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Objective To evaluate the clinical results of the Ilizarov technique for the treatment of the complex rigid talipes equinovarus deformities.Methods From July 2005 to July 2011,28 patients (41 feet) with rigid talipes equinovarus deformities which had been corrected with the Ilizarov technique were retrospectively analyzed,including 18 males (26 feet) and 10 females (15 feet) with an average age of 15.3 years.According to the classification system proposed by Diméglio,31 feet were categorized as grade Ⅲ,and 10 as grade Ⅳ.We performed corrections with a soft tissue release in 23 feet,and with a limited osteotomy in 18,and then a Ilizarov external fixator was applied.Anteroposterior and lateral X-rays were taken to compare the pre and postoperative data in terms of the angle of plantarflexion and dorsiflexion,the range of motion of the ankle joint,radiological measurements of the talocalcaneal angle.Results All the 28 patients achieved an outpatient follow-up,with an average of 25 months.All patients achieved a plantigrade foot with an almost normal appearance as the fixator was removed after applied for an average of 5.1 months (range,2-14).At the preoperative and final follow-up respectively,the angle of dorsiflexion of the foot was -45.0°±12.0° and 9.5°±5.5°,the angle of plantarflexion was 67.0°±14.0° and 45.5°±7.8°,talocalcaneal angle was 6.5°±4.5° and 22.5°±5.5° in anteroposterior radiograph and 5.5°±11.0° and 40.6°±8.5° in lateral radiograph.Spastic ischemia occurred in one foot and relieved by a slower distraction rate.Wire-hole infections occurred in 5 feet and treated by dressing changs,wire tract altering and antibiotic therapy,finally the infections were controlled.Deformity relapsed in one foot three months after the device was removed,then corrected with an additional fixator application and has not recurred till the final follow-up.Toe contracture and residual deformity occurred in 5 feet and 3 feet,respectively.Conclusion The Ilizarov technique is an effective method for correction of complex rigid talipes equinovarus deformities,with which the appearance and function of the foot could be kept as much as possible,and without impact on food development.
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Objective To analysis the medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in adults.Methods From March 2003 to December 2008,sixty-two patients with femoral neck fractures were operated.There were 50 males and 12 females,with an average age of 39 years (ranged from 16 to 62 years).Fifteen cases suffered from traffic accidents and 47 from falling injury.There were 8 cases which fracture site was infer-head in Garden type Ⅱ,twenty-nine cases in type Ⅲ and 25 cases in type Ⅳ.The average time were 12 hours (2-96 hours) from injured to hospital admission and 4 days (2-8 days) from injured to operation.Partial weight bearing started on 3 months postoperatively and full weight bearing on 6 months.The postoperative duration of follow up was 3 to 5 years in 39 cases.Healing of fractures and avascular necrosis of the femoral head were evaluated based on the X-ray results or MRI if necessary.The pain,function,deformity,range of motion were evaluated based on Harris joint function scores.Results Nonunion of fracture was noted in 2 cases during the follow-up period.The fracture healing rate was 96.8％.The avascular necrosis of the femoral head was noted in 6 cases (15.4％).There were statistical significant differences between 3 months of postoperation and 3 years of postoperation in the pain,function,deformity,range of motion.After 3 years of postoperation,there were excellent in 29 cases,good in 6 cases,general in 1 case,poor in 3 cases according to Harris joint function scores.Conclusion This technique is relatively simple and has high rate of fracture healing.The avascular necrosis of the femoral head rate is low.The medium-and long-term results are satisfactory.
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[Objective]To discuss the changes and clinical significance of microcirculation in lower limbs in patients with lumbar canal stenosis under different circumstances.[Method]Prospectively,randomly,the nail fold microcirculation of the big toe in 50 patients were investigated with WX-6 microcirculation instrument before and after operation at 7~10 days and 3~6 months.The averages were compared with that of 30 healthy persons with q test.Two groups were defined according to the claudication distance as 0～100 meter and 300～400 meter and tested.The averages were analyzed with t test.[Result]There were statistically significant differences between the patients group and the healthy group and before and after surgery(P0.05).The most significant change was the form of blood flow.[Conclusion]The dysfunction of sympathetic nerve resulting from lumbar canal stenosis will impair the microcirculation of lower limbs and aggravate intermittent claudication.The operation will improve the microcirculation and alleviate the symptoms significantly.The microcirculation test in lower limbs can serve as an objective method for the preoperative diagnosis and postoperative assessment for therapeutic efficacy.
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Objective To discuss the diagnostic value of parasagittal reconstruction CT for the lumbar intervertebral foraminal stenosis.Methods From Jan.2003 to Apr.2004,15 suspected cases with lumbar intervertebral foraminal stenosis based on the routine clinical and radiologic examinations were diagnosed by means of the CT parasagittal reconstruction and operated on .Results All showed L_(4~5) or L_5~S_1 foraminal stenosis,2 cases far lateral disc protruded,8 cases the vertebral endplate posteriolateral spurs extruded into foramina,1 spondylolisthesis pseudoarthrosis pressed,4 cases had the narrow intervertebral space along with the flavum ligament hypertrophy and facet superioanterio subluxation. 7 cases showed horizontal stenosis and 8 cases showed vertical stenosis.6 cases wereⅡ?,9 cases were Ⅲ?. Conclusion The parasagittal reconstruction CT for the lumbar foraminal stenosis can compensate for the drawbacks of the routine axial CT, show more clearly and vividly and guide the operations more accurately.