中国青年踝关节跖屈、背屈肌群力量的研究

目的 :(1 )通过测试健康青年踝关节背屈、跖屈肌群的力量 ,为运动训练、损伤和康复提供实验依据 ;(2 )探讨健康青年踝关节跖屈、背屈肌群工作的生物力学规律。方法 :利用CYBEX -60 0 0型测力系统对 70例健康青年 (男 35人 ,女 35人)踝关节背屈、跖屈肌群进行等长和等速测试。结果发现 :在等长测试中 ,男、女踝关节背屈肌群峰力矩均随测试角度的增加而增加 ,跖屈峰力矩随测试角的增加而减小。在等速向心测试中 ,男、女踝关节背屈、跖屈肌群峰力矩随测试角速度的增加而减小。两种测试均表明 ,跖屈肌群峰力矩大于背屈肌群峰力矩 (P <0 0 5)。男性与女性相比 ,绝对力矩较大(P <0 0 5) ;但去除体重因素后 ,男、女相对力矩间差距缩小。结果表明 ,用相对峰力矩比较男、女肌力的差别更为合理。通过对踝关节背屈 /跖屈肌群峰力矩比值的研究 ,发现我国健康青年普遍踝关节背屈肌群力量比较薄弱 ,推测这可能是导致踝关节易扭伤的原因之一     

无骨折的踝关节脱位一例

患者　男 ,2 5岁。 1年前因在跑跳中落地时 ,左脚跟落于他人足背 ,足内翻扭伤摔倒。伤后踝部即刻肿胀并有明显畸形 ,30min后来我院急诊。体检发现左踝前方空虚 ,足呈内翻畸形并向后方移位 ,前足血运及感觉未见异常 ,足趾活动正常。X线片检查可见距骨向内、后方脱位 ,足呈内翻位 ,踝关节未见骨折和下胫腓分离。即刻闭合复位 ,膝下踝关节前后石膏托固定 ,6周后拆除 ,开始踝关节功能活动 ,并逐步负重行走。 1年后随诊复查 ,患者仅感踝关节有轻微疼痛 ,踝的前外侧有压痛 ;关节功能跖屈正常 ,背伸较对侧减少约 10°;关节内外翻检查正常。X线片示…     

慢性踝关节不稳患者三维步态动力学特征

目的:研究慢性踝关节不稳患者步态的三维动力学特征,探讨其运动功能变化及生物力学机制。方法:选择慢性踝关节不稳患者15名(实验组),依据其年龄、身高、体重匹配健康受试者15名(对照组)。采用三维动作捕捉系统和Visual 3D软件观测受试者步行时支撑期地面反作用力(GRF)及踝关节力矩的变化。结果:实验组在矢状轴、额状轴和垂直轴的GRF第1峰值较对照组差异均无统计学意义(P>0.05),但3个轴向的GRF第2峰值均较对照组小,其中矢状轴向前和垂直轴向上的GRF差异具有统计学意义(P<0.01)。踝关节力矩于矢状面、额状面、水平面的第1峰值分别是背伸、内翻和内收力矩,实验组较对照组差异均无统计学意义(P>0.05)。踝关节力矩于3个面的第2峰值分别是跖屈、外翻和外展力矩,实验组均较对照组小,其中跖屈和外展力矩差异具有统计学意义(P<0.05)。结论:慢性踝关节不稳患者步行过程中,于支撑末期向上、向前的地面反作用力以及踝跖屈、外展力矩降低,这可能是踝跖屈、外翻肌群肌肉功能不足所致,但导致踝关节跖屈功能不足的主要肌群尚需进一步明确。     

关节镜下改良Brostr?m法治疗慢性踝关节不稳合并多韧带松弛症

目的探讨关节镜下改良Brostr?m法治疗慢性踝关节不稳合并多韧带松弛症的疗效。方法采用回顾性病例系列研究分析2016年1月至2020年12月华中科技大学同济医学院附属协和医院收治的26例慢性踝关节不稳合并多韧带松弛症患者的临床资料, 其中男10例, 女16例;年龄18～48岁[(27.5±7.1)岁]。患者均在关节镜下行改良Brostr?m法修复距腓前韧带(ATFL)。观察手术切口愈合情况。术前、术后3个月及末次随访时采用距骨倾斜角变化评价踝关节稳定性, 采用美国足踝外科学会(AOFAS)踝-后足评分评价踝关节功能, 采用视觉模拟评分(VAS)评价疼痛改善程度。观察并发症情况。结果患者均获随访18～47个月[(25.3±8.5)个月]。手术切口均Ⅰ期愈合。距骨倾斜角由术前(15.6±4.7)°降低至术后3个月及末次随访的(4.1±1.3)°、(3.5±0.9)°(P均<0.01)。AOFAS踝-后足评分由术前(65.8±14.5)分提高至术后3个月及末次随访的(86.5±5.6)分、(93.4±4.2)分(P均<0.01)。VAS由术前的3.0(2.0, 4.0)分降至术...     

籽骨移位与踇外翻关系的负重轴位X线研究

目的 基于籽骨负重轴位片对第一跖骨头下胫、腓侧籽骨位置变化与踇外翻关系的研究。方法 踇外翻49足均摄取足负重正位片及籽骨轴位片，依据正位片所测踇外翻角(HVA)分轻、中、重3组。在籽骨轴位片测量并获得胫、腓骨籽骨中心到第2跖骨长轴的垂直距离(SAP_t-2、SAP_f-2)及胫-腓籽骨中心距离(SAP_t-f)来反映胫、腓侧籽骨的位置，为矫正各足解剖差异，将获得的距离值与第2跖骨长度(AB)的比值(SAP_t-2/AB,SAP_f-2,SAP_t-f/AB)作为距离指标纳入统计分析。采用Pearson相关分析评价各距离指标与HVA、籽骨旋转角(SRA)的相关性，单因素分差分析用于进一步评价距离指标在踇外翻组间的差异有无统计学意义。结果 腓侧籽骨位置(SAP_f-2)与HVA、SRA均无明显相关性(P>0.05),胫-腓籽骨间距(SAP_t-f/AB)与HVA呈负、弱相关(r=-0.305,P=0.033)、与SRA没有明显...     

钢板与螺钉内固定治疗后踝骨折的临床疗效比较

目的比较钢板与螺钉内固定治疗后踝骨折的疗效。方法回顾性分析2015年3月-2017年3月甘肃省天水市四零七医院脊柱关节科治疗的66例后踝骨折患者。男性36例,女性30例;年龄21~63岁,平均39.6岁。根据手术方法不同分为钢板内固定33例(钢板组)和螺钉内固定33例(螺钉组),观察并比较两组患者手术时间、术后住院时间、术后完全负重时间、骨折愈合时间、踝关节活动度及美国足踝外科协会(AOFAS)踝与后足功能评分。结果患者获得随访:钢板组(24.7±11.3)个月,螺钉组(23.8±10.3)个月(t=0.338,P=0.736);手术时间:钢板组(77.8±13.9)min,螺钉组(67.8±14.6) min(t=2.850,P=0.006);术后住院时间:钢板组(6.6±1.7) d,螺钉组(6.4±1.8) d(t=0.464,P=0.644);术后完全负重时间:钢板组(9.2±2.1)周,螺钉组(10.8±2.2)周(t=3.022,P=0.004);骨折愈合时间:钢板组(11.6±2.7)周,螺钉组(12.5±2.9)周(t=1.304,P=0.197)。术后6个月随访时AOFAS评分:钢板组(89.5±6.5)分,螺钉组(82.3±6.4)分(t=5.731,P<0.001);末次随访时AOFAS评分:钢板组(91.4±6.3)分,螺钉组(91.3±6.7)分(t=0.0623,P=0.950);术后6个月随访时踝关节活动(背屈、跖屈、内翻、外翻)范围:钢板组(19.4±3.5)°、(38.6±5.7)°、(19.8±3.7)°、(24.7±4.4)°,螺钉组(17.2±4.6)°、(35.2±4.8)°、(17.2±3.2)°、(22.1±5.3)°;末次随访时踝关节活动(背屈、跖屈、内翻、外翻)范围:钢板组(20.3±4.3)°、(40.3±5.5)°、(21.2±3.5)°、(26.2±4.2)°,螺钉组(19.8±4.3)°、(41.3±5.5)°、(20.8±3.5)°、(26.8±4.2)°。两组术后6个月随访时踝关节活动度比较差异有统计学意义(P<0.05),而末次随访时,两组踝关节活动度比较,差异无统计学意义(P>0.05)。结论对于后踝骨折,采用钢板或螺钉内固定治疗均可获得满意临床疗效。采用钢板固定,患者可早期完全负重活动,早期(术后6个月)踝关节功能更优,而螺钉固定手术创伤较小。     

机械性踝关节不稳患者踝屈、伸肌群等速肌力评价

目的:评价机械性踝关节不稳(mechanical ankle instability,MAI)患者踝屈、伸肌群的等速肌力。方法:20名单侧机械性踝关节不稳患者的双侧踝关节分别接受等速肌力测试(60°/s和120°/s)。比较患侧和健侧踝关节屈、伸肌群相对峰力矩、平均功率、总功和屈伸力矩比的差异。结果:60°/s时,两侧伸肌群相对峰力矩、平均功率及总功的差别均无统计学意义(P=0.303,P=0.548,P=0.452),屈肌群相对峰力矩、平均功率和屈伸力矩比均无显著性差异(P=0.417,P=0.275,P=0.870),但屈肌群总功有显著性差异(P=0.043)。120°/s时,两侧伸肌群相对峰力矩、平均功率及总功差别均无统计学意义(P=0.096,P=0.069,P=0.233),但屈肌群相对峰力矩、平均功率、总功和屈伸力矩比有显著性差异(P=0.030,P=0.043,P=0.017,P=0.036)。结论:机械性踝关节不稳患者患侧踝关节跖屈肌群快速运动时肌力下降,这可能与其踝关节稳定性有关。     

强化训练对士兵踝关节肌力和跟腱横截面积的影响

目的评价踝关节强化训练对士兵踝关节肌力的影响,找到合适的、能快速提高训练成绩的训练方法。方法随机挑选新入伍的士兵和第二年度兵各30名,并对新兵专门添加为期8周的踝关节背伸、跖屈、内外翻的肌力强化训练,然后采用CYBEX-6000型等速测试训练系统分别对训练前、强化训练8周时的新兵和第二年度兵进行踝关节肌力等速测试和跟腱横截面积测量。结果新兵训练前、强化训练8周后、第二年度士兵的跟腱横截面积(分别为0·64±0·05cm2、0·67±0·07cm2、0·65±0·07cm2)与体重呈正相关(r=0·446),消除体重因素后,各组间无明显差异(P=0·698,F=0·361);训练前的踝关节背伸、跖屈、内外翻的峰力矩、力矩加速能、耐力、屈伸峰力矩之比等指标均明显低于强化训练8周组和第二年度士兵组(P<0·05或0·01)而强化组和第二年度兵组之间无明显差异(P>0·05)。结论新兵8周强化训练能取得与经常规训练的第二年度兵接近的效果,即强化训练可以在短期内快速促进体能储备,从而提高训练成绩;训练后跟腱截面积无明显变化,提示踝关节肌力的提高不是通过肌腱肥大实现的,而与肌腱的功能结构塑形改建有关。     

改良Chevron截骨术联合(足母)收肌切断术治疗轻中度(足母)外翻

目的 评估改良Chevron截骨术联合(足母)收肌切断术治疗轻中度外翻患者的手术效果.方法 对符合观察条件的36例(50足)患者进行了临床手术资料的回顾性观察,对其手术前后资料进行整理,并通过美国足踝外科协会(足母)趾-跖趾-趾间关节评分(AOFAS)和视觉模拟评分(VAS)对手术效果进行量化比较.结果 随访及评分结果显示,所有患者术后(足母)外翻症状有了很大改观,术后未出现感染、跖骨头坏死、愈合不良等并发症.HVA由术前(31.1°±4.3°)降至术后(14.8°±2.9°),差异有统计学意义(P ＜0.05);IMA由术前(14.5°±3.4°)降至术后(7.4°±2.5°),差异有统计学意义(P＜0.05);AO-FAS评分由术前(48.7 ±7.0)分升至术后(85.1±5.7)分,差异有统计学意义(P＜0.05).功能评级优26足,良19足,中5足,优良率90％.结论 选择改良后的手术术式进行(足母)外翻畸形的矫正治疗,效果显著,值得临床推广.     

距下关节镜联合跟腱前外侧纵向切口锁定钢板内固定治疗跟骨关节内移位骨折

目的探讨距下关节镜联合跟腱前外侧纵向切口锁定钢板内固定治疗跟骨关节内移位骨折的临床疗效。方法采用回顾性病例系列研究分析2016年1月至2018年5月徐州市中心医院收治的38例(38足)跟骨关节内移位骨折患者的临床资料,其中男21例(21足),女17例(17足);年龄21~53岁[(33.7±6.2)岁]。依据Sanders分型:Ⅱ型7例,Ⅲ型27例,Ⅳ型4例。均采用距下关节镜联合跟腱前外侧纵向切口锁定钢板内固定治疗。观察并记录手术时间、术中处理情况、伤口愈合情况、术后神经/血管/肌腱损伤等并发症情况,术前、术后第2天及末次随访时观察Bhler角、Gissane角、跟骨的长度/宽度/高度及骨折愈合情况。术前及末次随访时采用视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分、踝关节功能评分(FAOS)对临床效果及踝关节功能进行评价。结果患者均获随访12~42个月[(18.7±5.3)个月]。手术时间为45~100 min[(72.4±22.6)min]。无一例植骨,术中出现跟骨后关节面微骨折9例。切口均获得Ⅰ期愈合。未出现早期神经、血管和肌腱损伤等并发症。末次随访时Bhler角、Gissane角、跟骨长度/宽度/高度较术前显著改善(P<0.01),与术后第2天比较,差异均无统计学意义(P>0.05)。末次随访时所有患者骨折获得愈合,无畸形或骨髓炎。末次随访时VAS由术前5(3,9)分降至0(0,3)分,AOFAS踝-后足评分由术前(68.3±10.5)分提高至(90.6±5.0)分,FAOS由术前(66.9±9.1)分提高至(89.8±4.3)分(P<0.01)。AOFAS踝-后足评分:优27例,良8例,中3例,优良率为92%。结论对于跟骨关节内移位骨折,采用距下关节镜联合跟腱前外侧纵向切口的锁定钢板内固定治疗,复位精准,术后并发症发生率低,功能恢复满意。     

Treatment of spastic varus/ equinovarus foot with split-tendon transfers in cerebral palsy: How does it affect the hindfoot motion?

IntroductionThe flexible spastic varus foot in cerebral palsy is commonly corrected by split-tendon transfer of tibialis anterior or tibialis posterior. These tendon transfers are said to preserve hindfoot motion, which is until now not been proven. Therefore, the aim of the study was to show the hindfoot motion following split-tendon transfer in comparison to a midtarsal arthrodesis.Materials and methodsA retrospective study was done on patients with flexible spastic varus foot in cerebral palsy who underwent a combined split-tendon transfer of tibialis anterior and posterior. Patients with a rigid foot deformity underwent a midfoot arthrodesis. These children and normal children served as controls. An instrumented gait analysis was done in all patients before and at follow-up. A statistical analysis was done using 2-factor ANOVA with repeated measures on time.ResultsThirteen children underwent a combined split-tendon transfers of tibialis anterior and posterior muscles and 14 children midtarsal arthrodesis. The mean follow-up was 2.4 (SD=0.8) years for flexible varus foot and 1.9 (SD=0.7) years for rigid foot deformity. The preoperative hindfoot range of motion in eversion-inversion was 54% and 49% of TD controls in flexible varus foot and rigid foot deformity respectively. At follow-up, it reduced further to 45% and 42% of TD controls in the respective groups.ConclusionBoth flexible and rigid hindfoot deformity reduced the hindfoot motion. However following surgery, the hindfoot motion reduced further and was identical in both groups independent of the type of surgery. This indicates a tenodesis-effect of split-tendon transfers on the hindfoot.     

Gender differences in frontal and sagittal plane biomechanics during drop landings

PURPOSE: To determine gender differences in lower-extremity joint kinematics and kinetics between age- and skill-matched recreational athletes. METHODS: Inverse dynamic solutions estimated the lower-extremity flexion-extension and varus-valgus kinematics and kinetics for 15 females and 15 males performing a 60-cm drop landing. A mixed model, repeated measures analysis of variance (gender (*) joint) was performed on select kinematic and kinetic variables. RESULTS: Peak hip and knee flexion and ankle dorsiflexion angles were greater in females in the sagittal plane (group effect, P < 0.02). Females exhibited greater frontal plane motion (group (*) joint, P = 0.02). Differences were attributed to greater peak knee valgus and peak ankle pronation angles (post hoc tests, P = 0.00). Females exhibited a greater range of motion (ROM) in the sagittal plane (group main effect, P = 0.02) and the frontal plane (group (*) joint, P = 0.01). Differences were attributed to the greater knee varus-valgus ROM, ankle dorsiflexion, and pronation ROM (post hoc tests). Ground reaction forces were different between groups (group (*) direction, P = 0.05). Females exhibited greater peak vertical and posterior (A/P) force than males (post hoc tests). Females exhibited different knee moment profiles (Group main effect, P = 0.01). These differences were attributed to a reduced varus moment in females (post hoc tests). CONCLUSION: The majority of the differences in kinematic and kinetic variables between male and female recreational athletes during landing were observed in the frontal plane not in the sagittal plane. Specifically, females generated a smaller internal knee varus moment at the time of peak valgus knee angulation.     

骨质疏松性胸腰椎损伤分类及严重程度评分4分患者的治疗选择

目的探讨骨质疏松性胸腰椎损伤分类及严重程度评分(OTLICS)4分的急性症状性骨质疏松性椎体压缩骨折(OVCF)患者的治疗方法选择。方法采用回顾性病例对照研究分析2016年2月至2018年2月西安交通大学医学部附属红会医院收治的108例急性症状性OVCF患者临床资料,其中男21例,女87例;年龄55~92岁[(71.6±5.3)岁]。所有患者OTLICS均为4分。76例采用手术治疗(手术治疗组),32例采用非手术治疗(非手术治疗组)。比较两组患者治疗前、治疗后1周、3个月、6个月及末次随访时的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、健康调查简表(SF-36)评分;比较两组治疗前后伤椎恢复情况(伤椎后凸Cobb角和伤椎前缘高度比)、相邻节段椎体骨折及并发症发生情况。结果患者均获随访12~18个月[(13.4±4.2)个月]。术后1周、3个月、6个月手术治疗组VAS[(3.5±1.0)分、(2.1±0.6)分、(2.0±0.4)分]低于非手术治疗组[(6.4±1.7)分、(5.3±1.5)分、(3.3±0.6)分](P均<0.05),ODI[(45.8±10.3)分、(35.3±8.6)分、(26.5±7.1)分]低于非手术治疗组[(65.7±12.1)分、(58.3±10.7)分、(45.6±9.3)分](P均<0.05),SF-36评分[(82.8±1.4)分、(85.0±1.5)分、(88.0±1.3)分]高于非手术治疗组[(80.4±1.3)分、(81.5±1.4)分、(85.6±1.1)分](P均<0.05),而末次随访时VAS、ODI、SF-36评分两组间比较,差异均无统计学意义(P>0.05)。术后3个月、6个月、末次随访时手术治疗组Cobb角[(18.3±3.9)°、(17.5±3.0)°、(17.8±1.6)°]小于非手术治疗组[(22.4±2.2)°、(22.5±1.7)°、(22.1±1.3)°](P均<0.05),伤椎前缘高度比[(75.4±8.6)%、(76.6±8.6)%、(75.2±8.3)%]高于非手术治疗组[(63.5±7.6)%、(65.2±7.4)%、(62.8±7.2)%](P均<0.05)。手术治疗组术后发生邻近椎体骨折6例(8%),非手术治疗组发生2例(6%)(P>0.05)。手术治疗组术后出现并发症8例(11%),非手术治疗组出现6例(19%)(P>0.05)。结论对于OTLICS 4分的急性症状性OVCF患者,应及时行手术治疗,可迅速缓解疼痛、矫正畸形、促进功能恢复,从而提高生活质量。     

Frontal plane knee angle affects dynamic postural control strategy during unilateral stance

PURPOSE: Center of plantar pressure (COPP) location moves toward the forefoot as ankle plantar flexor muscles attempt to maintain postural control during single leg stance. This study evaluated relationships between frontal plane tibiofemoral joint angulation during relaxed bilateral stance and mean COPP locations during vision-denied single leg stance at 20 degrees knee flexion. METHODS: Fifty-six nonimpaired athletes (29 female, 27 male) were evaluated for frontal plane tibiofemoral joint angulation and standing foot angle by using two-dimensional videography (30 Hz). Mean anterior-posterior and mediolateral COPP locations were assessed during single leg stance on a mat (25 Hz, 15 s). One-way ANOVA and Tukey HSD tests evaluated group differences (P < or = 0.05) based on frontal plane tibiofemoral joint angulation. RESULTS: Group 1 (genu varus or genu valgus < 5 degrees ) displayed a mean anterior-posterior COPP location of 54.2 +/- 6% from the (0,0) coordinate starting point at the anterolateral foot (10.3 +/- 2 cm from the posterior sensor edge). Group 2 (genu varus angulation > or = 5 degrees ) and group 3 subjects (genu valgus angulation > or = 5 degrees ) displayed mean anterior-posterior COPP locations of 60.6 +/- 8% and 60.7 +/- 7% (8.8 +/- 2 cm and 8.7 +/- 2 cm from the posterior sensor edges), respectively. Group 2 (12.5 +/- 3 N x kg(-1)) and group 3 (12.4 +/- 3.1 N x kg(-1)) subjects also displayed greater mean plantar force magnitude/body weight than group 1 (10.3 +/- 2 N x kg(-1)) subjects. Mean ankle plantar flexor moment magnitudes did not differ between groups. CONCLUSIONS: Rearfoot directed mean anterior-posterior COPP locations and greater plantar force magnitudes/body weight suggests that subjects with genu varus or genu valgus relied more on the subtalar and midtarsal joint control function of the ankle plantar flexor muscle group for lower extremity dynamic postural control.     

Muscle contributions to tibiofemoral shear forces and valgus and rotational joint moments during single leg drop landing

Anterior cruciate ligament (ACL) injuries commonly occur during single-leg landing tasks and are a burdensome condition. Previous studies indicate that muscle forces play an important role in controlling ligamentous loading, yet these studies have typically used cadaveric models considering only the knee-spanning quadriceps, hamstrings, and gastrocnemius muscle groups. Any muscles (including non-knee-spanning muscles) capable of opposing the anterior shear joint reaction force and the valgus joint reaction moment are thought to have the greatest potential for protecting the ACL from injury. Thus, the purpose of this study was to investigate how lower-limb muscles modulate knee joint loading during a single-leg drop landing task. An electromyography-informed neuromusculoskeletal modeling approach was used to compute lower-limb muscle force contributions to the anterior shear joint reaction force and the valgus joint reaction moment at the knee during a single-leg drop landing task. The average shear joint reaction force ranged from 153 N of anterior shear force to 744 N of posterior shear force. The muscles that generated the greatest posterior shear force were the soleus, medial hamstrings, and biceps femoris, contributing up to 393 N, 359 N, and 162 N, respectively. The average frontal plane joint reaction moment ranged from a 19 Nm varus moment to a 6 Nm valgus moment. The valgus moment was primarily opposed by the gluteus medius, gluteus minimus, and soleus, with these muscles providing contributions of up to 38, 22, and 20 Nm toward a varus moment, respectively. The findings identify key muscles that mitigate loads on the ACL.     

The effect of tibiotalar alignment on coronal plane mechanics following total ankle replacement

BackgroundGait mechanics following total ankle replacement (TAR) have reported improved ankle motion following surgery. However, no studies have addressed the impact of preoperative radiographic tibiotalar alignment on post-TAR gait mechanics. We therefore investigated whether preoperative tibiotalar alignment (varus, valgus, or neutral) resulted in significantly different coronal plane mechanics or ground reaction forces post-TAR.MethodsWe conducted a non-randomized study of 93 consecutive end-stage ankle arthritis patients. Standard weight-bearing radiographs were obtained preoperatively to categorize patients as having neutral (±4°), varus (≥5° of varus), or valgus (≥5° of valgus) coronal plane tibiotalar alignment. All patients underwent a standard walking assessment including three-dimensional lower extremity kinetics and kinematics preoperatively, 12 and 24 months postoperatively.ResultsA significant group by time interaction was observed for the propulsive vertical ground reaction force (vGRF), coronal plane hip range of motion (ROM) and the peak hip abduction moment. The valgus group demonstrated an increase in the peak knee adduction angle and knee adduction angle at heel strike when compared to the other groups. Coronal plane ankle ROM, knee and hip angles at heel strike, and the peak hip angle exhibited significant increases across time. Peak ankle inversion moment, peak knee abduction moment and the weight acceptance vGRF also exhibited significant increases across time. Neutral ankle alignment was achieved for all patients by 2 years following TAR.ConclusionsRestoration of neutral ankle alignment at the time of TAR in patients with preoperative varus or valgus tibiotalar alignment resulted in biomechanics similar to those of patients with neutral preoperative tibiotalar alignment by 24-month follow-up.     

Foot and ankle kinematics in patients with posterior tibial tendon dysfunction

The purpose of this study is to provide a quantitative characterization of gait in patients with posterior tibial tendon dysfunction (PTTD), including temporal-spatial and kinematic parameters, and to compare these results to those of a Normal population. Our hypothesis was that segmental foot kinematics were significantly different in multiple segments across multiple planes. A 15 camera motion analysis system and weight-bearing radiographs were employed to evaluate 3D foot and ankle motion in a population of 34 patients with PTTD (30 females, 4 males) and 25 normal subjects (12 females, 13 males). The four-segment Milwaukee Foot Model (MFM) with radiographic indexing was used to analyze foot and ankle motion and provided kinematic data in the sagittal, coronal and transverse planes as well as temporal-spatial information. The temporal-spatial parameters revealed statistically significant deviations in all four metrics for the PTTD population. Stride length, cadence and walking speed were all significantly diminished, while stance duration was significantly prolonged (p<0.0125). Significant kinematic differences were noted between the groups (p<0.002), including: (1) diminished dorsiflexion and increased eversion of the hindfoot; (2) decreased plantarflexion of the forefoot, as well as abduction shift and loss of the varus thrust in the forefoot; and (3) decreased range of motion (ROM) with diminished dorsiflexion of the hallux. The study provides an impetus for improved orthotic and bracing designs to aid in the care of distal foot segments during the treatment of PTTD. It also provides the basis for future evaluation of surgical efficacy. The course of this investigation may ultimately lead to improved treatment planning methods, including orthotic and operative interventions.     

Ilizarov技术结合载万古霉素骨水泥治疗胫骨创伤后骨感染合并骨与软组织缺损的疗效

目的探讨Ilizarov骨搬运技术结合载万古霉素骨水泥垫块在胫骨创伤后骨感染合并骨与软组织缺损中的疗效。方法采用回顾性病例系列研究分析2016年6月至2019年6月安徽医科大学第一附属医院收治的11例胫骨创伤后骨感染合并骨与软组织缺损患者临床资料,其中男7例,女4例;年龄21~56岁[(41.5±12.1)岁]。清创后骨缺损长度(8.1±2.6)cm,软组织缺损面积(16.2±4.7)cm2。首先行骨感染灶清除、骨缺损区载万古霉素骨水泥垫块填充,然后行Ilizarov骨搬运治疗骨与软组织缺损。记录软组织对合时间、断端会师时间、外固定时间、外固定指数。末次随访时采用Johner-Wruhs评分评定疗效,采用美国矫形外科足踝协会(AOFAS)踝-后足评分评估踝关节功能。观察术后并发症情况。结果患者均获随访13~27个月[(17.9±4.5)个月]。软组织对合时间为48~155 d[(101.7±29.0)d],断端会师时间为55~167 d[(111.6±29.5)d],外固定时间为154~450 d[(322.9±86.3)d],外固定指数为31.1~61.5 cm/d[(40.8±7.5)cm/d]。末次随访时Johner-Wruhs评分评定效果:优2例,良4例,中5例。AOFAS踝-后足评分为61~94分[(76.6±12.7)分],其中优3例,良2例,可6例。4例患者行二次手术治疗,其中2例患者会师端愈合不良,经Ⅱ期植骨后骨折愈合。患者均未因软组织缺损行游离或局部转位皮瓣修复。随访过程中无发热、创面流脓、软组织坏死、神经血管损伤等并发症。结论Ilizarov骨搬运技术结合载万古霉素骨水泥垫块治疗胫骨创伤后骨感染合并骨与软组织缺损并发症少,在骨延长的同时可同时实现软组织的闭合。     

Relationship between passive ankle dorsiflexion range,dynamic ankle dorsiflexion range and lower limb and trunk kinematics during the single-leg squat

BackgroundLimited passive ankle dorsiflexion range has been associated with increased knee valgus during functional tasks. Increased knee valgus is considered a contributing factor for musculoskeletal disorders in the lower limb. There is conflicting evidence supporting this association. The extent of passive ankle dorsiflexion range is associated with dynamic ankle dorsiflexion range and the way how these variables are related to lower limb or trunk kinematics is unclear.Research questionWhat is the association between passive ankle dorsiflexion range or dynamic ankle dorsiflexion range with shank, thigh, pelvis or trunk movements during the single-leg squat?MethodsThis is a cross-sectional study with a convenience sample. Thirty uninjured participants performed the single-leg squat with their dominant limb. Ankle, shank, thigh, pelvis and trunk 3D kinematics were recorded. Passive ankle dorsiflexion range was assessed through the weight-bearing lunge test and the dynamic ankle dorsiflexion range was defined as the ankle dorsiflexion range of motion in the sagittal plane during the single-leg squat.ResultsGreater passive ankle dorsiflexion range was associated with smaller thigh internal rotation (r= -0.38). Greater dynamic ankle dorsiflexion range was associated with smaller trunk flexion (r = 0.59) and pelvis anteversion (r= -0.47). Passive ankle dorsiflexion range and dynamic ankle dorsiflexion range were not associated.SignificanceGreater passive ankle dorsiflexion range seems to be associated with a better lower limb alignment during the single-leg squat, while dynamic ankle dorsiflexion range seems to reflect different lower limb and trunk kinematic strategies.