[Treatment of old calcaneal fractures with calcaneus V-shape osteotomy for the subtalar joint preservation].

OBJECTIVE: To observe the clinical effect of calcaneus V-shape osteotomy for the subtalar joint preservation in the treatment of old calcaneal fractures. METHODS: A retrospective study was conducted on 18 patients (18 feet) with old calcaneal fractures treated by calcaneus V-shape osteotomy from March 2014 to November 2017. Included 13 males and 5 females, aged from 23 to 48 years old with an average of (34.3±4.5) years and the course of disease was from 2 to 9 months with an average of (4.5±4.1) months. According to the classification of Sanders, 14 cases of type II and 4 cases of type III. The postoperative complications were observed. The changes of Böhler angle, Gissane angle, heel height and the tilt angle of talus were compared between before operation and 12 months after operation. Maryland foot score was used to evaluate the curative effect. RESULTS: Fourteen patients were followed up, 4 patients were loss to follow-up. And the follow-up time was 13 to 35 months, with an average of (21.2±4.1) months. The fracture healing time was 10 to 12 weeks with an average of (12.4±2.1) weeks. One patient had skin necrosis of incision after operation, and no complications such as nonunion of fracture and loosening or rupture of internal fixation were found. The tilt angle of talus, Böhler angle, Gissane angle, heel height at 12 months after operation were (11.4±5.1)°, (24.7±4.3)°, (124±3.1)°, (46.1±2. 8) mm, respectively, while before operation were (9.1±2.9)°, (6.8±3.1)°, (93.4±11.7)°, (34.5±5.3) mm, there were significant difference between before and after operation. Maryland score was significantly increased from 59.21±7.21 preoperatively to 86.34 ±4.14 postoperatively 12 months(t=43.1, P<0.05), and 8 cases got excellent results, 4 good, 1 fair, 1 poor. CONCLUSIONS: Calcaneus V-shape osteotomy for subtalar joint preservation is one of the effective methods in the treatment of old calcaneal fractures, which has the advantages of preserving subtalar joint, correcting calcaneal deformity, inproving foot appearance, alleviating foot pain and raising foot function.

[Four kinds of operative methods for subtalar arthrodesis in treating old calcaneal fracture].

OBJECTIVE: To explore clinical efficacy of four surgical methods for subtalar joint fusion and internal fixation in treating old calcaneal fractures. METHODS: From March 2014 to November 2017, 25 patients (26 feet) with old calcaneal fractures treated with four surgical methods of subtalar arthrodesis were retrospectively analyzed, including subtalar joint fusion in situ for 2 patients (2 feet), subtalar articular strut bone graft fusion for 6 patients (6 feet), subtalar joint fusion with calcaneus V-shaped osteotomy for 6 patients(6 feet), and subtalar bone graft fusion with calcaneus cuneiform osteotomy for 11 patients (11 feet). They aged from 23 to 70 years old with an average of (36.7±5.8) years old, and the courses of disease ranged from 3 to 35 months with an average of (9.5±5.1) months. Postoperative complications were observed, talar tilt angle, calcaneus Böhler angle, Gissane angle, and the heel height were compared before and after surgery at 12 months. VAS score and American Orthopaedic Foot and Ankle Society(AOFAS) score were employed to evaluate clinical efficacy at 12 months after surgery. RESULTS: Twenty-one patients (21 feet) were followed up for 13 to 34 months with an average of (20.1±3.7) months, four patients(5 feet) were lost to follow-up. Two patients were underwent surgical incision rupture, 1 patient occurred fracture nonunion, and no complications such as fracture nonunion, loosening or fracture of internal fixation occurred in the other patients. There were significant differences between preoperative and postoperative in talar tilt angle[(5.3±2.4)° vs (11.2±4.6)°, t=7.24, P<0.05], calcaneus Böhler angle[(5.4±2.7)° vs(25.5±5.3)°, t=11.2, P<0.05], Gissane angle[(89.4±9.6)° vs (122.0±5.2)°, t=8.13, P<0.05], and heel height[(28.5±5.1) mm vs(47.1±3.7) mm, t=6.45, P<0.05]. VAS score was decreased from 5.2±1.0 before operation to 1.6±0.7 at 12 months after operation(t=5.12, P<0.05); AOFAS score was improved from 52.4±6.4 to 86.2±5.2 at 12 months after operation(t=6.41, P<0.05); 14 feet got excellent results, 4 good , 2 moderate and 1 poor. CONCLUSIONS: Subtalar joint fusion in situ, subtalar articular strut bone graft fusion, subtalar joint fusion with calcaneus V-shaped osteotomy, and subtalar bone graft fusion with calcaneus cuneiform osteotomy are effective operation methods for old calcaneal fractures, which have advantages of relieving pain, correcting deformity of calcaneal, improving foot function. Reasonable selection and treatment is the key to ensure the efficacy.

[Bone and soft tissue combined with surgery for the treatment soft flatfoot combined with painful navicular bone].

OBJECTIVE: To explore short-term clinical effects of bone and soft tissue combined with surgery for the treatment of soft flatfoot accompanied with painful navicular bone. METHODS: From May 2015 to August 2017, 16 patients (16 feet) with navicular bone soft flatfoot accompanied with painful navicular bone were treated with bone and soft tissues operation (gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon). Among them, there were 9 males (9 feet) and 7 females (7 feet), aged from 22 to 48 years old with an average of (32.0±3.4) years old. The duration of diseases ranged from 6 months to 5 years with an average of (2.4±1.7) years. The postoperative complications were observed, talocalcaneal angle, the first metatarsal horn of the talus, arch height, angle of inclination and calcaneal valgus before and after operation at 12 months were compared. VAS score and AOFAS score after operation at 12 months were applied to evaluate pain relief and function. RESULTS: All patients were followed up for an average of (18.4±3.5) months(13~25 months). The incisions of patients were healed at grade A without wound infection, nonunion or delayed union, internal fixation fracture or loosening and other complications. Medial pain of foot was disappeared and motor ability was restored at 12 months after operation. Arch height, angle of inclination and the first metatarsal horn of the talus of lateral X-ray before operation and after operation at 12 months on weight-bearing foot were(21.51±1.20)°vs(31.01±1.62)°, (10.71±1.52)°vs(22.12±2.11)°, (15.61±1.41)°vs(5.10±1.20)°; talocalcaneal angle, the first metatarsal horn of the talus of AP X-ray before operation and after operation at 12 months on weight-bearing foot were (36.12±2.21) ° vs (22.12±2.61)°, (13.41±1.51)°vs(4.30±0.91)°; calcaneal valgus of axial X-ray before operation and after operation at 12 months on weight-bearing foot were (10.80±1.21)°vs(3.92±1.81)°; there were statistical difference in imaging indicators between preoperation and 12 months after operation. VAS score was significantly decreased from (6.21±2.31) before operation to (1.82±0.56) at 12 months after operation (t=2.64, P<0.05). AOFAS score was obviously increased from (51.2±5.6)before operation to (87.1±4.7)at 12 months after operation (t=3.43, P<0.05). CONCLUSIONS: Bone and soft tissue operation (namely, gastrocnemius release, medial displacement calcaneal osteotomy, and excision of accessory navicular with reconstruction of posterior tibial tendon) could obviously relieve foot pain, improve foot appearance and function in patients with navicular bone soft flatfoot complicated with painful navicular bone, and has certain clinical efficacy.

Capsaicin-loaded folic acid-conjugated lipid nanoparticles for enhanced therapeutic efficacy in ovarian cancers.

In this study, folic acid-conjugated lipid nanoparticles were successfully prepared to enhance the active targeting of capsaicin (CAP) in ovarian cancers. The particles were nanosized and exhibited a controlled release of drug in the physiological conditions. The folic acid (FA)-conjugated system exhibited a remarkably higher uptake of nanoparticles in the cancer cells compared to that of non-targeted system. The folate-conjugated CAP-loaded lipid nanoparticles (CFLN) upon interacting with cancer cells were internalized via receptor-mediated endocytosis mechanism and resulted in higher concentration in the cancer cells. Consistently, CFLN showed a remarkably higher toxic effect compared to that of non-targeted nanoparticle system. CFLN showed significantly higher cancer cell apoptosis with nearly 39% of cells in apoptosis chamber (early and late) compared to only ∼21% and ∼11% for CAP-loaded lipid nanoparticles (CLN) and CAP. The loading of drug in the lipid nanoparticle system extended the drug retention in the blood circulation and allowed the active targeting to specific cancer cells. The prolonged circulation of drug attributed to the antifouling property of polyethylene glycol molecule in the structure. Overall, study highlights that using targeting moiety could enhance the therapeutic response of nanomedicines in the treatment of solid tumors.