ABSTRACT
Objective:To explore the clinical efficacy of periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus （OCLTs）.Methods:A retrospective case series study was used to analyze the clinical data of 26 patients with severe OCLTs treated at Zhejiang Armed Police Corps Hospital from January 2013 to October 2019. There were 21 males and 5 females，aged 17-49 years ［（36.3 ± 10.9）years］. All patients were treated using periosteum-covered iliac crest autografts. The visual analogue scale （VAS），American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and ankle joint range of motion （ROM） were assessed before operation，6 months after operation and at the last follow-up （≥ 12 months）. The area of talus injury with MRI at the same level was recorded before operation and at the last follow-up. The healing of talus and joint surface was detected with CT at the last follow-up. The healing of the incision and osteotomy site and complications were observed.Results:All patients were followed for 12 to 22 months［（15.1 ± 3.2）months］. The VAS was （2.4 ± 0.9）points and （1.7 ± 0.6）points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （5.4 ± 1.2）points （ P < 0.01）. Meanwhile，the VAS at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The AOFAS ankle-hindfoot score was （71.7 ± 7.8）points and （87.8 ± 6.2） points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （66.5 ± 7.5） points （ P < 0.01）. Meanwhile，the AOFAS ankle-hindfoot at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The ankle ROM was （58.4 ± 5.5）° and （70.0 ± 4.9）° at postoperative 6 months and at the last follow-up，significantly improved when compared to the preoperative （42.3 ± 8.1）° （ P < 0.01）. Meanwhile，the ankle ROM at the last follow-up was significantly improved when compared to that at postoperative 6 months （ P < 0.01）. The area of talus injury with MRI at the same level was 0.67（0.55，0.89）cm 2 at the last follow-up，significantly improved when compared to preoperative 2.64（1.98，3.68）cm 2 （ P < 0.01）. The transplantation had neither obvious defects nor joint surface steps based on CT findings. All surgical incisions were healed by first intention. There were no complications such as incision infection，skin necrosis，nonunion of osteotomy，malunion or severe ankle joint disorder except that 8 patients had residual local subchondral bone?marrow?edema-like?signal?and 2 patients showed delayed healing of medial malleolus osteotomy. Conclusion:For patients with severe OCLTs，periosteum-covered iliac crest autografts can effectively relieve ankle pain，improve ankle function，and reduce the area of injury.
ABSTRACT
Objective To explore a new microsurgical method for reconstruction of finger pulp defect.Methods From May 2008 to May 2009,10 male patients with finger pulp defect were treated in our hospital,aged from 18 to 38 years (average,26 years).The index finger was involved in 6 patients,the middle finger in 3 patients and the ring finger in 1 patient.All finger pulp defects were caused by machine injury.The defect sizes ranged from 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.Six patients suffered from single skin defect,and 4 patinets suffered from skin defect combined with nail bed laceration and distal phalangeal fractures.All patients were performed emergency operations.The defects were reconstructed by using arterialized venous flap with microsurgical suture of the dorsal branch of the proper digital nerve.The fractures were fixed by Kirschner wires.The donor area was covered with skin grafts.Results All flaps survived completely.The fractures healed 8 to 10 weeks postoperatively.All patients were followed up for 4 to 6 months,all flaps presented satisfactory appearance,normal texture,with no pigmentation at the last followup.The static 2-point discrimination of the flaps ranged from 8 to 12mm.All injured fingers obtained good recovery of flexion and extension of the distal interphalangeal joints.The nails of the fingers with laceration of nail bed grew smoothly.The nail bed with laceration grew smoothly,and some new nails could be seen.The skin grafts applied to the donor area survived completely.Conclusion The arterialized venous flap with suture of the dorsal branch of the proper digital nerve is a good method for reconstruction of finger pulp defect,which had the following advantages:slight donor injury,low anesthesia risk,simple operative technique,and satisfactory postoperative function and appearance.