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Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement (TVR) under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass (during June 2010 to December 2021) in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery (prevention group) and patients not taking prokinetic agents within three days after surgery (control group). Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group (P<0.05). The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group (P<0.05). Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients.
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Objective:To investigate the clinical effects of the modified posteromedial approach combined with the anterolateral approach in the treatment of posterior pilon fractures in the supine position.Methods:A retrospective was conducted to analyze the clinical data of 54 patients [45 males and 9 females with an age of (47.7 ± 13.1) years] who had been treated surgically for posterior pilon fractures from January 2016 to December 2020 at Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into 2 groups according to their surgical positions: a supine group of 24 patients (the modified posteromedial approach combined with the anterolateral approach in the supine position) and a prone group of 30 patients (the posteromedial approach combined with the anterolateral approach in the prone position). The 2 groups were compared in terms of operation time, hospitalization time, radiographic outcomes (bone union time and ratio of congruent articular reduction), range of ankle motion, and postoperative complications. The post-operative function was evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ) and the visual analogue scale (VAS).Results:There was no statistically significant difference between the 2 groups in the general clinical data before operation, showing comparability ( P>0.05). The mean follow-up time was (19.4 ± 4.4) months for the supine group and (17.8 ± 4.2) months for the prone group. The operation time, hospitalization time, bone union time, rate of fixation of syndesmosis and ratio of congruent articular reduction were (90.8 ± 9.9) min, (9.5 ± 2.4) d, (8.4 ± 1.4) weeks, 33.3% (8/24) and 95.8% (23/24) in the supine group, and (89.1 ± 10.8) min, (9.5 ± 2.5) d, (8.1 ± 1.4) weeks, 53.3% (16/30) and 96.6% (29/30) in the prone group, showing no significant differences (all P>0.05). At the last follow-up, the dorsiflexion and plantar flexion of the ankle, VAS, and MOXFQ scores for pain, walking and social capability were, respectively, 15.0° ± 2.1°, 26.1° ± 4.2°, (1.0 ± 0.5) points, 20.0(0, 30.0) points, (16.5 ± 13.2) points and 12.5(0, 18.8) points in the supine group, and 15.7° ± 1.6°, 27° ± 4.0°, (1.3 ± 0.7) points, 12.5(10.0, 30.0) points, (19.0 ± 11.5) points and 15.6(6.3, 25.0) points in the prone group, showing no significant differences ( P>0.05). The total incidence of complications was 8.3% (2/24) in the supine group and 3.3% (1/30) in the prone group, showing no significant difference either ( P>0.05). Conclusion:In the treatment of posterior pilon fractures, as the modified posteromedial approach combined with the anterolateral approach in the supine position is equivalent to the posteromedial and the posterolateral approaches in the prone position in terms of reduction quality, bone union time, functional outcomes and complications, it can be used as an alternative choice.
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Objective:To observe the curative effects and complications of open reduction and fixation with cannulated screws and an augmented plate for Pauwels type Ⅲ femoral neck fractures.Methods:A retrospective study was conducted to analyze the data of 8 patients with fresh Pauwels Ⅲ femoral neck fracture who had been treated from January 2015 to October 2018 at Department of Trauma and Orthopaedics, Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine. There were 7 males and 1 female with an age of (47.7±14.0) years. The Pauwels angle ranged from 50° to 70° in 6 cases and was >70° in 2 cases. As the original closed reduction was not ideal in all the patients, open reduction via the modified Smith-Petersen approach and fixation with cannulated screws and an augmented plate were performed. Fracture healing, Harris hip score, and complications were followed up at 1 month, 6 months, 1 year, and 3 years postoperatively.Results:At 1 month after operation: 8 patients were followed up, their Harris hip score was (38.4±3.6) points, and there were 7 cases of femoral neck shortening and 1 case of incision fat liquefaction. At 6 months after operation: 7 patients were followed up, their Harris hip score was (70.6±2.8) points, and 1 patient healed anatomically, 4 patients healed with shortening, and 2 patients healed with delay and shortening. Femoral neck shortening, withdrawal of cannulated screws, and screw loosening within the augmented plate were all increased compared with 1 month after operation. At 1 year after operation: 7 patients were followed up, their Harris hip score was (85.5±4.4) points, there were no significant changes in fracture healing or complications compared with 6 months after operation. At 3 years after operation: the patient lost to prior follow-up died of heart disease 34 months after operation, 1 patient had to undergo total hip arthroplasty due to fracture nonunion and cutout of cannulated screws at 16 months after operation, and the other 6 patients had a Harris hip score of (93.6±2.5) points. Of the 6 patients, femoral neck fracture healed in 5 (shortening healing in 4, including 1 case complicated with femoral head necrosis, and anatomical healing in 1) but did not in one.Conclusions:In the treatment of Pauwels type Ⅲ femoral neck fractures, open reduction and fixation with cannulated screws and an augmented plate does not lead to ideal curative effects. The main complication is shortening of the femoral neck. The auxiliary role of augmented plate fixation is not obvious.
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【Objective】 To investigate the effect and mechanism of achyranthes bidentata polysaccharides (ABPS) on the differentiation of bone mesenchymal stem cells (BMSCs) into nucleus pulposus-like cells. 【Methods】 Five 4-week-old SD rats were sacrificed and their BMSCs were isolated and purified by repeated adherent method. The third-generation BMSCs were treated with different concentrations of ABPS for 48 h. The cell viability was detected by MTT method. The highest concentration of ABPS was selected for subsequent experiments. According to different treatment methods, cells were divided into control group (conventional culture), ABPS group (200 mg/L of ABPS), Notch1 group (transfected with Notch1), Notch1 negative control group (transfected with Notch1 negative control), and ABPS+Notch1 group (200 mg/L of ABPS was added after transfection with Notch1). After 14 days of induction, the cell survival rate was measured by MTT method. CollagenⅡ was detected by immunohistochemical staining. The mRNA and protein expression levels of collagenⅡ, aggrecan, Notch1 and Hes1 were detected by qPCR and Western Blotting respectively. The glucosaminoglycan (GAG) was detected by alcian blue method on the 1st, 4th, 7th, 10th and 14th day of cell culture. 【Results】 After BMSCs were treated with 400 mg/L of ABPS for 48 h, the cell survival rate was significantly lower than that in the control group (P<0.05). When the concentration was ≤200 mg/L, ABPS had no significant toxic effect on the growth of BMSCs. After 14 days of induction, compared with the control group, A value, GAG content in the medium, the expressions of collagen II and aggrecan mRNA and protein in the ABPS group were increased, and the expressions of Notch1 and Hes1 mRNA and protein were decreased (P<0.05). The relative cell viability, GAG content in the medium, the expressions of collagen II and aggrecan mRNA and protein in the Notch1 group were decreased, and the expressions of Notch1 and Hes1 mRNA and protein were increased (P<0.05). ABPS+Notch1 could partially reverse the inhibitory effect of Notch1 overexpression on the differentiation of BMSCs into nucleus pulposus-like cells. 【Conclusion】 ABPS can promote the differentiation of BMSCs into nucleus pulposus-like cells, and the mechanism may be related to the inhibition of Notch1 pathway.
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Depression has become a serious global public health problem due to its high incidence and great harm, and has aroused the attention of the society. Ketamine, a commonly used intravenous anesthetic and analgesic in clinical practice, has been found to have unique advantages in antidepressant therapy in recent years. With the development of research, the enantiomeric isomers of ketamine, (S)-ketamine and (R)ketamine have entered the research field of antidepressant therapy. In this paper, we reviewed the progress of research on the antidepressant effects and mechanisms of ketamine, (S )-ketamine and (R)-ketamine, and provide a brief overview of the antidepressant effects of metabolites of ketamine, thereby deepening the understanding of the readers in the field of antidepressant effects of ketamine.
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Objective:To explore the long-term clinical efficacy of subtalar arthrodesis for treating sinus tarsi syndrome (STS) with peroneal spasm.Methods:Clinical informationof 32 patients with sinus tarsi syndrome complicated with peroneal spasm who were treated by subtalar arthrodesis from January 2006 to December 2016 was retrospectively analysed. There were 19 males and 13 females, aged 29.3±10.9 y (range: 13-56 y), and course of disease is 2.1±1.7 y (range: 1-10 y). All patients suffered from tarsal sinus pain and intractable peroneal spasm. The aetiology was foot or ankle inversion sprainin 25 patients, lower limb nerve injury in four patients, and ambiguous causes in three patients.The patients were divided into three groups according to their initial symptoms. Group A: Patients with simple peroneal spasm underwent tarsal sinus debridement firstly and subtalar joint fusion after symptom recurrence. Group B: Patients with peroneal spasm combined with other symptomsunderwent sinus tarsal cleansing and other symptomatic operations, and received subtalar joint fusion after symptoms recurred. Group C: Patients with peroneal spastic flat foot were treated withsubtalar joint fusion directly.Preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, visual analogue scale (VAS) scores for pain during daily activities, and 36-item short form health survey (SF-36) scoreswere investigated.Results:32 cases were successfully completed operation, following-up 87 (40, 133) months. Group A(14 cases): The patients were treated withsinus tarsi debridement first. But their symptoms recurred in an average of 7.7 months after surgery. Later they received subtalar joint fusion. Group B (15 cases): In addition to tarsal sinus debridement, 3 cases were undergone tarsal coalitions resection, 3 cases were got denervation of tarsal sinus, 6 cases were received subtalar joint stabilization, and 3 cases were released their peroneal tendons. Their symptoms recurred in an average of 6.4 months after surgery, and they eventually were undergone subtalar arthrodesis. Group C (3 cases): Their initial symptoms were severe, manifested as rigid flat feet caused by peroneal tendons spasm, so they directly underwent subtalar joint fusion. The average AOFAS ankle and hindfoot scores for all patients increased from 27.86±10.79 points before treatment to 86.34±7.17 points at the last follow-up after operation ( t=23.505, P<0.05). The VAS scores decreased from 8.00±1.57 points before treatment to 1.91±1.06 points at the last follow-up after operation ( t=18.407, P<0.05). The SF-36 scores increased from 35.84±12.12 points before treatment to 86.20±10.32 points at the last follow-up after operation ( t=24.203, P<0.05). Conclusion:Sinus tarsi syndrome with peroneal spasm due to its complicated etiology and pathogenesis can give priority to sinus tarsal debridement or other symptomatic surgeries. If the symptoms recur, subtalar arthrodesis can be an alternative choice to achieve the long-term effects.
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Objective@#To investigate clinical value of ankle arthroscopy in diagnosis of type Danis-Weber B ankle fracture with the distal tibiofibular syndesmosis injury.@*Methods@#From August 2014 to January 2018, a total of 52 cases of type Danis-Weber B ankle fractures with an average age of 35.37±11.19 years, including 31 males and 21 females were treated. Each patient underwent preoperative assessment, according to the patient's clinical manifestations and imaging examination before operation. The Cotton test and the external rotation test were conducted in the C arm X-ray to evaluate whether there is the distal tibiofibular syndesmosis injury. All fractures were treated with open reduction and internal fixation. Repair was conducted with 3.5 mm wire anchor and nail for triangular ligament injury. The Cotton test and external rotation test were performed under ankle arthroscopy. The injury of the lower tibiofibular syndesmosis was observed and evaluated by cotton test and external rotation test in patients who were found to be associated with lower tibiofibular joint injury. After internal fixation of fracture and repair of tibiofibular syndesmosis injury with TightRope, the repair effects of tibiofibular syndesmosis injury was observed under direct vision of ankle arthroscopy. The VAS score, AOFAS score and Baird-Jackson score was used as an index to observe the pain and ankle function before and after operation for 12 months follow-up.@*Results@#Preoperative X-ray showed 19 cases of lower tibiofibular joint injury. Preoperative CT showed 28 cases of lower tibiofibular joint injury. Preoperative MRI showed 39 cases of lower tibiofibular joint injury. A total of 36 cases of joint injury of lower tibiofibular syndesmosis were confirmed under arthroscopy of ankle. After repair of tibiofibular syndesmosis injury with TightRope, complete reduction and stability of inferior tibiofibular syndesmosis were confirmed under ankle arthroscopy. At 12 months after operation, the VAS score decreased from 8.13±1.32 points preoperation to 0.75±0.73 points after operation. The AOFAS and Baird-Jackson scores increased from 26.59±3.35 points, 16.44±3.63 points preoperation to 94.36±3.03 points, 90.29±6.45 points after operation, respectively. There was significant difference before and after operation (P<0.05). The postoperative VAS score, AOFAS score and Baird-Jackson score of 16 patients without lower tibiofibular ligament injury were confirmed in the ankle arthroscopy group, namely 0.58±0.67 points, 95.27±4.67 points, 91.98±9.23 points.@*Conclusion@#Ankle arthroscopy can be used to observe the injury of tibiofibular syndesmosis under direct vision. The positive rate of diagnosis of inferior tibiofibular syndesmosis injury was 69.2% (36/52). It can provide reliable evidence for correct diagnosis and treatment of type Danis-Weber B ankle fracture with lower tibiofibular joint injury with significant meaning in selecting operative methods and in evaluating the effect of lower tibiofibular ligament repair.
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Objective To investigate clinical value of ankle arthroscopy in diagnosis of type Danis-Weber B ankle fracture with the distal tibiofibular syndesmosis injury.Methods From August 2014 to January 2018,a total of 52 cases of type Danis-Weber B ankle fractures with an average age of 35.37± 11.19 years,including 31 males and 21 females were treated.Each patient underwent preoperative assessment,according to the patient's clinical manifestations and imaging examination before operation.The Cotton test and the external rotation test were conducted in the C arm X-ray to evaluate whether there is the distal tibiofibular syndesmosis injury.All fractures were treated with open reduction and internal fixation.Repair was conducted with 3.5 mm wire anchor and nail for triangular ligament injury.The Cotton test and external rotation test were performed under ankle arthroscopy.The injury of the lower tibiofibular syndesmosis was observed and evaluated by cotton test and external rotation test in patients who were found to be associated with lower tibiofibular joint injury.After internal fixation of fracture and repair of tibiofibular syndesmosis injury with TightRope,the repair effects of tibiofibular syndesmosis injury was observed under direct vision of ankle arthroscopy.The VAS score,AOFAS score and Baird-Jackson score was used as an index to observe the pain and ankle function before and after operation for 12 months follow-up.Results Preoperative X-ray showed 19 cases of lower tibiofibular joint injury.Preoperative CT showed 28 cases of lower tibiofibular joint injury.Preoperative MRI showed 39 cases of lower tibiofibular joint injury.A total of 36 cases of joint injury of lower tibiofibular syndesmosis were confirmed under arthroscopy of ankle.After repair of tibiofibular syndesmosis injury with TightRope,complete reduction and stability of inferior tibiofibular syndesmosis were confirmed under ankle arthroscopy.At 12 months after operation,the VAS score decreased from 8.13 ± 1.32 points preoperation to 0.75±0.73 points after operation.The AOFAS and Baird-Jackson scores increased from 26.59±3.35 points,16.44±3.63 points preoperation to 94.36±3.03 points,90.29±6.45 points after operation,respectively.There was significant difference before and after operation (P<0.05).The postoperative VAS score,AOFAS score and Baird-Jackson score of 16 patients without lower tibiofibular ligament injury were confirmed in the ankle arthroscopy group,namely 0.58±0.67 points,95.27±4.67 points,91.98±9.23 points.Conclusion Ankle arthroscopy can be used to observe the injury of tibiofibular syndesmosis under direct vision.The positive rate of diagnosis of inferior tibiofibular syndesmosis injury was 69.2% (36/52).It can provide reliable evidence for correct diagnosis and treatment of type Danis-Weber B ankle fracture with lower tibiofibular joint injury with significant meaning in selecting operative methods and in evaluating the effect of lower tibiofibular ligament repair.
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Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1% (13/35),54.3% (19/35),74.3% (26/35) and 68.6% (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI > ankle arthroscopy > CT > C-arm roentgenography,with significant differences between them (P < 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.
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Objective To analyze histomorphometrical characteristics of the bone and bone marrow tissues of the lumbar vertebrae in rabbits with fluoride treatment,and its correlation with signal intensity of MRI.Methods Forty New Zealand albino rabbits aged three months old were randomly divided into fluoride exposure of 30 cases and control of 10 cases,male and female,half each.One hundred milligrams of sodium fluoride were added to the municipal water each liter (fluoride content 100 mg/L) as drinking waterto fluorine for 180 days.Twenty-four of 30 cases with fluoride exposure had complete data (male10 casesand female14 cases).The same municipal water was used as control drinking water (fluoride content < 0.9 mg/L).Eight of 10 cases with control had complete data (male andfemale in half).Twenty-four cases with fluoride treatment and complete data were classified into sensitive and resistant type according to the MRI signal intensity of the lumbar vertebra.Histomorphometrics of the vertebra and its correlation with the MRI signal intensity,and sensitivity in early diagnosis of osteofluorosis and feasibility of susceptibility to osteofluorosis detected with MRI were analyzed.Results Theratios of trabecular bone volume (BV),hematopoietic cell volume (HV) and fluid volume (FV) in bone marrow tissue to total cavernous tissue volume (TT) in group with fluoride treatment were 18.3%±2.6%,45.2%±6.0% and 10.4%±5.7% respectively.These were 14.5%±2.8%,36.3%±7.3% and 6.2%±2.1% in control group respectively.These parameters in fluoride group were significantly increased compared to control group.The ratio 26.0%± 8.0% of adipocyte volume (AV) to TV in fluoride group was significantly lower than that 43.3%±5.6% in control group.Two of 24 cases with fluoride exposure (8.3%,2/24) were sensitive and the remaining 22 (91.7%,22/24) were in resistance.The valuesof BV/TT,HV/TV and FV/TV were considered to be sensitive,resistant and control from large to small,while AV/TV value were opposite.A comparison resuhs of signal intensity in MRI showed that vertebra T1WI contrast to noise ratio (CNR) in the sensitive was the minimum (3.0±0.8),followed by resistance (21.3±3.8) andmaximum in the control (28.3±3.1),but CNR of FsT2WIwas opposite.There were positive associations between T1WI and AV/TV,FV/TV and BV/TV,and between FsT2WI and FV/TV and BV/ TV.There were inverse associationsbetween FsT2WI and AV/TV.Theoptimal threshold value of the vertebra T1WI CNR was 23.2 or lessin early diagnosis of skeletal fluorosis,with sensitivity of 83.3% and specificity of 100%.FsT2WI was 5.7 or more,with sensitivity of 45.8% and specificity of 100%.Conclusion The pathogenesis of osteofluorosis is relative to changes in bone marrow microenvironment and cells number in bone marrow tissue,and is correlated to MRI signal intensity.
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Objective To investigate the clinical curative result of the new method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation.Methods From March 2006 to October 2012,21 patients (15 male,6 female) with chronic peroneal tendon subluxation via a novel method of postermedial deepen of the fibular groove.In this group:Ⅰ grade 5 cases;Ⅱ grade 9 cases;Ⅲ grade 5 cases;Ⅳ grade 2 cases.All patients were followed up for at least 24 months.The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score and visual analogue score (VAS) were used to evaluate the clinical outcomes.Operation time,time to heal and complications were also recorded.Results The average operation time was 50 minutes (30-70 minutes).The blood loss was 30-60 ml,average 40 ml.All incisions healed after operation,no case of incision infection,skin necrosis and sural nerve,vascular injuryed.Mean AOFAS score was significantly increased from (55.2±7.1) preoperative to (93.6±5.6) postoperative.15 patients with excellent,good for 1 cases.The excellent and good rate was 100% (16/16).VAS score by an average of (5.3±2.1) points down to (1.2±1.1) points postperative.All the patients can wear normal shoes postoperative,waking with normal gait.No patients had peroneal tendon tenosynovitis,tendon adhesion,fracture of lateral malleolus and other serious complications,no dislocation recurrent,strength of the peroneal muscle returns to normal.Conclusion The novel method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation was safe and effective for ankle instability with a relatively short time.
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Objective To evaluate the influence of simple subtalar arthrodesis to the motion and degeneration of midfoot.Methods Data of 37 patients (27 males,10 females) with an average age of 42.6 years who had undergone subtalar joint fusion from January 1996 to August 2011 were retrospectively analyzed.The MOS item short form health survey (SF-36),American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score were used.Midfoot sagittal and coronal motion were measured on ankle radiographs of maximum plantar flexion and dorsiflexion.On sagittal plane,the Meary angle was measured and the bilateral tarsometatarsal joints mobility was compared.On coronal plane,tibio-plantar angles (TPA) on 30 degrees varus slope and 30 degrees valgus slope were respectively measured on the anterio-posterior ankle X-ray films to observe the changes of midfoot activities.Besides,single photon emission computed tomography/computed tomography (SPECT/CT) of bilateral foot and ankle was taken to estimate the degeneration of midfoot joint.Results All the 37 patients were followed-up,with mean follow-up period of 9.2 years.The average SF-36 scores was increased from 34.26± 11.02 points preoperatively to 77.59± 12.57 points postoperatively.The average AOFAS midfoot scores were 86.14± 16.79 points preoperatively and 86.43± 16.70 points postoperatively without any statistical significant difference.On sagittal plane,medial tarsometatarsal joints mobility was limited by 20%.According to coronal plane of varus slope,the average TPA of healthy side and operated side were 61.32° and 64.91°,respectively,so the varus mobility of operated side was limited by 12.5%.While standing on the valgus slope,the average TPA of both sides were 76.54° and 82.28°,which indicated that valgus mobility of operated side was reduced by 42.6%.35.1% patients of talonavicular joint,56.8% patients of calcaneocuboid joint,and 27.0% patients of metatarsal cuboid joint were found mild joint degeneration on SPECT/CT images without any clinical symptoms.Conclusion Subtalar arthrodesis can affect midfoot with less limit of sagittal mobility and more limit of coronal movement.And the lateral joints degeneration is more likely to happen for their compensatory activity.
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Objective To study on the different results of a minimally invasive method to reconstruct the ligaments of the lateral ankle using semitendinosus tendon autograft and tendon allograft.Methods Data of 68 patients with chronic ankle instability who had undergone lateral ligament reconstruction from September 2006 to June 2011 were retrospectively analyzed.In the group of semitendinosus autograft,there were 32 patients (19 males,13 females) with an average age of 32.4 years old.Semitendinosus was harvested through 2 small knee incisions.While in the group of tendon allograft,there were 36 patients (22 males,14 females) with an average age of 34.2 years old.For the ankle reconstruction,4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip,the talar neck,and the middle of the calcaneus.Anatomical reconstruction of the anterior talofibular ligament and calcaneofibular ligament was then performed through these small incisions.AOFAS questionnaires were used to measure clinical outcomes,donor site morbidity and patients' satisfaction.Preoperative and postoperative stress tests were performed and radiographic parameters were measured.Results The average operation time of the autograft group 85.5 ± 11.5 min was significantly longer than that in the allograft group 58.1±10.2 min,but the fever days in the latter 5.5±1.5 d was significantly longer than in the former 2.5±1.2 d.In autograft group,23 patients got followed up,and the mean period of follow-up was 33.5±6.7 months.The mean AOFAS score increased from 62.3±8.2 to 95.1 ±7.5.In allograft group,26 patients got followed up,and the mean period of follow-up was 28.5±6.7 months.The mean AOFAS score increased from 60.2±8.4 to 94.8±5.5.There were 5 patients (3 of autugraft group and 2 of allograft group) with residual instability on uneven ground.One case of the autologous group had instability in daily life.No patient presented weakness or disability in the donor site.The satisfaction level of the autograft group was excellent in 16,good in 5 and bad in 2.Significant improvement in stress radiographic parameters was noted for the talar tilt angle,with reduction from a mean of 14.0° to 3.8°; anterior talar displacement reduced from a mean of 12.3 to 4.6 mm.The satisfaction level of the allograft group was excellent in 17,good in 5 and bad in 4.The talar tilt angle reduced from 13.0° to 3.6°; anterior talar displacement reduced from 11.5 to 4.3 mm.Conclusion There is no differences in efficacy could we found in using these 2 kinds of materials.The process of healing and rehabilitation of tendon autograft is slightly faster than the tendon allograft,but the allograft tendon has many advantages such as limited injury,simple procedure andavoiding of donor site morbidity.
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Objective To evaluate the significance of weight-bearing lateral radiographs in evaluation of malunited frac-tures of the ankle. Methods 17 patients with malunited fractures of the ankle were treated by different reconstructive operations be-tween March 2010 and October 2012, including 9 females and 8 males, aged from 17 to 64 years. According to the Takakura classifi-cation of ankle arthritis, there were 7 patients in grade 1, 4 in grade 2 and 6 in grade 3. Simple open reduction and internal fixation were performed in 5 patients, supramalleolar tibial osteotomy in 5, lengthening osteotomy of the fibula in 2, supramalleolar tibial and fibular osteotomy in 5. Tibiofibular clear space on the anteroposterior radiograph. Medial clear space, tibiofibular clear space and tib-iofibular overlap on ankle mortise radiographs were compared preoperatively and at last follow-up. Tibial lateral surface angle (TLS), the offset of the center of talar rotation from the tibial axis, and the displacement of tibiotalar articular surface center on weight-bear-ing lateral X-ray were also compared preoperatively and at last follow-up. AOFAS score was used to evaluate the function of the ankle. Results The duration of follow-up was 9 to 32 months. Bone healing was observed in all patients, and the average healing time was 11 to 14 weeks. Ankle joint degeneration grade had no exacerbation. The medial clear space, tibiofibular clear space and tibiofibular overlap had no significant difference between the pre and postoperative. Statistically significant change was seen postoperatively in the values of TLS (76.9°±4.1° vs 80.9°±5.2°). The offset of the center of rotation from the tibial axis and the displacement of tibiotalar articular surface center were changed from 10.8 ± 2.1 mm to 2.0 ± 0.5 mm and 4.5 ± 1.5 mm to 2.2 ± 1.0 mm, respectively. The average AOFAS score was improved from 45.7 ± 15.9 points preoperatively to 82.0 ± 9.9 points postoperatively. Conclusion Weight-bearing lateral radiographs can be used to judge the ankle restoration. Even if the mortise radiograph had relative good realignment, it may ap-pear obvious deformity on lateral radiographs. Good reduction of lateral radiographs requires that the mid axis of the tibia should pass through the center of talar rotation and tibiotalar articular surface be parallel on the lateral radiograph.
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Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P < O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8%).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.
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Objective To evaluate the clinical results of surgical treatment of isolated fractures of the sustentaculum tali of calcaneus via medial approach.Methods The data of 23 patients with isolated fractures of the sustentaculum tali of calcaneus was retrospectively analyzed who were treated with open reduction and internal fixation with cannulated screw or Kirschner wire via medial approach from September 2006 to March 2011.There were 19 males and 4 females,with an average age of 26.3 years (range,17-41 years).Associated injuries included 4 cases of talus fracture,4 of metatarsal fracture,and 3 of cuboid fracture.The functions of hiudfoot were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores pre-operation and post-operation respectively.Results Fifteen patients got followed up with an average 20.5 months (10-56 months).Thirteen patients were rated as good,2 as excellent,and the excellent and good rate was 100%(15/15).All the fractures were stabilized reliably,and got clinical union with no obvious complications occurred.Time of fracture union was 8-10 weeks,with an average of 8.5 weeks.Three patients felt mild transient pain during the recovery of walking,but their pain disappeared quickly after physical therapy.No patients developed wound infection,nonunion and other complications.Conclusion For isolated fractures of the sustentaculum tali of caleaneus with articular surface displaced greater than 1 mm or involving the articular surface of middle subtalar joint,open reduction and internal fixation operation via medial approach under direct visualization is recommendable.
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Objective To evaluate the curative effect and related factors of the treatment for the osteochondral lesion of talus (OLT) by the osteochondral autografts harvested from medial femoral condyle of the ipsilateral knee.Methods The data of 15 OLT patients was retrospectively analyzed who received the operation during July 2009 to November 2012.There were 8 males,and 7 females,with an average age of 49.6±17.2 years (range,19-73 years).International Knee Documentation Committee (IKDC) and Lysholm score were used to evaluate the knee function preoperatively and postoperatively respectively.The ankle functions and pain were assessed according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind-foot score and visual analogue scale (VAS) preoperatively and postoperatively respectively.Correlations between age or follow-up duration and all the score increments were further analyzed by Spearman rank correlation test.Results Twelve patients complete the follow up,with an average duration of 21.8±10.4 months.The average IKDC,Lysholm,AOFAS,and VAS were 90.91±6.44,95.33±8.00,63.58±18.50,and 7.25±1.54 respectively before operation,and 85.63±11.89,90.75±11.83,90.33±4.98,2.17±1.19 respectively after operation.Correlation coefficients of age between AOFAS,Lysholm,and IKDC score increments were -0.74,-0.63,and-0.76,respectively.There were 4 cases which received excellent effect (33%),5 cases (42%) good and 3 (25%) fair.Conclusion The ankle joint function of patients with OLT recovered well by treated with osteochondral autografts harvested from medial femoral condyle of the ipsilateral knee operation.A correlation was found between patients' age and postoperative functional recovery of ankle and knee joint.
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ObjectiveTo evaluate effect of periarticular osteotomy in the treatment of asymmetrical ankle arthritis.MethodsSixty-five patients with asymmetrical ankle arthritis were treated with periarticular osteotomy between February 2005 and May 2011,including 43 females and 22 males,aged from 35 to 74 years (mean,55.5 years).According to the Takakura classification of ankle arthritis,there were 29 patients in grade 2,32 in grade 3 and 4 in grade 4.Supramalleolar tibial osteotomy were performed in 20 patients,supramalleolar tibial and fibular osteotomy in 12,supramalleolar osteotomy combined with calcaneal osteotomy in 30 patients,and supramalleolar tibial and fibular osteotomy combined with calcaneal osteotomy in 3patients.Forty three patients underwent ligament reconstruction procedures.Based on radiographs,the tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were compared before and after operation.AOFAS-AH score was used to evaluate the function of the ankle.ResultsFifty-nine patients were followed up for an average of 35.7 months (range,7 to 94 months).Bone healing was observed in all patients,and the average healing time was 7 to 8 weeks.The average AOFAS-AH score was improved from 49.7 points preoperatively to 78.6 points 12 months postoperatively.Tbe average TAS and TLS was improved from 86.1° and 70.0° preoperatively to 93.9° and 81.5° 6 months postoperatively,respectively.Delayed wound healing occurred in 5 patients,which was resovled after nursing care.Forty-two patients felt excellent about results,15 felt good and 2 fell fair.ConclusionPerarticular osteotomy is a sound method in the treatment of asymmetrical ankle arthritis,based on chosing proper patients.The procedure can decrease the contact pressures on the degenerated cartilage and prolong the life span of the ankle.
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The accuracy and repeatability of computer aided cervical vertebra landmarking (CACVL) were investigated in cephalogram. 120 adolescents (60 boys, 60 girls) aged from 9.1 to 17.2 years old were randomly selected. Twenty-seven landmarks from the second to fifth cervical vertebrae on the lateral cephalogram were identified. In this study, the system of CACVL was developed and used to identify and calculate the landmarks by fast marching method and parabolic curve fitting. The accuracy and repeatability in CACVL group were compared with those in two manual landmarking groups [orthodontic experts (OE) group and orthodontic novices (ON) group]. The results showed that, as for the accuracy, there was no significant difference between CACVL group and OE group no matter in x-axis or y-axis (P>0.05), but there was significant difference between CACVL group and ON group, as well as OE group and ON group in both axes (P<0.05). As for the repeatability, CACVL group was more reliable than OE group and ON group in both axes. It is concluded that CACVL has the same or higher accuracy, better repeatability and less workload than manual landmarking methods. It's reliable for cervical parameters identification on the lateral cephalogram and cervical vertebral maturation prediction in orthodontic practice and research.
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Objective To analyze the effect of ankle joint proprioceptor injury on the functional ankle instability. Methods The study enrolled 18 ( 13 males) with chronic ankle instability treated with ligament reconstruction operation. The American Orthopaedic Foot and Ankle Surgeons (AOFAS)score was used for evaluation of the function before and after operation and the balance system evaluate the proprioception function. The two ankle ligament specimens from fresh frozen body and the tissue samples from operation were used for investigation of the structure and distribution of the sensory corpuscles by using histology and immunohistoehemical staining. Results The sections were evaluated with a microscope and an image analyzer. Labeled nerve endings were mapped, measured and categorized. Type Ⅰ ( Ruffini-like ending) , type Ⅱ ( Pacinin-like corpuscle ) and type Ⅳ- (noncorpuscular) nerve endings could be identified in all the lateral ankle ligaments, with majority of types Ⅰ and Ⅱ nerve endings.These receptors were distributed primarily over the superficial ligament and near the bony attachments.There was statistical difference between preoperative and postoperative sway distance as well as between preoperative and postoperative AOFAS score. Conclusions This study suggests that the longer history,severer symptoms and lower AOFAS score may lead to the severer injury of the mechanical proprioceptors.The proprioceptor injury is correlated with ankle joint instability and the ligament reconstruction is effective to avoid the repeated injury of the proprioceptor.