Treatment of equinovarus accompanied with ulcer using Ilizarov technology and limited operation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the surgical method and clinical curative effect of Ilizarov technique combined with limited surgical treatment for neurotrophic malnutrition equinovarus accompanied with weight-bearing area ulcer.</p><p><b>METHODS</b>From July 2004 to December 2011, 21 cases of neurological disorders equinovarus with skin ulcer in weight-bearing area were treated including 14 males and 7 females with an average age of 21.3 years old ranging from 8 to 32 years. Among them,19 cases with talipes equinovarus were on account of spina bifid and 2 cases on account of spinal cord injury of lumbar sacral segment. Nine cases were on the left foot and 12 cases were right foot. The ulcer area in out-below side of the fifth metatarsal bone was in 6 cases, in basement of the fifth metatarsal bone in 5 cases,in lateral of calcaneocuboid joint 2 cases, and in lateral of subtalar joint in 8 cases. Surgical procedure included plantar medial release technique, tendo-chilles lengthenning, and three-joint partial osteotomy. During operation,the skin and soft tissue of ulcer were resected and the incision was sutured when the ulcer was in the lateral of subtalar joint, and ankle Ilizarov external fixation for extension was installed after correcting talipes equinovarus partially. For the legacy skin ulcer in weight-bearing area,the Shenrg-ji cream (Chinese characters) was used after operation for one time per day until the wound healed. Adjusting Ilizarov external fixation for correcting residual deformity until it is satisfaction. During this process weight-bearing walking was keeping.</p><p><b>RESULTS</b>All cases were followed up from 6 to 52 months with an average of 28 months. All ulcers were healing and no recurrence. The ulcer healing time was 14 to 36 days postoperative (26 days in average). Eighteen deformity feet were corrected satisfactorily, and recovered fully plantar foot, 3 feet appeared mild deformity after 1 year. Ankle joint activity appeared limited in 15 cases and got completely rigidity in 6 cases. The AOFAS increased from preoperative 34.0±7.2 to 86.0±8.5 postoperatively; 8 feet got excellent, 10 good,3 fair.</p><p><b>CONCLUSION</b>The clinical effect of Ilizarov technique combined with limited operation and the Sheng-ji cream in correction of the talipes equinovarus with skin ulcer in weigh-bearing area on account of neurotrophic malnutrition is satisfactory, the surgical method is simple and the treating course in security, and serious complications can be avoided.</p>

Clinical analysis of 107 patients with foot and ankle deformities caused by spinal bifida / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida.</p><p><b>METHODS</b>The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed.</p><p><b>RESULTS</b>One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment.</p><p><b>CONCLUSIONS</b>Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.</p>

Analysis of middle-term outcome of the imaging characteristics after the percutaneous laser disc decompression / 中华外科杂志

<p><b>OBJECTIVE</b>To study the imaging findings outcome of the percutaneous laser disc decompression (PLDD) and evaluate the middle-term safety and efficacy of PLDD.</p><p><b>METHODS</b>The imaging data of 22 cases suffered cervical spondylosis or lumbar spondylosis and treated by PLDD more than 3 years were retrospectively reviewed. To observe the intervertebral space of the invasive disc and the intervertebral disc hernia before and after the operation on the lateral projection of X-ray and the axial view of the MRI. To make a statistical analysis of the data.</p><p><b>RESULTS</b>There was no obvious change of disc height involving the anterior disc height, the intermediate disc height and the posterior disc height after the PLDD at the final follow-up (P > 0.05). At last time follow-up, the Sagittal Index (SI) are 0.10 - 0.54 and 0.06 - 0.39 before and after the PLDD in the treatment of cervical vertebra. The statistical difference were significant (P < 0.05). In lumbar vertebra, the SI is 0 - 0.71 and 0 - 0.48 disc before and after the PLDD. The statistical difference were very significant (P < 0.01).</p><p><b>CONCLUSIONS</b>The PLDD will not destroy the intervertebral space of the cervical and lumbar vertebra obviously; moreover, it can effectively reduce the disk hernia. The PLDD is a safe and effective Mini-invasive surgery for cervical vertebra and lumbar vertebra diseases.</p>