Objective:To investigate the feasibility and clinical effect of arthroscopic limited excision of flexor hallucis longus(FHL) tendon sheath combined with open technique of posterior ankle joint capsule for hallucal ganglion cyst(HGC) deriving from the ankle joint.Methods:This is a retrospective case series study. From September 2021 to September 2023, the clinical data of 18 patients (18 feet) with HGC deriving from ankle joint treated by arthroscopic limited excision of FHL tendon sheath combined with posterior ankle capsule opening technique at Department of Orthopedic, Xuzhou Central Hospital were analyzed retrospectively. There were 12 males and 6 females. The age was (49.5±10.7) years (range:32 to 66 years). There were 10 cases on the right side and 8 cases on the left side; 11 cases in fibular, 3 cases in plantar, 2 cases in tibial and 2 cases in tip. There were 8 cases of primary operation and 12 cases of recurrence after resection in other hospital. There were 10 cases with complete skin and soft tissue and 8 cases with ulcer.All patients underwent arthroscopic limited excision of FHL tendon sheath combined with open technique of posterior ankle joint capsule.Clinical evaluations included the American Orthopedic Foot and Ankle Society ankle-hindfoot score(AOFAS-AH), visual analog scale (VAS). The data were compared by paired sample t test and Wilcoxon rank sum test. Results:All cases successfully completed the operation. The operation time was (46.3±8.1) minutes (range:35 to 65 minutes), and the intraoperative blood loss was (6.8±3.1)ml (range:2 to 15 ml). All patients primarily healing without any complications such as infection and skin necrosis. All 18 patients were followed up for (16.3±2.9) months (range:12 to 20 months),and no recurrence. One patient complained of numbness of tibial nerve innervation, and the symptoms disappeared after 3 months of symptomatic treatment with oral mecobalamin. At the last follow-up, the AOFAS-AH significantly improved from 78.9±7.1 (range:65 to 90) preoperatively to 95.8±3.3 (range:89 to 100) postoperatively ( t=9.62, P<0.01). The VAS ( M(IQR)) was reduced from 3(4) preoperatively to 0(1) postoperatively ( Z=-3.75, P<0.01). Conclusions:Arthroscopic limited excision of FHL tendon sheath combined with open technique of posterior ankle joint capsule is an effective and feasible surgery, which realizes accurate and minimally invasive treatment process and good short-term clinical effect.

Objective:To investigate the feasibility and clinical effect of arthroscopic limited excision of flexor hallucis longus(FHL) tendon sheath combined with open technique of posterior ankle joint capsule for hallucal ganglion cyst(HGC) deriving from the ankle joint.Methods:This is a retrospective case series study. From September 2021 to September 2023, the clinical data of 18 patients (18 feet) with HGC deriving from ankle joint treated by arthroscopic limited excision of FHL tendon sheath combined with posterior ankle capsule opening technique at Department of Orthopedic, Xuzhou Central Hospital were analyzed retrospectively. There were 12 males and 6 females. The age was (49.5±10.7) years (range:32 to 66 years). There were 10 cases on the right side and 8 cases on the left side; 11 cases in fibular, 3 cases in plantar, 2 cases in tibial and 2 cases in tip. There were 8 cases of primary operation and 12 cases of recurrence after resection in other hospital. There were 10 cases with complete skin and soft tissue and 8 cases with ulcer.All patients underwent arthroscopic limited excision of FHL tendon sheath combined with open technique of posterior ankle joint capsule.Clinical evaluations included the American Orthopedic Foot and Ankle Society ankle-hindfoot score(AOFAS-AH), visual analog scale (VAS). The data were compared by paired sample t test and Wilcoxon rank sum test. Results:All cases successfully completed the operation. The operation time was (46.3±8.1) minutes (range:35 to 65 minutes), and the intraoperative blood loss was (6.8±3.1)ml (range:2 to 15 ml). All patients primarily healing without any complications such as infection and skin necrosis. All 18 patients were followed up for (16.3±2.9) months (range:12 to 20 months),and no recurrence. One patient complained of numbness of tibial nerve innervation, and the symptoms disappeared after 3 months of symptomatic treatment with oral mecobalamin. At the last follow-up, the AOFAS-AH significantly improved from 78.9±7.1 (range:65 to 90) preoperatively to 95.8±3.3 (range:89 to 100) postoperatively ( t=9.62, P<0.01). The VAS ( M(IQR)) was reduced from 3(4) preoperatively to 0(1) postoperatively ( Z=-3.75, P<0.01). Conclusions:Arthroscopic limited excision of FHL tendon sheath combined with open technique of posterior ankle joint capsule is an effective and feasible surgery, which realizes accurate and minimally invasive treatment process and good short-term clinical effect.

Objective:To examine the feasibility and clinical effect of all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture.Methods:This is a retrospective case series study. From February 2021 to February 2023, the clinical data of 24 patients (30 feet) with Achilles tendon contracture treated with all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening were analyzed retrospectively. There were 10 males and 14 females, aged (32.8±16.1) years (range: 9 to 62 years). There were 8 cases of left side only, 10 cases of right side only and 6 cases of bilateral. There were 14 cases (16 feet) of foot varus, 4 cases (6 feet) of foot valgus, and 6 cases (8 feet) without deformity. All patients underwent all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening. The surgical effects were evaluated using the maximum dorsal extension angle of ankle joint in knee extension position, the visual analogue scale (VAS) of pain, the American Orthopedic Foot and Ankle Society ankle-hindfoot score(AOFAS-AH). Paired sample t test was used to compare the scores before and after operation.Results:All patients successfully completed the operation, and the operation time of Achilles tendon lengthening was (22.0±5.7)minutes (range: 15 to 35 minutes) and the intraoperative blood loss was (6.5±2.7)ml (range: 2 to 15 ml). All patients primarily healing without any complications such as sural nerve injury, Achilles tendon rupture, important blood vessel injury, and obvious decrease of lift heel strength of achilles tendon. All 24 patients were followed up for (17.2±4.5) months (range: 12 to 28 months). One patient suffered from lift heel′s weakness in one foot after operation, and recovered after repeated lift heel functional exercises. The ankle dorsiflexion function of two patients with calf triceps spasm were not improved after operation, and it was obviously improved after botulinum toxin injection. At the last follow-up, the maximum dorsal extension angle of ankle joint in knee extension position increased from -9.2°±7.6°(range:-25° to 5°) preoperatively to 14.5°±7.0°(range:0° to 28°)( t=24.83, P<0.01); the VAS score was reduced from (4.5±1.7) points (range:1 to 8 points) preoperatively to (1.5±0.9) points (range:0 to 3 points) ( t=9.53, P<0.01), the AOFAS-AH was increased from (60.5±11.4)points (range:38 to 85 points) to (90.8±5.4) points (range:80-100 points)( t=14.21, P<0.01). Conclusions:All-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture not only provides Achilles tendon lengthening, but also avoids complications such as Achilles tendon rupture and sural nerve injury. It is an effective method for the treatment of Achilles tendon contracture.

Objective:To examine the feasibility and clinical effect of all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture.Methods:This is a retrospective case series study. From February 2021 to February 2023, the clinical data of 24 patients (30 feet) with Achilles tendon contracture treated with all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening were analyzed retrospectively. There were 10 males and 14 females, aged (32.8±16.1) years (range: 9 to 62 years). There were 8 cases of left side only, 10 cases of right side only and 6 cases of bilateral. There were 14 cases (16 feet) of foot varus, 4 cases (6 feet) of foot valgus, and 6 cases (8 feet) without deformity. All patients underwent all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening. The surgical effects were evaluated using the maximum dorsal extension angle of ankle joint in knee extension position, the visual analogue scale (VAS) of pain, the American Orthopedic Foot and Ankle Society ankle-hindfoot score(AOFAS-AH). Paired sample t test was used to compare the scores before and after operation.Results:All patients successfully completed the operation, and the operation time of Achilles tendon lengthening was (22.0±5.7)minutes (range: 15 to 35 minutes) and the intraoperative blood loss was (6.5±2.7)ml (range: 2 to 15 ml). All patients primarily healing without any complications such as sural nerve injury, Achilles tendon rupture, important blood vessel injury, and obvious decrease of lift heel strength of achilles tendon. All 24 patients were followed up for (17.2±4.5) months (range: 12 to 28 months). One patient suffered from lift heel′s weakness in one foot after operation, and recovered after repeated lift heel functional exercises. The ankle dorsiflexion function of two patients with calf triceps spasm were not improved after operation, and it was obviously improved after botulinum toxin injection. At the last follow-up, the maximum dorsal extension angle of ankle joint in knee extension position increased from -9.2°±7.6°(range:-25° to 5°) preoperatively to 14.5°±7.0°(range:0° to 28°)( t=24.83, P<0.01); the VAS score was reduced from (4.5±1.7) points (range:1 to 8 points) preoperatively to (1.5±0.9) points (range:0 to 3 points) ( t=9.53, P<0.01), the AOFAS-AH was increased from (60.5±11.4)points (range:38 to 85 points) to (90.8±5.4) points (range:80-100 points)( t=14.21, P<0.01). Conclusions:All-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture not only provides Achilles tendon lengthening, but also avoids complications such as Achilles tendon rupture and sural nerve injury. It is an effective method for the treatment of Achilles tendon contracture.

OBJECTIVE: To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents. METHODS: The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient's upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint. RESULTS: The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%. CONCLUSION Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.
Male ; Female ; Humans ; Adolescent ; Child, Preschool ; Child ; Elbow ; Humeral Fractures/surgery* ; Retrospective Studies ; Joint Deformities, Acquired/surgery* ; Elbow Joint/surgery* ; Limb Deformities, Congenital ; Osteotomy/methods* ; Humeral Head ; Range of Motion, Articular ; Computers ; Treatment Outcome

Objective:To investigate the functional outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic talocalcaneal coalition.Methods:The study was a retrospective case-series research.The data of 17 adult patients (17 feet) with symptomatic talocalcaneal coalitions,treated with PASTA from March 2018 to February 2022 in Xuzhou Central Hospital were collected.This procedure involved 10 males and 7 females,aged (42.4±7.5) years(range:31 to 58 years).There were 9 cases on the right side and 7 cases on the left side.According to the Rozansky classification,there were 4 cases of type Ⅰ,7 cases of type Ⅱ, 3 cases of type Ⅲ,3 cases of type Ⅳ.The following items such as wound healing and bony union of the subtalar joint were observed.Clinical assessment was performed using pain visual analogue scale (VAS),American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and 36-item short form health survey (SF-36) scores.The paired t test was used for data comparison. Results:The follow-up time was (24.8±6.9) months(range:12 to 40 months).There were no complications such as wound infection,deep vein thrombosis,nonunion,or screw breakage.One patient with preoperative spasm,relieved after the second surgical procedure (peroneal brevis tendon lengthening).The union time of the subtalar joint was (8.8±2.2) weeks(range:6 to 12 weeks).At the final follow-up,the VAS decreased from 6.4±1.3 to 1.3±0.9 ( t=14.114, P<0.01), the AOFAS ankle-hindfoot score increased from 49.0±8.1 to 90.0±5.1 ( t=38.782, P<0.01),and the SF-36 score increased from 50.8±9.5 to 91.0±4.9 ( t=20.468, P<0.01). Conclusion:PASTA for adult patients presenting with symptomatic talocalcaneal coalition offers advantages of minimal trauma,fast recovery,and few complications,which is an effective method.

Objective:To investigate the functional outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic talocalcaneal coalition.Methods:The study was a retrospective case-series research.The data of 17 adult patients (17 feet) with symptomatic talocalcaneal coalitions,treated with PASTA from March 2018 to February 2022 in Xuzhou Central Hospital were collected.This procedure involved 10 males and 7 females,aged (42.4±7.5) years(range:31 to 58 years).There were 9 cases on the right side and 7 cases on the left side.According to the Rozansky classification,there were 4 cases of type Ⅰ,7 cases of type Ⅱ, 3 cases of type Ⅲ,3 cases of type Ⅳ.The following items such as wound healing and bony union of the subtalar joint were observed.Clinical assessment was performed using pain visual analogue scale (VAS),American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and 36-item short form health survey (SF-36) scores.The paired t test was used for data comparison. Results:The follow-up time was (24.8±6.9) months(range:12 to 40 months).There were no complications such as wound infection,deep vein thrombosis,nonunion,or screw breakage.One patient with preoperative spasm,relieved after the second surgical procedure (peroneal brevis tendon lengthening).The union time of the subtalar joint was (8.8±2.2) weeks(range:6 to 12 weeks).At the final follow-up,the VAS decreased from 6.4±1.3 to 1.3±0.9 ( t=14.114, P<0.01), the AOFAS ankle-hindfoot score increased from 49.0±8.1 to 90.0±5.1 ( t=38.782, P<0.01),and the SF-36 score increased from 50.8±9.5 to 91.0±4.9 ( t=20.468, P<0.01). Conclusion:PASTA for adult patients presenting with symptomatic talocalcaneal coalition offers advantages of minimal trauma,fast recovery,and few complications,which is an effective method.

Objective:To investigate the efficacy of total ankle arthroscopy for resection of the talus os trigonum and debridement of the synovium of flexor hallucis longus (FHL) in the treatment of osteogenic posterior ankle impingement syndrome (PAIS) complicated with flexor hallucis longus tenosynovitis (FHLT).Methods:The 14 patients with osteogenic PAIS and FHLT were retrospectively analyzed who had been treated at Department of Hand-Foot-Ankle Microsurgery, Xuzhou Central Hospital from July 2017 to July 2019. They were 8 men and 6 women, aged from 29 to 53 years (mean, 42.4 years). The talus os trigonum and the giant posterolateral process of the talus were resected under total ankle arthroscopy in the prone position of the posterior ankle while the FHL was released and cleared. The efficacy was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Maryland functional score, and pain visual analog scale (VAS) between preoperation and one year postoperation.Results:All patients were followed up for 12 to 24 months (average, 15 months). For all patients, their plantar flexion and dorsal extension were improved significantly from preoperative 19.2°±4.0° and 14.2°±2.7° to postoperative 42.9°±2.7° and 24.5°±3.2°, their AOFAS score increased significantly from preoperative 42.1±4.2 to 91.6±2.7 at one year postoperation, their Maryland score increased significantly from preoperative 43.9±4.1 to 91.9±3.5 at one year postoperation, and their VAS score decreased significantly from preoperative 6 (6, 7) to 0 (0, 0) at one year postoperation (all P<0.05). Conclusion:In the treatment of osteogenic PAIS complicated with FHLT, total ankle arthroscopy for resection of the talus os trigonum and release of FHL can lead to fine efficacy and limited surgical invasion, resolving the FHL pathological inflammation and PAIS at the same time.

Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.

Objective:To explore the basic rules of hemodynamics of the multi-territory flap in the early stage.Methods:In this paper, based on the prototype of the free flaps and vascularized pedicled transpositional flaps. The angiosome theory was applied as a basis to systematically analyze the blood flow pathway, the resistance network, and the series or parallel connection mode between each resistance network within the flap, according to the knowledge of fluid mechanics and current pathway, and finally the mathematical model was used for deduction.Results:Based on the model, it can be concluded that a dynamic flow balance can be achieved in the arteries and veins of the multi-territory flap in the early stage and the flap could be divided into four areas: the effective microcirculation zone, the venous stasis zone, the relative ischemic zone and the absolute ischemic zone. And the following inferences can be drawn: (1) The blood supply to the vascular pedicle is constant by pressure rather than by flow. (2) The resistance of the flap varies by the position or the relative position of the arterial vascular pedicle and venous vascular pedicle. (3) The flow velocity decrease gradually from the pedicle to the distal end. (4) The main factors that lead to distal flap necrosis vary depending on the region in which they are located: the venous stasis zone is mainly due to obstructed venous return, and the relative and absolute ischemic zones are mainly due to insufficient arterial blood supply.Conclusions:The basic rules and characteristics of hemodynamics of the multi-territory flap in the early stage can be well explained by this theoretical model, the pedicled artery and vein of the flap can achieve a dynamic balance of flow, and the blood flow gradually decreases from the pedicle to the distal end. The survival range of the flap depends on the pressure difference between the artery and vein as well as the resistance of the blood flow path in the flaps. The distal necrotic area of the flap can be divided into venous stasis area and arterial insufficiency area.