踝关节软组织撞击综合征的关节镜治疗

目的总结踝关节软组织撞击综合征(ankle soft tissue imp ingem ent syndrom e,ASTIS)的临床和病理特点以及关节镜手术治疗的效果。方法2000年11月~2005年4月,21例ASTIS伤后1~48个月,(13.6±9.9)月接受关节镜手术,镜下切除撞击组织,并进行病理检查。术后采用AOFAS(美国足踝外科协会)后足-踝评分法评定手术效果。结果关节镜下显示20例存在滑膜组织撞击(14例合并以下其他组织撞击),下胫腓前韧带远侧束撞击5例、纤维瘢痕组织撞击4例、距腓前韧带组织撞击3例和半月板样组织撞击3例。16例合并关节软骨损伤。21例术后随访7~60个月,(34.3±9.4)月,AOFAS主客观评分术后较术前均明显提高,总体评分术前(67.0±9.7)分,术后(94.0±6.4)分(t=-7.205,P=0.000),主观评分术前(20.7±6.6)分,术后(35.7±4.9)分(t=-5.003,P=0.000)。结论踝关节软组织撞击综合征多继发于踝关节创伤。发生部位以踝关节前外侧更多见。撞击组织为滑膜、韧带、瘢痕组织及半月板样组织。关节镜治疗ASTIS效果满意。     

关节镜下治疗踝关节软组织撞击综合征

目的 对踝关节软组织撞击综合征的关节镜下诊断和治疗进行初步探讨。方法 对近年来３０例踝关节软组织撞击综合征的关节镜下诊治经验进行总结。术前体检发现肿胀和疼痛以踝前外侧为主２４例,以踝前内侧为主６例在伤后半年～１年进行手术。关节镜下见到不同程度的滑膜增生、肥厚,韧带的撕裂或软骨损伤,均在关节镜下予以切除并清理关节。结果 术后平均随访２年４个月,优７例,良１９例,可４例,优良率８７％。结论 踝关节扭伤     

踝关节软组织撞击综合征的诊断和治疗

目的 探讨踝关节软组织撞击综合征的诊断和治疗。方法 1995年3月～2001年5月，我科共收治踝关节软组织撞击综合征36例。其中经MRI检查后行踝关节切开嵌夹软组织切除术14例，关节镜检查及镜下切除嵌夹软组织22例。结果 随访36例，时间6月～7年，平均22月，优9例，良19例，可7例，差1例，优良率77．8％(28／36)。结论 关节镜检查及镜下手术是治疗踝关节软组织撞击综合征有效方法。     

足踝部皮肤软组织缺损的显微外科修复选择

目的 探讨应用带蒂皮瓣及游离皮瓣修复足踝部软组织缺损的方法和临床疗效.方法 2008年3月至2010年3月共收治28例足踝部软组织缺损患者,男21例,女7例;年龄6～62岁,平均34.0岁.致伤原因:交通伤13例,机器压砸伤11例,坠落伤2例,慢性溃疡1例,烫伤1例.皮肤缺损面积4.0 cm×7.0 cm～11.0 cm×44.0 cm.术前根据患者足踝部软组织缺损及其他组织损伤情况,急诊或择期选择带蒂皮瓣或游离皮瓣移植修复足缺损,其中应用股前外侧皮瓣10例,腓肠神经营养血管皮瓣8例,内踝上穿支皮瓣4例,跗外侧皮瓣3例,足底内侧皮瓣2例,背阔肌皮瓣1例.术后对皮瓣的存活情况和愈合质量进行随访. 结果 28例患者术后获4～24个月(平均14个月)随访.2例术后出现皮瓣远端坏死,2例皮瓣边缘部分坏死,经换药、抗感染和植皮术后创面愈合;其余移植的皮瓣均成活,创面一期修复,皮瓣外形良好,质地、弹性好,足踝部功能恢复,行走正常. 结论 足踝部软组织缺损修复应根据损伤部位、面积及程度来决定选用邻近带蒂组织或游离组织移植修复.足跟及踝部缺损可选用腓肠神经营养血管皮瓣、足底内侧皮瓣、内踝上皮瓣和跗外侧皮瓣等;大面积或广泛剥脱伤需选用游离皮瓣,如股前外侧皮瓣或背阔肌皮瓣;前足小范围缺损,应用跗外侧皮瓣进行修复有其优势.     

应用皮肤牵张带治疗足踝部皮肤软组织缺损

目的探讨皮肤牵张带(externaltissueextender,ETE)在治疗足踝部皮肤软组织缺损中的价值。方法2001年7月～2003年2月,应用皮肤ETE治疗8例足踝部软组织缺损患者,男6例,女2例;年龄5～85岁,平均51.6岁;非缺血性糖尿病足3例,右踝部外伤性皮肤缺损跟骨外露2例,左外踝皮肤溃疡1例,类风湿性关节炎行左踝关节融合术后伤口不愈合1例,右足背皮肤缺损跖骨外露1例;软组织缺损面积最大为5.0cm×12cm,最小为3.5cm×3.5cm。于伤口的两侧标记皮肤ETE的进针点和出针点,每针相隔1.8cm,距伤口边缘0.5cm。治疗期间每天牵拉硅胶带1～2次以维持合适的张力,直至伤口合拢。结果8例患者均获得随访,随访时间2～20个月,平均5个月。其中7例痊愈,1例类风湿性关节炎行左踝关节融合术后伤口不愈合的患者(伤口5cm×3.5cm)经皮肤ETE治疗后仍未愈合,考虑与长期应用激素,创口周缘皮肤所含胶原萎缩,所能承受的张力小有关;另外患者在治疗过程中出现伤口感染,致牵张的皮肤裂开,患者自动出院,随访半年仍未愈合。结论应用皮肤ETE治疗足踝部皮肤软组织缺损,手术时间短,对患者造成的局部损伤小,术后恢复快,尤其适用于老年非缺血性糖尿病足部溃疡患者。     

Reconstruction of soft tissue injuries of the foot and ankle with microsurgical techniques

Microsurgical reconstruction for injuries of the foot and ankle includes, in addition to repair of small nerves, vessels, and tendons, coverage of soft tissue defects. Local transpositional and island pedicle flaps are ideal when available and adequate. The choice of free vascularized flaps is based on its potential durability, contour, bulk, and appearance. Thin cutaneous flaps, fascial flaps, and muscle flaps covered with split thickness skin grafts are appropriate in specific areas. Neurosensory flaps and methods of reinnervation may have a place in extensively denervated feet. Good postoperative pedorthic care aids in the final outcome.     

MRI对软组织肿瘤的诊断价值

目的探讨MRI对软组织肿瘤的诊断价值。方法收集2001年10月至2004年8月180例软组织病变患者的MRI资料进行回顾性分析,男78例,女102例;年龄4～70岁,平均32岁;均以疼痛、软组织肿胀伴肿块形成为主要征象。全部病例均经手术、病理证实为软组织肿瘤。采用美国Picker公司0.23T开放式磁共振扫描装置。常用脉冲序列为快速自旋回波T1WI和T2WI及短时回复序列脂肪抑制成像。检查平面包括冠状面,矢状面,横断面。180例软组织病变中,软组织良性肿瘤153例,其中肌肉血管瘤52例,腱鞘巨细胞瘤34例,神经源性肿瘤26例,脂肪瘤23例,硬纤维瘤18例;软组织恶性肿瘤17例,其中恶性纤维组织细胞瘤7例,恶性淋巴瘤3例,脂肪肉瘤2例,软骨肉瘤、肌纤维肉瘤、黑色素瘤、面部肉瘤、平滑肌肉瘤各1例;类肿瘤病变10例,其中骨化性肌炎2例,脂肪坏死8例。良、恶性肿瘤比例为9∶1。手、足部腱鞘巨细胞瘤(33/34例)、血管瘤(23/52例)较为常见;恶性纤维组织细胞瘤常累及大腿(大腿4/7例)和上臂(3/7例);发生于腹股沟的肿物多为恶性(4/5例)。结果良性肿瘤直径为1~18cm,恶性肿瘤直径为4~10cm。肿瘤形态不规则,多呈分叶状、类圆形。病变组织T1WI多为等或等低信号,T2WI多为等高信号或以高信号为主的混杂信号。神经源性肿瘤好发于皮下脂肪或肌肉间,形成囊实性     

游离穿支皮瓣修复足踝部软组织缺损的临床效果

背景：足踝部软组织缺损是创伤骨科临床治疗难点,皮瓣移植仍然是不可替代的治疗手段之一。目的：探讨利用两种不同游离穿支皮瓣修复足踝部软组织缺损的临床技术。方法：2006年8月至2012年4月,30例足踝部软组织缺损伴骨外露患者行皮瓣移植术。男24例,女6例,年龄3～52岁,平均28岁。术前应用负压封闭引流技术处理,创面范围6cm×8cm-11cm×23cm。其中游离胸脐穿支皮瓣修复12例,游离股前外侧穿支皮瓣修复18例。结果：术后30例皮瓣全部成活。随访时间为3～24个月,平均11．0个月。皮瓣修复后外形大部分满意,皮瓣末梢二点分辨觉为10-22mm,胸脐穿支皮瓣和股前外穿支皮瓣组术后3个月左右恢复S2以上感觉百分比分别达58．3％和68．8％。结论：足踝部软组织缺损的游离皮瓣选择采用股前外穿支皮瓣或胸脐动脉穿支皮瓣均可。穿支皮瓣能够减少二次手术比例。负压封闭引流技术能显著减少皮瓣感染比例。     

Negative pressure wound therapy for soft tissue injuries around the foot and ankle

Background  

This study was performed to evaluate the results of negative pressure wound therapy (NPWT) in patients with open wounds in the foot and ankle region.     

Salvage of severe ankle varus deformity with soft tissue and bone rebalancing

The etiology of ankle varus is multifactorial. Treatment recommendations after failed conservative care include hindfoot and ankle fusions or total ankle arthroplasty (TAA) with ligament rebalancing. The purpose of this study was to evaluate chronic varus ankle deformities through corrective calcaneal osteotomies and lateral soft tissue reconstruction. All skeletally mature patients with at least 5 degrees of ankle varus were included in the study. Pre and postoperative radiographs were retrospectively reviewed measuring talar tilt. All patients had a lateral closing wedge (Dwyer) calcaneal osteotomy, joint debridement, and lateral ankle ligament reconstruction. Eight feet were included in the study. The average follow-up time was 20.6 months. Six patients (six feet) were asymptomatic and did not have any additional surgery at their most recent follow-up. Two patients failed treatment, requiring surgical intervention for persistent pain and/or deformity. The average postoperative ankle varus correction overall was 4.9 degrees. We found ankle varus on average of less than 10 degrees can be reliably corrected with a combination of lateral ligament reconstruction and calcaneal osteotomy. Approximately 50% of the deformity was corrected when comparing pre and postoperative talar tilt values. In patients with varus deformity greater than 10 degrees preoperatively, persistent varus may occur.     

Accessory soleus muscle simulating a soft tissue tumor of the posteromedial ankle region.

The author reports the case of an adolescent male diagnosed with a symptomatic accessory soleus muscle. Surgical exploration with intraoperative appearance is depicted. This malady is uncommon, although it has been reported primarily as a unilateral entity.     

负压封闭引流技术在足踝部皮肤软组织缺损治疗中的应用

目的 探讨负压封闭引流(VSD)技术在治疗足踝部皮肤软组织缺损中的临床作用.方法 2003年12月至2008年5月采用VSD技术结合二期创面手术治疗15例足踝部皮肤软组织缺损患者(VSD组),男9例,女6例;年龄16～65岁,平均(38.7±14.4)岁.创面范围为5 cm×8 cm～15 cm×20 cm.选取同期15例采用传统换药的患者作为对照组.比较两组患者的等待二期手术时间、二期手术前换药次数、创面完全愈合时间、创面愈合治疗费用.结果 VSD组15例创面全部治愈,无全身和局部并发症发生;创面二期处理采用游离植皮覆盖12例,二期缝合2例,局部皮瓣移位修复1例.两组患者等待二期手术时间、二期手术前换药次数及创面完全愈合时间比较差异均有统计学意义(P＜0.05),而创面愈合治疗费用差异无统计学意义(P＞0.05).结论 VSD技术能充分引流和刺激创面肉芽组织快速生长、缩短治愈时间,是治疗足踝部皮肤软组织缺损的一种简便、有效方法.     

Benign soft tissue tumours of the foot & ankle: A pictorial review

The purpose of this pictorial review is to aid the clinician in distinguishing different benign lesions within the foot and ankle. We discuss the typical clinical and radiological findings as well as management options for intra and extra-compartmental lesions. Differentiation between sarcoma and benign lesions is imperative when presented with any mass in the foot or ankle.     

带蒂皮瓣治疗小腿和足踝部皮肤软组织缺损

目的探讨小腿和足踝部皮肤软组织缺损的手术方法及其疗效评价。方法1997年6月至2005年12月,43例小腿及足踝部皮肤软组织缺损的患者,男38例,女5例;年龄7～63岁,平均35岁;皮瓣面积4cm×3cm～25cm×15cm。采用9种带蒂的肌皮瓣和筋膜皮瓣进行治疗:(1)腓肠肌内、外侧头肌皮瓣带蒂转移修复小腿中上1/3合并膝关节前及内侧皮肤软组织缺损2例;(2)小腿前内侧交腿皮瓣修复小腿中段胫前皮肤软组织缺损2例;(3)带隐神经小腿内侧交腿皮瓣修复前足足底缺损1例;(4)带胫后动脉小腿内侧逆行岛状皮瓣修复足背部皮肤软组织缺损1例;(5)小腿内侧远端蒂筋膜皮瓣修复小腿中下1/3胫前皮肤软组织缺损2例;(6)腓肠神经营养血管蒂逆行岛状皮瓣修复小腿中下1/3、踝部及足跟皮肤软组织缺损17例;(7)隐神经营养血管蒂逆行岛状皮瓣修复小腿中下1/3、踝部及足背皮肤软组织缺损14例;(8)外踝上动脉逆行岛状皮瓣修复足背皮肤软组织缺损2例。(9)足内侧远端带蒂岛状筋膜皮瓣修复第一跖骨头处皮肤软组织缺损2例。结果43例皮瓣中有37例术后全部成活,创面一期愈合,1例皮瓣浅层坏死,5例皮瓣远端边缘少许坏死,经短期换药后愈合。所有病例均得到随访,皮瓣全部良好。结论治疗小腿和足踝部皮肤软组织缺损应严格掌握手术适应证,合理选择皮瓣种类。腓肠神经和隐神经营养血管蒂岛状皮瓣是较理想的修复小腿及足踝部软组织缺损的材料。     

Differential diagnosis of bone and soft tissue tumors by MRI

Musculoskeletal neoplasms are rare, and both the medical history and complaints of the patients are usually uncharacteristic and of limited information. After a clinical evaluation and biplane conventional radiography, the clinician must classify the patient as having a nonprogressive or progressive primary benign, primary malignant, or metastatic bone tumor. In the case of a probably benign, nonprogressive bone tumor, the patient has to be observed continuously or an additional biopsy should be performed. In the case of a probably malignant lesion, the patient should be referred for further staging and treatment to an orthopedic oncologist. Conventional biplane radiography, scintiscan, computed tomography scan, and magnetic resonance imaging (MRI) are indispensable in staging and treatment planning for patients with musculoskeletal tumors. For limb salvage procedures, delineation of the tumor from adjacent tissue structures is crucial. Hence, MRI of the entire anatomic structure involved, together with adjacent joints, is of the utmost importance, both in the coronal and axial planes. The significance of MRI in clinical follow-up depends on keeping the sequences and imaging planes used constant. Differentiating pseudotumors from true neoplasms still poses a challenge. The cellular pattern and matrix characteristics of a lesion cannot definitely be identified as neoplastic even with application of all imaging modalities including MRI. Information on epidemiology, clinical picture, radiology, and histology of the lesion is necessary to draw a firm conclusion. Biopsy is still the first choice in making the diagnosis.