Percutaneous planter fasciitis release under local anesthesia: A prospective study Ramji Lal Sahu

Purpose: Plantar fasciitis is the most common cause of pain on the bottom of the heel. It occurs when the strong band of the tissue supporting the arch of foot becomes irritated and inflamed. The majority of patients can be treated conservatively but some resistant cases need surgery eventually. This study aims to evaluate the outcome results of percutaneous planter fascia release under local anesthesia for chronic planter fasciitis. Methods: This prospective study was conducted in the Department of Orthopaedic Surgery in the School of Medical Science and Research, Sharda University, India from December 2010 to December 2013. Totally 78 patients with planter fasciitis for more than 6e12 months were recruited from the outpatient department. All patients were operated on under local anesthesia and followed up for a year. Results: The clinical results were evaluated in terms of pain, activity level and patient satisfaction. Pain relief was achieved averagely at eight weeks after surgery. The results were excellent in 88.46% (69/78) patients and good in 6.41% (9/78) patients. Neither complications of lateral column instability, sinus tarsitis and metatarsalgia nor wound-related complications were encountered. On subjective evaluations, 88.46% (69/78) patients reported full satisfaction and 6.41% (9/78) reported partial satisfaction after treatment. Conclusion: Percutaneous planter fasciitis release under local anesthesia is a minimally invasive procedure that can be performed in the outpatient setting. It is easy, quick, effective and moreover with few complications.     

Periocular Necrotising Fasciitis—A Case Report

Purpose: To document the step-by-step reconstructive surgical rehabilitation, over a 12-month period, of a patient with severe periocular necrotising fasciitis. Methods: This is a retrospective interventional case note review of a 68-year-old man who developed necrotising fasciitis a few days after an insect bite. He had severe facial cellulitis with subsequent necrosis of all four eyelids despite broad spectrum antibiotics. Results: The initial management included performing a wide surgical debridement, with the removal of infected and necrotic tissue extending bilaterally from the forehead to the mouth. Split skin grafts were used to cover the extensive tissue defects. Subsequent horizontal eyelid shortening and full-thickness skin was required to correct severe cicatricial ectropions, eyelid displacement and improve lagophthalmos. Conclusions: Necrotising fasciitis is an acute fulminant infection of the subcutaneous fat and deep fascia. The initial appearance may look like cellulitis but necrosis quickly follows. Facial disease with extensive periocular involvement represents a significant management challenge.     

冲击波治疗足底筋膜炎的临床研究进展

足底筋膜炎是一种自限性疾病,病因不明,目前临床上还没有根治足底筋膜炎的方法.相对于手术治疗的不良反应大、复发率高,冲击波治疗安全、无创、治愈率高等优势日益突出.笔者对近年来冲击波治疗足底筋膜炎的临床研究概况进行综述.     

一种基于足压数据主成分分析的足弓形态智能检测方法

目的 根据临床中平足与高弓足量化评估的要求,提出一种基于足压数据主成分分析（principal component analysis, PCA）智能快速足弓形态检测方法,并验证其临床有效性。方法 纳入诊断为足弓异常与足弓健康的志愿者,设计研发一套便携式足弓智能检测系统。采用44×52阵列式薄膜压阻传感器,采集静态站立式足底压力分布数据,利用自行编写的PCA算法自动拟合足轴线,进行足弓诊断并生成诊断报告。将足压采集结果与现有设备进行比对,验证足压数据的准确性。对于平足、高弓足和正常3类足弓的判别算法,通过对比临床诊断验证评估准确性。结果 该系统与现有压力采集设备的测量结果具有较好的相关性,接触面积偏差低于3.2%,计算拟合的足轴线与临床定义角度偏差小于1°,且该系统能获得与临床中足弓形态诊断相符率92.6%的评估结果。结论 引入PCA对足轴线自动化拟合,实现了快速而准确提取足弓信息的目的。该方法可用于临床实践中平足与高弓足的辅助筛查,有助于开展足弓畸形程度的量化分析和病理机制的研究。     

体外冲击波治疗足底筋膜炎的疗效研究

目的 探讨体外冲击波治疗足底筋膜炎前后T2值的变化及其对足底筋膜炎疗效的评估价值。 方法 对符合条件的23例足底筋膜炎患者行体外冲击波治疗，每周1次，3次为1个疗程，治疗前及首次治疗后4 h行磁共振检查，治疗前及疗程结束1个月后分别对患者进行视觉模拟评分法（VAS）、足跟压痛指数（HTI）、美国矫形外科足踝协会（AOFAS）踝-后足评分系统评价，并记录患者治疗前后的最长行走时间。对患者治疗前后筋膜、肌肉、脂肪垫T2值，最长行走时间及患者VAS评分进行比较，采用Pearson相关分析上述感兴趣区T2值变化量与VAS评分变化量的相关性。 结果 经冲击波治疗后患者的VAS评分、HIT评分、AOFAS评分较治疗前明显改善，最长行走时间明显延长。磁共振成像显示治疗后4 h筋膜及周围软组织的水肿程度增加，T2压脂高信号影的范围及程度增多，T2值变化量与VAS评分变化量呈正相关。 结论 体外冲击波对足底筋膜炎有较好的疗效，可明显减轻足部疼痛，改善足部运动功能，治疗后磁共振T2值的变化能够反映足底筋膜炎的疗效。     

Thera-band弹力带结合神经肌肉促通技术对偏瘫患者的影响

目的:观察偏瘫患者使用Thera-band弹力带进行两种上肢神经肌肉促通技术(PNF)短时训练时的疗效。方法:脑卒中偏瘫患者28例,测试其训练前安静站立、健手带动患手(方法一)和仅健手(方法二)使用Thera-band弹力带进行PNF D2伸模式训练后足底压力及站位平衡的变化。结果:方法二的患足前半足、整足平均压力低于方法一(P0.05),压力中心偏移的椭圆轨迹长度、椭圆轨迹包络面积高于方法一(P0.05)。结论:方法一较方法二对提高患者患侧前足的受力、增加患侧的整体足底压力、调整身体平衡的改善效果更好。     

Sonography of Dermatologic Emergencies

Dermatologic conditions may be the subjects of potential emergency consultations, and the knowledge of their sonographic appearance can facilitate an early diagnosis and management. In this pictorial essay, the sonographic dermatologic anatomy, technique, and conditions that can be supported by a prompt sonographic diagnosis are reviewed. The sonographic signs that may help diagnose these entities are discussed with a practical approach.     

Results after gastrocnemius recession in 73 patients

BackgroundVery few studies describe the clinical results and complications following the surgical procedure of gastrocnemius recession.PurposeTo survey the patient reported outcomes in patients operated with gastrocnemius recession as single procedure for various foot conditions.Material and methods93 patients operated with gastrocnemius recession as single procedure between 2006 and 2011 were detected in the database. 73 patients responded to the invitation for study participation. Questionnaires containing patient reported satisfaction, complications, plantar flexion power and visual analog pain score were used for evaluation of the postoperative result.Results45/73 (62%) patients reported a good or excellent result. 8/73 (11%) patients reported a significant postoperative complication. 16/73 (22%) patients noted reduced or severely reduced plantar flexion power after surgery. VAS pain score significantly decreased from 7.0 before surgery to 1.8 (p =0.015) after surgery for patients with plantar fasciitis (n =18) and from 5.6 to 2.3 (p < 0.01) for patients with metatarsalgia (n = 28).ConclusionPatients treated with gastrocnemius recession for plantar fasciitis demonstrated good clinical results. The complication rate was higher than reported by others.     

头颈部结节性筋膜炎临床病理分析

目的 探讨头颈部结节性筋膜炎的临床病理、免疫表型特征及诊断、鉴别诊断方法。 方法 收集28例头颈部病理诊断为结节性筋膜炎患者的临床表现,并采用HE染色及EnVision法对其病理形态、免疫组化表达进行检测及回顾性分析。 结果 患者男女比例基本相同(1∶1.15);4~77岁,平均40岁;病程较短,25例少于6个月,肿块平均直径为1.3 cm,边界尚清,无包膜,15例位于外耳周围(53.6%),6例位于面部(21.4%),鼻背部及腮腺分别为3例(10.7%),另1例位于颈部(3.6%)。巨检显示肿瘤多呈结节状,镜下由增生的梭形或胖梭形的纤维母及肌纤维母细胞组成,呈漩涡状及编织状排列,并见黏液样基质和胶原纤维,部分病例可见微囊性腔隙,呈渔网状,间质内常可见外渗的红细胞及多核巨细胞。免疫组化表达Vimentin、SMA、MSA、calponin和CD10,不表达CK、Desmin、CD34、S-100、WT-1、ALK等。随访2~125个月,患者经手术切除后,均无复发。 结论 结节性筋膜炎是一种良性的自限性的纤维母细胞/肌纤维母细胞增生性病变,手术局部切除是最好的治疗方法。因其进展较快,镜下核分裂象易见,并可以侵犯周围组织等原因,很容易被误诊为各种恶性软组织肿瘤,在诊断为结节性筋膜炎之前一定要排除其他肿瘤性病变,再作出病理诊断。免疫组化表达结果有助于诊断和鉴别诊断该疾病,另外有文献表明结节性筋膜炎存在MYH9-USP6基因融合,故可行FISH检测从而帮助诊断和鉴别诊断该病。     

以急性会厌炎为首诊的3例颈部坏死性筋膜炎病例报告并文献复习

目的 探讨急性会厌炎与颈部坏死性筋膜炎的相关性及治疗经验。 方法 回顾性分析3例以急性会厌炎为首诊的颈部坏死性筋膜炎患者的临床资料,对急性会厌炎与颈部坏死性筋膜炎间的相关性及诊治经过进行分析。 结果 3例患者经颈部CT明确诊断后均行手术治疗,1例死亡,2例治愈出院。 结论 对于以急性会厌炎为首诊经积极抗感染抗炎治疗无效的患者应警惕颈部坏死性筋膜炎的可能。积极抗感染治疗、及时局部切开引流,并重视全身基础疾病的治疗是颈部坏死性筋膜炎治疗的关键。