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OBJECTIVE@#To assess the effectiveness of supramalleolar osteotomy (SMOT) as a therapeutic intervention for varus-type ankle arthritis, while also examining the associated risk factors that may contribute to treatment failure.@*METHODS@#The clinical data of 82 patients (89 feet) diagnosed with varus-type ankle arthritis and treated with SMOT between January 2016 and December 2020 were retrospectively analyzed. The patient cohort consisted of 34 males with 38 feet and 48 females with 51 feet, with the mean age of 54.3 years (range, 43-72 years). The average body mass index was 24.43 kg/m 2 (range, 20.43-30.15 kg/m 2). The preoperative tibial anterior surface angle (TAS) ranged from 77.6° to 88.4°, with a mean of 84.4°. The modified Takakura stage was used to classify the severity of the condition, with 9 feet in stage Ⅱ, 41 feet in stage Ⅲa, and 39 feet in stage Ⅲb. Clinical functional assessment was conducted using the Maryland sore, visual analogue scale (VAS) score, and psychological and physical scores in Health Survey 12-item Short From (SF-12). Radiology evaluations include TAS, talar tilt (TT), tibiocrural angle (TC), tibial medial malleolars (TMM), tibiocrural distance (TCD), tibial lateral surface angle (TLS), and hindfoot alignment angle (HAA). The results of clinical failure, functional failure, and radiology failure were statistically analyzed, and the related risk factors were analyzed.@*RESULTS@#The operation time ranged from 45 to 88 minutes, with an average of 62.2 minutes. No complication such as fractures and neurovascular injuries was found during operation. There were 7 feet of poor healing of the medial incision; 9 pin tract infections occurred in 6 feet using external fixator; there were 20 cases of allograft and 3 cases of autograft with radiographic bone resorption. Except for 1 foot of severe infection treated with bone cement, the remaining 88 feet were primary healing, and the healing area was more than 80%. All patients were followed up 24-82 months, with an average of 50.2 months. Maryland score, VAS score, SF-12 psychological and physiological scores, and TAS, TC, TLS, TCD, TT, TMM, HAA, and Takakura stage were significantly improved at last follow-up ( P<0.05). Postoperative clinical failure occurred in 13 feet, functional failure in 15 feet, and radiology failure in 23 feet. Univariate analysis showed that obesity, TT>10°, and Takakura stage Ⅲb were risk factors for clinical failure, HAA≥15° and Takakura stage Ⅲb were risk factors for functional failure, and TT>10° was risk factor for radiographic failure ( P<0.05). Further logistic regression analysis showed that TT>10°, HAA≥15°, and TT>10° were risk factors for clinical failure, functional failure, and radiographic failure, respectively ( P<0.05).@*CONCLUSION@#SMOT is effective in the mid- and long-term in the treatment of varus-type ankle arthritis, but it should be used with caution in patients with obesity, severe hindfoot varus, severe talus tilt, and preoperative Takakura stage Ⅲb.
Subject(s)
Male , Female , Humans , Middle Aged , Ankle , Ankle Joint/surgery , Retrospective Studies , Osteoarthritis/surgery , Osteotomy/methods , Risk FactorsABSTRACT
Objective:To observe the curative effects of triplane intra-articular osteotomy in the treatment of malunion of calcaneal intra-articular fracture.Methods:The 16 patients were retrospectively analyzed who had been admitted to Foot and Ankle Surgery Department, Honghui Hospital from January 2016 to December 2019 for malunion of calcaneal intra-articular fracture. They were 12 males and 4 females, with an average age of 43.4 years (from 31 to 58 years). The left side was affected in 10 cases and the right side in 6 cases. All malunions were type Yu Ⅱ (compressed bone fragments on the posterior articular surface) and treated with triplane intra-articular osteotomy. The curative effects were assessed by comparing the radiological parameters, American Orthopaedic Foot and Ankle Surgery Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS) and psychological and physical scores in Health Survey 12-item Short Form (SF-12) between preoperation and the final follow-up.Results:All the patients were followed up for 20 to 60 months (average, 42.9 months); the bone healing time was 10 to 14 weeks (average, 11.5 weeks). At the final follow-up, their B?hler angle (25.7°±2.3°), Gissane angle (117.1°±5.8°), Meary angle (2.9°±1.3°), talocalcaneal angle (31.3°±3.0°), hindfoot alignment angle (3.9°±1.8°), ankle height [(82.3±2.6) mm], calcaneus height [(56.9±2.4) mm], calcaneus width [(41.4±2.1) mm], AOFAS ankle-hindfoot score [(82.3±7.3) points], median VAS score [3 (2, 3) points], SF-12 psychological score [(46.6±3.6) points], and SF-12 physiological score [(43.6±3.5) points] were significantly improved than the preoperative values [8.4°±2.7°, 137.5°±9.3°, 8.3°±4.3°, 24.6°±3.7°, -4.6°±3.2°, (76.1±3.1) mm, (53.8±3.0) mm, (50.2±2.2) mm, (51.9±7.7) points, 6 (6, 7) points, (37.5±3.8) points, and (31.0±2.6) points] (all P<0.01) Conclusion:In the treatment of type Yu Ⅱ malunion of calcaneal intra-articular fracture, triplane osteotomy can anatomically reduce the bone fragments of collapsed posterior articular surface, reshape the normal anatomy of the calcaneus, and preserve the subtalar joint, leading to positive short- and mid-term follow-up effects.
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The outbreak of COVID-19 has spread quickly across 114 countries/territories/areas in six continents worldwide and has been announced as a pandemic by WHO. This study analyzed global COVID-19 epidemiological trends, examined impact of the pandemic on global health security, diplomacy, and social environment in China, and provided short- and long-term strategic policy recommendations for China’s subsequent preparedness and responses.
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Brazil, Russia, India, China and South Africa are the five BRIC countries which have showed a rapid growth in economic development in recent years especially in international health assistance area, which has gradually become a force that cannot be ignored. This article compares and analyzes the current status and character-istics of the BRIC countries in the field of international health assistance and compares them with the Countries of the Economic Cooperation and Development Organization's Development Assistance Committee ( ECDO-DAC) . It will also summarize the new features, advantages and disadvantages of the health development assistance exerted by the BRICS countries;and ultimately provide suggestions for the future international health development aid policy of China.
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Objective To study the changes of serum myeloperoxidase(MPO)in patients with acute ischemic stroke ,and to probe into the relationship of serum MPO with types of carotid atherosclerotic plaques ,the degree of neural function defect and the activi‐ties of daily living (Barthel Index) .Methods Totally 78 cases of patients with acute ischemic stroke was selected as observation ob‐jects .The patients with acute ischemic stroke were divided into good ,medium and poor three groups according to Barthel index . Based on the scoring of neurologic impairment degree from standards of CSS :mild impairment group(0 to 15 points) ,moderate im‐pairment group(16 to 30 points) ,and severe impairment group(31 to 45 points) .Based on the type of atherosclerotic plaques all pa‐tients were divided into soft plaque group ,mixed plaque and hard plaque group .The 1evels of serum MPO was compared between different group .Results The heavier nerve function defect degree ,the levels of serum MPO in patients with ischemic stroke were higher ,and it had significant difference between groups (P<0 .05) .The Barthel index was the better ,the levels of serum MPO was lower .The levels of serum MPO was different among the soft plaque group ,mixed plaque and hard plaque group ,and its were sig‐nificantly different between the three groups ,and the type of atherosclerotic plaque was related to the neural function defect and Barthel index level .Conclusion Ischemic stroke is associated with serum MPO levels ,neurological deficits ,Barthel index and stabil‐ity of atherosclerotic plaque ,and the levels of serum M PO is helpful for judging state of the disease and guiding in clinical diagnosis and treatment .
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With the 2015 deadline for fast approaching the millennium development goals ( MDGs) , attention has turned to what should follow.The post-2015 development agenda is due to be adopted by the world leaders in a high-level summit which was held in New York in September 2015 .This paper summarizes the health-related MDGs progress and suggestions, describes the negotiations process on the health-related post-2015 development agenda, dis-cusses the proposed framework of the sustainable development goals and its indicators, and then provides some sug-gestions on the Chinese participation in the post-2015 development agenda as well as in the upcoming high-level sum-mit.