ABSTRACT: To explore the surgical approach of percutaneous double hemisection and evaluate its clinical efficacies.
From May 2006 to November 2011, a total of 59 patients were recruited. There were 36 males and 21 females with a mean age of 38.2 years (range: 8 - 62). Forty-two varus and 6 valgus feet underwent percutaneous double hemisection. The 0.5 cm coracoid incision was adopted at the medial and lateral aspects of Achilles tendon. Percutaneous double hemisection was employed according to the deformity angles of varus and valgus feet. Manipulative correction was applied slowly until 30° dorsiflexion of ankle. Short leg cast was immobilized for 5 weeks at 30° dorsiflexion of ankle. The force of Achilles tendon, motion of ankle and Hannover Achilles tendon scores were followed up.
Fifty-two patients were followed up for a mean period of 16.5 months (range: 6 - 60). Seven patients were lost. At the end of follow-up, 48 patients with varus and valgus deformities were corrected effectively. When compared with the normal side, the force of Achilles of the operated side of 50 patients had no change while that of 2 patients decreased slightly; the motion of ankle joint increased from (2.8 ± 0.3)° preoperatively to (28.5 ± 1.4)° postoperatively (P < 0.05); the Hannover Achilles Tendon Scores rose from (68.5 ± 3.5) preoperatively to (82.6 ± 4.2) points postoperatively (P < 0.05). The outcomes were excellent (n = 44), very good (n = 5), good (n = 2) and poor (n = 1). The excellent and good rate was 94.2%.
As an effective therapy for Achilles tendon contracture syndrome, percutaneous double hemisection has fewer complications and a faster recovery.
Zhonghua yi xue za zhi 09/2012; 92(33):2345-8.
ABSTRACT: To investigate the human tenocyte cytoskeleton under different in vitro stretching conditions and analyze the relations between the changes of tenocytic cytoskeleton and different stretching loads.
Human tenocytes, cultivated for 5 -7 passages, were stretched under 4%, 8% and 12% cyclic mechanical stretching with a duration of 2, 4, 8, 12, 24 hours and a frequency of 0.5 and 1.0 Hz. Laser scanning confocal microscope was used to examine the changes of F-actin and nucleus after immunofluorescent staining at different cyclic mechanical stretching loads on human tenocyte. The uni-cell average fluorescence intensity was measured with an image analysis system by the photos of human tenocyte cytoskeleton and analyzed by the single factor analysis of variance.
After cyclic stretching under 4% stretching with a duration of 2 hours at 0.5 Hz, the microfilament of human tenocyte had an irregular and dim alignment. F-actin was thicker and ruptured under 4% stretching with a duration of 4 hours. Under 8% stretching with a duration of 4 hours at 0.5 Hz, all actin microfilaments ruptured, but part of membrane microfilament remained intact. There was a rising trend of actin filament fracturing under 12% stretching with a duration of 2, 4, 8, 12, 24 hours at 1.0 Hz. And all actin filaments fractured at 24 hours. In the control group, the fluorescent intensity of F-actin was at the highest and the filament remained intact. Under the same stretching frequency, the fluorescent intensity of F-actin had a declining trend and significant differences existed under different stretching loads with different durations (P < 0.05). The fluorescent intensity of F-actin increased in all experimental groups, but it was lower than that of the control group with a duration of 8 hours. The expression of F-actin decreased with a longer duration and reached its lowest at 24 hours. The most obvious phenomenon of nuclear condensation and apoptotic body formation was observed under 4% stretching with a duration of 4 hours at 0.5 Hz.
Different cyclic mechanical stretching may cause the in vitro breakage and depolymerization of human tenocytic F-actin. Such an effect correlates with stretching force and its duration.
Zhonghua yi xue za zhi 07/2011; 91(25):1780-5.
ABSTRACT: To investigate the relationship between glenoid inclination or version and supraspinatus tendon full-thickness tears.
Forty-two cases of unilateral supraspinatus tendon full-thickness tears were confirmed by clinical examinations and MRI scans. The bilateral glenoid inclination and version angles, measured by the volume rendering technique (VRT) and multi-planar reformation (MPR) of multi-slice computed tomography (MSCT) under 16-slice spiral CT scans, were compared by paired t test in all cases.
The average inclination angle was (97.6 ± 4.0)° and (96.1 ± 2.9) at affected and healthy sides respectively. And the difference had statistical significance (P = 0.001); the average version angle was (-3.2 ± 5.0)° and (-3.1 ± 4.7)° at affected and healthy sides respectively. And the difference had no statistical significance (P = 0.79).
The glenoid inclination angles are correlated with supraspinatus tendon full thickness tears while but the glenoid version angles are not. A larger glenoid inclination angle may be a positive predictive factor of supraspinatus tendon full-thickness tears.
Zhonghua yi xue za zhi 12/2010; 90(47):3335-8.
ABSTRACT: To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage IIB and Stage III adult-acquired flatfoot.
The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage IIB adult-acquired flatfoot and 7 cases of stage III adult-acquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ), talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomies to restore their proper alignments. The optimal positioning of hindfoot could be achieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses.
All patients were followed-up with a mean time of 13.2 (6 - 21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2.6 postoperatively (P < 0.01). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied. Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported.
Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage IIB and III adult-acquired flatfoot deformity. It may relieve pains, correct structural deformities and obtain excellent clinical outcomes.
Zhonghua yi xue za zhi 09/2010; 90(33):2313-6.
ABSTRACT: To investigate the clinical outcomes of medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction.
From 2005 to 2009, 10 patients (13 feet) of acquired flexible flatfoot with obvious heel valgus underwent medial displacement calcaneal osteotomy with mini-incision. The lateral skin incision of 3.0 - 4.5cm was made to explore the lateral calcaneal wall. Calcaneal osteotomy was performed from inferior and lateral to superior and medial, perpendicular to the longitudinal axis of calcaneal body. The distal segment was displaced medially for 1/3-1/2 width of calcaneal body and fixed by two parallel cannulated screws. All patients were evaluated at 6 weeks, 3 months, 6 months, 12 months and every 6 months pre- and post-operatively by clinical examinations and radiological studies. All patients were physically examined with an extended protocol of questionnaires and the AOFAS Ankle & Hindfoot Scales. The lateral view of full foot allowed an assessment of bone healing, calcaneus inclination angle (CI), talocalcaneal angle (TC) and talar first metatarsal angle (TMT). The AP view of full foot allows assessment of TC and TMT. The heel varus/valgus alignment could be evaluated on the axial radiographs of hindfoot.
With a mean postoperative follow-up period of 20.3 months (range 7 - 55 Ms), all patients had bone union as confirmed by clinical examination and radiology. The AOFAS rating scale improved from a pre-operative mean of 50.3 to a mean of 80.2 at 6 months and a mean of 84.2 at last follow-up, without any complication of infection, nerve injure and so on. All radiographic parameters were statistically significant (P < 0.001), including CI, TC and TMT on the lateral view and TC and TMT on the AP view. The heel varus/valgus was corrected on the axial view.
The medial displacement calcaneal osteotomy with mini-incision is a recommended procedure for the treatment of acquired flexible flatfoot with excellent clinical outcomes, correction of deformity and fewer complications.
Zhonghua yi xue za zhi 09/2010; 90(33):2320-3.