Calcaneus bone mineral density in Japanese women with rheumatoid arthritis

Objectives The aim of this study was to investigate the relationships among bone mineral densities (BMD) in the calcaneus and leg activity of daily living (L-ADL) in rheumatoid arthritis (RA) patients.Methods We measured and compared calcaneus BMD using single X-ray absorptiometry and lumbar spine and femoral neck BMD using dual X-ray absorptiometry in 158 Japanese female outpatients with RA and 358 normal controls (NC).Results Regardless of whether the women were premenopausal or postmenopausal, calcaneus and femoral neck BMDs in the RA group were significantly lower than in the NC group. Calcaneus BMD correlated with the modified health assessment questionnaire, L-ADL score, and 10-m walking time, regardless of whether the patients were premenopausal or postmenopausal (P<0.01).Conclusions We conclude that calcaneus BMD reflects the L-ADL of RA patients very well and allows us to perform the same level of BMD evaluation as that with current BMD measurement methods.     

小切口微型锁定钢板与传统切口钢板内固定治疗跟骨关节内骨折的对照研究

目的：比较小切口微型锁定钢板内固定与传统L形切口钢板内固定治疗跟骨关节内骨折的临床疗效。方法对20例跟骨骨折患者采用小切口微型锁定钢板内固定术治疗（A组）,其中SandersⅡ型14例,Ⅲ型4例,Ⅳ型2例;18例跟骨骨折患者采用传统L形切口手术入路钢板内固定术治疗（B组）,其中SandersⅡ型9例,Ⅲ型6例,Ⅳ型3例。统计并比较两组患者手术时间、切口长度、住院天数、术后第1天的VAS评分、术后切口愈合情况、植骨例数、出血量、术后末次随访时影像学检查及术后半年的足部功能[按美国足踝外科协会（AOFAS）踝后足评分评定]。结果所有患者均获6～15个月（平均10.3个月）随访,A组患者手术时间、切口长度、住院天数及VSA评分均少于B组,切口甲级愈合所占的比例大于B组,差异均有统计学意义（P＜0.05或0.01）;两组植骨例数、术后影像学检查所见及AOFAS踝后足评分的差异均无统计学意义（均P＞0.05）。结论对SandersⅡ型及部分Ⅲ型跟骨骨折患者,采用小切口微型锁定钢板内固定治疗,具有手术切口小、创伤小、手术时间短、住院时间短、切口并发症少、疗效确切等优点。     

长寿地区成年女性骨密度测量结果评估

目的 检测广西巴马地区20岁～60岁成年女性的骨密度,探讨其骨密度变化的规律.方法 随机选取当地268位20岁～60岁成年女性,按不同年龄分组,每组5岁,共8组.应用韩国生产跟骨超声骨密度测定仪,测定跟骨骨密度.采用SPSS16.0对数据进行分析.结果 268例全部进入分析.(1)女性的峰值骨密度处于36岁～40岁年龄组,峰值组的骨密度高于绝经后组(P＜0.05),且随年龄的增加呈现先升高后下降的趋势.(2)女性的骨密度随年龄的增加而减少,导致骨质疏松症的发病率升高.(3)Pearson相关分析显示,女性的SI和年龄呈现出负相关(r=-0.193,P＜0.01),和身高有显著关系(r=0.157,P＜0.05),并未发现与体重和BMI有关系.结论 广西巴马地区20岁～60岁女性SI值与年龄和身高均有显著相关性,本研究获得的SI值为进一步探讨长寿地区成年女性的骨密度状况提供参考依据.     

经皮撬拨复位克氏针内固定治疗Sanders2型跟骨舌形骨折

目的:观察经皮撬拨复位克氏针内固定治疗Sanders 2型跟骨舌形骨折的疗效,探讨Sanders 2型跟骨舌形骨折的治疗方案。方法:15例Sanders 2型跟骨舌形骨折患者,采用经皮撬拨复位克氏针内固定治疗,要求后跟距关节面解剖复位,恢复跟骨的长宽高度和Bhler角、Gissane角。术后2年内每月随访1次,根据AOFAS评分标准对患者的术后功能作出评价,并结合X片测量Bhler角及Gissane角,分析比较手术前后两角度的变化。结果:15例全部完成随访。术前Bhler角平均(8.2±1.3)度,术后平均(34.5±2.6)度,差异有高度显著意义(P<0.01);术前Gissane角(107.5±4.8)度,术后平均(116.3±5.1)度,差异有高度显著意义(P<0.01)。术后2年的AOFAS评分平均82.6分。结论:经皮撬拨复位克氏针内固定治疗Sanders 2型跟骨舌形骨折具有关节面复位准确、疗效可靠及创伤小等优点,但必须正视该方法的缺陷。     

手术治疗跟骨关节内移位骨折

目的：应用切开复位内固定术治疗有移位的跟骨关节内骨折。方法：手术治疗有移位的跟骨关节内骨折9例11足,其中按Sanders分类ⅡA型4足,ⅢAB型4足,ⅢAC型1足,均予切开复位内固定,IV型2足,予距下后关节融合,其中7足进行植骨,结果：全部病例经16－37月（平均22月）随访,优7例,良3例,差1例。结论：手术治疗跟骨关节内骨折,可以恢复跟骨关节面平整,跟骨宽度和高度,疗效肯定,CT检查可以明确骨折情况,指导手术。     

Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures

A retrospective chart review was performed on patients treated at a level one trauma centre for displaced intra-articular calcaneal fractures by a single trauma surgeon between January 1998 and July 2007. Patients were treated with open reduction and internal fixation utilising the extended lateral incision and a new type of fixation not described before. Threaded 1.575 mm (0.062 in.) Kirschner wires (K-wires) were used for fixation post-operatively along with standard plates, screws and bone substitute.There were 278 fractures in 246 patients that were treated with ORIF for displaced intra-articular calcaneal fractures during this 9-year period. Standard calcaneal lateral approach and hardware was supplemented with percutaneous threaded K-wires. An average of 5.0 fully threaded 1.575 mm K-wires were inserted per calcaneal fracture. Five (1.8%) patients had a K-wire infection; 0.6% of all K-wires became infected and 3.1% of K-wires broke.Lateral calcaneal apical wound issues are minimised and patients experience an overall low complication rate. The fixation also ensures non-weightbearing compliance.     

Hémangiome épithélioïde du calcaneus

Résumé: L’hémangiome épithélioïde des os est une tumeur vasculaire bénigne survenant très rarement dans les os du pied. Nous rapportons le cas d’un hémangiome épithélioïde du calcaneus gauche d’un homme de 65 ans. La présentation clinique, radiologique, scanographique, IRM et histologique de la tumeur est donnée. Les radiographies et le scanner objectivaient une lésion ostéolytique bien définie avec une condensation périphérique dans le calcaneus. L’IRM précisait que le centre liquidien était réhaussé par l’injection de gadolinium alors que la portion périphérique était de signal graisseux. L’analyse histologique nous montrait qu’il s’agissait d’un hémangiome épithélioïde osseux. L’exérèse chirurgicale en est le meilleur traitement mais le pronostic reste incertain avec toujours la crainte d’avoir méconnu un contingent malin au sein de la tumeur. Des récidives ont été rapportées après chirurgie et un suivi à long terme est nécessaire. La meilleure connaissance de cette tumeur pourrait permettre d’en améliorer le diagnostic et le traitement.     

Primary lymphoma of the calcaneus

 Primary non-Hodgkin’s lymphoma (NHL) of bone is a rare condition. Presented herein is a case of primary NHL of the calcaneus illustrating many of the classic features of the disease. Emphasized in this report are the nonspecific clinical and conventional radiographic features of primary NHL of bone, which may mimic inflammatory, neuropathic, infectious, or other neoplastic conditions of the extremities. The importance of early cross-sectional radiologic studies, such as magnetic resonance imaging, lies in the early characterization of the mass-like features and local extent of such lesions, helping to raise the suspicion of neoplastic disease.     

AO跟骨钢板治疗SandersⅣ型跟骨骨折

目的 总结用AO跟骨钢板治疗SandersⅣ型跟骨骨折的经验。方法 对15例18足SandersⅣ型跟骨骨折用AO跟骨钢板进行开放复位内固定治疗，采用Kerr设计的跟骨骨折百分评分系统作为疗效评定标准。结果 18足骨折术后全部得到随访，时间7～39个月，平均11．6个月，优良率83．3％。手术并发症发生率为16．7％，以前期为主，主要是皮缘坏死。结论 开放复位AO跟骨钢板内固定是治疗SandersⅣ型跟骨骨折的良好方法。临床治疗效果与跟骨后距下关节面、跟骨的Bohler氏角、Gissane角以及跟骨的长、宽、高等的复位质量有关。     

The sprain fracture of the calcaneus revisited

Fractures of the anterior–superior process of the calcaneus are considered to be unusual. The fracture is difficult to visualize in standard X-ray projections and is easily missed, and often misdiagnosed as a sprain of the anterior talo-fibular ligament. The usual injury is an avulsion-type fracture, which generally has good prognosis. There exists another type of injury involving a compression fracture of the anterior articular process of the calcaneus. They differ from the avulsion injuries in management and prognosis. Neglected or delayed treatment can often lead to prolonged disability and significant derangement of the calcaneo-cuboid joint. A case of compression fracture of the anterior–superior process of the calcaneus treated by open reduction and internal fixation is presented.