BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.H...BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.展开更多
BACKGROUND Tuberculosis remains a complicated problem.A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis.Delayed management,particularly in osteoarticular regions,results...BACKGROUND Tuberculosis remains a complicated problem.A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis.Delayed management,particularly in osteoarticular regions,results in unnecessary procedures,including joint-sacrificing surgery.CASE SUMMARY Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented.The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.CONCLUSION The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis,especially in tuberculosis endemic regions.展开更多
AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review acco...AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.展开更多
Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 ...Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 joints in the foot and the ankle.Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented.The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle,subtalar,first metatarsophalangeal,and second tarsometatarsal joints,and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty.Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle.Additionally,the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint,and can prolong the need for further,more aggressive surgical interventions such as fusion or arthroplasty.展开更多
Objective:To research the sodium hyaluronate joint cavity filling combined with exercise therapy on the indicator of pain,motor function,and levels of inflammatory factors in joint fluid in patients with post-traumati...Objective:To research the sodium hyaluronate joint cavity filling combined with exercise therapy on the indicator of pain,motor function,and levels of inflammatory factors in joint fluid in patients with post-traumatic knee arthritis.Method Totally 100 patients(Department of Orthopaedics,The second Affiliated Hospital to Liaoning University of Chinese Medicine,2013.10-2018.8)with post-traumatic knee arthritis were selected,then they were divided into observation group(n=50)and control group(n=50).The control group was given glucosamine sulfate and sodium hyaluronate joint cavity filling,the observation group was given leg press with visual feedback,they were treated 4 weeks.Assessing the pain degree through visual analog scale(VAS),hospital for special surgery knee score(HSS)as the indicator of motor function,inflammatory factor(TNF-α,IL-6,and IL-8)in the joint fluid.Results The score of VAS were lower than pretherapy(P<0.05),the degree of VAS of observation group were lower than control group(P<0.05).The score of HSS were higher than pretherapy(P<0.05),the degree of VAS of observation group were higher than control group(P<0.05).The inflammatory factor(TNF-α,IL-6,and CRP)in the joint fluid were lower than pretherapy(P<0.05),and the observation group were lower than control group(P<0.05).Conclusions Giving sodium hyaluronate joint cavity filling combined with exercise therapy can improve the function of joint.展开更多
Objective:To analyze and explore the clinical value of arthroscopy in traumatic sports ankle arthritis.Methods:The study period was from June 2016 to June 2020.A selected sample of 25 patients with traumatic sports an...Objective:To analyze and explore the clinical value of arthroscopy in traumatic sports ankle arthritis.Methods:The study period was from June 2016 to June 2020.A selected sample of 25 patients with traumatic sports ankle arthritis in Qingyang People's Hospital were treated.All patients underwent arthroscopy and the specific treatment effects were analyzed.Results:Comparing the preoperative and postoperative ankle-hindfoot scores,the distance of talus advancement,modified Mcguire's ankle scoring system,and visual analog scale(VAS)pain scores,the postoperative results were significantly better than those of the preoperative(P<0.05).Conclusion:Arthroscopy in traumatic sports ankle arthritis has a significant effect,with minor trauma and rapid postoperative recovery which improves various discomfort symptoms.It is worthy of promotion and application.展开更多
Background:End-stage ankle arthritis impairs joint function and patients' mobility.Total ankle replacement is a surgical procedure to treat severe ankle arthritis.Salto Talaris Anatomic Ankle^(TM)(STAA) was design...Background:End-stage ankle arthritis impairs joint function and patients' mobility.Total ankle replacement is a surgical procedure to treat severe ankle arthritis.Salto Talaris Anatomic Ankle^(TM)(STAA) was designed to mimic the normal ankle anatomy and flexion/extension of the ankle movement.The purpose of this study was to examine the effect of an STAA ankle replacement on ankle joint function and mechanics during gait.Methods:Five patients with end-stage unilateral ankle arthritis were recruited.Patients performed level walking in a laboratory setting on 2occasions,prior to and 3 months after the STAA ankle surgeries.American Orthopedic Foot and Ankle Society(AOFAS) hindfoot score was obtained.A 12-camera motion capture system was used to perform walking analysis.Gait temporo-spatial parameters and ankle joint mechanics were evaluated.Paired Student's t tests and non-parametric Wilcoxon matched tests were performed to examine the differences in biomechanical variables between the pre-and post-surgery walking conditions.Results:Compared to the pre-surgical condition,at 3 months of post-STAA surgery,patients experienced greater improvement in AOFAS hindfoot score(p = 0.0001);the STAA ankle demonstrated a 31% increase in ankle joint excursion(p = 0.045),a 22% increase in ankle plantarflexor moment(p = 0.075),a 60% increase in ankle power absorption(p = 0.023),and a 68% increase in ankle power production(p = 0.039).Patients also demonstrated a 26% increase in walking speed(p = 0.005),a 20% increase in stride length(p = 0.013),a 15% decrease in double support time(p = 0.043),and a 5% decrease in total stance time(p = 0.055).Conclusion:Three months after surgeries,the STAA patients experienced improvements in ankle function and gait parameters.The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking.展开更多
Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the la...Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.展开更多
Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may aris...Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>展开更多
目的:探讨影响踝关节骨折患者术后创伤性关节炎的危险因素,并构建风险预测模型。方法:选取2020年5月至2022年5月治疗的550例踝关节骨折患者为研究对象,按照7∶3分为建模组(385例)和验证组(165例),建模组根据术后是否发生创伤性关节炎将...目的:探讨影响踝关节骨折患者术后创伤性关节炎的危险因素,并构建风险预测模型。方法:选取2020年5月至2022年5月治疗的550例踝关节骨折患者为研究对象,按照7∶3分为建模组(385例)和验证组(165例),建模组根据术后是否发生创伤性关节炎将患者作为发生组(112例)和未发生组(273例)。记录患者的年龄、身体质量指数(body mass index,BMI)、性别、吸烟史、糖尿病史、致伤原因、骨折类型、手术时机、体力劳动、开放性损伤、骨质疏松、复位不良、术后负重时间、血管损伤、手术方式等信息;采用单因素和多因素Logistic回归分析影响踝关节骨折患者术后发生创伤性关节炎的危险因素;采用R软件建立构建列线图预测模型;采用受试者工作特征(receiver operating characteristic,ROC)曲线、校准图形验证模型的区分度以及一致性。结果:建模组112例出现术后创伤性关节炎,273例未发生。单因素分析结果显示,发生组和未发生组年龄、BMI、骨折类型、手术时机、体力劳动>Ⅱ级、开放性损伤、骨质疏松、复位不良例数比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示年龄(OR=2.887)、BMI(OR=4.042)、骨折类型(OR=4.244)、手术时机(OR=2.665)、体力劳动>Ⅱ级(OR=5.099)、骨质疏松(OR=10.219)、复位不良(OR=3.112)均为影响踝关节骨折患者术后创伤性关节炎的独立危险因素(P<0.05)。基于以上危险因素建立预测踝关节骨折患者术后创伤性关节炎发生风险的列线图模型,并进行内外部验证,结果显示建模组和验证组校准曲线显示校正曲线和理想曲线拟合度均较好,表明模型预测术后创伤性关节炎发生风险与实际发生风险基本一致;ROC曲线下面积分析结果显示分别为0.867[95%CI(0.826,0.908)]、0.882[95%CI(0.827,0.938)],表明预测模型具有良好的预测能力。结论:年龄、BMI、骨折类型、手术时机、体力劳动>Ⅱ级、骨质疏松、复位不良均为影响踝关节骨折患者术后创伤性关节炎的危险因素,基于以上危险因素构建的预测模型可有效评估踝关节骨折患者术后创伤性关节炎的发生风险。展开更多
Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvio...Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvious foot varus deformity, and 17 were almost normal in appearance. There were 13 males and 15 females with an average age of 49.4 years （range, 23-67 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankles. The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） preoperatively and at I year follow-up. Results： Twenty-eight patients were followed up for 19.8 months on average （range, 1-2 years）. Superficial wound infection occurred in 3 cases, and was cured after debridement; the other incisions healed by first intention without complications. All ankles were fused at 1 year follow-up after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, or nonunion. The postoperative AOFAS ankle and hindfoot score was 83.13±3.76, showing significant difference when compared with the preoperative score （45.38±3.21, P〈0.01）. VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up （P〈0.05）. Conclusion： Modified Blair ankle fusion has the advantages of high feasiblity, less cost and rigid fixation. It shows high reliability in pain relief and may obtain a good clinical effectiveness.展开更多
目的 分析模拟仿真功能评估训练系统(BTE Primus RS)对踝关节创伤性关节炎患者三维步态参数的影响。方法 收集2019年12月至2021年12月宝鸡市中医医院康复医学科收治的96例踝关节创伤性关节炎患者,根据电脑数字表法进行随机分组,对照组4...目的 分析模拟仿真功能评估训练系统(BTE Primus RS)对踝关节创伤性关节炎患者三维步态参数的影响。方法 收集2019年12月至2021年12月宝鸡市中医医院康复医学科收治的96例踝关节创伤性关节炎患者,根据电脑数字表法进行随机分组,对照组48例予以常规训练,观察组48例予以BTE Primus RS训练,比较2组患者的干预效果、关节活动度、三维步态参数及无痛步行距离。结果 训练后,观察组患者的总优良率是93.8%,高于对照组的79.2%(P<0.05);观察组患者踝关节的外翻、背伸、外展、跖屈及内收角度均高于对照组(P<0.05);观察组患者患足廓清地面的最大距离、步长均长于对照组,同时步频与步速也高于对照组(P<0.05);观察组中无痛步行200~500 m及>500 m的患者数高于对照组,而无痛步行距离<200 m的患者数则低于对照组(P<0.05)。结论 BTE Primus RS训练在踝关节创伤性关节炎患者中的应用效果显著,有助于提升其干预效果,改善关节活动度与三维步态参数,并且促进无痛步行距离延长。展开更多
基金Supported by Scientific research project of Hunan Education Department,No.21B0075Science project of Hunan Provincial Health Commission,No.B2015-82。
文摘BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.
文摘BACKGROUND Tuberculosis remains a complicated problem.A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis.Delayed management,particularly in osteoarticular regions,results in unnecessary procedures,including joint-sacrificing surgery.CASE SUMMARY Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented.The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.CONCLUSION The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis,especially in tuberculosis endemic regions.
文摘AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.
文摘Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 joints in the foot and the ankle.Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented.The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle,subtalar,first metatarsophalangeal,and second tarsometatarsal joints,and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty.Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle.Additionally,the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint,and can prolong the need for further,more aggressive surgical interventions such as fusion or arthroplasty.
文摘Objective:To research the sodium hyaluronate joint cavity filling combined with exercise therapy on the indicator of pain,motor function,and levels of inflammatory factors in joint fluid in patients with post-traumatic knee arthritis.Method Totally 100 patients(Department of Orthopaedics,The second Affiliated Hospital to Liaoning University of Chinese Medicine,2013.10-2018.8)with post-traumatic knee arthritis were selected,then they were divided into observation group(n=50)and control group(n=50).The control group was given glucosamine sulfate and sodium hyaluronate joint cavity filling,the observation group was given leg press with visual feedback,they were treated 4 weeks.Assessing the pain degree through visual analog scale(VAS),hospital for special surgery knee score(HSS)as the indicator of motor function,inflammatory factor(TNF-α,IL-6,and IL-8)in the joint fluid.Results The score of VAS were lower than pretherapy(P<0.05),the degree of VAS of observation group were lower than control group(P<0.05).The score of HSS were higher than pretherapy(P<0.05),the degree of VAS of observation group were higher than control group(P<0.05).The inflammatory factor(TNF-α,IL-6,and CRP)in the joint fluid were lower than pretherapy(P<0.05),and the observation group were lower than control group(P<0.05).Conclusions Giving sodium hyaluronate joint cavity filling combined with exercise therapy can improve the function of joint.
文摘Objective:To analyze and explore the clinical value of arthroscopy in traumatic sports ankle arthritis.Methods:The study period was from June 2016 to June 2020.A selected sample of 25 patients with traumatic sports ankle arthritis in Qingyang People's Hospital were treated.All patients underwent arthroscopy and the specific treatment effects were analyzed.Results:Comparing the preoperative and postoperative ankle-hindfoot scores,the distance of talus advancement,modified Mcguire's ankle scoring system,and visual analog scale(VAS)pain scores,the postoperative results were significantly better than those of the preoperative(P<0.05).Conclusion:Arthroscopy in traumatic sports ankle arthritis has a significant effect,with minor trauma and rapid postoperative recovery which improves various discomfort symptoms.It is worthy of promotion and application.
文摘Background:End-stage ankle arthritis impairs joint function and patients' mobility.Total ankle replacement is a surgical procedure to treat severe ankle arthritis.Salto Talaris Anatomic Ankle^(TM)(STAA) was designed to mimic the normal ankle anatomy and flexion/extension of the ankle movement.The purpose of this study was to examine the effect of an STAA ankle replacement on ankle joint function and mechanics during gait.Methods:Five patients with end-stage unilateral ankle arthritis were recruited.Patients performed level walking in a laboratory setting on 2occasions,prior to and 3 months after the STAA ankle surgeries.American Orthopedic Foot and Ankle Society(AOFAS) hindfoot score was obtained.A 12-camera motion capture system was used to perform walking analysis.Gait temporo-spatial parameters and ankle joint mechanics were evaluated.Paired Student's t tests and non-parametric Wilcoxon matched tests were performed to examine the differences in biomechanical variables between the pre-and post-surgery walking conditions.Results:Compared to the pre-surgical condition,at 3 months of post-STAA surgery,patients experienced greater improvement in AOFAS hindfoot score(p = 0.0001);the STAA ankle demonstrated a 31% increase in ankle joint excursion(p = 0.045),a 22% increase in ankle plantarflexor moment(p = 0.075),a 60% increase in ankle power absorption(p = 0.023),and a 68% increase in ankle power production(p = 0.039).Patients also demonstrated a 26% increase in walking speed(p = 0.005),a 20% increase in stride length(p = 0.013),a 15% decrease in double support time(p = 0.043),and a 5% decrease in total stance time(p = 0.055).Conclusion:Three months after surgeries,the STAA patients experienced improvements in ankle function and gait parameters.The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking.
文摘Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.
文摘Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>
文摘目的:探讨影响踝关节骨折患者术后创伤性关节炎的危险因素,并构建风险预测模型。方法:选取2020年5月至2022年5月治疗的550例踝关节骨折患者为研究对象,按照7∶3分为建模组(385例)和验证组(165例),建模组根据术后是否发生创伤性关节炎将患者作为发生组(112例)和未发生组(273例)。记录患者的年龄、身体质量指数(body mass index,BMI)、性别、吸烟史、糖尿病史、致伤原因、骨折类型、手术时机、体力劳动、开放性损伤、骨质疏松、复位不良、术后负重时间、血管损伤、手术方式等信息;采用单因素和多因素Logistic回归分析影响踝关节骨折患者术后发生创伤性关节炎的危险因素;采用R软件建立构建列线图预测模型;采用受试者工作特征(receiver operating characteristic,ROC)曲线、校准图形验证模型的区分度以及一致性。结果:建模组112例出现术后创伤性关节炎,273例未发生。单因素分析结果显示,发生组和未发生组年龄、BMI、骨折类型、手术时机、体力劳动>Ⅱ级、开放性损伤、骨质疏松、复位不良例数比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示年龄(OR=2.887)、BMI(OR=4.042)、骨折类型(OR=4.244)、手术时机(OR=2.665)、体力劳动>Ⅱ级(OR=5.099)、骨质疏松(OR=10.219)、复位不良(OR=3.112)均为影响踝关节骨折患者术后创伤性关节炎的独立危险因素(P<0.05)。基于以上危险因素建立预测踝关节骨折患者术后创伤性关节炎发生风险的列线图模型,并进行内外部验证,结果显示建模组和验证组校准曲线显示校正曲线和理想曲线拟合度均较好,表明模型预测术后创伤性关节炎发生风险与实际发生风险基本一致;ROC曲线下面积分析结果显示分别为0.867[95%CI(0.826,0.908)]、0.882[95%CI(0.827,0.938)],表明预测模型具有良好的预测能力。结论:年龄、BMI、骨折类型、手术时机、体力劳动>Ⅱ级、骨质疏松、复位不良均为影响踝关节骨折患者术后创伤性关节炎的危险因素,基于以上危险因素构建的预测模型可有效评估踝关节骨折患者术后创伤性关节炎的发生风险。
文摘Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvious foot varus deformity, and 17 were almost normal in appearance. There were 13 males and 15 females with an average age of 49.4 years （range, 23-67 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankles. The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） preoperatively and at I year follow-up. Results： Twenty-eight patients were followed up for 19.8 months on average （range, 1-2 years）. Superficial wound infection occurred in 3 cases, and was cured after debridement; the other incisions healed by first intention without complications. All ankles were fused at 1 year follow-up after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, or nonunion. The postoperative AOFAS ankle and hindfoot score was 83.13±3.76, showing significant difference when compared with the preoperative score （45.38±3.21, P〈0.01）. VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up （P〈0.05）. Conclusion： Modified Blair ankle fusion has the advantages of high feasiblity, less cost and rigid fixation. It shows high reliability in pain relief and may obtain a good clinical effectiveness.
文摘目的 分析模拟仿真功能评估训练系统(BTE Primus RS)对踝关节创伤性关节炎患者三维步态参数的影响。方法 收集2019年12月至2021年12月宝鸡市中医医院康复医学科收治的96例踝关节创伤性关节炎患者,根据电脑数字表法进行随机分组,对照组48例予以常规训练,观察组48例予以BTE Primus RS训练,比较2组患者的干预效果、关节活动度、三维步态参数及无痛步行距离。结果 训练后,观察组患者的总优良率是93.8%,高于对照组的79.2%(P<0.05);观察组患者踝关节的外翻、背伸、外展、跖屈及内收角度均高于对照组(P<0.05);观察组患者患足廓清地面的最大距离、步长均长于对照组,同时步频与步速也高于对照组(P<0.05);观察组中无痛步行200~500 m及>500 m的患者数高于对照组,而无痛步行距离<200 m的患者数则低于对照组(P<0.05)。结论 BTE Primus RS训练在踝关节创伤性关节炎患者中的应用效果显著,有助于提升其干预效果,改善关节活动度与三维步态参数,并且促进无痛步行距离延长。
文摘目的:系统评价全踝关节置换术(total ankle arthroplasty,TAA)和踝关节融合术(ankle arthrodesis,AA)在治疗终末期踝关节炎的临床疗效。方法:文献检索PubMed、EMBASE和Cochrane图书馆数据库发表的TAA或AA治疗终末期踝关节炎的文献,检索日期从建库至2021年6月。采用偏倚风险工具进行文献质量评价。采用RevMan 5.3软件美国足对两组踝外科协会踝与后足评分(American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale,AOFAS)、视觉模拟评分(visual analog scale,VAS)、踝关节骨关节炎评分(ankle osteoarthritis scale,AOS),步态分析(步速、步频、步幅)、活动范围(range of motion,ROM),满意度、并发症和再次手术率进行Meta分析。结果:共纳入12篇文献,其中AA组1050例,TAA组3760例,共计4810例患者。Meta分析结果显示两组的AOFAS总分[MD=-3.12,95%CI(-9.02,2.96),P=0.31]、疼痛评分[MD=1.60,95%CI(-1.35,4.54),P=0.29]、对线评分[MD=-0.04,95%CI(-0.52,0.44),P=0.88]、VAS[MD=0.10,95%CI(-0.49,0.68),P=0.74]和AOS总分[MD=-4.01,95%CI(-8.28,0.25),P=0.06]比较,差异无统计学意义(P>0.05)。TAA组AOFAS功能评分较TAA组明显改善[MD=44.22,95%CI(-8.01,-0.43),P=0.03]。两组步态分析比较差异无统计学意义(P>0.05)。两组术后ROM[MD=-4.93,95%CI(-6.35,-3.52),P<0.00001]和术前到随访ROM变化[MD=-5.74,95%CI(-8.88,-2.61),P=0.0003]均有显著改善。两组的满意度比较差异无统计学意义[OR=1.011,95%CI(0.46,2.23),P=0.98]。与AA组相比,TAA组的并发症[OR=1.61,95%CI(1.26,2.06),P=0.0002]与非翻修再次手术率[OR=1.61,95%CI(1.17,2.21),P=0.003]明显更低,两组的翻修再次手术率[OR=1.02,95%CI(0.37,2.78),P=0.97]差异无统计学意义(P>0.05)。结论:AA与TAA的临床疗效相似,但TAA的非翻修再次手术率和主要手术并发症明显降低。因此,还需要进一步的高质量的方法学研究和长期的随访来证实该结论。
