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踝周组织缺损修复

闭合复位经胫后空心钛钉内固定在三踝骨折时后踝骨折的应用

目的 总结闭合复位经胫后空心钛钉内固定治疗三踝骨折时后踝骨折的临床效果。 方法 2004 年6 月－ 2007 年1 月，采用闭合复位经胫后应用空心钛钉内固定治疗三踝骨折时后踝骨折30 例。男16 例，女14 例；年龄20 ～ 65 岁，平均45 岁。左侧18 例，右侧12 例，均为闭合骨折。根据Lange-Hansen 分型：Ⅲ、Ⅳ度旋后- 外旋型17 例，Ⅳ度旋前- 外旋型10 例，Ⅱ度旋前- 外展型3 例。后踝骨折均超过关节面的25%，均合并内、外踝骨折。伤后至手术时间为5 ～ 11 d。 结果 3 例复位困难行切开复位内固定，术中见后踝为粉碎性骨折，有骨块嵌顿，不能复位。术后切口均Ⅰ期愈合。27 例获随访，随访时间12 ～ 48 个月，平均31.2 个月。骨折全部愈合，愈合时间81 ～ 108 d，平均87 d，无断钉等并发症。疗效根据Baird-Jackson 标准进行评定，优18 例，良5 例，可3 例，差1 例，优良率为85.2%。平均恢复工作时间为70 d。 结论 闭合复位经胫后空心钛钉内固定是治疗后踝骨折的有效方法之一 。

踝关节缺损的修复重建二例

腘动脉陷迫综合征外科治疗疗效分析

目的探讨外科治疗腘动脉陷迫综合征（popliteal artery entrapment syndrome，PAES）的疗效。 方法回顾分析2006年4月－2014年4月收治的14例PAES患者临床资料，其中男13例，女1例；年龄20～54岁，平均35.5岁。左侧4例，右侧9例，双侧1例。10条患肢足背动脉搏动消失，5条患肢足背动脉搏动减弱；踝肱指数0.51±0.07。病程2周～12个月，平均5.2个月。根据PAES不同诊断及分型对9例患者行腘动脉周围异常组织松解术及腔内治疗术，余5例腘动脉功能性陷迫行保守治疗。 结果1例行肌切除、闭塞动脉取栓动脉成形术者，术后5 d腘动脉再次闭塞，行插管溶栓术后再通。其余患者经手术治疗及保守治疗后踝肱指数上升至0.93±0.22，与术前比较差异有统计学意义（t=5.634，P=0.000），跛行症状均缓解。14例均获随访，随访时间5～81个月，平均29.7个月。8例行腘动脉松解术后下肢活动正常，腘动脉血流通畅；1例介入下行球囊扩张术后11个月腘动脉再狭窄，给予抗血小板、抗凝保守治疗后症状未见反复。5例保守治疗患者治疗后下肢活动正常，腘动脉血流通畅。 结论PAES患者早期确诊并及时外科干预能获较好近、中期临床疗效。

Effectiveness of Tang’s arthroscopy approach for anterior and posterior ankle impingement syndrome

ObjectiveTo investigate the effectiveness of Tang’s arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome.MethodsBetween August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang’s arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups (P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement.ResultsMedian operation time of group A was 50.5 minutes ［95%CI (49.3, 54.6)］, which was significantly shorter than that of group B ［88.5 minutes, 95%CI (76.5, 92.8)］ (Z=−4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups (t=−0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). The median subjective satisfaction score of group A was 2.0 ［95%(1.4, 1.7)］, which was better than that of group B ［2.0, 95%(1.6, 2.2)］ (Z=−2.480, P=0.013).ConclusionArthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang’s approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.

Experience sharing of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran: clinical analysis of 112 cases

ObjectiveTo analyze the safety and effectiveness of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran (ASO). MethodsThe clinical data of patients with femoropopliteal ASO were collected and analyzed. The patients were treated by ultrasound-guided endovascular intervention in the Xijing Hospital of Air Force Military Medical University, from March 2015 to June 2021. The endovascular intervention methods included the arterial balloon dilation (ABD) alone, stent implantation (SI), Rotarex mechanical thrombus removal (Abbreviationas: Rotarex), and thrombolytic catheter implantation (CDT), etc. ResultsAll 112 patients (121 affected extremities) who met the research criteria were collected. Among them, there were 13, 68, and 40 affected extremities by the Rutherford classification of 2, 3, and 4, respectively, while 41, 39, and 41 affected extremities by the Trans-Atlantic Inter-SocietyConsensus Ⅱ classification of A, B, and C, respectively. Among 121 affected extremities, 61 underwent the ABD alone, 27 underwent ABD plus Rotarex, 12 underwent ABD plus SI, 6 underwent ABD plus SI plus Rotarex, 3 underwent ABD plus SI plus CDT, 7 underwent ABD plus CDT plus Rotarex, and 5 underwent ABD plus CDT. The ultrasound-guided endovascular treatments were completed successfully in 118 affected extremities (the success rate was 97.5%), and 3 affected extremities were not completely completed by ultrasound guidance. After operation, 5 affected extremities had pseudoaneurysm and 7 affected extremities had hematoma at the puncture site, which were cured after conservative management. The ankle-brachial index (ABI) of the affected extremities immediately after surgery was statistically higher than that before surgery [0.89±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.36 (0.34, 0.38), paired t-test (t=–25.17), P<0.001]. After a follow-up of 12 months, one patient had a metatarsal amputation and one patient died (acute myocardial infarction). The restenosis rate and reintervention rate of the target lesions were 25.0% (30/120) and 15.0% (18/120) at 12 months postoperatively, and the late loss of diameter was (0.88±0.25) mm. The ABI was still higher than before surgery [0.78±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.25 (0.22, 0.27), paired t-test, t=–17.61, P<0.001]. ConclusionFrom analysis results of this data, it can be seen that, ultrasound-guided endovascular intervention is a safe and effective treatment for selective femoropopliteal ASO.

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults

ObjectiveTo investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.MethodsBetween January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness.ResultsThe operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved (t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved (t=−27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up.ConclusionIt is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

2型糖尿病患者踝肱指数临床相关因素研究

【摘要】 目的 了解踝肱指数(anklebrachial index,ABI)对诊断糖尿病下肢动脉病变的意义及其相关因素分析。 方法 对2007年5月-10月156例2型糖尿病患者测定ABI,根据ABI分为3组:低ABI组(ABIlt;0.9)、高ABI组(ABIgt;1.3)、正常组(0.9≤ABI≤1.3),测量身高、体重、血压、血糖、糖化血红蛋白、血脂、尿微量白蛋白水平。 结果 156例糖尿病患者中低ABI组37例,高ABI组16例,正常组103例。低ABI组的年龄、糖尿病病程、高血压病程、舒张压均高于正常组(Plt;0.05);高ABI组的年龄、糖尿病病程、高血压病程、收缩压、脉压、TG均高于正常组(Plt;0.05);两异常组的HDLC均较正常组降低(Plt;0.05)。高ABI组的脉压高于低ABI组,高ABI组的舒张压低于低ABI组(Plt;0.05)。行双下肢血管彩色多普勒超声检查,低ABI组、高ABI组及ABI正常组出现血管异常者分别为29例(78.38%)、13例(81.25%)和12例(1165%)。 结论 年龄、病程、血压、血脂是影响ABI的关键因素,高ABI患者和低ABI患者临床表现各有特点。

REVERSED SURAL NEUROVASCULAR FASCIO-CUTANEOUS FLAP FOR RECONSTRUCTION OF SOFT-TISSUE DEFECTS IN ANKLE AND FOOT

Objective To evaluate clinical significance of reversed sural neurovascular fasciocutaneous flap for reconstruction of softtissue defects in ankle and foot. Methods From July 1994 to December 2002, 52 cases of soft-tissuedefects in the ankle and foot were reconstructed by use of reversed sural neurovascular fascio-cutaneous flap, including 47 cases of traumatic defects, 3 cases of chronic ulcer and 2 cases of tumors. The flap area ranged from 4 cm×6 cm to 10 cm×21 cm. Results The flaps survived in 48 cases; the distal part necrosed and secondary free-skin graft were further conducted in 4 cases. All soft-tissue defects were repaired and their accompanied bone and tendon exposurehealed. Forty-six cases were followed-up for 5 months to 48 months, the color and texture of the flaps were excellent and 2point discrimination was 11-17 mm(14 mm on average).The functions of ankle joints were good.Conclusion The reversedsural neurovascular fascio-cutaneous flap is convenient in design and dissection. Its use can retained and replace vascular anostomosed flaps to certain degrees.

关节镜下治疗距骨负重面骨样骨瘤一例报告