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Objective:To investigate the early effect of modified posterior tibialis muscle transfer in treating foot drop and varus deformity caused by common peroneal nerve injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 6 patients with foot drop of common peroneal nerve palsy and varus deformity admitted to Beijing Jishuitan Hospital from December 2017 to October 2019, including 4 males and 2 females, aged 33-48 years [(39.5±6.0)years]. The left side was involved in 4 patients and the right side in 2 patients. All patients underwent posterior tibial muscle transfer. The insertion of posterior tibial muscle was reconstructed in the fourth metatarsal with the tendon allograft to correct foot drop and varus deformity. The range of motion of active ankle dorsiflexion and plantar flexion and range of motion of varus and valgus of foot were measured before operation and at the last follow-up. The isokinetic torque peak value of ankle dorsiflexion and plantar flexion at 60°/s angular velocity and peak isokinetic torque of foot varus and valgus at 60°/s angular velocity were measured before operation and at the last follow-up. The postoperative foot imaging evaluation was performed at the last follow-up, including Meary angle, calcaneal projection and diameter of the fourth metatarsal. The American Orthopaedic Foot & Ankle Association (AOFAS) ankle-hindfoot score was used to evaluate the ankle function.Results:All patients were followed up for 6-17 months [10(6, 15)months]. At the last follow-up, the range of motion of dorsiflexion of the ankle [6(0, 10)°] and foot valgus [3(0, 5)°] were significantly improved compared with the preoperative level [-31(-33, -28)°, -10(-12, -8)°] ( P<0.05); the ankle dorsiflexion torque [(7.7±0.8)Nm] and foot valgus torque [(7.2±0.7)Nm] were significantly improved compared with the preoperative level [(0.0±0.0)Nm, (2.1±0.6)Nm]at 60°/s angular velocity ( P<0.01). Imaging examination showed no acquired flat foot deformity and deformation of the fourth metatarsal insertion. The AOFAS ankle-hindfoot score increased from 50-73 points [(61.3±8.4)points] before operation to 75-97 points [(86.8±7.2)points] at the last follow-up ( P<0.01). Conclusion:For foot drop and varus caused by common peroneal nerve injury, modified posterior tibialis muscle transfer can increase the torque of ankle dorsiflexion and valgus, improve the ankle range of motion, and accelerate the ankle function recovery.
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Objective@#To present the clinical result of a procedure using pedicle posterior interosseous perforator adipofascial flaps for the treatment of congenital proximal radioulnar synostosis (CPRUS).@*Methods@#Eight forearms (from eight patients) with CPRUS were treated by the operation during December 2013 to January 2018 at Beijing Jishuitan Hospital. The average age of the children are seven years old (range: five years old to twelve years old). There were six boys and two girls. Seven forearms were classified as the Cleary type Ⅲ, and one forearm was classified as the Cleary type Ⅱ. Five children were suffered with bilateral CPRUS, and three children were unilateral. The average fixed forearm pronation angle was 43° (range: 0° to 80°). The operating procedure: a dorsal incision from olecranon to the distal 1/3 part of the middle axial of forearm was designed. Then the pedicle posterior interosseous perforator adipofascial flap was harvested. Elevated the anconeus muscle retrogradely, and the location of the osseous synostosis was exposed. Then the radial volar Henry incision just below the elbow joint crease was designed, the insertion part of the biceps brachii was exposed and elevated. The osseous synostosis was exposed and removed with the help of burr at the dorsal side. The cartilage part of the radial head was remolded. A trapeziform osteotomy was made at the site of radial tubercle due to the deformity angle of the radial shaft to reduce the dislocated radial head, then the distal and proximal part of radius was reduced and fixed with plate and screw. The pronator quadratus and the adipofascial flap were pulled to the volar side, and sutured to the deep fascia. The tendon of the biceps brachii was pulled dorsally and reattached to the radial tubercle. Postoperatively, an above-the-elbow splint was applied to keep the elbow in 90° of flexion and the forearm in 80° of supination. Three days later, the other splint was used to keep the forearm in 80° of pronation. Two splints were worn every other day alternatively. At four weeks after the operation, the ROM exercises were initiated both actively and passively, with the splints worn every other night alternatively. The splint was worn for six months.@*Results@#All patients received follow-up, the average duration of follow-up was 27 months (average: 6-48 months). The space of the proximal radioulnar joint could be seen clearly in seven patients, without the sign of recurrence of the synostosis. The synostosis was occurred in one child. Removed the synostosis part and the implant six months after operation, and placed an allograft tendon ball as the interposition tissue simultaneously. The problem was resolved successfully after that. Fingers extension weakness was happened in two patients, and recovered spontaneously and completely in three months. Limitation of elbow extension was occurred in two patients (range: 15° and 20°). The average pronation was 32.5° (range: 10°-65°), and the average supination was 31.9° (range: 10°-70°).@*Conclusions@#Using the perforator adipofascial flap pedicled with posterior interosseous vessels to treat the CPRUS is an easier method compared with classical Kanaya method . It could prevent the recurrence of synostosis effectively, and the treatment result is satisfied. The possibility of injury of the deep branch of radial nerve may be the potential problem.
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To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result. Methods From September, 2016 to November, 2018, 17 patients (21 hips) with ANFH had undergone robot-assisted free fibular grafting. There were 14 males and 3 females, of which, 8 cases were associated with the right side, 5 cases the left side, and 4 cases with both sides. The average age was 35 (ranged from 17 to 55) years. There were 7 patients suffered from idiopathic ischemic necrosis of femoral head, 4 patients who had cannulated screws fixed after a femoral neck fracture, 4 patients who had a history of alcohol consumption, 1 patient who had taken corticosteroids for 6 months to treat nephritis, and 1 patient who had a history of alcohol consumption and had also taken corticosteroids. Seventeen hips were in Ficat stage II, and 4 hips were in Ficat stage III. The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation, to place a cannula in the optimal position. Then a bone window was created and the fibula was placed into the bone tunnel.Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula. Finally, the vessels were anastomosed. The patient remain in bed completely for a week with the use of vasodilator. The follow-up was accomplished with phone call and outpatient clinic, and Harris score was evaluated. Results All 21 surgical procedures were successful. The guide pins and fibula were accurately placed according to the robot’s plan, and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads, 4 to 6 mm from the articular surface. Conventional anticoagulant, anti-infective therapy was performed after the pro-cedure. Ten patients were followed-up postoperatively more than 1 year, with an average of 15 (from 12 to 24) months. The function of the hip joint recovered smoothly for 9 patients.Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region, 4 to 6 mm from the articular surface.One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation.However, joint move-ment was restricted for the left hip and the pain was significant.An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula.The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum.The Harris score was 62.4±13.6 before operation, and 84.5±4.5 at the last time of followed-up after opera-tion.The difference in Harris scores was statisticly significant (P＜0.05). Conclusion With the assistance of an or-thopaedic robot system, the guide pin can be accurately positioned, thereby allowing the tip of the fibula to be inserted in-to the optimal anatomical position and maximising its mechanical efficacy.In theory, it is the best choice for performing fibular bone transplantation in ANFH.And the early effect of treatment is good.
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Objective:To investigate the outcomes of applying microvascular anastomotic coupling de-vices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical out-come.Methods:From March to September 2013,19 injured arteries from 18 male patients who presen-ted at Department of Hand Surgery,Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures.COUPLER,a microvascular anastomotic coupling device was applied in these artery injury repair operations.The 19 repaired arteries included 3 brachial arteries,6 ulnar arteries and 10 radial arteries.After the procedures,all the 18 patients were then fol-lowed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality.Results:The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was (71.5 ± 40.9)d with the longest follow-up time as 116 d and shortest as 14 d.No patient returned to the opera-ting room after the procedures and after being dismissed from the hospital.None of the 18 cases were re-ported to have problems with circulation and thrombosis formation in their upper extremities.Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends.Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis;while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery.These evidences indicated that the outcomes of our initial evalua-tion for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were posi-tive.Conclusion:Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures.The procedures are quick,effective and safe. The clinical application of this microvascular anastomotic coupling device in artery injures is promising, however,additional evidences through further clinical investigation with more cases are warranted.