foot. After discovering the nidus, the patient underwent surgical excision with an excellent outcome.

即刻改变触地方式对着鞋跑时内侧纵弓在体运动学的影响

目的探究即刻转换触地方式对着鞋跑步时内侧纵弓在体运动学的影响。方法采用高速双平面荧光透视成像系统采集15名健康男性跑者即刻改变触地方式前后右足在跑步支撑阶段[跑速:(3±0.15)m/s]的荧光图像。根据CT图像重建第1跖骨和跟骨三维骨骼模型及其局部坐标系,并通过3D-2D配准获取内侧纵弓在跑步支撑期的6自由度(six degree of freedom,6 DOF)数据(简化为第1跖骨相对跟骨的运动)。采用一维统计参数映射(statistical parametric mapping,SPM)比较即刻改变触地方式前后内侧纵弓的6 DOF运动趋势,并对其特征值进行配对样本t检验。结果相比后跟跑,即刻前掌跑时,在支撑期的15%~21%第1跖骨相对跟骨的外移、支撑期17%~45%第1跖骨的前移和支撑期的18%~39%第1跖骨的背屈均显著增加(P<0.05)。即刻前掌跑时,第1跖骨相对跟骨的前移最大值、背屈最大值、前后平移活动范围及内侧纵弓压缩变化量均显著增加(P<0.05)。结论由习惯后跟跑即刻转换为前掌跑后,内侧纵弓矢状面的形变显著增加,尤其是内侧纵弓的压缩变化量增加约10%,可能有助于其弹性能量的储存与释放。

A New Intramedulary Locking Plate for the Osteotomy of the V. Metatarsal in the Correction of the Tailors Bunion. Midterm Results of 21 Patients

Background: Since we are very successful in the operation of hallux valgus using a transverse sub-capital osteotomy fixated with an intramedullary angle-stable locking plate, and a tailors bunion is understood as a reversed hallux valgus, we have applied the operation also for such indication. Method: The osteotomy was carried out at a straight V. metatarsal subcapitally, and in case of an outwardly curved V. metatarsal at the bending location. The intramedullary plates are available in different designs and the plate and screws disappear completely in the bone, so the soft tissues are not disturbed. The head of the plate is either straight or curved in order to shift the distal fragment sufficiently. Results: 26 patients were operated within a period of 5 years (2008-2012). 21 patients were followed up after an average of 34.4 months. The IM angle IV/V could be improved by an average of 11.76 to an average of 4.10. This is a highliy significant pre- to postoperative difference of 7.66 (t = 15.07, p < 0.001). The AOFAS score was improved by an average of 42.24 points from 55.76 points preoperatively to 98.00 points postoperative. There was no pseudo-arthrosis and no wound healing impairment. All patients were either satisfied or very satisfied with the surgery. Conclusion: This method does not have the disadvantages of the other common operations of the Tailors bunion and is applied now as a standard method in this deformity.

正常足与外翻足前足承重比例与跖骨头下压力的研究

目的 从生物力学角度探讨外翻足承重比例及跖骨头下压力的改变情况。方法将测试对象分为正常组(160足)、轻中度(足母)外翻组(100足)、重度(足母)外翻组(56足)三组,运用我所生物力学室研制的足底压力测试系统,对正常足与(足母)外翻足足底压力进行测试,并将结果进行统计分析。结果 轻中度(足母)外翻足前足承重比例较正常足增加,重度(足母)外翻足前足承重比例介于正常足与轻中度(足母)外翻足之间。(足母)外翻足存在着前足压力外移的趋势,这种改变和畸形的程度相关。结论 从生物力学角度证明,(足母)外翻前足承重比例及各跖骨头下压力的变化随(足母)外翻畸形程度增加出现不同程度的变化。

正常足与外翻足跖骨头下压力与足部负重比例变化的关系

目的 :从生物力学角度探讨外翻足前足横弓跖骨头下压力的改变情况。方法 :运用本所生物力学室研制的足底压力测试系统 ,对正常足与外翻足足底压力进行测试 ,并将结果进行统计分析。结果 :随着足部负重比例的增加 ,外翻足前足中间跖骨头下压力的变化较快 ,与正常足相比具有显著差异。结论 :从生物力学角度证明 ,正常足前足具有横弓结构 ,外翻足前足存在横弓塌陷。

足底内侧逆行岛状皮瓣修复前足底顽固性溃疡

目的 为临床前足底顽固性溃疡的修复提供一种方法。 方法 自 1 998年起 ,应用以足底内侧血管束远端为蒂的足底内侧逆行岛状皮瓣修复前足底顽固性溃疡 5例 ,同期矫正局部畸形 ,皮瓣切取范围 3.5～ 5.0 cm×4.0～ 5.5 cm,术后注意皮瓣区近期不负重 ,保持清洁干燥。 结果 皮瓣全部成活 ,随访 6～ 1 4个月 ,皮瓣质地好 ,可见较厚角化层 ,但皮瓣痛觉迟钝 ,患足可负重行走 ,溃疡无复发。 结论 以足底内侧动静脉为蒂的逆行岛状皮瓣血运好 。

低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面

目的探讨低旋转点隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面的术式,并总结其临床效果。方法 2005 年 1 月- 2007 年 8 月,应用低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧皮肤软组织缺损创面 6 例。男 4 例,女 2 例;年龄 28 ～ 53 岁。左足 2 例,右足 4 例。重物压砸伤 5 例,车祸伤 1 例。患足均伴肌腱、骨外露或坏死皮肤软组织切除后肌腱、骨外露。急诊手术 2 例,择期手术 4 例。清创后创面缺损为 7.0 cm × 5.0 cm ～ 9.0 cm × 5.5 cm。皮瓣旋转点位于内踝上 1 ～ 3 cm 处,切取皮瓣大小为 8.0 cm × 6.0 cm ～ 13.0 cm × 6.5 cm。其中 2 例将皮瓣内隐神经近断端和创面内足背内侧皮神经残端吻合。供区创面中厚皮片植皮修复。结果 4 例术后皮瓣顺利成活;2 例术后 2 d 皮瓣远端出现肿胀、水疱,经对症处理后愈合。供区植皮全部成活。6 例患者均获随访,随访时间 6 ～ 18 个月。皮瓣厚薄、颜色及质地接近受区。术中吻合神经的 2 例皮瓣痛、温觉恢复,两点辨别觉分别为 8 mm 和 9 mm;未吻合神经的4 例皮瓣恢复保护性感觉。患足负重行走正常,皮瓣无皮肤破溃。结论低旋转点的隐神经营养血管远端蒂皮瓣血供可靠,是修复前足背侧缺损创面的一种较好方法。

游离腓动脉穿支皮瓣修复前足皮肤缺损

目的:探讨应用游离腓动脉穿支动脉皮瓣修复前足软组织缺损的方法和临床效果。方法:2007年6月至2011年6月,11例前足皮肤软组织缺损,其中男10例,女1例;年龄23～46岁,平均28.6岁;车祸伤4例,压砸伤3例,机器绞伤4例。缺损面积为2.0cm×4.0cm～4.0cm×8.5cm。11例均为前足复合组织缺损。采取急症或亚急诊游离腓动脉肌皮穿支动脉皮瓣移植修复。受伤至手术时间6～96h,平均31.8h。切取面积2.5cm×4.5cm～4.0cm×9.0cm。动脉血管蒂与受区采用端端吻合。结果:术后皮瓣全部成活。9例获得随访,时间6～24个月,皮瓣略臃肿,外观及弹性良好,功能较好,皮瓣供区组织损伤轻,较小的缺损,供区可直接缝合,即便植皮,瘢痕较小且隐蔽。结论:腓动脉穿支动脉动脉皮瓣的血管解剖恒定、皮瓣厚薄适中,操作简单,是修复前足软组织中小面积缺损的有效方法。

外翻及相关畸形的综合手术治疗探讨

目的:评价综合手术治疗外翻与前足相关畸形的效果。方法:回顾性分析本院收治的中、重度外翻合并前足畸形患者289例307足的临床资料,应用综合矫形手术治疗效果。结果:优良率:85.6％,患者对术后足外形及功能满意,前足痛改善。结论:对于中、重度外翻患者,除纠正趾外展外翻外,还应注意伴发畸形的处理,综合矫形手术不失为一种可以考虑的手术方法。

足内侧皮神经营养血管远端蒂皮瓣修复前足软组织缺损

目的评价应用足内侧皮神经营养血管远端蒂皮瓣修复前足软组织缺损的效果。方法自2012年1月至2016年9月,共从住院病人组织缺损患者中选择10例前足软组织缺损患者应用足内侧皮神经营养血管远端蒂皮瓣进行修复。结果 9例患者的皮瓣均顺利成活。1例患者有皮瓣远端皮缘坏死现象,经切痂换药后创面愈合。术后患者均获随访,随访时间6~12个月,平均9.5个月。皮瓣外形不臃肿,色泽、质地优良,耐磨无破溃。结论采用足内侧皮神经营养血管远端蒂皮瓣修复前足软组织缺损,具有手术切取方便,其术后皮瓣质地柔软,外形美观,供区损伤小等特点,是修复前足软组织缺损的理想方法。

女鞋鞋跟高度对前掌动态稳定性的影响

旨在研究女性穿着不同跟高的鞋子行走时前掌压强和受力面积的变化,再根据前掌受力面积和压强的变化客观地评估高跟鞋前掌处的稳定性。研究发现,当高跟鞋跟高超过5.5 mm以后,前掌压强急剧增加,受力面积减少。这将严重影响高跟鞋的稳定性。

三种游离穿支皮瓣修复足背及前足组织缺损

目的探讨游离膝降动脉穿支皮瓣、隐动脉穿支皮瓣及股前外穿支皮瓣修复足背及前足软组织、复合组织缺损的疗效。方法纳入2010年8月至2014年10月35例足背及前足组织缺损患者,创面面积为9 cm×4.5 cm^26 cm×13 cm。采用游离膝降动脉穿支皮瓣修复12例(A组),游离隐动脉穿支皮瓣修复8例(B组),游离股前外穿支皮瓣修复15例(C组)。若为开放性损伤,则在皮瓣移植术前应用负压封闭引流装置覆盖5~7 d。结果术后34例皮瓣全部成活,仅1例(女童,7岁)股前外穿支皮瓣远端1/3坏死,2周后经削痂植皮后创面愈合。术后随访3~38个月,平均12.3个月。皮瓣修复后外形大多令人满意,术后3个月A组有3例、B组有2例进行二次修薄手术。A组有1例出现小腿持续肿胀,1例出现供区切口愈合不良;B组有5例出现供区肢体持续肿胀,3例出现供区切口愈合不良,4例供区远端出现皮疹。结论游离膝降动脉穿支皮瓣及游离隐动脉穿支皮瓣修复后大多需行二次修薄手术。游离股前外穿支皮瓣质地好,切取面积大,可避免二次修薄手术,受区影响较小,但仅可用于单纯足背或前足软组织覆盖。游离膝降动脉穿支皮瓣可制备皮-骨或皮-肌(肌腱)复合瓣用于修复足部复合组织缺损。