人工跖趾关节置换的临床应用

目的总结应用跖趾关节置换手术治疗足部疾患的临床经验,评价手术治疗效果。方法自2011年3月至2012年6月,我科共有52例足部疾患患者接受跖趾关节置换手术治疗,其间Freiberg病患者28例（35足）,合并腮外翻15例（16足）;第1跖趾关节骨关节炎患者18例（20足）;跖趾关节创伤性关节炎患者6例（6足）。均应用Swanson人工关节假体实施跖趾关节置换手术治疗。采用美国足踝外科协会评分系统对手术前后疼痛、行走、穿鞋及跖趾关节活动度等进行临床评价。结果随访时间3—25个月,平均13．4个月。所有病例术后关节疼痛明显改善,活动度改善。通过AOFAS评分评定,所有患者术后较术前有明显改善。结论Swanson人工跖趾关节置换术治疗足部疾患近期疗效满意,能明显改善关节活动度及疼痛,是一种较为可行的术式。     

Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

Purpose

Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity.

Methods

We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy.

Results

The mean IMA was decreased from 15.8 (range 12–22) degrees to 7.8 (range 0–12) degrees. The mean pre-operative HVA was 39 (range 21–52) degrees and the mean postoperative HVA was 11.8 (6–19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2).

Conclusion

The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.     

Pseudoaneurysm of the Posterior Tibial Artery after Manipulation under Anesthesia of a Total Ankle Replacement

Although pseudoaneurysm of the posterior tibial artery has been reported, no investigators have discussed the development of a pseudoaneurysm after manipulation under anesthesia of a total ankle replacement. We present the case of a 59-year-old female with end-stage post-traumatic tibiotalar joint disease who underwent an uneventful INBONE® Total Ankle Replacement. She experienced continued postoperative pain and impingement after physical therapy. Consequently, she underwent manipulation under anesthesia. The manipulation provided complete and immediate pain relief. However, she developed a pseudoaneurysm of the posterior tibial artery that required vascular repair. She recovered uneventfully and was ambulating free of pain with improved functionality. Although manipulation under anesthesia of a total ankle replacement is a valuable, noninvasive tool that can provide near-immediate pain relief, it is important to realize that this distal arterial injury, although uncommon, is a possibility.     

Relationship of Alignment and Tibial Cortical Coverage to Hypertrophic Bone Formation in Salto Talaris® Total Ankle Arthroplasty

A retrospective analysis of 107 Salto Talaris^® total ankle replacements was performed to determine the effect of alignment and tibial cortical coverage on the formation of heterotopic bone. The radiographic parameters were studied for at least 18 months to detect any changes over time. The angle of insertion of the implant was most often in varus and with a positive anterior slope. A slight increase was seen in the slope over time (p < .0001) but was not clinically relevant. The mean percentage of cortical coverage of the tibial component was 89%, and only 7 patients had complete coverage of both the anterior and the posterior cortices. The percentage of patients who had hypertrophic bone growth increased over time (p < .0001). As the slope of the implant increased, there was a negative correlation with the degree of tibial coverage (p = .007). There was also an increase in the extent of hypertrophic bone as the tibial coverage decreased. None of the patients had symptoms that required an additional surgical procedure. The results of the present study indicate a high incidence of hypertrophic bone proliferation when the dimensions of the tibial component do not match the anteroposterior depth of the tibia at the plane of resection. Despite the high occurrence rate, the clinical relevance of hypertrophic bone is obscure.     

先天性并指畸形治疗的回顾性分析

目的探讨先天性并指畸形的治疗体会,规范治疗方法,提高治愈率。方法对我院近两年收治的30例先天性并指畸形患者,采用游离植皮及皮瓣等6种手术方法进行分指。以掌背侧顺行推进皮瓣、掌背侧逆行岛状皮瓣、五角推进皮瓣、局部“V—Y—W”推进皮瓣及菱形皮瓣重建指蹼：以“Z”形和全厚皮片修复指体。结果本组24例总体治疗效果满意,其余6例行二次手术,其中植皮坏死3例,手指瘢痕屈曲挛缩2例,指蹼创面感染、继发瘢痕增生形成不全并指1例。结论并指的手术时机应选择在出生后6个月～2年,并指的手术设计应注重指蹼的重建,重建的方法应首选掌背侧顺行或逆行皮瓣转移术：指体修复应选择全厚皮片,以预防手指的屈曲挛缩。     

Weil截骨术与Jacopy截骨术治疗应力性跖痛症的临床疗效对比观察

背景：跖痛症是指发生于跖骨头下方的前足疼痛,可由解剖结构异常、病理性或医源性因素诱发。其病变主要是因为前足集中的局部应力负荷反复作用造成。治疗可分为保守治疗与手术治疗,对大部分跖痛症而言,采用保守治疗即可取得较好的疗效,若保守治疗无效,则可采取手术治疗,其目的是恢复前足正常的应力分布。目的：探讨跖骨远端weil截骨术与Jacoby截骨术治疗应力性跖痛症的临床疗效,从而为临床上更加合理有效的治疗跖痛症提供方法和依据。方法：2010年5月至2012年9月,我院收治应力性跖痛症患者65例,其中42例（63足）患者资料完整,得到随访,男8例（13足）,女34例（50足）;年龄39～78岁,平均56-3岁。单侧11例,双侧31例;病变于第2跖骨头下24例,第3跖骨头下ll例,第2、3跖骨头下同时累及7例。合并跖趾关节脱位12例,跽外翻畸形16例,跖间神经瘤5例。所有病例随机分为A、B两组,A组19例（32足）,B组23例（31足）。A组采用跖骨远端Weil截骨术、B组采用Jacoby截骨术治疗,经过平均18个月的随访,对手术前后局部疼痛症状、患者足底应力变化、足部功能改善情况进行比较分析。结果：两种手术前后疼痛缓解均有显著性差异,以Weil截骨组疼痛缓解更明显,但两组间疼痛缓解无明显统计学差异。两组患者手术前后患趾跖骨头下应力峰值明显下降。Weil截骨组,手术前后立位时和足跟抬高时的病变跖骨头下应力分别下降35％和51％;Jacoby截骨组分别下降25％,n45％。根据美国足踝外科协会Maryland跖趾关节百分评分法对两组患者进行评定：优,A组24足（占75％）,B组22足（占71％）;良,A组6足（占18．8％）,B组5足（占16．1％）;可,A组2足（占6．2％）,B组4足（占12．9％）。A组优良率为93．8％,B组为87．1％。结论：对于应力性跖痛症患者,跖骨远端Weil截骨术与Jacoby截骨术治疗均可取得满意确切的效果。但weil截骨术手术操作技巧要求更高,Jacoby截骨术对初学者更易掌握。临床需要根据患者的实际情况及个体需求灵活选择。     

Current Concepts in the Treatment of Gouty Arthritis

Gouty arthritis is an extremely painful condition that causes functional impairment. Gouty arthritis has become increasingly complex because of multiple comorbidities, iatrogenic factors and hyperuricemia that is refractory to treatment. In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares.     

游离旋髂浅动脉皮瓣修复足部皮肤缺损的临床应用

目的探讨游离旋髂浅动脉皮瓣修复足部皮肤缺损的临床效果。方法 2015年5月—2017年4月周口淮海医院采用游离旋髂浅动脉皮瓣修复足部皮肤缺损13例,其中男性10例,女性3例;年龄13～65岁,平均37. 5岁。致伤原因:道路交通伤4例,机械绞伤3例,压砸伤6例。皮肤软组织缺损范围4. 0cm×6. 5cm～9. 0cm×12. 5 cm,创面均不同程度存在泥沙、碎屑等异物残留,并伴有足部的肌腱、骨骼等深部组织损伤外露。皮瓣切取范围为5. 0cm×7. 0cm～10. 0cm×14cm,其中急诊修复4例,经清创术后应用VSD技术处理7～10d,择期修复创面9例。结果 11例皮瓣完全成活,2例皮瓣边缘局部皮肤坏死,经拆线、换药等对症治疗后创缘愈合。供区切口均Ⅰ期愈合。13例经术后6个月～2年随访,皮瓣外形满意及足部功能恢复满意,无皮肤破溃及磨损现象,患足负重、行走功能恢复良好。结论应用游离旋髂浅动脉皮瓣修复足部皮肤缺损,临床效果良好。     

Lien entre usage des réseaux sociaux et image corporelle chez les adolescents : une revue systématique de la littérature

ObjectivesThis study aimed to update the scientific knowledge concerning the relationship between the use of social networking sites and body image among adolescents.MethodsA preregistered systematic review was conducted following PRISMA guidelines and allowed to include 30 peer-reviewed articles for qualitative analysis, consisting of 26 unique samples (n = 31,331; M_age = 14.89; SD_age = 1.07). The search was conducted on Pubmed, PsychInfo and Scopus focusing on studies that included any social network site use and body image measures while being based on general population adolescent samples. Social networking site use referred: 1) to any online activities such as browsing, posting, editing selfies, liking, commenting; 2) to any exposure to appearance-related content; or 3) to a measure of frequency use. The scope of social networking sites considered in the present review was extended to online video-sharing platforms and online dating applications due to their relationship with appearance. Body image as considered through MeSH terms referred to a wide range of possible outcomes including body and facial dissatisfaction, dysmorphophobia, body surveillance, self-objectification, body shame, weight concerns, self-monitoring. Any mental health outcome was extracted when available although its absence was not an exclusion criterion..ResultsAmong the 30 studies included in the review, 22 were cross-sectional, seven were longitudinal and one had an experimental design. Overall, among studies based on unique samples, 18 studies included both males and females (n = 28,081; M_age 14.84; SD_age = 1.06), seven were based exclusively on female samples (n = 2,507; M_age 14.87; SD_age = 1.19), while one study recruited only male adolescents (n = 743; M_age 15.90; SD_age = 0.54). Only six studies were based on representative samples. These studies reported a robust association between frequency of social networking site use and negative body image among both females and males. In addition, exposure to appearance-related content was also deleterious to body image. The association between the use of social media and negative body image may involve negative mental health outcomes, such as depressive symptoms, low body esteem and problematic use of social media. Measuring specific activities on social network sites or exposure to appearance-related content (e.g. selfies editing; selfies posting) may be more accurate than using a frequency of overall use (e.g. during the past month) when predicting body image. Studies addressing underlying processes supported that the relationship between use of social media and body image may not be direct but rather involve intermediary steps on both cognitive and social levels, namely internalization of the thin ideal, self-objectification, peer appearance-related feedback, ascendant social comparison with peers and celebrities. Also, it remains unclear whether mental health mediates this relationship.ConclusionsThe association between the use of social networking sites and negative body image is robustly supported in the literature. However, studies measuring frequency of overall use may instead be predicting negative body image with a nested measure of the use of social network sites, namely specific activities involving appearance-related content. Due to the observed discrepancies between self-reported frequency of social networking site use and actual use in methodological literature, future research may rather measure behaviors commonly encountered on a given platform. Furthermore, there is a need to distinguish specific site categories such as highly visual social media when focusing on body image outcomes. . Focusing on specific social media platforms may in turn lead to more targeted prevention regarding a safe utilization of social networking sites among adolescents. Despite the growing body of research concerning the association between social media and body image, the current review underlines that additional longitudinal and experimental studies are needed to investigate potential bidirectional effects, as well as studies based on representative samples to improve generalization to adolescent populations.