To study the histological and mechanical properties of the patellofemoral cartilage in different regions. Patellofemoral cartilage in knee can be divided into different regions: central of femoral trochlear groove, medial and lateral facets of trochlear groove; ridge of patella, medial and lateral facets of patella. Nine fresh cadaver samples were selected for sampling, and the cartilage in each area was 10 mm. The histological staining (HE staining, Safranin O-fast green staining, toluidine blue staining, and Masson staining) were performed, immunohistochemistry (Type II collagen fiber measurement) and quantitative composition of cartilage in different regions were studied. The stress–strain curves of cartilage in different regions were measured under unidirectional infinite compression. Histologically, the patellofemoral cartilage was different in six regions, the cartilage of patellar ridge was the thickest, and the femoral trochlear groove region had the most fiber content. The uniaxially compression test showed the different strain rate of cartilage in different regions, in which the femoral trochlear groove cartilage was the stiffest. The hardness of cartilage on the femur side is greater than that on the patella side. The cartilage of patellar ridge was the thickest, and the cartilage of femoral trochlear groove region was the hardest. The tissue structure of each region was the same, but the proportion of tissue components was different. The pressure stimulation causes histological differences, and histological changes adapt to the characteristics of pressure distribution.

Objective This study aims to compare the clinical efficacy, ankle function, radiographic parameters, and lower limb alignment changes between supramalleolar osteotomy alone and that combined with fibular osteotomy in the treatment of varus ankle osteoarthritis, and to provide a reference for clinical decision-making. Materials and methods This was a continuous retrospective analytical single-center study performed in the orthopedic surgery unit of the Hospital. The American orthopedic foot and ankle society (AOFAS)ankle-hind score, and Visual Analogue Scale (VAS) were used for pre-and postoperative functional evaluation as well as the range of motion (ROM)of ankle on sagittal plane. The tibial anterior surface angle (TAS), talar tilt angle (TT), medial displacement of the talus (MDT), knee joint congruence (JLCA) angle and hip-knee-ankle (HKA) angle were evaluated pre-and postoperatively. Results The remaining 28 patients in Group I and 27 in Group II were included in the final analysis. fter surgery, the clinical and radiographic parameters of both groups were significantly improved compared with preoperative values (P < 0.05). The range of motion (ROM) of the ankle joint decreased postoperatively in both groups, but there was no significant difference in postoperative ROM between the two groups (P > 0.05). Compared with the SMOT alone group, the SMOT + FO group had significantly higher postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, lower medial distal tibial angle (MDL), and more improved knee joint line convergence angle (JLCA) (all P < 0.05). The significant correlations were found between the AOFAS and MDT changes(r=-0.341,P = 0.011). Conclusion Both SMO alone and SMO + FO can effectively alleviate pain and improve ankle function in patients with varus ankle osteoarthritis. The SMO + FO approach has advantages in improving AOFAS scores, MDL, and JLCA, suggesting that it may be a more optimal surgical option for patients with specific indications.

Patellofemoral osteoarthritis (PFOA) comprises distinct medial (MPFOA) and lateral (LPFOA) subtypes, yet their specific risk factors remain poorly defined. This study aimed to investigate the independent and interactive effects of patellar morphology (Wiberg classification) and femorotibial rotation (FTR) on the risk of developing compartment-specific PFOA in patients with stable patellofemoral joints. This retrospective, single-center study analyzed 246 knees from 235 patients with stable patellofemoral joints. Patients were categorized into MPFOA and LPFOA groups based on MRI-assessed cartilage damage using the WORMS score. Radiographic and MRI data were used to measure anatomical parameters, including FTR angle, Wiberg patellar type, hip-knee-ankle angle, patellar tilt, and TT-TG distance. Multivariate logistic regression analyses, adjusted for age, sex, and BMI, were performed to identify independent risk factors for MPFOA and LPFOA. The interaction between FTR and Wiberg type was also assessed. For MPFOA, Wiberg type I patella (OR = 4.364, 95

Abstract Background The incidence of medial patellofemoral articular cartilage injuries was significantly higher than that of the lateral, although many studies have suggested that lateral patellofemoral intercompartmental pressure is higher than that of the medial. The mechanism of medial patellofemoral cartilage injury remains unknown. The objective of this investigation is to explore the factors that may influence the development of medial compartment osteoarthritis in the patellofemoral joint. Methods This study included imaging of 246 knees from 235 patients. These patients were divided into medial more severe patellofemoral compartment osteoarthritis group(MPFOA), lateral more severe patellofemoral compartment osteoarthritis group(LPFOA) by the Whole-Organ Magnetic Resonance Imaging Score (WORMS). The development of MPFOA or LPFOA was analyzed by logistic regression equations about these factors: hip-knee-ankle angle (HKA), Suleus angle (SA), Congruence angle (CA), Lateral Patellofemoral angle (LPTA), Patellar Tilt angle (PTA), Patellofemoral index (PFI), Insall-Salvati index (I-S), Femorotibial rotation angle (FTR), Tibial tubercle-trochlear groove distance (TT-TG), Patella Wiberg type, Dejour classification of femoral trochlea, and Kellgren-Lawrence (K-L) grade. Results 123 cases had a more severe osteoarthritis in the medial patellofemoral compartment compared to the other 123 cases. The results of binomial multivariate logistic regression analysis showed that having a Wiberg type I patella (OR = 4.364, 95%CI:1.910 ~ 9.969, P = 0.000), and having a FTR > 10° (OR = 3.497, 95%CI:1.370 ~ 8.926, P = 0.009) were high-risk factors for MPFOA. 70 cases had a more severe osteoarthritis in the lateral patellofemoral compartment compared to 176 other cases. The results of binomial multivariate logistic regression analysis showed that having a Wiberg type III patella (OR = 2.916, 95%CI: 1.267 ~ 6.712, P = 0.012), and having a FTR < 0° (OR = 4.601, 95%CI: 1.416 ~ 14.946, P = 0.011) were all high-risk factors for LPFOA. Conclusions FTR angle and patellar Wiberg type have a strong influence on the severity and incidence of medial and lateral osteoarthritis of the patellofemoral joint. The prevalence of MPFOA may not be related to varus and vaglus of the lower limb. The dynamic factors of the weight-bearing position of the patellofemoral joint are important when studying the pathogenesis of medial patellofemoral osteoarthritis.

Background: The H2FPEF score, a convenient tool developed for diagnosing heart failure with preserved ejection fraction (HFpEF), exhibited useful prognostic utility in HFpEF. However, the applicability and the prognostic value of the H2FPEF score in Chinese HFpEF patients have yet to be fully confirmed. The study aimed to evaluate the effect of modified H2FPEF score on the prognosis of Chinese HFpEF patients. Methods: In this retrospective study, we calculated the H2FPEF scores by body mass index (BMI) >= 25 kg/m(2) and 30 kg/m(2) respectively, for 497 consecutive HFpEF patients in China. Subjects were divided into low- (0 - 3 points), intermediate- (4 - 6 points), and high-score (7 - 9 points) groups. The primary and secondary endpoints were heart failure (HF)-related events and acute coronary syndrome (ACS), respectively. Cox proportional hazard models were applied to calculate hazard ratios (HRs). Receiver operating characteristic (ROC) curves and areas under the curve (AUC) were used to evaluate the prediction of the H2FPEF score for adverse outcomes. Results: Over a mean follow-up of 40.46 +/- 6.52 months, the primary and secondary endpoints occurred in 168 patients (33.8%) and 97 patients (19.5%), respectively. By the definition of obesity as BMI >= 25 kg/m(2), a higher incidence of HF-related events and ACS was observed among those with a higher modified H2FPEF score. The modified H2FPEF significantly predicted HF-related events (AUC: 0.723; 95% confidence interval (CI): 0.676 - 0.770; P < 0.001) and ACS (AUC: 0.670; 95% CI: 0.608 - 0.731; P < 0.014) with higher power than the H2FPEF score calculated by BMI >= 30 kg/m(2). The cutoff of the modified H2FPEF score was 6.5 for detecting HF-related events and ACS. Conclusions: The modified H2FPEF score, using BMI >= 25 kg/m(2) to define obesity, could more effectively predict the occurrence of subsequent cardiovascular events in Chinese HFpEF patients. The modified H2FPEF score above 6.5 is a risk factor for adverse cardiovascular events in HFpEF patients.

Abstract Medial-lateral retinacular plasty is a new surgical technique designed based on anatomical and biomechanical studies and the advantages of traditional proximal repositioning. To compare the complication rates and outcomes of lateral supportive ligamentoplasty and lateral supportive ligament release for lateral patellar dislocation. In a retrospective study, 71 patients (mean age, 14.40 ± 1.28 years; 45females and 26males) received either medial and lateral retinacular plasty (37 patients) or medial retinacular plasty and LR release (34 patients) between October 2013 and December 2017. The number of patellar apprehension signs, Kujala score and patellar tilt angle(PTA), patellar lateral shift(PLS), congruence angle(CA), and medial patellar glide (MPG) from computed tomography scan have been incorporated into the clinical evaluation. All patients were followed up, and the shortest follow-up time was 2 years. Patients were followed up for a mean period of 29 months (24–38 months). The mean Kujala score was significantly lower (P = 0.027) in the LR release group (82.00 points) than in the LR plasty group (86.35 points). Moreover, there was a significant difference between preoperative and postoperative outcomes for MPG. (P < 0.05). The MPG was smaller in the LR plasty group than the LR release group. In this retrospective study, medial and lateral brachioplasty can effectively correct patellofemoral joint tracking and improve knee function in patients with patellar dislocation.

Abstract Object Varus-valgus lower alignment is a risk factor for patellofemoral osteoarthritis, but malalignment alone affect not only the tibiofemoral joint but also the patellofemoral joint. The aim of the present study was to analyse the contact area of patellofemoral joint in varus alignment and valgus alignment of healthy subjects using magnetic resonance imaging. Methods Twenty-six healthy subjects with valgus lower limb alignment (Group I, n = 26) and twenty-six volunteers with varus lower limb alignment (Group II, n = 26) was performed. An MRI scan was used to capture and measure the patellofemoral joint articular cartilage contact area at different degrees of knee flexion (20°, 40°,60°) in passive movement. All subjects were categorized on the basis of the global limb alignment and mechanical alignment of the femur and tibia. Varus alignment is hip–knee–ankle angle ≥ 3°; and valgus alignment is hip–knee–ankle angle ≥ − 3°. To obtain medial facet contact area and lateral facet contact area for each slice, the length of each respective line of contact was multiplied by the 5 mm slice thickness. Results The overall joint contact area increased from 168.0 ± 20.5 mm2 at 20° knee flexion to 334.4 ± 30.5 mm2 at 60° knee flexion in group (I) The overall joint contact area increased from 178.0 ± 18.9 mm2 at 20° knee flexion to 328.9 ± 27.2 mm2 at 60° knee flexion in group (II) There was a significant difference in lateral facet contact area between group I and group II at 40° of knee flexion. There was significantly different in medial facet contact area between group I and group II at 20° and 40° of knee flexion. Conclusions Throughout the knee movement, the contact area on the lateral facet of the patellofemoral joint was greater in the valgus group. In the early phase of knee flexion, the contact area of the medial patellofemoral joint was larger in the varus group. Lower alignment is an important factor in patellofemoral joint degeneration.

PURPOSE:To develop a comprehensive and effective personalized scoring system on the basis of demographic and clinical characteristics for predicting recurrence probability in patients with primary lateral patellar dislocation (LPD). METHODS:Participants included 261 primary patients with LPD with 2-year minimum follow-up from our hospital across 2013 to 2020. Demographic and clinical characteristics were collected retrospectively. The backward stepwise method was performed to identify independent predictors and construct a nomogram to predict the probability of recurrence. The predictive performance was assessed by receiver operating characteristic curves, calibration plots, and decision curve analysis. RESULTS:After variables selection, 6 independent predictors of recurrence (skeletal maturity, trochlear dysplasia, tibial tuberosity-trochlear groove distance, mechanical axis deviation, Insall-Salvati index, and patellar tilt) were enrolled in our model. Validation of this nomogram in both training and validation cohort revealed powerful predictive ability, with an area under the curve of 0.962 and 0.977, respectively. The nomogram also showed great calibration and good clinical practicability. CONCLUSIONS:Our study presented a nomogram that incorporates 6 independent risk factors (skeletal maturity, trochlear dysplasia, tibial tuberosity-trochlear groove distance, mechanical axis deviation, Insall-Salvati index, and patellar tilt), which can be conveniently used to accurately predicts the risk of recurrence after primary LPD in individual cases. LEVEL OF EVIDENCE:Level III, retrospective comparative prognostic study.

Purpose To investigate the differences of patellofemoral joint pressure and contact area between the process of stair ascent and stair descent. Methods The finite element models of 9 volunteers without disorders of knee (9 males) to estimate patellar cartilage pressure during the stair ascent and the stair descent. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and ligament model. The three-dimension models of the patella, femur and tibia were developed with the medical image processing software, Mimics 11.1. The ligament was established by truss element of the non-linear FE solver. The equivalent gravity direction (-z direction) load was applied to the whole end of femur (femoral head) according to the body weight of the volunteers, and the force of patella was observed. A paired-samples t -test or Wilcoxon rank sum test to make comparisons between stair ascent and stair descent. Statistical analyses were performed using SPSS 22.0 using a P value of 0.05 to indicate significance. Results During the stair descent (knee flexion at 30°), the contact pressure of the patella was 2.59 ± 0.06Mpa. The contact pressure of femoral trochlea cartilage was 2.57 ± 0.06Mpa. During the stair ascent (knee flexion at 60°), the contact pressure with patellar cartilage was 2.82 ± 0.08Mpa. The contact pressure of the femoral trochlea cartilage was 3.03 ± 0.11Mpa. The contact area between patellar cartilage and femoral trochlea cartilage was 249.27 ± 1.35mm 2 during the stair descent, which was less than 434.32 ± 1.70mm 2 during the stair ascent. The area of high pressure was located in the lateral area of patella during stair descent and the area of high pressure was scattered during stair ascent. Conclusion There are small change in the cartilage contact pressure between stair ascent and stair descent, indicating that the joint adjusts the contact pressure by increasing the contact area.

Background To explore the risk factors and develop a nomogram in order to predict surgical site infection (SSI) after open reduction and internal fixation (ORIF) for closed pilon fractures (CPF). Methods A prospective cohort study with one-year follow-up was carried out in a provincial trauma center. From January 2019 to January 2021, 417 adult patients with CPFs receiving ORIF were enrolled. A Whitney U test or t test, Pearson chi-square test, and multiple logistic regression analyses were gradually used for screening the adjusted factors of SSI. A nomogram model was built to predict the risk of SSI, and the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used for evaluating the prediction performance and consistency of the nomogram model. The bootstrap method was employed to test the validity of the nomogram. Results The incidence of SSI after ORIF for CPFs was 7.2% (30/417): 4.1% (17/417) of superficial SSIs and 3.1% (13/417) of deep SSIs. The most common pathogenic bacteria were Staphylococcus aureus (36.6%, 11/30). The multivariate analysis showed tourniquet use, longer preoperative stay, lower preoperative albumin (ALB), higher preoperative body mass index (BMI) and hypersensitive C-reactive protein (Hs-CRP) were independent risk factors of SSI. Additionally, the C-index and bootstrap value of the nomogram model were 0.838 and 0.820, respectively. Finally, the calibration curve indicated that the actual diagnosed SSI had good consistency with the predicted probability, and the DCA showed that the nomogram had clinical value. Conclusions Tourniquet use, longer preoperative stay, lower preoperative ALB, higher preoperative BMI and Hs-CRP were five independent risk factors of SSI after closed pilon fractures treated by ORIF. These five predictors are shown on the nomogram, with which we may be able to further prevent the CPS patients from SSI. Trial registration NO 2018-026-1, October /24/2018, prospectively registered. The study was registered in October 24, 2018. The study protocol was designed based on the Declaration of Helsinki and admitted by the Institutional Review Board. The ethics committee approved the study on factors related to fracture healing in orthopedic surgery. Data analyzed in the present study were acquired from the patients who underwent open reduction and internal fixation from January 2019 to January 2021.

Abstract Background The aim of this study is to report our institution’s experience regarding the application of allogeneic tendons for the reconstruction of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability. Methods This retrospective study included 34 (34 ankles) patients surgically treated for malunited lateral malleolar avulsion fractures with chronic lateral ankle instability from January 2016 to December 2019. All patients underwent allogeneic tendon reconstruction. The pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores、Karlsson Ankle Functional Scores (KAFS) and visual analogue scale (VAS) scores were used to evaluate the functional recovery of the ankle joint. The final follow-up, based on radiographic assessment, including talar tilt and anterior talar translation, was performed to evaluate the stability of the postoperative ankle joints. Results Thirty-two patients (32 ankles) returned for final clinical and radiologic follow-up at an average of 29 (range 24–35) months and 2 patients (2 ankles) were lost to follow-up. The preoperative talus inclination angle (13.6 ± 1.9°) and anterior displacement (9.6 ± 2.8 mm) were re-examined under X-ray and found to be reduced to 3.4 ± 1.2° and 3.8 ± 1.1 mm, respectively (p＜0.01). The AOFAS scores increased from 58.5 ± 4.0 to 90.9 ± 3.8 and the Karlsson scores improved from 52.2 ± 3.6 to 89.8 ± 4.5, which was obviously better and the difference was statistically significant (P < 0.01). The VAS scores were significantly reduced from a preoperative mean of 6.8 ± 1.0 to 2.8 ± 0.9 postoperatively (p＜0.01). Conclusion In this population and with this follow-up, the application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appeared safe and effective.

Abstract Purpose To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial tubercle transfer combined with medial patellofemoral ligament (MPFL) reconstruction by imaging methods, and to guide clinical treatment and rehabilitation. Methods From October 2015 to March 2022, 23 patients with RPD who underwent tibial tubercle transfer combined with MPFL reconstruction were retrospectively enrolled. All patients were assessed by CT in the supine position with the knee fully extended and the quadriceps relaxed. The CSA of VMO and the ratio of CSA of VMO to body weight (CSA/BW) were measured at the upper pole of the patella, 5 mm above the upper pole of the patella and 5 mm below the upper pole of patella. The differences of measured parameters were compared before surgery and at follow-up, including CSA of VMO and CSA/BW. Test level α = 0.05. Results The tibial tubercle-trochlear groove (TT-TG) distance was significantly reduced at follow-up compared with that before surgery (27.91 ± 1.95 mm vs 12.33 ± 1.07 mm, P < 0.001). The CSA of VMO was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (473.06 ± 106.32 mm2 vs 562.97 ± 157.90 mm2, P < 0.001), at the upper pole of the patella (641.23 ± 188.45 mm2 vs 700.23 ± 177.55 mm2, P = 0.029), and at 5 mm above the upper pole of the patella (788.25 ± 238.62 mm2 vs 849.79 ± 180.84 mm2, P = 0.018). The CSA/BW was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (7.83 ± 2.52 mm2/kg vs 9.22 ± 3.54 mm2/kg, P < 0.001), at the upper pole of the patella (10.48 ± 3.62 mm2/kg vs 11.42 ± 4.14 mm2/kg, P = 0.020), and at 5 mm above the upper pole of the patella (12.86 ± 4.65 mm2/kg vs 13.68 ± 3.86 mm2/kg, P = 0.017). Conclusion After tibial tubercle transfer combined with MPFL reconstruction, CSA of VMO increased in patients with RPD, which will help to enhance patellar stability and reduce recurrence.

Constructing protective forests to control water and soil erosion is an effective measure to address land degradation in the Bashang Plateau of North China, but forest dieback has occurred frequently due to severe water deficits in recent decades. However, transpiration dynamics and their biophysical control factors under various soil water contents for different forest functional types are still unknown. Here, canopy transpiration and stomatal conductance of a 38-year-old Ulmus pumila L. and a 20-year-old Caragana korshinskii Kom. were quantified using the sap flow method, while simultaneously monitoring the meteorological and soil water content. The results showed that canopy transpiration averaged 0.55 ± 0.34 mm d−1 and 0.66 ± 0.32 mm d−1 for U. pumila, and was 0.74 ± 0.26 mm d−1 and 0.77 ± 0.24 mm d−1 for C. korshinskii in 2020 and 2021, respectively. The sensitivity of canopy transpiration to vapor pressure deficit (VPD) decreased as soil water stress increased for both species, indicating that the transpiration process is significantly affected by soil drought. Additionally, canopy stomatal conductance averaged 1.03 ± 0.91 mm s−1 and 1.34 ± 1.22 mm s−1 for U. pumila, and was 1.46 ± 0.90 mm s−1 and 1.51 ± 1.06 mm s−1 for C. korshinskii in 2020 and 2021, respectively. The low values of the decoupling coefficient (Ω) showed that canopy and atmosphere were well coupled for both species. Stomatal sensitivity to VPD decreased with decreasing soil water content, indicating that both U. pumila and C. korshinskii maintained a water-saving strategy under the stressed water conditions. Our results enable better understanding of transpiration dynamics and water-use strategies of different forest functional types in the Bashang Plateau, which will provide important insights for planted forests management and ecosystem stability under future climate changes.

Patellar instability (PI) is a common knee injury in adolescents, but the crucial biomarkers and molecular mechanisms associated with it remain unclear. We established a PI mouse model and investigated PI-related changes in gene expression by RNA sequencing (RNA-seq). Differentially expressed gene (DEG) analysis and enrichment analysis were performed to identify crucial genes and pathways associated with PI. Subsequently, a protein-protein interaction, DEG-miRNA, DEG-transcription factors, and DEG-drug interaction networks were constructed to reveal hub genes, molecular mechanism, and potential drugs for PI. Finally, the reliability of the sequencing results was confirmed by real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry. Upon comparison with the control group, 69 genes were differently expressed in PI, including 17 upregulated and 52 downregulated ones. The DEGs were significantly enriched in Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling pathway and immune responses. The protein-protein interaction network identified ten PI-related hub genes, all of which are involved in the JAK/STAT signaling pathway or inflammation-related pathways. DEG-miRNA and DEG-transcription factor networks offered new insights for regulating DEGs post-transcriptionally. We also determined potential therapeutic drugs or molecular compounds that could restore dysregulated expression of DEGs via the DGIdb database. RT-qPCR results were consistent with the RNA-seq, confirming the reliability of the sequencing data. Immunohistochemistry results suggested that JAK1 and STAT3 expression was increased in PI. Our study explored the potential molecular mechanisms in PI, provided promising biomarkers and suggested a molecular basis for therapeutic targets for this condition.

Atrial fibrillation/atrial flutter (AF/AFL) has progressed to be a public health concern, and high systolic blood pressure (HSBP) remains the leading risk factor for AF/AFL. This study estimated the HSBP attributable AF/AFL burden based on the data from the Global Burden of Disease (GBD) study 2019. Numbers, age‐standardized rates (ASR) of deaths, disability‐adjusted life years (DALYs), and corresponding estimated annual percentage change (EAPC) were analyzed by age, sex, sociodemographic index (SDI), and locations. Gini coefficient was calculated to evaluate health inequality. Globally, HSBP‐related AF/AFL caused 107 091 deaths and 3 337 876 DALYs in 2019, an increase of 142.5% and 105.9% from 1990, respectively. The corresponding mortality and DALYs ASR declined by 5.8% and 7.7%. High‐income Asia Pacific experienced the greatest decrease in mortality and DALYs ASR, whereas the largest increase was observed in Andean Latin America. Almost half of the HSBP‐related AF/AFL burden was carried by high and high‐middle SDI regions, and it was experiencing a shift to lower SDI regions. A negative correlation was detected between EAPC and SDI. Females and elderly people tended to have a higher AF/AFL burden, whereas young adults (30–49 years old) experienced an annual increase in AF/AFL burden. The Gini index of DALYs rate decreased from 0.224 in 1990 to 0.183 in 2019. Despite improved inequality having been observed over the past decades, the HSBP‐related AF/AFL burden varied across regions, sexes, and ages. Cost‐effective preventive, diagnostic, and therapeutic tools are required to be implemented in less developed regions.

目的 探讨距下关节稳定器治疗儿童柔韧性平足症的手术疗效.方法 回顾性分析2018年6月至2020年8月在河北医科大学第三医院足踝外科采用距下关节稳定器治疗的28例(40足)柔韧性平足症患者的资料,其中男16例(24足),女12例(16足),所有患者经保守治疗无效,故选择行距下关节制动手术治疗.术前和术后末次随访时,通过美国足踝外科协会(American Orthopedic Foot Ankle Society,AOFAS)踝-后足评分来评价踝关节功能恢复情况;采用视觉模拟评分法(visual analogue scale,VAS)评分对患者术后的主观本体感觉进行评估;比较治疗前后距骨第1跖骨角(Meary角)、跟骨倾斜角(Pitch角)、距舟覆盖角(talonavicular coverage angle,TCA)、距骨第 1 跖骨角(talar 1 metatarsal angle,T1MT)、距骨第2跖骨角(talar 2 metatarsal angle,T2MT);观察随访期间的手术并发症情况.结果 28例患者(40足)均获随访12～18个月,平均15.2个月.术后切口均一期愈合,无软组织并发症.4足出现跗骨窦区域疼痛,2足给予局部封闭及冲击波治疗后好转;2足经更换较小型号的螺钉后,跗骨窦区域疼痛消失;其余患者拆除支具后逐渐开始使用矫形鞋垫负重行走,无不适主诉.末次随访时的VAS评分、AOFAS踝-后足功能评分和影像学相关指标较术前显著改善,差异有统计学意义(P＜0.01).结论 应用距下关节稳定器治疗儿童柔韧性平足症,操作简单,创伤小,安全可靠,疗效显著.

OBJECTIVE:To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus.METHODS:Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief.RESULTS:Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate.CONCLUSION:Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

目的 探讨三关节截骨矫形融合术治疗成人僵硬性高弓足的临床效果.方法 回顾性分析2018年1月至2020年1月应用三关节融合(距下关节、跟骰关节、距舟关节)治疗10例成人僵硬性高弓足患者;患者行三关节融合术的同时联合跟腱Z行延长及跖筋膜松解作为辅助术式改善足部功能,同时保证术后踝关节的功能位,采用美国足踝外科协会(AOFAS)踝-后足评分、视觉模拟疼痛评分(VAS)及患者术前术后的主观满意度,末次随访时通过影像学分析对比跟骨倾斜角(Pitch角)、距骨第一跖骨角(Meary角)等.结果 术后10例患者全部获得随访,随访时间为15～36个月,平均23.4个月,患者均未出现手术切口感染,且术后患者的外观、症状、步态等方面均有明显的提高,末次随访时满意度评价:非常满意7例,满意2例,一般1例,不满意0例.术后AOFAS评分高于术前,VAS评分低于术前,Meary角、Pitch角及第一跖楔关节高度较术前明显改善,差异有统计学意义(P<0.05).结论 三关节截骨矫形融合治疗成人僵硬性高弓足可以显著纠正关节畸形,解除足部疼痛,提高患者的生活质量,但三关节融合术主要应用后足僵硬型高弓足,因其限制了足部部分功能,故应严格把握手术适应证.

目的 探讨Chevron截骨导向器引导下截骨治疗轻中度外翻的临床效果.方法 2019年1至3月,对15例(24足)轻中度外翻患者进行截骨导向器引导下的Chevron截骨术.术前、术后测量外翻角(hallux valgus angle,HAV)、第一二跖骨间角(intermetatarsal angle,IMA),评估患者美国足踝外科协会(American orthopaedic foot&ankle society,AOFAS)踝-前足评分、视觉模拟评分(visual analogue scale,VAS)、主观满意度评价.结果 术后所有患者随访12～16个月,HAV术前平均(34.0±4.8)°、术后平均(9.7±1.7)°;IMA术前平均(11.8±1.2)°、术后平均(8.5±1.2)°;AOFAS评分术前平均(58.9±6.2)分、术后平均(93.5±4.5)分;VAS评分术前平均(6.8±0.6)分、术后平均(0.9±0.8)分;满意率为93.33％.结论 Chevron截骨导向器能够在术中进行精确截骨,保证截骨角度,提高截骨质量,保证截骨安全,对轻中度外翻矫形有良好的辅助作用.

Background: This study was performed to compare the operative outcome between percutaneous repair (modified Bunnell suture) and open repair (bundle-to-bundle suture) for treatment of acute Achilles tendon rupture.Methods: Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated. Thirty-six patients were treated by the bundle-to-bundle suture technique (Group A), and 36 patients were treated by the modified Bunnell suture technique (Group B). Functional examination included measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides using magnetic resonance imaging. The number of single-leg heel rises (height of >5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle joint range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome after a minimum 12-month postoperative follow-up period.Results: In total, 61 patients were followed up. The mean follow-up time was not significantly different between Group A (23.73 ± 2.81 months) and Group B (22.61 ± 3.96 months). However, there were significant differences in the heel-rise test (Group A, 1.74 ± 0.96; Group B, 2.37 ± 1.42) and length of the Achilles tendon (Group A, 11.98 ± 1.64 cm; Group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in Group A than B (p = 0.043). The cross-sectional diameter of the Achilles tendon after open repair was significantly different from that after percutaneous repair. There were no significant differences in the ATRS, AOFAS score, or VAS score at the final follow-up between the two groups. One patient in Group A had delayed wound healing, which resolved in about 40 days.Conclusions: Both suture methods described in this report can provide good clinical results. The bundle-to-bundle suture technique is more effective for restoration of the Achilles tendon length and muscle function. This method is safe, effective, and worthy of promotion.