Vascular anatomy of the first metatarsal bone and surgical implications according to the severity of hallux valgus deformity: A cadaveric study

BackgroundVascular injury after hallux valgus surgery is a rare condition but serious complications can ensue.MethodsWe performed an anatomical study using 26 cadaveric lower extremities. We enhanced first metatarsal bone’s (FMB) vascularization by injecting latex. Each specimen was classified according to the severity of hallux valgus deformity (HVD). Then we measured two distances: one between the first tarsometatarsal joint (FTMJ) to the first dorsal branch’s origin, the other between the first metatarsophalangeal joint (MTP) to the dorsal plexus’s origin.ResultsThe distance between the FTMJ and the first dorsal branch to the FMB ranges from 10 mm in normal feet to 15 mm in severe deformed feet. The distance between the MTP and the dorsal plexus’ origin ranges from 20 mm in normal feet to 25 mm in severe deformed feet.ConclusionsUnderstanding the foot’s vascular anatomy has allowed us to adapt surgical landmarks to the severity of the HVD and to avoid post-operative complications.     

The influence of bariatric surgery on hip and knee joint pain: a systematic review

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI’s Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.     

Extensor hallucis longus distal tenotomy for spasticity in a patient with interphalangeal joint hyperextension after stroke

BackgroundThe extension deformity of the interphalangeal (IP) joint of the hallux is a rare focal clinical entity usually detected in patients with no underlying pathology. It may be due to extensor hallucis longus (EHL) overactivity, although it has not been previously reported in patients with neurological disorders. The lesion should be differentiated from the persistent hyperextension of the great toe at the metatarsophalangeal (MTP) joint. Although MTP hyperextension of the hallux due to hypertonia of the EHL is a typical sequel of stroke, it has also been detected in a wide variety of disorders.Materials and MethodsA patient with right hemiparesis following stroke, which had an almost complete functional recovery, is presented. She was disabled by focal spasticity of the EHL, leading to persistent hyperextension of the IP joint of the hallux. The deformity appeared on the long-term follow-up, on both sides within a 3-year period. It was treated with bilateral percutaneous distal EHL tenotomy. On the left side, a percutaneous dorsal IP joint capsulotomy was additionally performed.Results and ConclusionA complete reduction of the deformity was achieved on both sides with functional rehabilitation. It is assumed that EHL hyperactivity following stroke in our patient was complicated by IP instead of MTP extension deformity, due to the coexistent flexor hallucis longus weakness. Bilateral distal EHL tenotomy, associated with percutaneous dorsal IP joint capsulotomy on the left side, provided satisfactory long-term results.     

术前预康复对全髋关节置换术后功能锻炼及运动耐力的影响

目的 探讨术前预康复在全髋关节置换（THA）术后患者关节功能和运动耐力中的干预效果。方法 80例THA患者随机分为实验组与对照组,每组各40例。对照组接受常规术前教育,实验组接受预康复训练。两组患者均在入院、术前1天、术后第2天、术后1周、术后2周使用Harris髋关节功能量表 (HHS)、Charnley髋关节功能评分量表（CHS）和6分钟步行试验（6MWT）来评估患者的关节功能及运动耐力状况。使用t检验、重复测量分析评估其干预效果。结果 经预康复训练后,实验组不同时间点HHS、CHS和6MWT有统计学意义(P<0.05);且组别和时间在HHS、CHS和6MWT上有交互作用。实验组HHS在术前1天、术后1周、术后2周均优于对照组（t=3.594、2.437、5.891,P<0.05）;实验组CHS在术前1天、术后1周、术后2周均优于对照组（t=2.318、3.724、6.439,P<0.05）;实验组6MWT在术前1天、术后1周、术后2周均优于对照组（t=3.878、5.891、8.750,P<0.05）。简单效应示,术前预康复对改善患者的HHS、CHS和6MWT直接及持续作用有统计学意义(P<0.05)。结论 术前预康复可改善THA术后患者关节功能和提升运动耐力,且随着时间改变,效果显著。     

滑膜软骨瘤病的X线病理分析

目的 探讨滑膜软骨瘤病的临床、病理与X线联系及诊断价值．方法 回顾性分析了17例滑膜软骨瘤病的临床、病理及X线表现．结果 本病好发于下肢大关节，多为单关节．膝关节10例(双侧2例)、肩关节3例、髋关节、肘关节、腕关节、指掌关节各1例．主要临床表现：关节肿痛、弹响(6例)，绞锁(3例)，触及可活动或不活动性硬块(9例)．X线特点：在关节内及其周围见数目、大小、密度、形态不一的钙化或骨化游离体．结论 正确判断和认识关节内游离体来源与发展的病理变化及X线表现对诊断本病有较重要的价值．     

The parabiliary venous system

Summary The parabiliary venous system originates from the pancreatico-duodenal and pyloro-duodenal veins, runs along the common bile-duct and the hepatic artery, and divides in the liver hilum into a venous network within the hilar plate. Embryologically, this system, apparently independent of the portal vein, develops together with the bile-ducts and the hepatic artery: these three structures are within the substance of the vasculo-biliary sheaths, and the whole complex invades the liver well after the distribution of the portal vein has been established. It should be pointed out that segments I and IV also appear rather late. Seventy-four specemins with injection of the system have been studied. The hilar plexus sends branches to the veins of the segments adjacent to the hilum. Some vessels directly supply the inferior surface of the quadrate lobe or the caudate lobe, or the left lobe. In 46.50% of specemins, part of the cystic veins are anastomosed with the Parabiliary system.

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Le système veineux parabiliaire

Résumé Le système veineux parabiliaire prend origine dans les veines pancréatico-duodénales et pyloro-duodénales, monte le long de la voie biliaire et l'artère hépatique, et se termine dans le hile dans un lascis veineux situé dans la plaque hilaire. Embryologiquement il semble étranger à la formation de la veine porte, se constitue en même temps que les canaux biliaires et les artères intra-hépatiques: ces trois éléments sont situés dans la texture même des enveloppes vasculo-biliaires, et le tout envahit le foie bien après la pénétration de la veine porte. L'étude porte sur 74 foies dans lesquels le système s'est trouvé injecté. Le plexus hilaire envoie des collatérales qui se jettent dans les veines des segments adjacents au hile. Mais certaines branches irriguent directement la face inférieure du lobe carré, ou le lobe gauche. Dans 46,50% des cas, une partie des veines cystiques se jettent dans ce système.

     

人体步行运动的关节力学研究

利用角度传感器和步态测力板,本文观察了人体的步行运动,采用Fourier数字滤波拟合出各关节的运动规律,依据多刚体动力变分原理建立了适合作实时计算和模型修改的人体步行动力学方程。对于步行中双脚着地时出现的闭环结构,作者借助测力板测出的脚底反力曲线,提出了由力——位移组成的混合求解法。用文中计算方法编制的软件可用于人体下肢疾病的临床医学诊断。