Die arthrodese des großzehengrundgelenks mit kleinfragmentplatte

Operationsprinzip Entknorpelungsarthrodese des ersten Metatarsophalangealgelenks. Versteifung in funktionell günstiger Stellung unter Verwendung einer dynamischen Kleinfragment-Kompressionsplatte (Abbildung 1).      

Low-cost pain infusion catheter for the control of postoperative pain in ambulatory foot surgery

The authors report the use of a low-cost method of providing prolonged patient controlled anesthesia at the surgical site following elective forefoot surgery performed in ambulatory surgical settings. In this series of 54 patients there were no postoperative complications and 95.92% of patients believed the device helped to control their post-operative pain.     

微创治疗拇趾外翻手术时机与疗效分析

目的探讨微创治疗拇趾外翻手术时机与疗效关系。方法对采用微创治疗的200例患者（375足）术前和术后8周外翻角（HVA）和第1、2跖骨间角（IMA）进行分组比较。结果随着年龄增大，拇趾外翻逐渐加重。不同程度拇外翻患者微创手术疗效不一。结论40岁以后年龄对本微创手术疗效影响不大，而与拇趾外翻严重程度关系密切。中重度拇趾外翻且年龄在50～60岁者为较好的手术时机。     

小切口拇外翻矫正手术中的护理干预

目的探讨手术室护理干预对局麻下的手术病人心理应激反应的影响。方法771例小切口拇外翻矫正术病人分组：干预Ⅰ组为手术全程给予音乐干预；干预Ⅱ组为手术全程给予心理护理支持和行为控制；对照Ⅰ组为手术前给予安定等镇静药；对照Ⅱ组术前不用安定镇静药；2个干预组手术前均未用安定镇静药；2个对照组手术中均未采用护理干预。结果通过观察4组病人的资料比较．客观监测显示有针对性的心理支持和行为控制对病人的生理体征变化有意义；主观体验显示给予恰当的护理干预明显优于给安定镇静药；而病人术前用与不用安定镇静药的比较则显示无差异。结论人性化的心理支持优于公式化的心理护理，恰当的护理干预可以减轻手术病人的心理应激反应，手术室护理干预可以替代局麻手术病人术前应用安定镇静药的作用。     

术前膝内外翻畸形程度对全膝关节置换术后疗效的影响研究

目的 探讨术前膝内外翻畸形程度对全膝关节置换术（TKA）后疗效的影响。方法 回顾性分析2016年3月至2020年6月因膝关节骨关节炎于武汉大学人民医院行初次全膝关节置换术的患者174例（178膝）。依据术前患肢髋膝踝角度分为A组（膝内翻≤10°）、B组（10°＜膝内翻≤20°）、C组（膝外翻≤10°）、D组（10°＜膝外翻≤20°）。其中,男27例,女147例;年龄65 ～ 88岁,平均（72.8±6.2）岁。记录术前及术后1周术侧HKA角,术前1周及术后末次随访时的HSS、ROM、AKS评分、VAS评分、AOFAS评分。对以上指标进行组间比较及相关性分析。结果 174例患者均获得随访,随访15 ～ 66个月,平均（42.0±16.0）个月。各组术后1周时HKA角均较术前明显改善（P＜0.05）;末次随访时各组患者的HSS评分、ROM评分、AKS功能和活动评分、AOFAS评分均较术前明显提高（P＜0.05）;VAS评分均较术前明显下降（P＜0.05）。不同程度内/外翻的术前各项指标、术后HKA及优良率、AOFAS评分比较,内/外翻程度越严重,结果越差（P＜0.05）;术后HSS评分、ROM、AKS功能及活动评分、VAS评分比较,差异均无统计学意义（P＞0.05）。膝内翻患者的术前HKA角与术前HSS评分、ROM、AKS活动及功能评分、VAS评分、AOFAS评分、术后AOFAS评分正相关（P＜0.05）,与术后HSS评分、ROM、AKS活动及功能评分、VAS评分无相关（P＞0.05）。膝外翻患者的术前HKA角与术前HSS评分、ROM、AKS活动及功能评分、AOFAS评分、术后AOFAS评分负相关（P＜0.05）,与术后HSS评分、ROM、AKS活动及功能评分、VAS评分、术前VAS评分无相关（P＞0.05）。结论 从中期随访来看,患者术前膝内、外翻畸形的严重程度对术后HKA对线优良率、术后踝关节功能、术前膝关节功能有显著影响,而对术后膝关节功能无显著影响。     

内侧单切口改良Chevron截骨联合关节外侧组织松解治疗轻中度拇外翻临床观察

目的 :探讨内侧切口改良Chevron截骨结合外侧组织松解治疗轻中度拇外翻的临床疗效。方法:自2015年7月至2016年6月采用改良Chevron截骨结合外侧组织松解治疗轻中度拇外翻患者26例,其中男2例,女24例;年龄45~65(54.6±4.8)岁;病程1~5(7.5±3.3)个月。术后12个月末次随访时测量患足HVA(拇外翻角)、IMA(第1、2跖骨间角),并采用AOFAS评分比较手术前后临床疗效。结果:术后26例患足切口均Ⅰ期愈合,未出现切口感染、跖骨头坏死、拇外翻畸形复发等并发症,其中2例出现皮肤轻度麻木症状,考虑皮神经损伤引起。26例患者获得随访,时间6~12(9.12±2.06)个月,术前HVA(30.01±3.71)°、IMA(14.00±1.50)°与术后的(9.41±4.16)°、(7.00±0.60)°比较差异有统计学意义。术前AOFAS评分为54.77±9.59与术后的92.73±5.47比较差异有统计学意义,其中优19例,良7例。结论:内侧单切口行改良Chevron截骨(必要时加做Akin截骨)并Acutrak全螺纹无头加压螺钉固定,并适度松解关节外侧软组织以治疗轻、中度拇外翻,具有暴露充分、操作简便、固定牢固、愈合较快的优势,而且通过适度的外侧松解,必要时Akin截骨配合内侧关节囊紧缩,较好地恢复内外侧软组织平衡,取得了较为满意的临床效果。     

3D打印技术制定个体化截骨角在拇外翻Chevron截骨矫形术中的应用

目的:探讨3D打印技术制定个体化截骨角在拇外翻Chevron截骨矫形术中的临床应用。方法:自2013年5月至2016年5月,采用Chevron截骨治疗轻中度拇外翻患者47例(66足),根据术前设计方案分为计算机截骨组(A组)和传统截骨组(B组)。其中A组25例(33足),男4例(5足),女21例(28足),平均年龄(47.88±6.08)岁,负重位跖骨间角(IMA)(13.58±1.15)°,术前AOFAS评分59.00±5.86,术前采用个性化3D打印技术设计操作方案,进行个体化截骨治疗;B组22例(33足),男3例(3足),女19例(30足),平均年龄(48.16±6.16)岁,负重位IMA(13.51±1.14)°,术前AOFAS评分60.67±5.85,术前仅参考负重位X线,根据手术经验截骨治疗。比较两组患者的手术时间、术中出血量、住院时间、术后1周VAS疼痛评分、创口愈合情况及术后负重位IMA的改善情况,并采用足踝外科评分系统(AOFAS)对术后足踝部功能进行评估。结果:A组随访时间为(12.41±2.32)个月与B组为(11.73±2.76)个月比较差异有统计学意义。B组1例术后失访排除,所有病例术后创口Ⅰ期愈合,两组患者手术时间、术中出血量、住院时间及术后1周VAS疼痛评分比较差异无统计学意义(P0.05);A组术后IMA为(5.21±0.88)°,B组IMA为(6.42±0.85)°,两组比较差异有统计学意义(t=5.68,P0.05)。A组AOFAS评分为88.15±5.19与B组为82.90±5.01比较差异有统计学意义;A组优14足,良19足;B组优5足,良27足;两组比较差异有统计学意义(P0.05)。结论:应用3D打印技术制定的个体化截骨方案治疗轻中度拇外翻,较传统经验制定手术方案能更好地纠正患者的IMA,改善术后足部功能,是一种个体化数字化的手术方案。     

Doppler imaging of vibrations as a tool for quantifying first tarsometatarsal joint stiffness

Objective. To assess whether first tarsometatarsal joint stiffness can be measured by Doppler imaging of vibrations and if so, to assess reference values.

Design. Repeated in vivo Doppler imaging of vibrations measurements at the first tarsometatarsal joint in healthy persons.

Background. Clinical hypermobility of the first tarsometatarsal joint is an important factor in a hallux valgus deformity. No objective and non-invasive test is available to quantify first tarsometatarsal joint mobility. Doppler imaging of vibrations, a technique recently developed to measure joint stiffness, might be an effective tool to quantify stiffness of this joint.

Methods. Vibrations were applied to the head of the first metatarsal in 46 feet of 23 healthy subjects and picked up by a transducer at both sides of the first tarsometatarsal joint. A pilot study was performed on three patients with hypermobility of the first tarsometatarsal joint. Measurements are expressed in threshold units related to colour Doppler imaging.

Results. The values of the threshold units were found to be very similar in healthy persons, with a good repeatibility; 95% of the healthy persons had a threshold unit below 3.4. No significant difference was found between the left and right foot, or between male and female subjects. Also there was no significant correlation with age or weight of the subjects. In the three patients with first tarsometatarsal hypermobility we found threshold units above 5.

Conclusions. With Doppler imaging of vibrations first tarsometatarsal joint stiffness can be measured in healthy persons in a non-invasive and objective way. In a pilot study, three patients with first tarsometatarsal hypermobility showed lower stiffness values than the healthy subjects.

Relevance This study presents a new method for quantification of first tarsometatarsal joint stiffness and provides reference values in healthy persons. First measurements on patients gave promising results to future use of this method for assessment of clinical hypermobility in hallux valgus patients.     

A Modified Foot and Ankle Score for Assessing Patient Outcomes After First Metatarsophalangeal Arthrodesis

First metatarsophalangeal (MTP) arthrodesis is commonly used to treat many end-stage first MTP diseases. The most widely used scale for measuring the clinical outcomes after this procedure, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal–Interphalangeal scale, has not been adequately validated and does not measure specific foot functions. Another outcome measure, the patient-reported Foot and Ankle Outcome Score (FAOS) has acceptable construct validity but poor content validity. The FAOS scale has 42 questions, many of which are unrelated to the hallux. We designed a short-form FAOS (sf-FAOS) consisting of 11 questions that are more relevant to first MTP arthrodesis. The sf-FAOS includes a pain subscale and a function subscale, and the score of each subscale ranges from 0 (worst outcome) to 100 (best outcome). Our study has shown that the sf-FAOS scale has acceptable validity, reliability, and responsiveness. In 21 feet (16 patients) with hallux valgus after >1 year of follow-up, the mean sf-FAOS pain score had improved by 44.9 points after surgery (from 51.2 to 96.0; p?<?.001), and the mean sf-FAOS function score had improved by 22.5 points (from 47.3 to 69.8; p?<.001). The improvement in the function score for running and jumping was limited.