Clinical Observation of Chinese Medicine Fumigation-washing Therapy for Treatment of Talipes Equinus Denervated Ulcer Induced by Tethered Cord Syndrome / 广州中医药大学学报

Objective To investigate the clinical effectiveness and safety of Chinese medicine fumigation-washing therapy in treating talipes equinus denervated ulcer induced by tethered cord syndrome(TCS) . Methods A total of 21 qualified patients were randomized into fumigation-washing group (N=12) and antibiotics group (N=9). Patients of fumigation-washing group were given fumigation-washing therapy with the self-prescribed Chinese medicine, and antibiotics group was given intravenous dripping of sensitive antibiotics. The treatment lasted for 7 continuous days. The clinical efficiency of the two groups was evaluated after treatment, and the period of preparing for surgery was recorded. The changes of ulcer area and ulcer surface exudate volume in the two groups were observed before and after treatment. And the changes in blood routine examination, hepatic and renal function, and immune function of the fumigation-washing group were monitored. Results(1) The total effective rate of fumigation-washing group was 83.3％, and that of the antibiotics group was 77.8％, the difference being insignificant (P>0.05). (2) The ulcer area and ulcer surface exudate volume in both groups were significantly decreased after treatment (P 0.05). (5) The average daily hospitalization fee in the fumigation-washing group was (47.98 ± 5.17) yuan, less than (227.88 ± 43.24) yuan in the antibiotics group, and the difference was significant between the two groups (P < 0.05). Conclusion Chinese medicine fumigation-washing therapy is effective, safe and practical in treating talipes equinus denervated ulcer induced by TCS, and the therapy has the advantages of decreasing exudation, promoting ulcer healing, reducing hospitalization fee, shortening the period of preparing for surgery, and decreasing the incidence of infection.

Effects of Achilles Tendon Lengthening on Talipes Equinus in Children with Spastic Cerebral Palsy / 中国康复理论与实践

Objective To evaluate the effects of Achilles tendon lengthening on talipes equinus in children with spastic cerebral palsy. Methods From December, 2013 to June, 2014, seventeen spastic cerebral palsy children with talipes equinus (34 feet) received Achilles ten-don lengthening. Ankle dorsiflexion range of motion (ROM) and surface electromyography from tibialis anterior and medial head of gastroc-nemius were measured before and 8 to 12 months after operation, respectively. ROM of passive and active dorsiflexion, root mean square (RMS) of tibia muscle group and co-contraction ratio (CR) when standing were compared. Results The ROM of ankle passive and active dorsiflexion increased (Z>4.867, P0.05), while CR reduced (t=2.38, P<0.05). Conclusion Achilles tendon lengthening can improve the coordination of tibia muscle group to increase the ROM of ankle for chil-dren with talipes equinus after spastic cerebral palsy.

Treatment of Talipes Equinus Deformity Using Free Radial Forearm Flap and Achilles Tendon Lengthening

PURPOSE: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. METHODS: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis (Terudermis(R)) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). RESULTS: The size of flaps varied from 6x12 to 15 x12cm (average, 12x7.8cm). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with Terudermis(R) were aesthetically better than those having skin grafts only. CONCLUSION: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.

Treatment of equinus deformity with Ilizarov fixator / 中华创伤骨科杂志

Objective To evaluate the treatment of equinus deformity with Ilizarov fixator. Methods From February 2003 to August 2005, 17 patients with traumatic equinus were managed with Ilizarov fixator in our department. A preoperatively constructed ring fixator was applied on the involved foot and leg. Three days after the fixation, the compression threaded rod in the front and the distraction threaded rod at the back were respectively shortened and lengthened by turning the screw nuts on the rods 2 to 4 rounds in four times per day in the first week, and then 1 to 2 rounds in four times per day, which resulted in gradual correction of equinus deformity. The Fixation was maintained in neutral position for 2 to 3 months after achieving sufficient equinus correction to ensure the state of dorsiflexion. An ankle-foot orthosis was applied during resting and sleeping for more than three months after removal of the fixator. Results The mean follow-up period was 10 months (range, 7 to 14). All the patients achieved 0? dorsiflexion 4 to 6 weeks after the treatment while in the Ilizarov apparatus. The fixator was maintained in patients for an average of 14.5 weeks (10 to 16 weeks). No blood vessel or nerve was injured. Three patients had one mild pin track infection which responded to conventional management. A 20? equinus contracture reoccurred to one patient six weeks after the removal of the apparatus which had been maintained only for 10 weeks because the patient noted severe pain with the apparatus. One patient chose to accept his improved but persistent 10? equinus contracture. One patient who had had reconstructive surgery for his severely damaged leg muscles and tibial defect eventually required tibiotalar arthrodesis. Entire foot weight bearing with zero angle and walking without significant footdrop were achieved in the other 14 cases. Two patients complained of pain while bearing weight. Active ankle dorsiflexion of 10? beyond the neutral position was achieved in patients with functioning ankle dorsal extension muscles. Conclusion Ilizarov fixator is an effective technique to correct the equinus deformity because of its minimal invasion.