Acute Achilles tendon rupture is a prevalent sports injury that significantly affects athletes and active individuals, leading to impaired function and substantial economic burdens. This study aims to evaluate the efficacy of biological amniotic membrane in minimally invasive surgical repair of acute Achilles tendon ruptures by comparing clinical outcomes between patients treated with the amniotic membrane and those who did not receive it. We conducted a retrospective analysis of clinical data from 62 patients treated between 2021 and 2024, with 30 patients in the biological amniotic membrane group and 32 in the control group. The postoperative rehabilitation protocol was identical in both groups.We recorded complication rate, the time for returning to sports, the American Orthopaedic Foot and Ankle Society score(AOFAS), Achilles tendon Total Rupture Score (ATRS). Compare the results between the 2 groups. No significant differences were observed in operative time or hospital stay between the control and amniotic membrane groups. Regarding functional outcomes, the amniotic membrane group demonstrated significantly higher AOFAS scores at 3 and 6 months postoperatively (P < 0.05). Similarly, this group also showed superior ATRS scores at the 3-month follow-up and less time for returning to sports compared to the control group (P < 0.05). However, in subsequent follow-up assessments, no significant differences were found between the two groups in any of the functional scoring metrics(P > 0.05). Each group recorded 1 complication. Our findings suggest that biological amniotic membrane may effectively enhance early functional recovery in patients undergoing minimally invasive surgical repair for acute Achilles tendon ruptures. Future research should focus on elucidating the mechanisms of action of the amniotic membrane to further refine tendon repair strategies.

Objectives To evaluate the clinical efficacy of reconstruction of plantar degloving injuries using a prefabricated anterolateral thigh plantar glabrous skin flap (PALT-PGSF). Methods Twelve patients, aged 22–56 years, with plantar degloving injuries were treated between July 2016 and December 2022. These defects are typically caused by traffic or machinery trauma. The avulsed plantar skin surfaces are intact, but revascularization are deemed unsuitable. The free tissue flaps transposed to reconstruct the defects were PALT-PGSFs. The flap size varied in width (6–13) cm and length (8–26 cm). The time from admission to reconstruction was 14–32 days (average, 23.1 days). The follow-up period ranged from 12 to 87 months (mean, 36.6 months). Results Eight cases were closed primarily and the other four were covered with skin grafts. All flaps survived; however, one case underwent an exploration procedure twice due to venous and arterial thrombosis. In two cases, ulcers occurred in the nonfabricated area of the flap, which was excised and replaced by PALT-PGSF area during the internal fixation removal and defatting procedure. In the other two cases, ulcers appeared on the front or outside of the feet. All the cases gained protective sensation on the weight-bearing portion of the heel. Patients can perform daily walking normally, and younger patients can even complete running and jumping exercises. Conclusion We advocate the use of the ALT-PGSF for the reconstruction of plantar degloving injuries.

Objective:To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF). Methods:Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured. Results:A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory. Conclusion:Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.

Post-traumatic tendon adhesions significantly affect patient prognosis and quality of life, primarily stemming from the absence of effective preventive and curative measures in clinical practice. Current treatment modalities, including surgical excision and non-steroidal anti-inflammatory drugs, frequently exhibit limited efficacy or result in severe side effects. Consequently, the use of anti-adhesive barriers for drug delivery and implantation at the injury site to address peritendinous adhesion (PA) has attracted considerable attention. Electrospun nanofiber membranes (ENMs) have been extensively employed as drugdelivery platforms. In this study, we fabricated a polylactic acid (PLA)-dipyridamole (DP)-graft copolymer ENM called PLC-DP. This membrane exhibits enzyme-sensitive features, allowing more controlled and sustained drug release compared with conventional drug-loaded ENMs. In experiments, PLC-DP implantation reduced tissue adhesion by 47 % relative to the control group while not adversely affecting tendon healing. Mechanistically, PLC-DP effectively activates the FXYD domain containing ion-transport regulator 2 (FXYD2) protein, thereby downregulating the fibroblast-transforming growth factor beta (TGF- beta)/Smad3 signaling pathway. PLC-DP leverages the anti-adhesive properties of DP and the enzyme-sensitive characteristics of graft copolymers, providing a promising approach for the future clinical treatment and prevention of PA.

The purpose of this study was to evaluate the clinical outcomes of the endoscopic-assisted locking block modified Krackow technique with a V-Y flap. The hypothesis was that the minimally invasive technique can reduce wound complications and facilitate early recovery. In total, 29 men with chronic Achilles tendon rupture who underwent either minimally invasive technique (n = 13) or open repair (n = 16) at our department between 2013 and 2019 were retrospectively analyzed. The rate of complications, time to return to moderate-intensity exercise, American Orthopedic Foot and Ankle Society ankle hindfoot score, Achilles tendon Total Rupture Score, heel-rise repetitions in 1 min, heel-rise height, and bilateral calf circumference at 6 months, 1 year, and 2 years postoperatively were recorded. All incisions healed primarily in the minimally invasive technique group; however, three patients in the open repair group experienced wound complications. The time to return to moderate-intensity exercise, American Orthopedic Foot and Ankle Society score, Achilles tendon Total Rupture Score, heel-rise repetition ratio, and heel-rise height ratio at 6 months postoperatively in the minimally invasive technique group were significantly better than those in the open repair group. However, it was not significantly different between both groups at 2 years postoperatively. Endoscopy allowed scar tissue and adhesions to be removed, allowing the tendon ends to be mobilized out of the small proximal and distal incisions. Minimally invasive technique may result in a lower wound complication incidence and provide better early functional recovery and return to moderate-intensity exercise time than the conventional open procedure in treating chronic Achilles tendon ruptures. Wuxi Ninth People’s Hospital Medical Ethical Committee, LW2021026. III.

Objective:To investigate the clinical effect of minimally invasive-locking block modified Krackow (MI-LBMK) and open giftbox technique in the treatment of Achilles tendon rupture.Methods:Fifty-six patients with Achilles tendon rupture from January 2016 to December 2018 were collected, including 54 males and 2 females, aged 40.7±9.4 years (range 26 to 65 years). The MI group (30 patients) used two minimally invasive incisions without exposing the rupture site, and the LBMK technique was used to repair the Achilles tendon. The open group (26 patients) used a posteromedial longitudinal incision and the giftbox technique was used to repair the rupture tendon. The Achilles tendon was repaired with 6-strand sutures in both groups. Early rehabilitation programs were adopted for postoperative rehabilitation, and regular follow-up (6 weeks, 3, 6, 12 and 24 months after operation) was performed to record the Achilles tendon resting angle (ATRA), American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Achilles tendon total rupture score (ATRS). The rupture gap and cross-sectional area (CSA) were measured by MRI at 6 weeks and 3 months after surgery.Results:A total of 30 patients in the MI group and 26 in the open group were enrolled. The differences between the two groups in age, body mass index, interval from injury to operation, and tendon rupture site were not statistically significant ( P>0.05). All patients were followed up to 24 months after surgery. There were no wound complications in MI group, and 2 cases of superficial infection and 1 case of wound skin necrosis occurred in open group. There was no re-rupture in both groups. The relative ATRA of MI group was -6.32°±0.99°, -3.90°±1.05°, -2.38°±0.84°, -0.25°±1.37° at 3, 6, 12 and 24 months after operation, respectively. The relative ATRA of open group was -7.88°±3.71°, -6.16°±1.10°, -4.53°±0.95°, -3.01°±0.95° at 3, 6, 12 and 24 months after operation, respectively. The differences between the two groups were statistically significant ( P<0.05). The ATRS of minimally invasive group at 6 months and 12 months were 72.70±7.41 and 92.97±3.35 respectively, and the ATRS of open group at 6 months and 12 months were 68.08±6.64 and 90.85±4.27 respectively, and the differences were statistically significant ( P<0.05). The AOFAS of minimally invasive group at 6 months and 12 months were 88.60±2.76 and 93.83±1.98 respectively, and the AOFAS of open group at 6 months and 12 months were 85.77±3.20 and 92.08±2.64 respectively, and the differences were statistically significant ( P<0.05). The difference in the gap between the tendon rupture ends measured by MRI sagittal plane T2WI between the two groups was not statistically significant ( P>0.05). The cross-sectional area of Achilles tendon in the MI group was higher than that of the open group at 12 weeks ( P<0.05). Conclusion:The MI-LBMK technique may protect the peritendon tissue and has fewer complications, and can enable the patient to return to daily life faster, with lower postoperative Achilles tendon elongation and better recovery of Achilles tendon function.

Background The medial plantar artery perforator (MPAP) flap is widely used to reconstruct the weight-bearing area of the foot. Traditionally, its donor site is closed using a skin graft, which is associated with several complications, including walking disability. This study aimed to examine our experience with using a super-thin anterolateral thigh (ALT) flap to reconstruct the MPAP flap donor site. Methods We examined 10 patients who underwent reconstruction of the MPAP flap donor site using a super-thin ALT flap between August 2019 and March 2021. The vascular pedicle was anastomosed to the proximal end of the medial plantar vessels or the end of the posterior tibial vessels. Results All reconstruction flaps survived and all patients were satisfied with the aesthetic appearance. No blisters, ulcerations, hyperpigmentation, or contractures occurred. All patients gained protective sensation in the super-thin ALT flap. The average visual analog scale score for the aesthetic appearance of the reconstructed foot was 8.5 ± 0.7 (range, 8–10). All patients were able to ambulate without aids and could wear regular shoes. The average revised Foot Function Index score was 26.4 ± 4.1 (range, 22–34). Conclusion Reconstruction of the MPAP flap donor site using a super-thin ALT flap is reliable and provides satisfactory functional recovery, aesthetic appearance, and protective sensation while minimizing postoperative morbidity.

Purpose To evaluate the clinical efficacy of using free tissue flap combined with contralateral instep thick plantar skin in reconstructing complex plantar forefoot defects. Methods During the past 8 years, 15 patients, aged 25–60 years, with defects in the soft-tissue and composite bone of the forefoot were treated. Their defects were caused by trauma. These defects were all located on the plantar forefoot. The free tissue flaps transposed to reconstruct defects were anterolateral thigh flaps, groin flaps, and latissimus dorsi flaps. Flap size varied in width 4-cm and length (6–16 cm). The mean size of flaps was 80.3 cm 2 . The follow-up period ranged from 12 to 90 months (mean, 25.5 months). Results Partial flap loss was observed in one anterolateral thigh flap and one latissimus dorsi flap. One patient showed skin graft loss at the defect site, and the wound was re-epithelialized by changing dressings. Hyperkeratosis was not observed in any of the cases. All patients were able to walk near-normally within 2.5 months after surgery, and there was no recurrence of ulceration. Conclusion We advocate using a free tissue flap combined with contralateral instep thick plantar skin for reconstruction of moderate or large complex plantar forefoot defects.

Objective:To investigate the clinical effect of superthin anterolateral thigh flap(ALTF) with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods:The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021. There were 15 males and 8 females with an average of 42(range, 22-59) years old, including 9 in left foot, 13 in right foot, and 1 in both feet. The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm. The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm. CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane. The perforator was exposed and dissected retrograde in the adiposal layer. The superthin ALTF was harvested to repair the foot wound. The donor site was sutured directly. All patients enter follow-up reviews at outpatient clinic or by WeChat. The appearance of flaps were recorded.Results:The superthin ALTF survived in all patients. Two cases had partial epidermal necrosis at the distal part of the flap. The thickness of the flap averaged approximately 4(range 3-6) mm. During 8-16(mean 12) months of follow-up, all superthin ALTF were soft in texture without ulceration. Two flaps required secondary defatting procedures, others showed satisfactory appearance without bulky deformity. Only linear scars left in donor areas.Conclusion:The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.

As an important load-bearing part of the body, joints are prone to articular cartilage degradation during exercise, resulting in joint pain, swelling, and deformity, which has an adverse impact on patients' life quality and social medical security. Therefore, this study aims to test an effective biopolymer scaffold in promoting the growth of chondrocytes in talus. Hydrogel (Gel)-nanohydroxyapatite (nHA) was invented as a new type of biopolymer scaffold for osteoarthritis treatment in this research. To detect the effects of Gel-nHA on guidance, cartilage matrix secretion, mineralization, proliferation, and migration of chondrocyte, we cultured chondrocytes to study the biological properties of nHA. It was found that Gel could guide chondrocytes to permeate and migrate, so it could be used as acellular matrix scaffolds for chondrocyte regeneration. In addition, nHA could stimulate chondrocytes to secrete cartilage matrix, such as type II collagen and mucopolysaccharide (GAGs). At the same time, nHA help to induce chondrocyte mineralization and stimulate the secretion of type X collagen, so as to better maintain the integrity of bone cartilage interface. In Gel-nHA, chondrocyte viability could be better maintained, and the proliferation and migration of chondrocytes could be better promoted, so as to better repair the articular cartilage of talus. Therefore, the Gel-nHA scaffold is expected to become an effective method for repairing talus cartilage in the future.

背景:踇外翻的手术治疗包括骨性手术及软组织的平衡手术,目前多凭借术者的经验制定手术方案.踇外翻的手术方式众多,病理变化复杂多样,没有一种手术能彻底解决踇外翻所有的问题,且手术疗效不确切,学习曲线也较长.目的:探讨数字化技术在踇外翻治疗中的应用.方法:检索PubMed数据库、万方数据库、CNKI中国期刊全文数据库收录的相关文献,英文检索词为"hallux valgus,digital technology,biomechanics,finite element,digital orthopedics,osteotomy",中文检索词为"踇外翻,数字化技术,生物力学,有限元,数字骨科,截骨术",检索时间为2000年1月至2020年5月,总计英文文献571篇,中文文献350篇,根据纳入标准选择其中的42篇进行综述.结果 与结论:①临床上治疗踇外翻时,利用软件进行三维仿真模型重建,在不同工况下模拟手术操作,分析矫形效果,这对于术前规划有着明确的指导意义,有利于降低跨外翻术后并发症的发生率,优化矫形效果;②利用计算机软件行三维建模及有限元足底应力分析,对于生物力学机制研究及术后临床疗效评估优势明显;③3D打印踇外翻截骨导板及骨骼模型的临床应用能够使踇外翻患者得到更精确、更个体化的治疗.

Objective:To analyze the efficacy of using the inducted membrane technique for repair of bone defect of upper limb through fabrication of bone cement spacer in vitro.Methods:From January to October 2009, 32 patients with upper limb bone defects were repaired with the inducted membrane technique through fabrication of bone cement spacer in vitro. There were 10 cases of non-infectious bone defect and 22 cases of infectious bone defect. The length of bone defect was 1.0 to 6.0 cm, with an average of 3.1 cm. There were 23 cases of segmental bone defect and 9 cases of partial bone defect. Location: radius in 7 cases, ulna in 3 cases, humerus in 3 cases, ulna and radius in 2 cases, finger in 5 cases, metacarpal in 7 cases, finger and metacarpal in 3 cases and wrist in 2 cases. According to different conditions, various forms of bone cement spacer such as cylinder, block or pebble and bead chain were made in vitro, and implanted into the bone defect after solidification and cooling. The bone healing and complications were recorded. The recovery of upper limb function in the last follow-up was evaluated by DASH upper limb function questionnaire.Results:One case of infectious bone defect needed to be expanded again after the first stage of operation. The second stage operation was performed at an average interval of 10.3 weeks (ranged, 7 to 14 weeks). There was no difficulty in removal and induced membrane damage. The postoperative follow-up ranged from 12 to 48 months, with an average of 16.7 months. One case of nonunion of ulna and one of metacarpal bone needed bone grafting again to heal, and 2 cases delayed healing. The clinical healing time was 2 to 9 months, with an average of 3.7 months. The infection recurred after bone healing in 2 cases of infectious bone defect. In the last follow-up, there was no fracture or re-fracture of fixator. The functional recovery of adjacent joints was excellent in 18 cases, good in 9 cases and fair in 5 cases. The excellent and good rate was 84.38%.Conclusion:The use of the inducted membrane technique for repair of bone defect of upper limb through fabrication of bone cement spacer in vitro will not lead to difficult removal of spacer and induced membrane damage defect, with less complications and satisfactory effect.

背景:Scarf截骨由于是跖骨干部位截骨,矫形力度较大,截骨矫形效果显著,但常因截骨顶点线及截骨角度的改变而使矫形波动较大,导致矫正不足或矫正过度.三维重建软件在三维模型重建、截骨手术模拟及指标测量等方面具有独特优势,因此有必要针对Scarf截骨术中截骨线的倾斜角度对矫形力度的影响进行量化研究.目的:利用3-matic软件分析Scarf截骨横行截骨线倾斜角度对拇外翻矫形力度的影响.方法:纳入2018年5月至2020年9月苏州大学附属无锡九院足踝外科收治的14例拇外翻患者共21足,年龄22-76岁.在模拟负重支架辅助下,获得拇外翻患者足部模拟负重CT影像,在Mimics软件中进行三维骨骼模型构建,导入3-matic软件对第1跖骨行模拟Scarf截骨术,调整横行截骨线的不同截骨角度进行模拟截骨,然后进行模拟术后拇外翻相关指标的测量,并与同一个体、同一指标的测量结果进行对比,分析各测量值的变化趋势.结果与结论:①Scarf截骨横行截骨线倾斜角度对于拇外翻角变化率、第1-2跖骨间夹角变化率、侧位第1-2跖骨间夹角变化率及跖骨头高度变化率有显著影响(P<0.05);②同时截骨线倾斜角度在20°-25°区间时侧位第1-2跖骨间夹角及跖骨头高度变化率显著增大,在15°-20°区间时拇外翻角、第1-2跖骨间夹角变化率明显增大;③提示利用计算机辅助技术于术前模拟规划可为拇外翻畸形矫正提供一种个性化、精确化的方式,有利于降低手术并发症如转移性跖骨痛的发生率,增大截骨术式的矫形力度和截骨安全性,提高患者满意度,减少手术医师的学习曲线,对于临床上拇外翻的手术方式提供指导和理论依据.

[目的]评价新型带髓内尖钩钩钢板治疗Danis-WeberA型外踝骨折的临床疗效.[方法]2016年8月-2019年2月,使用钩钢板治疗的Weber A型外踝骨折患者50例,男28例,女22例,年龄18～65岁.采用踝关节活动度(range of mo-tion,ROM)、美国足踝协会踝与后足功能(American Orthopaedic Foot& Ankle Society,AOFAS)评分以及患者的满意度评价临床效果.[结果] 50例患者手术均顺利完成,术中无血管、神经、肌腱损伤等严重并发症.术后随访12～24个月,平均(15.23±2.84)个月.术后12个月,在跖屈、内翻和外翻ROM患侧与健侧差异无统计学意义(P＞0.05),但是,患侧背伸ROM仍显著小于健侧(P＜0.05).末次随访时,AOFAS评分为85～95分,平均(92.32±4.84)分;患者主观满意度,优46例,良4例.影像显示,所有患者术后骨折复位良好,于术后16～24周达到骨折愈合.[结论]带髓内尖钩钩钢板对Weber A型外踝骨折有良好的固定效果.

Objective:To investigate the clinical effect of free anterolateral thigh flap(ALTF) combined with medial plantar flap(MPF) transfer in repairing forefoot and mid-foot degloving injury.Methods:From May, 2016 to November, 2019, 6 patients with forefoot and mid-foot degloving injuries underwent reconstructions using free ALTF combined with MPF. The study included 4 males and 2 females patients with an average of 43 (range, 35-55) years. The size of soft tissue defects was 15 cm×12 cm-19 cm×14 cm. The dimension of the MPF was 8 cm×5 cm-10 cm× 6 cm, and that of ALTF was 16 cm×7 cm-20 cm×8 cm. The ALTF was used to cover the dorsal and lateral foot, the flap artery was anastomosed to the dorsalis pedis artery. The MPF was used to repair the weight-bearing area of the forefoot, the flap artery was anastomosed to the medial plantar artery in recipient site. All patients entered follow-up by outpatient clinic or Wechat for 9-18(mean, 14) months, and the appearance of flap and limb function were recorded.Results:The MPF and ALTF survived uneventfully in all 6 patients, and the wound in donor and recipient areas healed in one stage. At the last follow-up, the flaps had satisfactory contour, the texture of the flaps was soft, the protective sensation was recovered, and the appearance and function of the foot recovered satisfactorily. The Maryland score of reconstructed foot function was considered excellent (90-100) in 4 cases and good (75-89) in 2 cases. The average Maryland score was 91.2.Conclusion:ALTF combined with MPF generated good effect and satisfactory function in repairing forefoot and mid-foot degloving injury.

Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.

目的:比较3-matic软件与传统X线平片对平足指标测量结果是否具有一致性.方法:在3-matic软件中,根据重建的足踝部负重状态三维骨骼模型,获取足踝部负重状态下的正位、侧位及后足冠状位图像,然后进行平足相关指标的测量,并与同一个体、同一指标的普通平片测量结果进行对比.结果:两种方法对于跟骨倾斜角、距舟覆盖角、正位距骨第一跖骨角的测量,两种测量方法没有统计学差异(P>0.05).对于侧位距骨第一跖骨角、距骨倾斜角、跟骨外移距离、内侧柱长度、内侧足弓角、外侧柱长度、外侧足弓角和跟骨外翻角的测量,两种测量方法具有显著统计学差异(P<0.05).结论:在3-matic软件中进行平足相关指标的测量具有直观清楚、非侵袭性、测量结果稳定等优点,测量时可以根据需要去除不相关的骨块,消除骨骼重影的干扰.对于平足各指标的测量,3-matic软件测量与平片测量结果不具有一致性,因此,利用数字化技术进行平足模拟手术时,不能直接参考平片测量的正常范围.

背景:对于骨缺损的治疗,早期与晚期阶段行诱导膜内植骨修复的骨愈合效果可能存在差异.目的:探讨早期与晚期阶段行诱导膜内植骨修复骨缺损的愈合效果差异和影响骨愈合的主要因素.方法:选择2007年1月至2017年8月无锡市骨科医院和无锡市人民医院行诱导膜技术治疗的63例胫骨骨缺损患者,其中男38例,女25例,年龄16-69岁,按骨水泥填塞后诱导膜内植骨时机不同分为2组:早期组(n=25)在骨水泥填塞后6-8周诱导膜内植骨,晚期组(n=38)在骨水泥填塞后10-12周诱导膜内植骨.随访评估两组骨缺损愈合与患肢功能恢复情况,分析发生延迟愈合和骨不连的原因.试验获得无锡市人民医院和无锡市骨科医院医学伦理委员会审批(LW2019001).结果与结论:①63例患者均顺利完成骨移植手术,术中发现早期组形成的诱导膜较薄、毛细血管相对较多,而晚期组形成的诱导膜通常较厚、毛细血管相对较少;②63例获得16-50个月随访;早期组伤口或切口一期愈合22例,延期愈合3例;晚期组伤口或切口一期愈合34例,延期愈合2例,二期愈合2例;③早期组延迟愈合1例,无骨不连病例,临床愈合时间5.0-12.0个月,平均6.64个月;晚期组延迟愈合2例,骨不连1例,临床愈合时间5.0-16.0个月,平均7.42个月;两组骨缺损愈合时间、骨不连发生情况比较差异无显著性意义(P>0.05);④早期组患肢功能恢复:优13例、良11例、可1例,晚期组患肢功能恢复:优17例、良18例、可3例,两组患肢功能恢复情况比较差异无显著性意义(P>0.05);⑤结果表明,不同时期行诱导膜内植骨对骨缺损骨愈合时间有一定影响,但影响较小,对愈合率无影响,而诱导膜体积和完整性、植骨质量和数量及断端稳定性等其它因素对骨缺损骨愈合,尤其是愈合率的影响更大.

Objective:To investigate the clinical effectiveness of peroneal artery perforator flap with anterior tibial artery perforator in repair of the soft tissue defect of dorsum of forefoot and midfoot.Methods:From February, 2015 to July, 2019, peroneal artery perforator flaps with anterior tibial artery perforator were used to repair dorsal foot soft tissue defect in 42 patients. There were 25 males and 17 females, with an averge age of 62(44-73) years. The size of soft tissue defect ranged from 7 cm×4 cm to 18 cm×5 cm. The recipient sites on forefoot and midfoot were repaired by peroneal artery perforator flaps with anterior tibial artery from the anterolateral aspect of shank. The donor sites were resurfaced with full-thickness skin graft. All patients were followed-up at the outpatient clinic or through WeChat for 3-12 months. The appearance of the flaps and limb recovery were recorded.Results:All flaps survived successfully. The donor sites and recipient sites were well healed. At the last follow-up, the texture and aesthetic of flaps were good, and the appearance and function of the foot were satisfactory.Conclusion:The peroneal artery perforator flaps with anterior tibial artery double blood supply and can be designed to repair large and distanced soft tissue defect of forefoot and midfoot.

目的:探讨旋髂浅动脉（SCIA）穿支皮瓣切取中预防生殖股神经（GFN）股支损伤的体会。方法:2014年5月至2019年5月,采用SCIA穿支皮瓣修复足部损伤32例,均获得门诊随访,有18例在SCIA靠近股动脉处发现有GFN股支通过,分别位于SCIA浅支浅层、SCIA浅深支之间、SCIA深支深层。通过解剖分离暴露GFN股支,切取皮瓣,修复足部创口,16例GFN股支暴露良好,未损伤,2例因位于SCIA浅、深支之间,且需切取共干血管蒂,予切断神经并取下血管蒂后缝接神经。结果:32例皮瓣均顺利成活,供区及受区创口均一期愈合。术后随访4~12个月,末次随访皮瓣质地优良,足部外形恢复满意。2例神经缝接患者在大腿前内侧有感觉减退,半年后恢复,余患者取皮瓣侧大腿前内侧均无感觉减退现象。结论:对GFN股支及SCIA蒂部血管的解剖分型分析及术前、术中设计,有利于预防GFN股支的损伤。