As one of the knee preservation surgical approaches, good clinical outcomes of high tibial osteotomy were reported. Aims of this study were to analyze the clinical outcome and pre- and postoperative radiographical parameter and knee functional score between distal tibial tubercle high tibial osteotomy (DTTHTO) and open wedge- high tibial osteotomy (OWHTO) in patients with varus knee osteoarthritis after more than 1 year following-up. A total of 194 consecutive patients in our joint center from March 2016 to October 2021 were enrolled, according to the surgical method, patients were divided into DDTHTO and OWHTO groups. Radiographic parameters of Kellgren-Lawrence grading, hip-knee-ankle angle, weight bearing line ratio and medial tibial plateau angle, knee functional score of American knee society (AKS) score, western Ontario and McMaster universities arthritis index (WOMAC) score, visual analogue score (VAS) were introduced to evaluate clinical outcome for patients who received DDTHTO and OWHTO. There were 103 knees and 89 knees in the OWHTO and DTTHTO group, respectively. Mean weight bearing line ratio for OWHTO and DTTHTO were 25.1 ± 11.7 and 25.2 ± 12.0% respectively, medial tibial plateau angle and hip-knee-ankle angle angle demonstrated that all patients in the present study inherited a varus angle ranges from 3.4° to 9.5°. Preoperative AKS, WOMAC and VAS were 68.4 ± 5.7 versus 69.0 ± 5.9, 109.3 ± 15.0 versus 107.7 ± 14.0 and 6.8 ± 1.0 versus 6.9 ± 0.8, and there was no significant difference between 2 groups (P > .05). Mean postoperative AKS and WOMAC score for patients in both OWHTO and DTTHTO group were significantly improved, moreover, postoperative VAS of DTTHTO patients was lower than that in OWHTO group (P < .05). When comparing the operation time, intraoperative blood loss and bone union time, DHHTO group shows a superiority in these variables over patients in OWHTO (121 ± 29.6 vs 145.7 ± 35.2 minutes, 115.0 ± 20.8 vs 103.3 ± 17.3 mL, 13.7 ± 4.1 vs 12.0 ± 2.8 weeks; P < .005) and incidence of complication was lower for DTTHTO group. DTTHTO in patients with varus knee osteoarthritis has good clinical outcomes, and it can achieve a better postoperative alignment. Operation time and surgical trauma were also less in patients who underwent DTTHTO.

Objective: The purpose of the study was to investigate the therapeutic efficacy and application value of Llizarov external fixator in the treatment of type II Pilon fracture.Methods: A total of 100 patients with type II Pilon fracture admitted to the orthopaedics department of our hospital from February 2017 to June 2019 were selected and their clinical data were retrospectively analyzed, and according to different surgical methods the patients were divided into 2 groups, group A and group B, with 50 patients in each group. Among them, group A patients received Llizarov external fixator, while group B patients were treated with delayed open reduction and internal fixation. After that, operation duration, intraoperative blood loss, the incidence of adverse reactions, ankle pain score, ankle activity score as well as the recovery of fracture sites of the patients were compared between the two groups, so as to analyze the clinical significance of the Llizarov external fixator.Results: The operation duration and intraoperative blood loss of the patients in group A were significantly lower than those in group B, with statistical significance (P<0.05); the incidence of adverse reactions of the patients in group A was significantly lower than that in group B, with statistical significance (P<0.05); the ankle pain score and ankle activity score of the patients in group A were significantly higher than those in group B, with statistical significance (P<0.05); the recovery of fracture sites of the patients in group A was significantly better than that in group B, with statistical significance (P<0.05).Conclusion: Treatment with Llizarov external fixator can significantly reduce operation duration, intraoperative blood loss and the incidence of adverse reactions, improve ankle function and promote the recovery of fracture sites in patients with type II Pilon fracture; therefore the Llizarov external fixator has high application value in the treatment of type II Pilon fracture.

Ossification timeline is a critical issue in studies regarding sesamoid bones at metatarsophalangeal (MTP) joints, but actual knowledge is still incomplete. The present study determines the cutoff age of sesamoids ossification at MTP joints. We conducted a retrospective review of radiographs of the feet from 5553 males and 3225 females between November 2005 and September 2012 to identify presence of sesamoids at 5 MTP joints and 3 variations of hallucal sesamoids. Age-specific prevalence of each presence and variations was calculated and clustered to produce latent age groups corresponding to the sesamoid ossification process in males and females, respectively. Males older than 7 years of age were divided into 5 age groups (8–11, 12–15, 16–29, 30–76, and 77–92 years), while females were classified into 4 age groups (8–11, 12–26, 27–76, and 77–92 years). According to the characteristics of sesamoid prevalence in each age group, the pre-ossification stage was defined at age 1–7 years in both genders and the ossifying stage was defined at age 8–29 years in males and 8–26 years in females. We also defined ossified stage as age 30–92 years in male and 27–92 years in females. The ossifying and ossified stages include 2 or 3 substages in both genders. A clustering analysis provided novel cutoff age points as ossification timelines for the sesamoid bones at MTP joints in males and females, which may have an impact on future sesamoid and skeletal development research.

目的 探讨自体髂骨移植治疗重度距骨软骨缺损的临床疗效分析.方法 选择2012年7月至2017年7月入院符合入选标准(距骨内侧缺损面积>1.5 cm2或病变深度>7 mm)的距骨软骨缺损患者35例,经内踝截骨、取同侧髂骨移植修复缺损部位,患者术前、术后随访均行CT和MRI检查,测量踝关节活动范围(ROM),采用美国矫形足踝协会(AOFAS)及视觉疼痛量表(VAS)对术前术后踝关节的功能及疼痛评定治疗效果,将手术前后相关指标进行统计学分析.结果 术后随访12～36个月,平均(20.6±8.3)个月.91.4％(32/35)的患者术后3个月踝关节肿痛消失,余患者肿痛消失时间较长,最终所有患者踝关节肿痛均消失,末次随访时,测量踝关节活动范围,ROM由术前平均(47.7±6.3)°增加到术后(63.4±7.4)°差异有统计学意义(P<0.01),AOFAS评分较术前显著提高(70.5±7.2,91.3±4.9,P<0.01),VAS评分较术前显著降低(7.2±1.2,1.7±1.1,P<0.01),随访MRI检查关节面修复满意,无明显术后并发症.结论 对于距骨内侧缺损面积>1.5 cm2或病变深度>7 mm的患者,取同侧髂骨移植修复缺损是一种疗效明显的外科手术方法,可广泛应用于临床.

Background: A nail and cement spacer is one of the option for the reconstruction of the proximal humerus after tumor resection among prosthesis unaffordable patients. However, making the cement spacer anatomically match its replacement remains challenging. Presentation of case: A 12-year-old boy was diagnosed with osteosarcoma in the right proximal humerus by core needle biopsy. After preoperative neo-adjuvant chemotherapy, a wide resection was performed, and the defect was reconstructed with an anatomically matched cement spacer. The cement spacer was fabricated using 3D-printed moulds, which were made according to the mirror image of the left humerus based on CT data. The post-operative course was uneventful, and at the 12-month follow-up, the patient is able to move with only some restriction in abduction and upward lift. The MSTD score was 21. Conclusion: Fabrication of an anatomically matched cement spacer using 3D-printed moulds is a simple, inexpensive, and reproducible procedure for reconstruction complex bone defect.

Objective:To explore the clinical effect of minimally invasive surgery in the treatment of adult patients with hallux valgus.Methods:The clinical data of 78 cases of adult patients with hallux valgus treated in our hospital from January 2012 to January 2014 in our hospital were selected as the research object and analyzed retrospectively, of which 13 cases underwent Mayo, 20 cases underwent McBride, 22 cases underwent Keller, 23 cases underwent modified McBride, then the clinical efficacy and gait were analyzed.Results:After treated by modified McBride, HVA and IMA level were lower than those by McBride, Keller and Mayo(P<0.05), and the excellent rate of modified McBride (91.30%) was higher than that of Mayo (46.15%), McBride (75%), Keller (81.82%), there was significant difference (P<0.05).Conclusion:Modified McBride can be used to correct hallux valgus and restore the thumb flexion and extension ability, improve the clinical efficacy, which is worthy of clinical promotion and application.

目的 探讨中西医结合在轻中度拇外翻合并第1跖骨内翻治疗中的应用价值.方法 选择收治的轻中度拇外翻合并第1跖骨内翻患者100例,平均分为对照组和观察组,每组50例.对照组实施西医治疗,观察组实施中西医结合治疗,对2组患者治疗后的患者的拇趾治疗情况、不良反应、X线相关检查结果进行比较.结果 观察组患者的治疗优良率为98.00%,对照组的优良率为84.00%,差异有统计学意义(P<0.05).观察组和对照组患者的不良反应发生率分别为4.00%、18.00%,差异有统计学意义(P<0.05).观察组患者的X线检查HVA值、IMA值、AOFAS评分与对照组比较,差异有统计学意义(P<0.05).结论 轻中度拇外翻合并第1跖骨内翻患者的治疗,对其实施中西医结合治疗,可以显著的提高患者的临床治疗效果,改善患者的拇外翻,并减少并发症的产生,有效的纠正患者的拇外翻角、跖骨间角等,所以中西医结合有较好的应用价值.

Objective To evaluate the therapeutic effect of oral and external application of Chinese medicine combined with Ilizarov external fixator and the accordion technique for severe chronic osteomyelitis of the tibia.Methods A total of 78 patients with severe chronic osteomyelitis of the tibia were randomized into a routine treatment group and a combined treatment group, 39 in each group. All the patients in the two groups received external fixation by use of Ilizarov external fixator and the accordion technique. All the patients in the combined treatment group received oralGuyu decoction. The patients who had large wound received vacuum-sealing drainage in the routine treatment group, and vacuum-sealing drainage combined with external application ofShengji-Yuhong plaster in the combined treatment group. All the patients were treated for 8 weeks and followed up for 2 years. The time to wound healing and fracture healing, and the drainage time were compared between the two groups. Functional and radiologic findings were evaluated according to Paley's criteria. The functions of the knee joint and ankle joint were evaluated using the Hospital for Special Surgery (HSS) knee score and the scoring system of Baird and Jackson, respectively.Results The time to wound healing (17.33 ± 6.21 dvs. 22.27 ± 8.12 d;t=3.018,P=0.004) and the time to fracture healing (32.25 ± 6.02 weeks vs. 36.37 ± 7.75 weeks;t=2.623,P=0.011), and the drainage time (17.01 ± 4.66 dvs. 21.51 ± 5.23 d;t=4.012, P<0.001) in the combined treatment group were significantly shorter than those in the routine treatment group. According to Paley's criteria, the patients who achieved a score of excellent or good for fracture healing (84.6%vs. 53.8%;χ2=7.282,P=0.007) and function (92.3%vs. 66.7%;χ2=6.369,P=0.012) in the combined treatment group were significantly more than those in the routine treatment group. The scores of the HSS knee score (84.56 ± 7.42vs. 78.81 ± 5.33;t=3.391,P=0.002) and the scoring system of Baird and Jackson (85.01 ± 8.21vs. 79.21 ± 6.78;t=3.402,P=0.024) in the combined treatment group were significantly higher than those in the routine treatment group.Conclusion OralGuyu decoction and external application ofShengji-Yuhong plaster combined with Ilizarov external fixator and the accordion technique can promote recovery of the joint function, fracture healing and wound healing.

目的 探讨抗生素骨水泥联合Ilizarov外固定架手风琴技术治疗胫骨重度慢性骨髓炎骨缺损的临床疗效并对慢性骨髓炎的预后作Paley愈合评价.方法 选择医院骨外科收治的15例行抗生素骨水泥联合Ilizarov外固定架手风琴技术,胫骨重度慢性骨髓炎骨缺损患者为试验组,外院15例行常规骨水泥联合Ilizarov外固定架手风琴技术治疗的胫骨重度慢性骨髓炎缺损患者为对照组.结果 与对照组相比,试验组胫骨创伤性骨髓炎骨缺损患者的创面愈合时间、骨折愈合时间、引流时间、住院时间及治疗费用均明显降低( P<0. 05), Paley愈合评价优良率明显升高( P<0. 05).治疗后3个月,两组患者膝关节HSS评分和踝关节功能Baird-Jackson评分情况均较治疗前明显升高,且试验组明显高于对照组( P<0. 05).结论 利用抗生素骨水泥联合Ilizarov外固定架手风琴技术治疗胫骨重度慢性骨髓炎骨缺损,疗效显著,可提高患者术后满意度和生活质量.

目的探讨Ⅰ期有限内固定结合负压封闭引流（VSD）技术治疗严重开放性跟骨骨折的疗效。方法2009年1月至2013年12月骨科收治的重度开放性跟骨骨折患者27例,其中男21例,女6例;年龄24~55岁,平均年龄（34.4±4.8）岁;单足损伤者16例,双足损伤者11例;均使用Ⅰ期复位有限内固定结合VSD技术治疗。观察患者术后伤口愈合情况,跟骨高度、宽度、Bihler角、Gissane角的恢复情况及AOFAS踝-后足评分系统进行综合评分。结果 38例开放骨折均未出现严重感染及慢性骨髓炎,其中2例术后首次去除VSD后出现浅表感染、局部皮肤坏死,经再次清创后更换负压吸引游离皮片移植覆盖创面愈合。15例足经7~10 d负压吸引去除VSD后,创面新鲜,肉芽组织填充满意,经换药治疗后瘢痕愈合。13例足去除VSD后因创面较大再次更换VSD1~2期后肉芽充分填充满意,行植皮术或换药后瘢痕愈合,25~41 d伤口痊愈。8例足去除VSD后因软组织缺损跟骨骨外露用小腿腓肠肌皮瓣覆盖创面,14~22 d愈合,3例足术后1~2年因行走疼痛最终行跟距关节融合术,5例足部分克氏针松动后自行脱落,其余30例足均于伤后6周~4个月愈合后拔除克氏针。此外,38例足没有截肢病例;跟骨高度、宽度、Bhler角和Gissane角均有较术前明显改善,其中28例足恢复满意,5例恢复欠佳。术后1年采用AOFAS踝-后足评分系统13例为优,10例为良,8例为可,7例为差。结论Ⅰ期有限内固定结合负压封闭引流（VSD）技术治疗开放性跟骨骨折并发症少,预后良好,对早期治疗重度开放性跟骨骨折提供一条可行的方法。

目的 观察肩关节镜下取髓内钉同时修复肩袖对肩关节功能的影响.方法 将肱骨干骨折髓内固定术后患者60例分为实验组(30例)和对照组(30例),实验组采用取出内固定并同时修复肩袖,对照组采用传统的切开方法取出内固定,没有对肩袖进行特殊修复.手术前后采用Constant-Murley肩关节功能评分及Neer肩关节功能评分评定肩关节功能.结果 随访2a后,2组患者术后Constant-Murley肩关节功能评分及Neer肩关节功能评分有显著性差异(P均＜0.05).结论 取髓内钉同时修复肩袖能显著改善术后肩关节功能.

Objective:To observe the clinical effect and safety of endostar combined with DIA neoadjuvant chemotherapy in treat-ing osteosarcoma.Methods:48 cases with osteosarcoma accepting treatment from Jan.2011 to Aug.2012 were divided into two groups randomly.The treating group was given endostar combined with DIA regimen before operation while the control group was treated firstly with operation before accepting DIA regimen.Results:There was statistical difference in the ORR(Overall response rate) between treat-ing group(75%) and control group(50%)(P0.05).There was no statistical difference when comparing tumor recurrence rate and survival rate between two groups(P0.05).The tumor cell necrosis rate was obviously lower in the treating group than in the control group,and differences between the two groups have statistical significance(P0.05).The chance of liver dysfunction and kidney dysfunction in the treating group is lower than that of the control group(P0.05).There was no statistical difference in the oral mucositis,bone marrow sup-pression and gastrointestinal reaction between two groups(P0.05).Conclusion:Endostar combined with DIA neoadjuvant chemotherapy could improve therapeutic effect in treatment of osteosarcoma,lessen the side effects caused by the chemotherapy,and deserves promot-ing.

Objective: To explore the clinical effect of core decompression combined with autologous bone-marrow mesenchymal stem cells in treating 54 cases with aseptic necrosis of head of femur.Methods: 54 cases of patients who accepted orthopaedic treatment from Nov 2011 to Mar 2012 in our hospital were divided randomly into two groups.The control group was treated with core decompression and the treating group was treated with core decompression combined with autologous bone-marrow mesenchymal stem cells.Results: One year after treatment,the Harris scores was(86.78±9.48) in the treating group,and was(71.18±8.36) in the control group,and the difference was statistically significant(P<0.05).The excellent and good rate was 84.38% in the treating group,better than that of the control group which was 55.17%(P<0.01).Conclusion: The clinical effect of core decompression combined with autologous bone-marrow mesenchymal stem cells in treating aseptic necrosis of head of femur is remarkable and convinced,and is superior to that of core decompression therapy alone.

Objective:To explore the clinical effect of autologous bone-marrow mesenchymal stem cells in treating aseptic necrosis of head of femur.Methods:55 cases accepted treatment from Sept 2012 to Jan 2013 in our hospital were divided randomly into two groups.The control group was treated with conventional therapy and the treating group was treated with autologous bone-marrow mesenchymal stem cells.Results:The clinical effect was more remarkable in treating group than in the control group,with statistically significant difference(P0.01).The diagnosis results from the DSA showed the treating group was better than the control group and the difference was also statistically significant(P0.01).There was no statistical difference in side effects between the two groups(P0.05).Conclusion:The self bone-marrow mesenchymal stem cells had apparent clinical effect in treating aseptic necrosis of head of femur and it was superior to conventional therapy.

Objective To summarize the clinical effect of the fracture of posterior malleolus by Anti-sliding plates from the ankle joint posterolateral approach,to explore indications of this methods.Methods From July 2005 to July 2009.the 35 cases of the fracture of posterior malleolus from the orthopedic department of The 3rd hospital and CangZhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University,treated by Anti-sliding plates from the approach of the posterolateral of ankle joint.summarizes the duration of surgery time,the bleeding and reset results of reduction,complications and ankle function.Results The average surgical time of 35 cases is 1.2 h.Average 120 mL bleeding.According to X-ray evaluation standard of Leeds,Optimal 28 cases.good 6 cases.poor 1 case,Excellent 97.1%.1 case limb numb for 5 days,without incisional drainage.infection and steel exposed.The average time of follow up is 31.2 months.average fracture healing time is 87 d.no broken nailing complications.According to the AOFAS,optimal 21 cases.good 9 cases.can 5 cases.poor 0 case.Excellent 85.7%.Conclusion The excellent reduction and reliable fixiation can be obtained by this methods for the fracture of posterior malleolus.Not only for a single large block,but the several and shift blocks.

目的观察分析双单边外固定架终末治疗胫腓骨高能量损伤临床疗效,探讨其优缺点。方法采用双单边外固定架终末治疗40例(42侧)胫腓骨骨折,按AO骨折分类:4.1.A2型8侧,4.1.A3型20侧,4.1.B2型3侧,4.1.C1型1侧,4.2.A1型2侧,4.2.B2型2侧,4.2.C2型3侧,4.3.A2型1侧,4.3.A3型2侧。结果40例随访平均12.5个月;骨折愈合时间平均5个月;外固定架平均使用7.2个月。按Johner-Wruhs胫骨骨折后最终结果评定标准,优良率为88.1%。结论采用双单边外固定架能有效固定胫腓骨骨折,是一种有效的治疗方法,可以作为终极治疗。