切开复位内固定术治疗跟骨关节内骨折疗效观察

目的观察切开复位内固定术治疗跟骨关节内骨折的疗效。方法回顾性分析骨科应用跟骨＂Y＂型解剖接骨板治疗跟骨骨折21例患者的临床资料,术后观察切口愈合情况及Maryland足部评分。结果术后复查X线片提示跟骨高度、Blher’s角及Gissane角均较术前明显改善。术后21例患者Maryland足部评分结果为：优11例,良8例,中2例,优良率90.48%。结论对于跟骨关节内骨折,我们认为需要积极行切开复位内固定术治疗,术中注意软组织保护,尽可能骨折复位,充分引流和术后加强切口管理是取得较满意疗效的关键。     

Diagnosis and management of calcaneal Yakes type IV AVM: Two case reports

Peripheral arteriovenous malformations (AVMs) are rare, congenital anomalies resulting from developmental genetic defects of the vasculature and cause significant disturbances in daily activities. AVMs can affect any part of the body and are rarely observed in the calcaneal region. Here, we describe two cases of Yakes type IV calcaneal AVMs managed by ethanol sclerotherapy at our institute.     

Clinical outcomes and complications of the Zadek calcaneal osteotomy in Insertional Achilles Tendinopathy: A systematic review and meta-analysis

BackgroundThe Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with Insertional Achilles Tendinopathy (IAT) that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT.MethodsPubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95 % confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4).ResultsTen studies with 232 patients were included. Functional scores and pain levels were significantly improved after the Zadek osteotomy (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia.ConclusionsThe Zadek osteotomy is a safe and effective procedure for patients with IAT. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this.Level of evidenceII.     

Recurrent heel ulcers with calcaneal osteomyelitis in myelomeningocele: Treatment by partial calcanectomy and posterior transfer of tibialis anterior tendon

OverviewCalcaneus deformity of the foot is common in patients with myelodysplasia, mainly due to muscle imbalance. This deformity, especially in ambulatory patients, can result in gait problems and development of pressure sores, which can be complicated by calcaneal osteomyelitis.Material and methodsThis retrospective cross-sectional study included 12 patients (18 feet), with calcaneus deformity due to myelomeningocele, and presented with penetrating heel ulcers complicated by calcaneal osteomyelitis. The mean age of the included cases was 11 years. The ulcers were unilateral in six patients and bilateral in six. Sensation was absent on the plantar aspect of the foot in all cases. The treatment was done in two stages; The first stage was eradication of infection and obtaining good soft tissue coverage, and the second stage was obtaining motor balance to achieve a more plantigrade and braceable foot.ResultsThe average follow-up period was 19.2 months. In the final follow-up, twelve feet were graded as good, five as fair and one as poor according to Legaspi grading system.ConclusionThe combination of partial calcanectomy and subsequent transfer of tibialis anterior tendon, to improve the foot position and gait, can efficiently prevent ulcer recurrence in myelomeningocele patients with calcaneal deformity.Level of clinical evidence: 4Retrospective case series study.