One-stage posteromedial release of congenital clubfoot

Turco's one-stage posteromedial release with internal fixation has been performed in 51 children with a total of 73 congenital clubfeet since 1973. Thirty-one children (44 feet) followed for 4-12 years were evaluated using the McKay rating system. The occurrence of good and excellent results was 70%. The relationship between these results and angles measured from roentgenograms was analyzed using multiple regression. The results showed a closer relationship to the anteroposterior talocalcaneal angle, the tibiocalcaneal angle, and the MTR angle.     

上肢先天性绞扼轮综合征的临床治疗

目的 对上肢先天性绞扼轮综合征进行临床分型,探讨一期完全切除环形绞扼轮术式的可行性,总结先天性绞扼轮综合征合并短小指、并指畸形的治疗经验.方法 先天性绞扼轮综合征的部位进行分区,对绞窄的程度进行临床分度.一次完全切除环形绞扼轮,并同时依据临床分型对软组织进行松解、修复.结果 本组11例15侧上肢绞扼轮均予以一期完全切除,术后肢体均未出现血运障碍.随访7个月至3.5年,平均2.1年.功能评价:优9侧占60.0%,良5侧占33.3%,差1侧占6.7%.结论 一期完全切除绞扼轮,对肢体远端的血运不会产生影响,在切除绞扼轮的同时,应根据绞扼轮的临床分型对深部组织予以修复.     

An experimental study on the pathogenesis of congenital hand malformation--with reference to local disturbance in the limb bud and congenital constriction band syndrome

In order to study congenital constriction band syndrome, we performed local cauterization of the lower limb buds of embryos in fertilized white leghorn eggs between hour 0 on day 4 (day 4-0) and day 7-0 of incubation. Constriction bands, acrosyndactyly, and amputation of digits, malformations characteristic of this syndrome, were all induced by intervention after day 5-0, when digital ray formation was first observed, indicating that they all develop after ray formation. Histological examination showed that encapsulation and shedding of the lesion containing hematoma and necrotic tissue at the distal end of a digital ray led to digit amputation. When the cells encapsulating this lesion extend over another digital ray, moreover, the ray tips fuse, while the rest of the two digits involved remain discrete-resulting in acrosyndactyly.     

Nonadjacent syndactyly in the congenital constriction band syndrome.

Hand anomalies in the amniotic band sequence are frequently both complex and difficult to explain in terms of our conventional understanding of limb embryogenesis. A case manifesting pseudosyndactyly between nonadjacent fingers confirms the role of an in utero disturbance after the seventh week, in concert with close apposition between nearby but not adjacent parts.     

Surgical treatment of congenital clubfoot with constriction band syndrome]

Twelve feet in 11 patients with constriction band syndrome age ranging from 3 to 18 months (mean age 11 months) were evaluated in this study. The constriction band was located at the in the calf, at distal, media and proximal third levels. All these patients were treated surgically by a wide peritalar release using the Cincinnati incision, followed by a two-stage Z-skin plasty. Both clinical and radiological results were evaluated. In our material an excellent result was achieved in 1 case, good results in 3 cases, satisfactory in 4 cases and poor in the remaining four cases. Very good and good results were achieved in feet with shallow bands type II and III, while poor results were found in feet with deep constriction band type I. Early surgical treatment followed by serial casting leads to better functional results.     

The prognosis in congenital lower limb hypertrophy.

Twenty-eight patients with congenital total hypertrophy and ten patients with lower limb hypertrophy with congenital vascular abnormalities are reviewed. The pattern of increase in leg length discrepancy during growth and its influence on surgical management is discussed and the clinical features of the affected limbs are described. In congenital total hypertrophy the maximal increase in leg length discrepancy of more than 2.5 cm at age 4 years are likely to develop significant limb overgrowth that will require eventual surgical correction. In patients with congenital vascular abnormalities the change of leg length discrepancy was variable in degree and unpredictable in pattern, even in those with similar venous anomalies. The outcome for the limb was detergiography.     

先天性缩窄带综合征并指畸形的临床分型及治疗策略

目的 研究和分析先天性缩窄带综合征并指畸形的临床特点,建立新的临床分型系统并确立相关的治疗策略.方法 回顾性分析2002年2月至2009年8月经治疗的先天性缩窄带综合征并指畸形40例,以临床形态特点为依据,结合既往已有的Patterson分型、Blauth分型,将具有相同或相似解剖形态学改变的归为同一类型,归纳出新的分型特点.新的分型系统包括:Ⅰ型(IA、m),Ⅱ型,Ⅲ型(ⅢA、ⅢB、ⅢC、ⅢD、ⅢE),Ⅳ型,Ⅴ型,以及Ⅵ型.方果 在本分型系统中,包括了既往Patterson分型、Blauth分型系统中的所有内容,同时增加了新的内容,如ⅢC、ⅢD、ⅢE、Ⅳ型、Ⅴ型,并将Blauth Ⅲ型(Ⅰ型)分为两个亚型.方论 新分型系统详细、全面地涵盖了先天性缩窄带综合征并指畸形的临床形态学特征,为合理选择手术治疗策略提供了基础.     

A new technique for correction of congenital constriction rings

BACKGROUND: Congenital constriction ring (CCR) is among the most common congenital anomaly of the extremities. However, few techniques have been described for correction of this anomaly, and none of these techniques could provide a complete elimination of the deformity. Therefore, new surgical techniques are needed for correction of this challenging deformity. PURPOSE: Here, a new technique, namely, Mutaf procedure, for the correction of congenital constriction rings is described. MATERIAL AND METHOD: In this technique, following excision of the fibrotic constriction ring, the groove is filled with the turnover dermofat flaps elevated from both sides of the ring in an alternating pattern. Then skin closure is done with rectangular-plasty technique. Over 8 years, this new technique was used for correction of severe CCRs of the lower extremities in 7 patients aged 1-7 years. RESULTS: In all patients, a normal extremity contour was obtained, with complete elimination of the sandglass deformity caused by the constriction ring. A mean follow-up of 3 years revealed a normal growth of the operated extremity in all patients. The scars were found to be esthetically acceptable. No further surgery was required. CONCLUSIONS: Filling the circular groove caused by the constriction ring with dermofat flaps, this new technique eliminates the soft tissue deficiency and provides a normal extremity contour. Moreover, since rectangular-plasty allows replacing the major limbs of the incisional scars within the relaxed skin tension lines, it provides a better scar in comparison with old Z-plasty techniques.     

Surgical correction of congenital constriction band syndrome in children: Replacing Z-plasty with direct closure

Congenital constriction band syndrome is a sporadic condition that may also be present in association with other congenital anomalies. It has an incidence varying from one in 1200 to one in 15,000 live births. There is a significant predilection for the upper extremities and distal limbs. The two main objectives for the treatment of congenital constriction band syndrome are improvement of function and improvement of cosmetic appearance. Different surgical techniques, such as Z-plasty, have been described and used for decades; however, direct closure after the excision of the constricting band seems to be the simplest and most appropriate, allowing the fatty tissue to naturally reposition itself under the skin. This technique is used in a two-stage approach to avoid affecting distal circulation to the limb.     

Prosthetic restoration in congenital lower limb deficiency. A case study.

We presented a synopsis of a young girl with congenitally deficient limb who underwent seven corrective surgical procedures and fabrication of a specially designed and constructed prosthesis. The surgical procedures are detailed as in the total rehabilitation approach. We have provided plastic laminated orthoses and prostheses to many patients with congenitally deficient upper and lower limbs. An additional paper will detail our experience with a series of plastic laminated orthoses and prostheses in patients with congentally deficient upper and lower extremities.     

Clinico-radiologic evaluation of deformation of the foot and lower limb in congenital clubfoot

In a typical form of congenital club foot there is a complex primary and secondary post-loading deformation both of the feet and of all the bones of the lower extremity which by all means should be taken into consideration when correction with apparatuses of perosseous external fixation is carried out for the complete elimination of the congenital malformation and the prevention of a recurrent deformation.     

Lower limb amputations during 3 years in Hungary

We reviewed nationwide hospital data of amputations during 3 years to provide a comparison with similar data gathered about 20 years ago. Data were provided by the National Medical Records Centre and processed by our personally developed programmes. The cause of amputation was most often vascular disease, amputees were usually elderly, and the large majority of amputation surgery was carried out on the lower limb. The rate of transtibial amputation has increased favourably in the last 2 decades, but there are large regional differences within the country. Mortality parameters remarkably exceed those of foreign countries. Although the data accuracy is compromised, there are still ways of exploiting the data in favour of quality improvement of care, e.g. improve transtibial amputation rate, reduce mortality. The publication of data can be of benchmarking importance for hospitals by enabling them to compare their own results with those of other hospitals, as well as to develop and improve performance. Received: 30 June 1997     

下肢肌力训练对髂胫束综合征治疗作用的研究进展

髂胫束综合征（iliotibial band syndrome,ITBS）作为一种下肢过度使用型损伤,已发展为膝关节外侧疼痛的常见原因。目前针对髂胫束综合征的治疗包括药物治疗、肌力训练、物理治疗以及手术治疗,在这些方法中,物理治疗、药物治疗及手术治疗往往只能缓解患者的症状,而下肢肌力训练作为一种安全有效的治疗手段通过关注患者恢复过程的动态变化,改善患者的肌肉力量,纠正异常步态,减少疾病的复发率。目前髂胫束综合征发病机制尚不明确,治疗方法不统一,需进一步研究与下肢相关的生物力学因素,制定更科学、更全面的肌力训练方法。     

戴戒术与单纯浅静脉剥脱术治疗原发性下肢深静脉瓣膜功能不全的比较

目的:比较股浅静脉戴戒术与单纯性浅静脉剥脱术治疗下肢深静脉瓣膜功能不全的疗效。方法:将2010年03月—2011年1月收治的48例下肢深静脉瓣膜功能不全伴静脉曲张患者随机分为观察组(股浅静脉戴戒术联合大隐静脉高位结扎剥脱术)和对照组(传统大隐静脉高位结扎剥脱术),通过彩色多普勒检测两组术前及术后股总静脉血管内径、平均血流速度及Valsalva试验下反流持续时间的变化。结果:与术前比较,术后两组患者的静脉瓣膜功能及血流动力学均明显改善,表现为股总静脉管径缩小、平均血流速度增快、静脉血流反流时间缩短(均P<0.05),但观察组上述3个变量手术前后变化程度(差值)均明显大于照组(均P<0.05)。结论:两种手术方式均是治疗下肢深静脉瓣膜功能不全的有效手段,但戴戒术的治疗效果优于单纯性浅静脉剥脱术。