儿童先天性马蹄内翻足术后复发原因分析

目的 分析先天性马蹄内翻足手术后复发的原因并提出预防措施。方法 对６６例８７足先天性马蹄内翻足首次手术后畸形复发的原因进行分析。结果 手术后复发的主要原因包括单纯软组织松解手术（３４足），转移肌肉发育差（９足），肌力平衡术中解剖定位错误、转移肌腱附丽点选择不当（２７足），术后石膏松脱致附丽点脱落（１７足）。结论 在彻底软件组织松解、纠正畸形的同时，选择发育良好的肌肉、正确的肌腱附丽点位置（第３楔状     

儿童先天性马蹄内翻足肌力平衡术后继发外翻原因分析

目的分析先天性马蹄内翻足肌力平衡术后继发外翻的原因并提出预防措施.方法对23例24足先天性马蹄内翻足肌力平衡术后继发外翻的原因进行分析.结果手术后继发外翻的主要原因包括肌力平衡术中解剖定位错误、转移肌腱附丽点选择不当,张力过大等.结论在彻底软组织松解、纠正畸形的同时,选择发育良好的肌肉、正确的肌腱附丽点位置(第3楔状骨为宜)及合适的张力以建立有效的肌力平衡是预防肌力平衡术后继发外翻的关键.     

儿童先天性马蹄内翻足肌力平衡术后发外翻原因分析

目的：分析先天性马蹄内翻足肌力平衡术后继发外翻的原因并提出预防措施。方法：对２３例２４足先天性马蹄内翻足肌力平衡术后继发外翻的原因进行分析。结果：手术后继发外翻的主要原因包括肌力平衡术中解剖定位错误、转移肌腱附丽点选择不当，张力过大等。结论：在彻底软组织松解、纠正畸形的同时，选择发育良好的肌肉，正确的肌腱附丽点位置（第３楔状骨为宜）及合适的张力以建立有效的肌力平衡是预防肌力平衡术后继发外翻的关键。．     

个性化软组织松解并胫后肌腱转移治疗僵硬型马蹄内翻足

目的观察个性化软组织松解并胫后肌腱前外置手术治疗儿童僵硬型马蹄内翻足的疗效。方法术前部分患儿进行分期石膏矫形,选择合适的切口,针对足部畸形的个体差异情况,对踝足部挛缩的软组织进行彻底松解及肌腱延长,恢复踝足部的正常外形和功能位,使用1～2枚克氏针进行固定,建立踝足部的静态平衡;再进行胫后肌腱转移,重建踝足部肌力的动态平衡。结果27例僵硬型马蹄内翻足患儿手术治疗后,经平均3年随访,患足均能够达到跖行步态,外形和功能恢复良好,优良率达92．78％,无一例患儿矫形复发。且患肢小腿的肌容量较之术前有明显增加。结论根据差异性,进行个性化软组织松解并胫后肌腱前外置手术治疗儿童僵硬型马蹄内翻足的方法,能够在患足畸形矫正的基础上,避免畸形复发和保持疗效的有效方法。术前分期石膏矫形有助于提高疗效。     

肌力平衡术治疗先天性马蹄内翻足远期疗效评价

【目的】探讨肌力平衡术治疗先天性马蹄内翻足(CCF)的远期疗效。【方法】将胫骨前肌附丽点外移于第三楔骨或骰骨内侧,跟腱延长,畸形严重者跖筋膜切断,足后内侧软组织松解,术后石膏固定矫形。【结果】用吉士俊百分制标准评定,82例患儿116只足随访时间5至21年,优良率达94.8%。【结论】肌力平衡术治疗CCF手术操作简便,疗效满意。     

普迪斯丝线代替钢丝在马蹄内翻足矫治手术中的应用

目的:应用普迪斯丝线代替钢丝在马蹄内翻足畸形外科矫治手术中将转移的肌腱固定于足跗骨,观察其治疗效果。方法:于2004-09/2005-01选择解放军第四军医大学西京医院骨科收治的马蹄内翻足畸形矫治手术患者133例165足,主要手术方式是软组织松解矫正畸形、转移胫前肌或胫后肌肌腱至第三楔状骨、建立肌动力平衡,所用将肌腱固定于骨的材料是普迪斯丝线。用普迪斯丝线编织拟转移的肌腱,经第三楔状骨钻骨洞,将肌腱引入骨洞中,调整张力合适(使足背伸在5°～10°位)后,丝线用钮扣固定于足底,保持一定的张力,术后长腿管型石膏固定,术后2周时更换石膏,继续固定4周。结果:术后随访时间为2个月～3年,其中术后2个月随访133例,术后6个月随访133例,术后1年随访102例,术后3年随访86例。①治疗效果:133例患者165足中,155足术后2周更换石膏时,检查转移的肌腱能维持良好的张力,能使足背伸在5°～10°位,术后6周拆除石膏,开始功能锻炼,转移肌肉能维持良好足背伸功能;8足胫前肌肌力<Ⅲ级,转移后不能发挥足背伸的功能,畸形复发,再次手术转移胫后肌腱,畸形纠正,足背伸的功能良好。1足复发病例且年龄超过10岁,畸形较重且僵硬,肌腱转移后踝关节活动度不佳,畸形复发,后改行截骨及外固定架矫形;1足系小儿麻痹后遗症病例且年龄超过10岁,转移后不能发挥足背伸的功能,畸形复发,后行关节融合手术。②材料的不良事件和副反应:全部病例没有出现排异反应及手术切口并发症,石膏外固定周期内未出现普迪斯丝线断裂情况和石膏松脱情况。结论:普迪斯丝线可作为一种选择,代替钢丝在马蹄内翻足畸形外科矫治手术操作中将转移的肌腱固定于足跗骨,治疗效果好。     

先天性马蹄内翻足的肌腱移植及软组织松解治疗

目的：总结和分析先天性马蹄内翻足的诊治现状及研究进展。方法：应用计算机检索Medline 1949—01／2005—10有关先天性马蹄内翻足治疗方面的文献，检索词“congenital clubfoot，tendon transfer”，限定文献语言种类为English。同时计算机检索中国期刊全文数据库1949-01/2005—12有关先天性马蹄内翻足治疗方面的文献，检索词为“先天性马蹄内翻足，肌腱转移术”，并限定语言种类为中文。对资料进行初审，查找全文，排除重复文章。共纳入30篇符合标准的文献。结果：先天性马蹄内翻足治疗包括保守及手术治疗，对于中重度者宜早期治疗行肌腱移植及软组织松解，建立早期动态肌力平衡。随着时代的发展，微创技术的应用，外固定架将起重要作用。结论：早期行肌腱移植及软组织松解建立动态肌力平衡，结合外固定架的应用是一项新的突破，使中重度先天性马蹄内翻足治疗进入一个新的时代。     

距下完全松解术加胫前肌外移治疗重度先天性马蹄内翻足的体会

目的推荐治疗重度先天性马蹄内翻足的手术方法,以提高疗效。方法距下完全松解加胫前肌外移治疗重度先天性马蹄内翻足30例45足,术后平均随访4年。结果畸形完全纠正40足(88.9％),畸形复发2足,2足并发足外翻畸形,1足局部皮肤坏死。结论距下完全松解加胫前肌外移,能使患足恢复良好的外形和功能。     

动力肌平衡治疗先天性马蹄内翻足疗效观察

目的动力肌平衡手术治疗先天性马蹄内翻足疗效观察。方法在彻底松解挛缩软组织,矫正骨性畸形的基础上,同时行胫前肌外移及外踝韧带重建术。结果采用此法共收治78例114足,随访98足,优良达94.1％,术后畸形不易复发。结论早期施行一次决定性手术,争取完全纠正畸形,妥善建立动力肌平衡,以保持矫正位置,是防止马蹄内翻足畸形复发的较好方法之一。     

胫前肌延长外移治疗先天性马蹄内翻足31例分析

目的：对胫前肌延长外移治疗先天性马蹄内翻足的疗效进行评价。方法：采用胫前肌延长外移治疗先天性马蹄内翻足31例,术后对患者采用G arceau标准进行评价。结果：胫前肌延长外移治疗先天性马蹄内翻足优良率95.56%。结论：胫前肌延长外移结合软组织松解、石膏固定是治疗先天性马蹄内翻足可靠方法之一。     

股前外侧皮瓣带血管化的阔筋膜在跟腱及软组织缺损中的应用

目的探讨股前外侧皮瓣带血管化的阔筋膜修复跟腱及软组织缺损的临床效果。 方法自2012年10月至2014年12月,采用股前外侧皮瓣带血管化的阔筋膜治疗跟腱及软组织缺损11例。皮肤缺损4 cm×6 cm~9 cm×13 cm,跟腱损伤部分缺损或全部缺损,病例的缺损长度2~5 cm。根据创面大小及跟腱损伤或缺损的程度,切取相应大小的股前外侧皮瓣及阔筋膜,设计跟腱缺损区处于穿支血管蒂部,修复跟腱缺损。患足跖屈位术后石膏固定6周。供区行中厚皮片移植修复。 结果11例皮瓣全部成活。2例皮瓣边缘少许坏死,部分指肪液化,换药后愈合。部分植皮的供区植皮完全成活。随访6~12个月,跟腱张力恢复,踝部跖屈背伸功能正常。 结论股前外侧皮瓣带血管化的阔筋膜修复跟腱及软组织缺损效果良好。     

交叉乳腺瓣修复重度乳头内陷

目的:为了修复重度乳头内陷从1992年至1998年修复重度乳头内陷47例,83只乳头。方法:采用交叉乳腺瓣修复。手术时充分松解乳头深面所有癍痕组织,充填了乳头内不足的组织量;利用4个乳腺瓣交叉重叠缝合,加固了乳头的基底,增加了乳头向外突出;并切除乳头及乳晕部4个交错的三角形区表皮以增加乳头基底部皮肤的环形张力,防止乳头的回缩。结果:经过3月至5年的随访(平均2年),乳头坚挺,持久,无一例复发,无一例乳头坏死及感觉障碍。结论:该术式操作简便,效果良好,是修复重度乳头内陷较好的一种方法。     

Elasticity of the supraspinatus tendon-muscle unit is preserved after acute tendon tearing in the rabbit

Supraspinatus tendon tearing is one of the most common causes of the shoulder pain and dysfunction, which often requires a surgical repair. In this situation, proximal tendon stump is usually retracted medially from its original insertion. For successful reduction of the retracted tendon stump to its original insertion, the elasticity of the tendon-muscle unit should be preserved by the time of surgery. The purpose of the present study was to clarify the chronological changes in the elasticity of the supraspinatus tendon-muscle unit after acute tendon tearing to determine the optimal timing for the surgery. Right supraspinatus tendon was detached (detached side) in 40 male Japanese white rabbits, with left shoulders served as controls (control side). Eight animals were euthanized at 3 days and 1, 2, 4, or 8 weeks after surgery. Tissue sound speed that closely correlates to its elasticity was measured with a scanning acoustic microscope. In the supraspinatus tendon, tissue sound speed at 3 days after surgery was 1691.1 m/s, compared to 1714.3 m/s at the control side, but the difference was not statistically significant at any postoperative time period up to 8 weeks. In the supraspinatus muscle, tissue sound speed was not affected at all by the detachment of the tendon. The present study indicated that the elasticity of the supraspinatus tendon-muscle unit was well preserved for 8 weeks after the detachment. In the clinical practice, the retracted supraspinatus tendon stump could be repaired without excessive tension by 8 weeks from the acute tendon tearing.     

高寒区创伤足跟部软组织缺损及骨髓炎的修复

目的探讨多种皮瓣对修复高寒环境下创伤所致足跟部软组织缺损的疗效。方法对高寒环境创伤、冻伤足踝、跟部大面积组织缺损患者35例(其中11例伴有骨髓炎形成),伤肢经早期复温处理,并根据各种缺损创面,应用下肢的皮瓣转移。结果采用皮瓣修复术后伤口Ⅰ期愈合者31例,4例皮瓣远端皮缘部分坏死;创伤区愈合后皮瓣质地优良,外形与功能满意。结论高寒区创伤后伤肢早期及时复温,采用多种皮瓣修复足部软组织缺损,有利于控制感染创面及骨髓炎。     

Ultrasound in the evaluation of the knee and patellar regions

Studies were carried out in 25 patients (mean age, 34.2 years) with knee or patellar problems, using a real-time scanner. The contralateral leg, which was asymptomatic, was used as a control. Identification of the patellar bone and the area of insertion of the infrapatellar tendon was not difficult. The area of insertion was less echogenic than other parts of the tendon. Patchy, partial, or total ruptures could be identified using ultrasound. Sonolucent structures in cases of Baker's cyst were easily identified. The study revealed three partial suprapatellar tendon ruptures, three partial infrapatellar tendon ruptures, six old injuries of the infrapatellar tendon with fibrosis and scar tissue, one case of prepatellar bursitis, one parapatellar (cartilaginous) loose body, two intraarticular loose bodies (bony), and four cases of Baker's cyst, of which one was found to be ruptured. The differences in echogenicity of the tendons and surrounding soft tissues were more conspicuous using interposed Kiteko than with direct skin contact.     

Triple tarsal arthrodesis in the treatment of spastic foot in cerebral palsy

Background. This article presents an evaluation of triple arthrodesis performed on patients with cerebral palsy. The indication for surgery was significant foot deformity causing disturbances in gait. Material and methods. From 1982 to 2000, triple arthrodesis was performed on 34 patients (16 boys, 18 girls, average age 16,5) with cerebral palsy. The most common form of CP was diparegia, 20 patients were operated unilaterally, 14 patients bilaterally; 48 operations were performed altogether (14 equino-varus feet and 34 planovalgus feet with adduction of the forefoot). The triple arthrodesis was joined with an elongation of the Achilles tendon, the posterior tendon of the tibial muscle, and the flexor digitorum and longus muscles. Follow-up was 6 years on the average (1-9 years). Results and conclusions. The results indicate that triple arthrodesis is a satisfactory method of spastic foot treatment with robust outcome in patients with cerebral palsy (able to walk). It is demonstrated that equinovarus deformity allows for better correction than planovalgus deformity.     

初次人工髋关节置换术后假体脱位原因分析及预防

目的探讨初次人工髋关节置换术后假体脱位的原因并提出预防措施。方法回顾分析2000年-2012年所完成221例人工髋关节置换患者及发生术后脱位的8例患者资料,总结脱位原因及所采取的预防措施。结果221例髋关节置换患者中,发生术后脱位8例,均为后外侧人路全髋关节置换患者,脱位原因包括术前并存肌力减退疾病、术中假体安置不当、术后不适当的体位改变及护理、宣教不到位等。8例脱位患者中2例行再次手术翻修后治愈,6例通过麻醉下行闭合复位治愈;7例随访1～5年,未再发生脱位。结论术前认真评估患者患髋软组织张力及合并疾病情况,选择设计合理的假体及组件,术中清除可能引起关节撞击的组织,正确放置人工关节假体及组件,术后指导患者正确的患髋活动方式对预防术后关节脱位都至关重要。     

Anatomie et tendinopathie patellaire : un malentendu

The anatomical structure linking the patella and the tibia is called the “patellar ligament” in the international nomenclature. This term is well accepted yet can be a source of confusion for non-specialists. This is because the priority role of this structure is not to maintain joint stability, the primary role of the cruciate ligaments and the collateral ligaments, but rather to prolong the mechanical action of the quadriceps muscle onto the leg skeleton beyond the “patellar sesmoid”. Patellar tendon injuries are a common observation in sports medicine. The proximal third of the tendon below the patella is most generally involved. This highly frequent tendinopathy sometimes termed an “insertion” tendiopathy. Based on 100 consecutive magnetic resonance imaging studies and cadaveric dissection, we confirm that the insertion of the patellar tendon is situated on the anterior aspect of the patella and not the tip. We describe two anatomical variants of the healthy patellar tendon (type 1 and 2) that should not be confused with a site of tendinopathy. The anatomical limits between tendinous tissue and infrapatellar adipose body (the Hoffa adipose ligament), notably on the upper third is still debated and merits further work.