ABSTRACT
<p><b>OBJECTIVE</b>To explore clinical efficacy of osteotomy and fusion in treating severe rigid equinus deformity.</p><p><b>METHODS</b>From April 2010 to October 2015, 13 patients(16 feet) with severe rigid equinus deformity were treated with osteotomy and fusion by hollow screw, including 6 males and 7 females aged from 39 to 62 years old with an average of(49.6±5.3) years old;the courses of diseases ranged from 5 to 27 years with an average of (9.0±4.8) years. Six patients (9 feet) were treated with osteotomy and fusion for three joints, 4 patients(4 feet) were treated with osteotomy and fusion for four joints, and 3 patients (3 feet) were treated with osteotomy and fusion for tibiotalar and calcaneal-talar joints. All patients manifested as foot pain, heel could not touch floor and walking before operation. Postoperative complications were observed, AOFAS score were applied to evaluate clinical effect.</p><p><b>RESULTS</b>Thirteen patients were followed up from 18 to 24 months with an average of 20 months. Only one patient occurred local skin necrosis after operation and healed by dressing change and anti-infective therapy. All feet obtained fracture healing, the time ranged from 12 to 16 weeks with an average of 13.2 weeks. AOFAS score were improved from 11.85±10.66 before operation to 81.38±3.69 after operation, and had significant difference(=-25.67, <0.05);15 feet good and 1 foot moderate.</p><p><b>CONCLUSIONS</b>Tibiotalar and calcaneal-talar joint fusion, osteotomy and fusion for three and four joints could treat severe rigid equinus deformity according to patients' individual and could obtain satisfied clinical effects.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arthrodesis , Calcaneus , Pathology , Equinus Deformity , General Surgery , Osteotomy , Treatment OutcomeABSTRACT
Objective To investigate the clinical effectivity of the muscular flap transposition and induced membrane technique in the emergency treatment for the limb salvage of Gustilo type Ⅲ B/C open fracture of lower leg. Methods From July, 2015 to December, 2017, 10 cases of Gustilo type Ⅲ B/C fracture of lower leg with bone defects were performed limb salvage surgery. Induced membrane technique was used to fill the bone defects in the emergency room.The gastrocnemius and/or soleus muscular flaps were transposed to cover the bone cement or ex-posed bone simultaneously in emergence treatment. After the wound healed completely, traditional bone grafting was used to repair the bone defects. There were 4 cases of Gustilo type Ⅲ B and 6 cases of Gustilo type Ⅲ C. The aver-age length of bone defect was (5.25±1.70) cm ranging from 3.0 cm to 11.0 cm. The gastrocnemius medial head flaps were performed in 5 cases, the combined application with the gastrocnemius medial head flaps and the medial hemimuscular flaps of soleus were performed in 2 cases, and medial hemimuscular flaps of soleus were transposed in 3 cases. Results The wounds in 6 cases were healed at one stage, but 2 cases healed by dressing because the exudate after skin grafting.In 1 case, the cross-leg flap was used to cover the exposed bone cement due to the necro-sis of soleus flap. The other 1 was performed the transposition of the lateral gastrocnemius flaps because the exposure of bone cement after the necrosis of the upper and lateral muscles in lower leg. In the second-stage, the bone defects were reconstructed by traditional bone grafting. The average healed time of bone was 7.2 months ranging from 5 months to 9 months. At the last followed-up time, all patients recovered their function of weight-bearing. The Paley's score of the adjacent joints: excellent in 8 cases and good in 2 cases. Conclusion The combination with induced membrane technique and local muscular flap transposition in emergency surgery is an effective method to limb salvage for the Gustilo type Ⅲ B/C open fracture of lower leg.
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OBJECTIVE@#To investigate the relationship between serum brain-derived neurotrophic factor, concentrations and BDNF gene Val66Met polymorphism and amnestic mild cognitive impairment (aMCI), and neuropsychological characteristics.@*METHODS@#Ninety-nine aMCI patients and 99 matched normal controls were recruited for the study. Multi-dimension neuropsychologic tests were used to extensively assess the cognitive function, an enzyme-linked immunosorbent assay was applied to measure serum BDNF concentrations, and polymerase chain reaction-restriction fragment length polymorphism was used to analyse BDNF gene Val66Met polymorphism in the subjects.@*RESULTS@#The scores of neuropsychologic tests in aMCI patients were significantly lower than those in the normal controls (all P0.05).@*CONCLUSION@#aMCI is characterized by episodic memory impairment. Decreased BDNF concentrations may play a role in the pathophysiology of aMCI, and BDNF gene Val66Met polymorphism may not be an important genetic factor in susceptibility to aMCI.