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Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.
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Objective To investigate the clinical curative result of the new method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation.Methods From March 2006 to October 2012,21 patients (15 male,6 female) with chronic peroneal tendon subluxation via a novel method of postermedial deepen of the fibular groove.In this group:Ⅰ grade 5 cases;Ⅱ grade 9 cases;Ⅲ grade 5 cases;Ⅳ grade 2 cases.All patients were followed up for at least 24 months.The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score and visual analogue score (VAS) were used to evaluate the clinical outcomes.Operation time,time to heal and complications were also recorded.Results The average operation time was 50 minutes (30-70 minutes).The blood loss was 30-60 ml,average 40 ml.All incisions healed after operation,no case of incision infection,skin necrosis and sural nerve,vascular injuryed.Mean AOFAS score was significantly increased from (55.2±7.1) preoperative to (93.6±5.6) postoperative.15 patients with excellent,good for 1 cases.The excellent and good rate was 100％ (16/16).VAS score by an average of (5.3±2.1) points down to (1.2±1.1) points postperative.All the patients can wear normal shoes postoperative,waking with normal gait.No patients had peroneal tendon tenosynovitis,tendon adhesion,fracture of lateral malleolus and other serious complications,no dislocation recurrent,strength of the peroneal muscle returns to normal.Conclusion The novel method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation was safe and effective for ankle instability with a relatively short time.
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Objective To investigate the feasibility and effect of recanalization of inferior vena cava with percutaneous transluminal angioplasty(PTA)by Inoue-balloon. Methods Eighty-nine patients with Budd-chiari syndrome(BCS)were treated with PTA by Inoue-balloon. Results After PTA, the median(interquartile range)diameter of hepatic segment inferior vena cava increased from 0.00(0.20 ～ 0.00) cm to 1.90(2.00 ～ 1.47)cm; (P
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Objective: To evaluate the effects of percutaneous balloon pulmonary valvuloplasty ( PBPV) for pulmonary valve stenosis (PS) by single-balloon, double-balloon and Inoue-balloon methods. Methods: PBPV was performed in 42 patients with PS. The systolic right ventricular pressure (SRVP) , systolic right ventricular outflow pressure and systolic pulmonary arterial pressure ( SPAP) were contrasted before and after the procedure. Systolic transpulmonary valve pressure gradient (TVPG) and total pressure gradient from right ventricular to pulmonary arterial after the procedure were compared among the three gropes. Results:SRVP, SRVOP were decreased from (14. 69?6. 01 )kPa, (12. 16?3. 48)kPa to (8.14?5.26)kPa, (5.39?2.21)kPa and PAP increased from (1.57?0.56)cm to (17. 16? 2.16)cm after PBPV, respectively. TVPGs were (2. 40?2. 05) kPa, (3. 29?2. 25 ) kPa, (2.52? 1.95)kPa and TPGs were (2. 40?2. 05)kPa, (4.98?4.26)kPa, (6.16?6.93)kPa, (5.65?4.75) kPa after PBPV by single balloon, double balloon and Inoue balloon methods, respectively. During the follow-up period (2. 5?1. 6) years, bloodflow velocity at pulmonary valve measured by supersonic Doppler decreased from (2. 38?1. 89) m/s immediately after PBPV to (2.22?1. 96) m/s, further TVPG decreasing was indicated. Conclusion: The short and long term results of PBPV for PS by each of the three methods were excellent. Inoue balloon may be the first choice for elder children and adults, while for younger children, single balloon method may be preferred. Double balloon method can be remained as the second choice when Inoue method failed.