四种外翻矫形术的疗效分析

目的：探讨四种矫正外翻、跖内翻手术的临床疗效及适应症。方法：单纯骨赘囊切除术、ＭｃＢｒｉｄｅ法、Ｍｉｔｃｈｅｌ法、Ｓｉｍｍｏｎｄｓ法。结果：四种术式的优良率依次为６０％、８１．４％、８９．４％及１００％。结论：Ｓｉｍｍｏｎｄｓ法治疗外翻并跖内翻效果最好。     

Valgus extension overload: diagnosis and treatment

Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. Athletes in many sports may experience VEO and other common pathologies related to the high repetitive stresses generated by the overhead throwing motion. VEO is characterized by reproducible pain that is elicited by repeatedly forcing the elbow into terminal extension while applying a valgus stress to the elbow. Pain at the posteromedial tip of the olecranon process is pathognomonic of the condition. Olecranon stress fractures are rare, but can cause significant discomfort and, if unrecognized or untreated, can lead to significant pain and dysfunction. Both of these conditions are treated initially with rest from throwing, followed by gradual return to throwing through an interval throwing program. When conservative measures fail, minimally invasive or arthroscopic surgical procedures can be used to address the problem. Successful return to competitive overhead sports is expected at all levels of competition with these conditions.     

(足母)外翻及正常足部的X线测量分析

目的 :通过外翻 (HV)和正常足部的X线测量分析 ,探讨外翻的发病机制及临床意义。方法 :对 118例正常人中 12 1足和 5 1例HV病人中 5 6足的外翻角 (HVA)、1～ 2跖骨间角、1～ 5跖骨间角和第 1跖骨长度与趾长度之比率进行测量 ,将测量数据进行统计学处理。结果 :正常足和HV病人测量结果分别为 :HVA 11.32°± 7.11°和 2 7.31°±6 0 3°,1～ 2跖骨间角 7.5 0°± 3.2 1°和 10 .2 1°± 3.5 6° ,1～ 5跖骨间角 2 1.80°± 7.6 0°和 2 7.92°± 9.80°,第 1跖骨长度与趾长度比值 1.13± 0 .0 9和 1.16± 0 .13。正常足男、女之间各种角度无统计学差异 (P >0 .0 5 ) ,正常足与HV病人的HVA、1～ 2和 1～ 5跖骨间角均有显著性差异 (P <0 .0 0 0 5 ) ,第 1跖骨长度与趾长度比值无差异 (P >0 .0 5 )。结论 :HV病人的首要X线表现为HVA增大 ,1～ 5跖骨间角增大是发生HV的主要基础 ,1～ 2跖骨间角增大是继发改变。HVA >2 0°,1～ 2跖骨间角 >10°是诊断和治疗HV的重要客观指标。     

Valgus high tibial osteotomy

A matched-pair comparative analysis was done comparing outcomes between a Coventry-type closing wedge valgus high tibial osteotomy (HTO) and an HTO using an Ilizarov apparatus. Thirty patients were treated with a mean follow-up interval of 28.1 months. Functional outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) osteoarthritis index. Clinical and radiographic assessment of the index knee, complications, and over-all satisfaction of the patients were assessed. The procedures were performed between 1994 and 1997. The two groups were equal with respect to baseline demographics - age, sex, body mass index, smoking status. The patients undergoing an Ilizarov HTO had a significantly greater decrease in pain and increase in function at final follow-up assessment. Eleven of the 15 patients in the Ilizarov group were satisfied with the procedure compared to five in the closing wedge HTO group. The treatment of medial compartment osteoarthritis in genu varum of the knee with an Ilizarov apparatus produces outcomes that are comparable to the standard lateral closing wedge osteotomy.     

外翻的X线研究（附30例外翻及50例健康女性足部有关角度的测量）

外翻是指　趾近节趾骨自第一跃趾关节处外翻、内旋，第一跖骨自跖趾关节处内翻，第一跖骨头向内侧突出变形。本文着重对　外翻进行有关Ｘ线方面的研究，并对３０例　外翻及５０例健康女性的足部进行有关角度的测量。     

Valgus Bracing for Degenerative Knee Osteoarthritis

Pain from osteoarthritis, the leading cause of disability in older patients, affects gait mechanics. Wearing an unloading brace may improve gait symmetry, decrease symptomatic pain, and increase activity for patients who have osteoarthritis of the knee or other varus knee deformities. Brace use may contribute to improved knee proprioception, gait parameters, and pain scores. Clinicians can recommend a trial of brace wear for patients who have knee pain as a conservative measure or to provide temporary pain relief before joint replacement surgery.     

Etiology and Management of Hallux Valgus in Athletes

The pain and disability associated with hallux valgus can be disabling during athletic performance. The etiology and progression of this bony and muscular deformity can be controlled with orthoses. When indicated, surgical correction will realign the first metatarsophalangeal joint to allow normal function.     

眼睑外翻畸形的治疗探讨

我科自1981年1月至2002年1月共收治眼睑外翻畸形病例415例,分别采用不同的手术方法进行修复,经过随访观察,效果满意。现报告如下。     

Depth of single-leg squat influences the two-dimensional analysis of knee,hip, and pelvis frontal plane motion in pain-free women

BackgroundThe single-leg squat (SLS) is often used to measure two-dimensional frontal plane motion; however, there is a variability in the SLS depth across studies.Research questionAre knee abduction (KABD), hip adduction (HADD), pelvic drop (PD), and lateral trunk flexion (LTF) angles different at greater knee flexion angles during a SLS?MethodsTwenty pain-free females (age=22.3 ± 1.1 years, height=1.68 ± 0.06 m, mass=63.1 ± 11.7 kg) participated in this cross-sectional study. Participants performed five SLSs to the lowest depth comfortable, keeping pace with a metronome, while being video recorded in the frontal and sagittal planes. The middle three SLSs were used for analysis. KABD, HADD, PD, and LTF angles were measured at 30º, 45º, 60º, 75º, and 90º of knee flexion using extracted images. Linear mixed model analyses were used to compare across knee flexion angles and clinical significance was determined by comparing angle changes to the standard error of measurement (SEM).ResultsWe observed significant differences for KABD (F=14.69, p < .001), HADD (F=46.29, p < .001), and PD (F=27.27, p < .001) among knee flexion angles. Post-hoc analyses revealed that KABD significantly increased at every increase of knee flexion angle (p ≤ .05, d=0.54–1.95), as did HADD (p ≤ .05, d=0.64–3.85) and PD (p ≤ .05, d=0.61–3.03). Changes in KABD, HADD, and PD often exceeded SEM for all changes in knee flexion angles.SignificanceKnee, hip, and pelvic frontal plane motions are influenced by knee flexion angles during 2D analysis of a SLS task. Our results highlight the importance of standardizing SLS depth during research and clinical practice to ensure appropriate comparisons across measurements.     

Valgus instability of the elbow in athletes

Valgus instability of the elbow in athletes is uncommon among athletes in general, but has a higher incidence in individuals who throw repetitively. When valgus overload injury results in disabling symptoms for the athlete, surgical reconstruction of the anterior band of the ulnar collateral ligament may be indicated. This procedure has been successful in getting athletes back to premorbid levels of competition. The authors provide a comprehensive review of valgus instability of the elbow and offer their preferred method of treatment.