Clinical treatment of the stenosing tenovaginitis of flexor digitorum by micro-wound technique using hooked needle-shaped surgical knife.

OBJECTIVE: To observe the therapeutic effect and safety of using the hooked needle-shaped knife to treat the stenosing tenovaginitis of flexor digitorum. METHODS: Sixty outpatients were divided into a treatment group of 30 cases treated by using the hooked needle-shaped knife, and a control group of 30 cases treated by block therapy. 6 months later, the alleviation of pain in the affected finger during movement, under pressure, traction and finger-bending anti-resistance was compared before and after treatment. RESULTS: The alleviation of pain during movement, under pressure, traction and finger-bending anti-resistance was much better in the treatment group than that of the control group (P < 0.01), with a effective rate of 93.3% in the treatment group and 80.0% in the control group (P < 0.01). CONCLUSION: The micro-wound technique using the hooked needle-shaped knife has definite effect and safety for stenosing tenovaginitis of flexor digitorum.

[Case control study of hook needle knife for the treatment of stenosing tenovaginitis of flexor digitorum].

OBJECTIVE: To investigate the effect and safety of the hook needle knife for the treatment of stenosing tenovaginitis of flexor digitorum. METHODS: From September 2007 to September 2008, 60 outpatients with stenosing tenovaginitis of flexor digitorum were randomized divided into the treatment group and the control group, 30 cases in each group. Among the patients, 44 patients were female and 16 patients were male, aged from 34 to 69 years, averaged 56 years, the duration of disease ranged from 1 month to 1 year, averaged 3 months. All the patients were treated with hook needle knife and local-blocking respectively. The patients were followed up for 6 months, and the relief of moving-pain, tender-pain, stretching-pain and resist-ing--pain were observed respectively. All the patients were evaluated by the symptoms with numerical rating scale. RESULTS: The relief of moving-pain, tender-pain, stretching-pain and resisting-pain in the treatment group were significantly better than those of the control group; and the therapeutic effects of treatment group were better than those of the control group. CONCLUSION: The method for treating stenosing tenovaginitis of flexor digitorum with hook needle knife has advantages of definite effects, micro-invasion and safety.

Long term efficacy of minimal incision osteotomy for hallux abducto valgus.

OBJECTIVE: To observe and evaluate the long-term results of minimal incision osteotomy for hallux abducto valgus. METHODS: From February 1995 to May 1999, 372 cases (705 feet) with hallux abducto valgus were treated with minimal incision osteotomy. Seventy-nine patients (150 feet) were followed up for more than five years (mean 7.5; range, 5.3-13.2 years) after surgery. The preoperative and postoperative hallux abducto valgus angles (HVA), intermetatarsal angles (IMA), tibial sesamoid position (TSP), American Orthopaedic Foot And Ankle Society (AOFAS) score, range of movement of the first metatarsophalangeal joint and lateral metatarsalgia were observed, measured and evaluated. RESULTS: Based on clinic curative effect evaluation criterion, 56 feet (37.3%) were excellent, 88 feet (58.7%) good, 6 feet (4.0%) fair. The postoperative mean AOFAS score was 84.20 ± 4.32 points. The mean HVA decreased from 33.28° to 12.31° and the mean IMA1-2 from 11.75° to 6.80°. The TSP was corrected from an average preoperative grade of 4.29 to a grade of 3.07 by final follow-up. There was no nonunion or delayed union, no avascular necrosis, no infection, and no hallux varus. Numbness in the big toe was found in 4 feet (2.7%). The range of motion of the first metatarsophalangeal joint decreased from 70.20° to 69.53°. Of 97 feet (64.7%) with pre-operative 2-5 metatarsalgia, this had disappeared in 35 feet, improved in 54 feet and was aggravated in 8 feet postoperatively. CONCLUSION: Minimal incision osteotomy is a simple and reliable technique for treating hallux abducto valgus with minimal complications.

[Swanson double-stem silicone implant arthroplasty in the treatment of Freiberg disease].

OBJECTIVE: To observe the short-term results of Swanson double-stem silicone implant arthroplasty in the treatment of late stage Freiberg disease. METHODS: From July 2006 to December 2007, Swanson double-stem silicone implant arthroplasty was performed on 13 patients, 11 male (1 foot) and 12 females (17 feet), suffering from late stage Freiberg diseases. All the cases were the second metatarsophalangeal joints. According to the Smillie classification, 11 feet present with grade 4 osteonecrosis, 7 feet with grade 5. The AOFAS scoring system was used for clinical assessment. All the patients were followed up for an average of 11.3 months (3 to 17 months). RESULTS: The mean preoperative and postoperative AOFAS scores were (50.06 +/- 9.59) and (77.50 +/- 4.99), respectively (P<0.05). The complaint of pain with joint motion was decreased in all patients. The postoperative passive range of motion of joints improved significantly. CONCLUSION: Swanson double-stem silicone implant arthroplasty yields satisfied short-term results in late stage Freiberg disease, which is effective to improve range of motion and relieve pain of joint.

[Observation on pathological changes of the medial aspect of the first metatarsal head of hallux valgus].

OBJECTIVE: To observe pathological characteristic of bone and soft tissue of the medial aspect of the first metatarsal head in order to investigate the pathogenesis of hallux valgus. METHODS: One hundred and twenty-three patients with hallux valgus (235 feet) were obtained from August 2003 to December 2004 in our department. The bone and soft tissue of the medial aspect of the first metatarsal head were taken out from the incision. The pathological conditions of specimen were observed by HE stain. RESULTS: The pathological changes included: degeneration and desmoplasia around the attachment point of tendon and joint capsule, reactive hyperplasia of periost, decreasing of bone trabecula, cartilaginification of periost, cortical bone and tendon insertion, bone formation and osteoclasts response. CONCLUSION: The pathological changes of the medial aspect of the first metatarsal head of hallux valgus presented extensive chronic inflammation.