Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain / 中国骨伤

OBJECTIVE@#To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain.@*METHODS@#The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability.@*RESULTS@#The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05).@*CONCLUSION@#Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Dentoalveolar changes observed after the use of customized bonded Shark-Tooth-Like Spurs (JAWs) in adult patients with anterior open bite

ABSTRACT Introduction: Tongue spurs have been successfully used for the early treatment of anterior open bite (AOB). However, according to our knowledge, their effectiveness in the treatment of adults has not been evaluated. Objectives: The purpose of the study was to assess the dentoalveolar changes observed after the use of customized bonded shark-tooth-like spurs (JAWs) in adults with AOB. Methods: Twenty-three adults (22.1±4.4 years) with AOB were selected for the treatment. JAWs made from compomer cement were bonded on the lingual surfaces of the maxillary and mandibular anterior teeth to correct tongue-thrusting. Lateral cephalograms and 3D digital models were obtained to evaluate dentoalveolar features observed before and at three time points after JAWs use. Paired t-test and repeated measure ANOVA tests were used to compare dentoalveolar changes, and Pearson's correlation was used to analyze the association of dentoalveolar changes and overbite changes. The significance level was set at p<0.05. Results: Significant 3D dentoalveolar changes were observed after the three months of treatment with JAWs. Improvement of overbite (1.0±0.6 mm) and overjet (0.2±0.3 mm), combined with a retroclination of maxillary (3.0±3.0°) and mandibular (2.2±2.7°) incisors, were observed (p<0.05). Moreover, a significant decrease in anterior dental arch width in both maxillary and mandibular arches (0.4±0.4 mm; 0.3±0.3 mm, respectively), and an increase of posterior maxillary (0.1±0.2 mm) dental arch width were observed (p<0.05). These significant changes occurred in the first month after the JAWs use. A significant correlation was found between the initial arch length discrepancy and the amount of overbite correction (r=0.456, p<0.05). Conclusions: Dentoalveolar changes occurred after the first-month therapy with JAWs. The retroclination of the anterior teeth combined with the expansion of posterior teeth suggests a posterosuperior change in the tongue position. These changes were beneficial for the treatment of AOB in adult patients.

RESUMO Introdução: Esporões linguais têm sido utilizados com sucesso para o tratamento precoce da mordida aberta anterior (MAA). No entanto, de acordo com nosso conhecimento, sua efetividade no tratamento em adultos ainda não foi avaliada. Objetivo: O objetivo do presente estudo foi avaliar as mudanças dentoalveolares observadas após o uso de esporões colados customizados JAWs (tipo dente de tubarão) em adultos com MAA. Métodos: Vinte e três adultos (idade média de 22,1±4,4 anos) com MAA foram selecionados para tratamento. Esporões confeccionados de compômero foram colados na superfície lingual dos dentes anteriores superiores e inferiores, para corrigir a interposição lingual. Radiografias laterais e modelos digitais 3D foram obtidos para avaliar as características dentoalveolares observadas antes do uso dos esporões e em três tempos distintos após seu uso. O testet pareado e testes ANOVA para medições repetidas foram utilizados para comparar as mudanças dentoalveolares, e a correlação de Pearson foi utilizada para analisar a associação entre as mudanças dentoalveolares e as mudanças na sobremordida. O nível de significância foi estabelecido em p<0,05. Resultados: Foram observadas mudanças dentoalveolares 3D significativas após três meses de tratamento com os esporões. Foram observadas melhorias na sobremordida (1,0±0,6 mm) e sobressaliência (0,2±0,3 mm), associadas à retroinclinação dos incisivos superiores (3,0±3,0°) e inferiores (2,2±2,7°) (p<0,05). Além disso, foi observada diminuição significativa na largura anterior das arcadas superior e inferior (0,4±0,4 mm; 0,3±0,3 mm, respectivamente) e um aumento na largura posterior da arcada dentária superior (0,1±0,2 mm) (p<0,05). Essas mudanças significativas ocorreram no primeiro mês após o uso dos esporões. Foi encontrada uma correlação significativa entre a discrepância inicial no comprimento da arcada e a quantidade de correção da sobremordida (r=0,456, p<0,05). Conclusões: Mudanças dentoalveolares ocorreram após o primeiro mês de tratamento com os esporões. A retroinclinação dos dentes anteriores combinada com a expansão dos dentes posteriores sugere uma mudança posterossuperior na posição da língua. Essas mudanças foram benéficas para o tratamento da MAA em pacientes adultos.

Age-Related Incidence of Cervical Spondylosis in Residents of Jeju Island

STUDY DESIGN: Cervical spine radiograms of 460 Jeju islanders. PURPOSE: To investigate the age-matched incidences and severity of the cervical disc degeneration and associated pathologic findings. OVERVIEW OF LITERATURE: Several related studies on the incidences of disc and Luschka's and facet joint degeneration have provided some basic data for clinicians. METHODS: Cervical radiographs of 460 (220 males and 240 females) patients in their fourth to ninth decade were analyzed. Ninety patients in their third decade were excluded because of absence of spondylotic findings. RESULTS: Overall incidence of cervical spondylosis was 47.8% (220 of 460 patients). The percentile incidences of spondylosis in the fourth, fifth, sixth, seventh, eighth and ninth decade was 13.2% (10 of 76 patients), 34.6% (37 of 107 patients), 58.9% (66 of 112 patients), 58.8% (50 of 85 patients), 70.3% (45 of 64 patients) and 75.0% (12 of 16 patients), respectively. The percentile incidences of one, two, three, four and five level spondylosis among 220 spondylosis patients was 45.5% (n=100), 34.1% (n=75), 15.0% (n=33), 4.5% (n=10), and 0.9% (n=2). Severity of disc degeneration ranged from ± to ++++, and was ± in 6.0% (24 segments), + in 49.6% (198 segments), ++ in 35.3% (141 segments), +++ in 9.0% (36 segments) and ++++ in 0.25% (one segment). Spurs and anterior ligament ossicle formed at the spondylotic segments, mostly at C4~6. The rate of posterior corporal spurs formation was very low. Olisthesis and ossification of the posterior longitudinal ligament were rarely combined with spondylosis. Cervical lordotic curve decreased gradually according to the progress of severity of spondylosis. CONCLUSIONS: The incidence of cervical spondylosis and number of spondylotic segments increase, and degeneration gradually becomes more severe with age.

Riesgo de lesiones quirúrgicas en la fasciotomía plantar percutánea: estudio anatómico en cadáveres frescos / Risk of surgical lesions in percutaneous plantar fasciotomy: anatomical study in fresh cadavers

Introducción: La fascitis plantar es una patología frecuente, cuyo tratamiento es conservador, aunque en los casos sin respuesta se realiza cirugía. El objetivo del presente trabajo fue determinar el riesgo de lesionar los elementos nobles en la cirugía percutánea y establecer una zona de seguridad. Materiales y métodos: En 11 piezas cadavéricas frescas, se realizó la fasciotomía percutánea según la técnica de De Prado y se evaluó la relación con los elementos nobles, la lesión o no de estos y la distancia entre la sección del bisturí y las estructuras vasculonerviosas. Resultados: No se evidenciaron daños en los nervios y vasos del retropié. El promedio de distancia entre el corte y el nervio plantar lateral fue de 16 mm, y entre el corte y el nervio digiti quinti, de 10,7 mm. No hubo lesiones vasculares. Conclusiones: Este estudio demuestra el bajo riesgo de lesión neurovascular durante la práctica de la fasciotomía plantar percutánea cuando se trabaja en contacto con el calcáneo.

Background: Plantar fasciitis is a common condition. In cases of non-response to conservative treatment, surgery is performed. The aim of the study was to determine the risk of injury to noble structures in percutaneous surgery, and to define a safety zone. Methods: In 11 fresh cadavers, percutaneous fasciotomy was performed according to the De Prado technique, and later evaluated with regards to injury to noble structures, and distance between the knife and neurovascular structures. Results: There was no evidence of any damage to hind-foot nerves and vessels. The average distance between the incision and the lateral plantaris nerve was 16 mm, and between the incision and the digiti Quinti nerve 10.7 mm. There were no vascular lesions. Conclusions: The study demonstrates the low risk of neurovascular injury during the practice of percutaneous plantar fasciotomy, when working in contact with the calcaneus.

Bilateral Transverse (Bowdler) Fibular Spurs with Hypophosphatasia in an Adolescent Girl

Hypophosphatasia is a clinically heterogeneous inheritable disorder characterized by defective bone mineralization and the deficiency of serum and tissue liver/bone/kidney alkaline phosphatase activities. Due to the mineralization defect of the bones, various skeletal findings can be radiologically observed in hypophosphatasia. Bowing and Bowdler spurs of long bones are the characteristic findings. The Bowdler spurs reported on in the previous pertinent literature were observed in the perinatal aged patients and these lesions have rarely involved adolescents. We herein report on a 14-year-old girl with fibular Bowdler spurs.