关节镜下跖腱膜起点切断术治疗顽固性跖腱膜炎

目的探讨关节镜下跖腱膜起点切断术治疗顽固性跖腱膜炎的临床疗效。方法 2011年10月至2012年7月,顽固性跖腱膜炎患者共41例实行关节镜下跖腱膜起点切断术治疗。采用视觉模拟评分(visual analogue scale,VAS)标准进行评估。记录手术时间及术中出血量。结果所有患者均获随访,随访时间12~18个月,平均14个月。术后VAS值为0分者有38例(92.7%),VAS值为1~3分者有3例(7.3%)。所有病例均无足底内侧血管神经损伤及切口感染。结论关节镜下跖腱膜起点切断术治疗顽固性跖腱膜炎,是安全有效的微创治疗方法。     

跖腱膜切断术治疗跖腱膜炎（附44例报告）

作者用跖腱膜切断术治疗用腱膜炎共５０足（４４例）。平均随访时间１１．２月结果显示５６．６％的病人症状完全消失，９４．９％的病人症状明显减轻、除部分病例有疤痕形成外来出现其它并发症．文中对跖腱膜炎的发病原因及手术方式进行了讨论。     

针切法治疗跖腱膜炎

目的 介绍针切法治疗跖腱膜炎的方法,并观察疗效。方法 治疗７０例,均系经保守治疗无效者。于足内侧跖腱膜附丽处横向进针,先行局封,然后换叉针头推切。结果 随访５４例６０足。３２例３６足一次针切全愈,２０例２２足显效,仅２例足需再次针切。结论：跖腱膜切断术包括直视下、关节镜下或Ｂ超引导下经皮切断,各具其优缺点。针切法则简单、损伤小、安全、迅速、更显优越。     

跖腱膜的解剖观察及临床意义

16只新鲜男性足标本经B超测量及解剖观察，发现跖腱膜中央带（CBPF）于止点处最厚，平均为0．24cm；于足弓处CBPF中、内侧部较外侧都稍厚。CBPF止点处相当于跟骨脂肪垫前2／5水平处。作者认为若单纯行跖腱膜切断术治疗跖腱膜炎时，则切断部位选择在足弓处较止点处为宜。     

跖趾关节背伸试验及跖趾关节背伸加强试验在诊断跖腱膜炎中的价值

目的 探讨跖趾关节背伸试验(DMPJT)及跖趾关节背伸加强试验(SDMPJT)在诊断跖腱膜炎(PF)时的价值.方法 对472例共611足经超声检查证实为PF的患者(PF组)及100例对照者(对照组)分别行DMHT和SDMHT.结果 PF组:DMHT阳性者96足,占15.7%;SDMHT阳性者570足,占93.3%.两者相比差异具有非常显著性意义(P<0.0001).对照组:DMHT和SDMPJT均为阴性.对照组和PF组相比,差异具有非常显著性意义(P<0.0001).结论 对PF的诊断,SDMPJT具有临床应用价值而DMHT不具有临床应用价值.     

关节镜下射频消融技术治疗跟痛症的疗效分析

目的:探讨通过关节镜下微创射频消融技术治疗慢性跟痛症的疗效。方法:选取2006年1月至2011年12月收治的跟痛症患者13例,男5例,女8例;年龄35～68岁。于足跟部标记疼痛点,行局部浸润麻醉。选取跟骨结节前缘跖腱膜两侧分别建立内外侧入路。皮下组织内注射15～20ml含0.03%肾上腺素的生理盐水,后以肌腱剥离器钝性分离皮下组织与跖腱膜,建立人工腔隙。关节镜监视下以射频消融技术清理增生杂乱的跖腱膜,清除跟周滑囊,再以TOPAZ刀头行跖腱膜局部网状打孔治疗。患者手术前后均行疼痛视觉模拟评分(VAS)及美国足踝外科协会后足评分(AOFAS-AH),术后随访6～12个月。结果:13例术后恢复良好,疼痛均有显著改善,VAS评分由术前的8.71±1.64,改善为术后1个月的6.27±2.53及术后6个月的2.30±2.69。AOFAS-AH评分由术前的56.43±3.72,改善为术后1个月的68.15±7.38及术后6个月的84.51±2.93。术中、术后均未出现血管神经损伤、感染等并发症。结论:跖腱膜长期受牵拉导致的跖腱膜炎及跟周滑囊炎是引起跟痛症的一个重要原因。关节镜监视下射频消融清除增生的组织及跟周滑囊,并行跖腱膜打孔治疗,手术操作简单,术中无须部分及完全切断跖腱膜或切除跟骨骨刺,创伤小,对患者足部功能影响小,有利于术后康复。     

采用KobeGurd系统行跖腱膜部分切断术治疗顽固性跟痛症的疗效

背景：跟痛症是足踝外科的常见病,目前临床主要通过保守方法治疗。但对于保守治疗无效或反复发作的病例,手术治疗也许是一种不错的选择。目的：观察足跟内侧小切口KobeGurd系统跖腱膜部分切断术治疗顽固性跟痛症后患者症状改善情况,探讨利用该方法治疗顽固性跟痛症的可能性。方法：2008年8月至2011年3月采用小切口KobyGard系统进行足跟内侧跖腱膜部分切断术治疗顽固性跟痛症患者68例,其中资料完整的56例（84足）,男24例（32足）、女32例（52足）,体重80 kg以上者46例。年龄28~72岁,平均47.6岁。病史均1年以上,最长者3.6年,平均1.8年。手术前后及末次随访时观察包括疼痛强度（VAS评分系统）、行走距离、站立时间、跟骨筋膜压痛及踝关节、距下关节的活动度等的临床疼痛指数变化,并进行后足疗效评定。结果：本组患者随访时间11~36个月,平均17个月。所有患者跟骨处疼痛完全消失,行走步态恢复正常。疼痛指数：术前平均为8.8,术后4周、8周、4个月、8个月分别为4.89、2.98、1.46和0。根据美国足踝外科协会Maryland后足百分评分法对本组患者进行评定,优66足（78.6%）,良16足（19.1%）,可2足（2.3%）。未出现跟骨骨折、足弓塌陷等并发症。结论：运用小切口KobeGurd系统跖腱膜部分切断术治疗顽固性跟痛症疗效满意,可作为临床治疗顽固性足跟痛的一种选择。     

两种不同术式治疗跖痛症临床疗效分析

[目的]探讨微创截骨与Weil截骨两种不同术式治疗跖痛症的适应证及临床疗效。[方法]对51例(64足/104跖骨)轻度跖痛症患者分别行跖骨颈部微创截骨抬高术(A组,24例/26足/55跖骨)和Weil截骨术(B组,27例/38足/49跖骨)。比较两组患者手术前后责任跖骨的VAS评分、ACFAS评分及跖骨头下最大压力、最大压强及冲量变化,评价两组病例的临床疗效。[结果]术后随访时间6~36个月,平均20个月。A、B两组病例手术前后VAS评分和ACFAS评分差异有统计学意义(P0.05);Footscan足底压力测试手术前后责任跖骨头下最大压力、最大压强及冲量差异均有统计学意义(P0.05)。A、B两组病例术后VAS评分、ACFAS及足底压力测试数据比较,差异无统计学意义(P0.05)。A组出现截骨延迟愈合4例(4跖骨)。[结论]两种截骨术均能有效缓解跖痛症的疼痛症状。微创截骨抬高术治疗跖痛症,疗效确定,易于掌握,并发症少,适合于临床推广应用。     

小剂量活血中药足弓跖内侧注射治疗跟骨骨刺综合症

跟骨骨刺综合症 (Plantarfasciitis/heel spur syndrome.PF/ HSS)跖腱膜炎 ,是跟痛症的最常见原因之一 ,目前认为跟骨骨刺不是引起疼痛的原因 ,疼痛是由于跖腱膜因反复微损伤在跟骨结节处炎症反应引起 [1 ,2 ] 。临床多在中年以上发病 ,主要临床症状为足跟部跖侧痛 ,行走时加重     

顽固性跟痛症的手术治疗

[目的]探索顽固性跟痛症的手术方式与治疗效果。[方法]回顾性分析2012年4月～2016年12月本科手术治疗的84例顽固性跟痛症患者。根据术前压痛点、局部封闭疗效和跟骨骨刺情况综合判断分析,15例行跟骨钻孔减压术(减压组),29例行骨刺切除并跖腱膜射频消融术(切除组);19例行胫后神经跟骨内侧支松解切断术(松解复合切断组),21例行骨刺切除、跟骨钻孔减压、跖腱膜射频消融和胫后神经跟骨内侧支松解切断术(复合组)。[结果]四组患者的VAS评分随术后时间延长而显著下降,差异均有统计学意义(P0.05)。而四组患者AOFAS-AH评分随术后时间延长而显著增加,差异均有统计学意义(P0.01);末次随访时,四组患者临床疗效优良率分别为:减压组93.33%,切除组93.10%,松解复合切除组100%,复合组95.23%,84例患者总体优良率为95.23%。[结论]顽固性跟痛症主要术式有跖腱膜射频消融术,跟骨骨刺切除术,跟骨钻孔减压术,胫后神经跟骨内侧支切断术,经术前充分的评估,根据疼痛的不同原因合理优化组合应用上述手术方式,临床效果满意。     

足底主要韧带损伤对足底压力分布的影响

目的 分析足底主要韧带损伤后足底压力及接触面积的变化情况. 方法 7例正常成人新鲜尸体足标本,解剖显露并依次切断足底跖筋膜,弹簧韧带、跖长韧带、跖短韧带,模拟足底主要韧带损伤.经电子万能试验机逐级加载至700 N,利用F-scan足底压力测鼍系统,测量足底韧带损伤前后足底压力峰值及接触面积的变化情况,对结果进行统计分析. 结果 标本后足部位一直为压力峰值区,当足弓内在维持结构损伤后,前足压力增加,峰值压力位于第3跖骨头下;而足底接触总面积无明显改变. 结论 足底韧带损伤后,足底压力分布将发生改变,足外侧的应力集中,可能是出现临床症状的一个重要原因.     

Island medial plantar artery perforator flap for reconstruction of plantar defects

Three cases in which island medial plantar artery perforator flaps were successfully transferred for coverage of the plantar defects are described. This perforator flap is different from the medial plantar flap based on the medial plantar artery. The flap has no fascial component and is nourished only with the perforator of the medial plantar vessel. Therefore, transection of the medial plantar artery is usually unnecessary. This flap can cover defects on the forefoot and heel without transaction of the medial plantar system. The advantages of this flap are no need for deep or long dissection for the medial plantar vessel, no exposure of the plantar sensory nerve, a short time for flap elevation, minimal donor-site morbidity, relatively large flap survival, and no damage of both the posterior tibial and medial plantar neurovascular systems.     

Reconstruction of plantar defects

Plantar defects are a challenge for the plastic surgeon; from 1984–1995 59 operations were performed in 57 patients. The radial forearm flap and the latissimus dorsi (LD) flaps were mainly used depending on the amount of tissue loss. Local flaps such as dorsalis pedis and instep flaps were used for smaller defects. The radial forearm flap is ideal in terms of thickness and stability for the sole but limited in its size. The LD flap is a safe procedure especially for severe injuries and osteitis, but has the disadvantage of being bulky and debulking procedures are frequently performed. For nerve reconstruction deep sensibility seems to be sufficient in order to obtain stable postoperative results. In this report the different operative methods are evaluated. Since 1991, the patients were monitored with static and dynamic foot pressure measurements and gait analysis to assess the postoperative result and prevent pressure ulcers, scar irritation and hyperkeratosis. Preoperative investigations may contribute to an optimal schedule for planning and stabilization of the operative regimen.     

Investigation of the relationship between the thickness of the plantar calcaneonavicular ligament and plantar fascia in patients with plantar fasciitis

BackgroundAlthough patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to elucidate the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system (US).MethodsThirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated. The thicknesses of both the spring ligament and plantar fascia were assessed via a US statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups. This was performed using Welch’s t-test, and the significance level was set at p < 0.01. In addition, Pearson’s correlation coefficient was calculated to assess the correlation between the spring ligament and plantar fascia thickness in the two groups, and the significance level was set at p < 0.01.ResultsThe spring ligament thickness in the painful group was significantly lower than that in the healthy group (p < 0.001). The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group (p = 0.03). In addition, the correlation between the spring ligament and plantar fascia thickness was moderately negative (r = −0.42, p = 0.001). The thicker the plantar fascia in the subjects, the thinner was the spring ligament.ConclusionsThe thickness of the spring ligament in patients with plantar fasciitis decreased. The thinning of the spring ligament was negatively correlated with the thickening of the plantar fascia as per the US evaluation. Based on the spring ligament thinning determined via US evaluation, interventions such as insoles from an early stage could prevent the onset of plantar fasciitis.