Physical treatment of foot deformities in childhood

During the period of development foot deformities can occur, not only during the growth and development, but also in the later age. The most frequent foot deformity is flatfoot, congenital club foot and hallux valgus. Prior to the decision on surgical treatment of the deformity, whenever possible the patient should be referred for physical therapy that may yield acceptable results in specific treatment phases. The basis of the treatment involves kinesitherapy, application of certain agents (thermotherapy, electrotherapy, ultrasound) and orthosis for maintaining corrections. If such therapy does not yield satisfactory results, the deformity is surgically corrected. After surgical correction, physical procedures can contribute to more rapid recovery and decrease possible complications (pain, edema, complex regional pain syndrome--Mb Sudec), which can follow the surgical correction of the deformity. In addition, the obligatory form of rehabilitation also involves kinesitherapy.     

膝关节牵伸器矫治膝部屈曲挛缩畸形的评价

[目的]通过对膝关节牵伸器矫治膝关节屈曲挛缩畸形及生物力学测评结果研究,论证该技术的安全性、临床疗效及治疗特点。[方法]49例患者(52个膝),应用标准的牵伸器治疗,采用综合评定标准评价临床结果;5例治疗前后膝部三维CT重建,观察关节结构的改变;检查15例治疗前后腘动脉的直径、血液流速及6例小腿肌电图、神经传导,以观察牵伸对腘动脉及肢体神经的影响;对3例患者分别以3种不同的牵伸及测试方法,初步观测不同的牵伸过程中屈曲角度与膝后软组织受力变化。[结果]52个膝关节功能均有恢复,最终优良率为65%;5例CT三维重建显示术后膝关节结构均较术前合理,关节面无破坏。统计结果显示牵伸过程对腘动脉没有明显的影响,可能对小腿神经有短暂的影响;3例患者用3种不同的牵伸及测试方法,最后结果均不同,说明软组织受力情况与牵伸方法、患者年龄及屈膝畸形程度有关。[结论]该治疗方法是安全的、合理的、有效的;膝后软组织受力受到多种因素的影响,因此牵伸速度应个体化,低负荷均匀的受力可能更有利于软组织的再生、相对更安全。     

Hemi-wedge osteotomy in the management of large angular deformities around the knee joint

Background

Angular deformity around the knee joint is a common orthopedic problem. Many options are available for the management of such problem with varying degrees of success and failure. The aim of the present study was to assess the results of hemi-wedge osteotomy in the management of big angular deformities about the knee joint.

Materials and methods

Twenty-eight limbs in 21 patients with large angular deformities around the knee joint were treated by the hemi-wedge osteotomy technique. The ages ranged from 12 to 43 years with an average of 19.8 years. The deformity ranged from 20° to 40° with a mean of 30.39° ± 5.99°. The deformities were genu varum in 12 cases and genu valgum in 9 cases. Seven cases had bilateral deformities. Small wedge was removed from the convex side of the bone and put in the gap created in the other side after correction of the deformity.

Results

At the final follow-up, the deformity was corrected in all cases except two. Full range of knee movement was regained in all cases. The complications included superficial wound infection in two cases, overcorrection in one case, pain along the lateral aspect of the knee in one case and recurrence of the deformity in one case. No cases were complicated by nerve injury or vascular injury.

Conclusion

Hemi-wedge osteotomy is a good method for treatment of deformities around the knee joint. It can correct large angular deformities without major complications.

     

A new orthosis for the management of clubfoot and other foot and leg deformities in infancy and early childhood

A new orthosis designed to deal with unilateral or bilateral idiopathic clubfoot after successful conservative or surgical treatment was used to maintain the correction and to prevent recurrence. Once the neutral position of the heel was achieved, the orthosis was found to be very useful in improving the correction of the hind-foot and/or the forefoot. The first 50 patients treated with the orthosis showed a 92% compliance rate for an average period of 9-12 months.     

近膝关节骨折并交叉韧带损伤的早期诊断与治疗

目的探讨近膝关节骨折合并交叉韧带损伤时，避免交叉韧带损伤漏诊的方法。方法２２例胫骨平台及股骨髁骨折患者，于麻醉后或内固定后行膝关节稳定试验，呈阳性者在内固定术同时行膝关节探查及交叉韧带修补术，结果２２例术中抽屉试验均为阳性，与探查结果完全符合。术后经７－４６个月随访：所有中层得膝关节稳定性良好，抽屉试验阴性，未见创伤性关节炎发生。结论对有内固定手术指征的近膝关节骨折，术中应检查交叉韧带是否损伤，避     

Orthopedic treatment of spinal deformities in infancy and early childhood

Surgical treatment of spinal deformities in infancy and early childhood (before age 6) is often very useful if the lesion is localized and curable by one unique surgery, such as hemivertebra resection and fusion. On the contrary, if the lesion, whether idiopathic or paralytic, is extended to a large part of the spine, early surgical treatment in infancy gives very disappointing results and often worsens the status of the child, especially respiratory function if the lesion is mainly thoracic. The goal of this paper is to explain in detail indications and management of non-surgical treatment of such lesions. These are variable according to localization, etiology, and associated anomalies, and are mainly based on proper casting (often repeated), bracing (often intermittent between casting) and proper respiratory equipment. From time to time, a surgical treatment is locally indicated, but most of the time results are disappointing and the best is to repeat non-surgical treatment until proper definitive arthrodesis can be performed. This approach is not very rewarding for the child and family, but is clearly better than sudden extensive surgery in early childhood with very severe and disastrous results in adulthood. It is our hope that the recommendations and thoughts presented in this paper will help readers to manage young children using the most efficient, non-aggressive, but long-lasting therapy.     

人工全膝关节置换治疗膝关节骨关节炎

目的探讨人工全膝关节置换术(TKA)治疗终末期膝关节骨关节炎的临床疗效。方法对行TKA治疗的181例终末期膝关节骨关节炎患者(226膝)分别于手术后40、120、180、360 d进行定期随访观察,对患者HSS膝关节功能评分及膝关节最大活动度进行比较。结果患者均获得随访,时间1~2年。膝关节功能HSS评分:优209膝(92.5%),良13膝(5.8%),可3膝(1.3%),差1膝(0.4%),优良率98.2%。术后各时间段的HSS评分及膝关节最大活动度均较术前显著提高,差异均有统计学意义(P0.05)。结论 TKA是治疗终末期膝关节骨关节炎的有效方法,正确的手术操作和合理的功能锻炼是取得满意临床效果决定性因素。     

股四头肌成形术治疗重度膝关节僵直

膝关节僵直是临床上的常见病，其主要原因是伸膝装置的挛缩与粘连。近3年来，我科应用股四头肌成形与膝关节松解治疗膝关节僵直23例，取得较好的效果。 1临床资料 本组23例，男18例，女5例；年龄22～59岁，平均29岁；病因：股骨干中下段骨折术后15例（其中6例为骨不连接）；     

Gait disorders and leg deformities in children

Gait disorders and leg deformities have become the most prevalent orthopedic problems in children in Japan. Usually, at the first visit to our outpatient clinics, there are many difficulties in fully determining the causes and prognoses of these problems. Several series of observations, carried out at intervals, will be required to ascertain whether these problems are really pathologic or whether they are actually within the normal range. In-toeing gait and bow-legged deformities were the most common complaints observed in each of the above problems. The conditions in the majority of such patients were observed to spontaneously improve with time. However, we must always focus on the patient's past history, beginning from infancy, and we must carry out some physical examinations so as not to overlook any actual disorders underlying the patient's present condition. Received: June 25, 2001     

Closed distraction epiphysiolysis for leg lengthening and axis correction of the leg in children

The distraction-epiphyseolysis is a method of leg-lengthening and allows to correct leg-deformities. A daily lengthening of 1 mm enhances ossification and enables a maximum lengthening of 8-10 cm. The indications, contra-indications and the method are described.     

Calcific myonecrosis of the lower leg: diagnosis and options of treatment

Introduction  Calcific myonecrosis is a rare condition characterized by a calcified lesion. Because this lesion sometimes presents as a huge mass with unique radiographic characteristics, it can be confused with soft tissue sarcoma. The appropriate treatment is still controversial. We report here three cases diagnosed as calcific myonecrosis of the lower leg and discuss its clinical presentation, diagnosis and options for treatment. Patients and methods  Three patients presented as expanding masses in the anterior or lateral compartment muscle and occurred more than 10 years after an initial injury. Plain radiographs showed a large soft tissue mass with extensive amorphous calcifications. Computed tomograms revealed a low-density tumor with scattered calcifications. Magnetic resonance imaging showed a bright, high-signal area on T2-weighted imaging consistent with fluid. Two patients underwent excisions for histopathological evaluation and one was treated conservatively because of the absence of disability. Results  Two operative patients had no complication and the returned to work without evidence of deterioration of the disease. In a patient treated conservatively, the mass was not enlarged and was still painless at 2-year follow-up. Conclusion  The key points for diagnosis were (1) amorphous liner calcification, (2) anterior or lateral compartment, (3) previous injury (several decades) of the tibia or femur, and (4) compartment syndrome. Although calcific myonecrosis is not commonly encountered, it must be considered in the differential diagnosis of an expanding intramuscular mass. In asymptomatic masses where the diagnosis is recognized, observation may be possible and unnecessary aggressive surgical intervention should be avoided.     

严重畸形的膝骨关节病人工关节置换术

目前,人工全膝关节置换的手术技术已基本成熟,但也有一些例外的病人,那就是严重畸形的骨关节病病人.这些病人往往畸形严重,手术中取得软组织及韧带的平衡非常复杂,取得完全的平衡是很困难的,以下简要介绍我院在处理这些病例的经验及手术技巧.