OBJECTIVETo evaluate the efficacy of small needle scalpel under ultraosonography guidance in plantar fasciitis.

METHODSFrom March 2011 to May 2015, 234 patients with plantar fasciitis were divided into ultrasound-guided group and traditional knife group. There were 117 patients in ultrasound guided group, including 54 males and 63 females, aged from 42 to 8 years old with an average of(54.36±15.04) years; the courses of disease was(15.72±9.55) months on average; treated with small needle scalpel under ultraosonography guidance. While there were 117 patients in traditional small needle scalpel group, including 52 males and 65 females, aged from 43 to 80 years old with an average of (53.6±18.14) years; the average course of disease was(16.98 ±8.99) months;treated only with needle knife. VAS score, tenderness score and AOFAS-AH score before treatment, 1 week, 1 month and 3 months after treatment were observed and compared between two groups.

RESULTSVAS score, tenderness score in ultrasound guided group were lower than traditional needle knife group, and had significant difference between two groups at 1 week, 1 month and 3 months after treatment;while ultrasound guided group was better than traditional needle knife group in alleviating pain. AOFAS-AH score in ultrasound guided group was higher than traditional needle knife group, and had significant difference between two groups at 1 week, 1 month and 3 months after treatment. The function of foot at different time points in ultrasound guided group was better than traditional needle knife group. Wound healing between two groups were better and no complications were occurred.

CONCLUSIONSNeedle knife under ultraosonography guidance is a reliable method for the treatment of plantar fasciitis, and has advantages of rapid onset, excellent efficacy, good functional recovery.

OBJECTIVETo evaluate clinical effects of repairing ankle and foot injuries with perforator-based propeller flaps.

METHODSFrom June 2012 to April 2014, 20 patients with soft tissue defects on the foot and ankle were treated by perforator-based propeller flaps, including 14 males and 6 females with an average age of (36.2±4.6) years old ranging from 8 to 64 years. Area of soft tissue defect varied from 5 cm×2 cm to 22 cm×7 cm. The time from injury to operation ranged from 8 to 90 days, with an average of(38.2±6.2) days. AOFAS scoring were applied to evaluate therapeutic effects.

RESULTSAll patients were followed up from 6 to 24 months with an average of(13.5±2.2) months. Appearance and quality of flap were good. Operation time was 90 to 210 min, with an average of(120±32) min. Nineteen flaps were survived successfully, the flap edge of 1 case was necrosis and healed after free skin grafting. A good contour was confirmed on the recipient area. The total AOFAS score was(93.1±10.0) at the final following-up, 14 cases obtained excellent results and 6 cases were good.

CONCLUSIONSPerforator-based propeller flaps for ankle and foot injuries has advantages of safe, effectivity and could receive good results.

OBJECTIVETo observe clinical effects of arthroscopy for posterior ankle impingement.

METHODSFrom January 2013 to December 2014, 34 patients with posterior ankle impingement were performed ankle arthroscopy with double passage, including 20 males and 14 females aged from 29 to 62 years old with average of 42.2 years old. VAS score were applied for evaluate joint pain before operation and 12 months after operation, AOFAS sore were used to assess ankle joint function.

RESULTSAll patients were followed up with 12 months, and incision were healed well, no complications occurred. Thirty-four patients were bony impingement and 19 patients were soft tissue impingement. Operation time ranged from 20 to 35 min with an average of(25.6±5.2)min. The posterior ankle impingement test of all patients was negative after operation. VAS score at 12 months after operation(1.2±1.3) was significantly higher than that of before operation(4.6±1.0). AOFAS score at 12 months after operation( 84.7±6.5) was also obvious higher than that of before operation (62.7±8.9).

CONCLUSIONSArthroscopy for posterior ankle impingement could relieve pain and improve function of ankle, shorten operative time, and it has a good clinical effect.

OBJECTIVETo analyze clinical efficiency and intraoperative considerations of ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage.

METHODSFrom April 2011 to April 2015, the clinical data of 17 patients diagnosed as ankle impingement syndrome were performed arthroscopy, including 12 males and 5 females, with an average age of 32.4 years (ranging from 22 to 47). Ankle arthroscopy cleaning were carried out according to clinical symptoms and radiological imaging, crashed part were cleaned too. Non steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate were used as conventional postoperatively treatment. AOFAS score and Ogilvie-Harris score were used to assess preoperative situation and postoperative situation.

RESULTSIntra-operative conditions showed 8 cases with anterior lateral impingement syndromes, 2 cases with anterior medial impingement syndromes, 2 cases with posterior impingement syndromes and 3 cases combined with anterior and posterior impingement syndromes. Distal bundle of anterior tibiofibular ligament, anterior talusfibular ligament and synovial tissue and scar tissue were cleared up during operation. Four patients were combined with concomitant articular cartilage injury, and damage area were about 1 mm×3 mm to 1.5 mm×4 mm. Microfracture treatment were performed by 1.2 mm diameter Kirschner wire. All patients were followed up from 8 to 24 months with an average of 14.3 months. AOFAS score increased from 62.3±5.20 preoperatively to 87.6±5.40 postoperatively, Ogilvie-Harris ankle score increased from 6.70±0.98 preoperatively to 12.80±1.21 postoperatively. No neurovascular damage, wound infection or wound healing problem occurred. Ankle swelling were appeared with different degrees, but disappeared at 4 to 8 weeks postoperatively.

CONCLUSIONSFor ankle impingement syndrome patients, ankle arthroscopy through anterior with posterior passage could effectively clear up bone and soft tissue impingement. Postoperatively non-steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate could effectively relieve ankle pain and swollen and achieve good therapeutic effect.

Acute Achilles tendon rupture is a common sports injury, is currently the best treatment for acute Achilles tendon rupture there are more controversial programs in the clinical, their treatment is divided into conservative treatment and surgical treatment. Conservative treatment for a long time, and then the higher Achilles tendon rupture rate, postoperative recovery slow. There are a number of complications traditional open surgery, and minimally invasive surgery in recent years developed a new technology that minimizes the exposure of the wound, reduce surgical trauma scope, shorten the operation time and reduce wound infection rate increasing importance in clinical practice, worthy of recommendation.

The reasonable selection of magnetic resonance imaging(MRI) scan sequence and parameters is very important for the objective evaluation of the results of clinical study and high quality imaging. The semi quantitative scoring system of total knee joint including Whole Organ Magnetic Resonance Imaging Score, Boston Leeds Osteoarthritis Knee Score, MRI Osteoarthritis Knee Score, Cartilage Repair Osteoarthritis Knee Score and so on. They can fully evaluate the imaging changes of various organs during the development of knee osteoarthritis. With the continuous development of MRI technology, the morphological and physiological changes of articular cartilage can be quantitatively assessed. T2 mapping, Diffusion Weighted Imaging, and delayed Gadolinium-Enhanced MRI of Cartilage can be quantitatively monitoring changes in cartilage matrix components. These quantitative and semi quantitative evaluation techniques are helpful to detect OA in its early stage, guide clinical early intervention, and also provide the possibility for the accurate evaluation of the therapeutic effect.

OBJECTIVETo summarize and analyze the surgical methods and therapeutic effects of repair of the finger proximal and middle segment soft tissue defect with three different types of skin flaps.

METHODSFrom May 2011 to May 2015, 102 patients with 115 fingers proximal and middle segment soft tissue defect underwent reconstruction with three different types of skin flaps. There were 59 males with 70 fingers and 43 females with 45 fingers, aged from 19 to 62 years old with an average of 45.6 years. Twenty-nine patients with 29 fingers were repaired by free peroneal artery perforator flaps, 35 patients with 37 fingers were repaired by the free vascularized flaps based on the wrist cutaneous branch of ulnar artery, 38 patients with 49 fingers were repaired by metacarpal dorsal artery perforator flaps. The soft tissue defect area varied from 1.8 cm×4.0 cm to 2.8 cm×5.4 cm. The flap area varied from 2.0 cm×4.4 cm to 3.1 cm×6.0 cm. The clinical results were evaluated based on flap survival rate, finger function and complications.

RESULTSAll flaps survived. Distal skin flap necrosis occurred in 5 flaps, but healed after wound dressing therapy. No deep infection were found in donor site and recipient site. There were 3 cases with partial necrosis of the skin graft, and delayed healing after wound dressing therapy. All patients were followed up from 6 to 28 months with an average of 10.6 months. The appearance and texture of flaps were well. The sensation were good, two-point discrimination was 9 to 13 mm. There were no obvious dysfunction happened in the donor site. The function of the fingers was excellent in 52 cases, good in 41, fair in 9 cases.

CONCLUSIONSAbout the repair of the finger proximal and middle segment soft tissue defect, the right flap should be choosen based on the difference of the sex and the age in patients, wounds situation, the master degree of the operation method and the hospital's technical conditions.