OBJECTIVE: To explore the effectiveness of the flexor digitorum longus (FDL) transfer combined with single-bundle spring ligament reconstruction and medial displacement calcaneal osteotomy in the treatment of stage ⅠAB progressive collapsing foot deformity (PCFD). METHODS: Between January 2019 and September 2023, 19 patients (19 feet) with stage ⅠAB PCFD were treated with FDL transfer combined with single-bundle spring ligament reconstruction and medial displacement calcaneal osteotomy. There were 11 males and 8 females, aged 18 to 60 years, with an average age of 45.5 years. Nine cases were on the left foot and 10 cases on the right foot. The disease duration was 9-21 months, with an average of 12.3 months. Postoperatively, the effectiveness was evaluated by visual analogue scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Tegner score. Based on X-ray films, the talonavicular coverage angle (TNCA), talus-first metatarsal angle (T1MT), Meary angle, and pitch angle were measured. The plantar pressure parameters of the foot were measured by the Footscan plantar pressure measurement system, including peak pressure and load of the forefoot, midfoot, and hind foot. The patients' satisfaction with the surgical outcome was evaluated. RESULTS: All 19 surgeries were successfully completed. One patient had poor incision healing after operation, while the incisions of the remaining patients healed by first intention. All patients were followed up 12-28 months (mean, 16.8 months). At last follow-up, the VAS score significantly decreased compared with that before operation, and the AOFAS score and Tegner score significantly increased ( P<0.05). Radiological measurements showed that the TNCA, T1MT, Meary angle, and Pitch angle all significantly improved compared with those before operation ( P<0.05). Plantar pressure tests indicated that the peak pressures of the forefoot and midfoot significantly reduced compared with those before operation ( P<0.05), while the peak pressure of the hind foot showed no significant change ( P>0.05). The forefoot load significantly increased and the midfoot load decreased compared with those before operation ( P<0.05), while the hind foot load showed no significant change ( P>0.05). The total satisfaction rate of patients with the surgical outcome (very satisfied+satisfied) reached 84.2% (16/19). CONCLUSION The FDL transfer combined with single-bundle spring ligament reconstruction and medial displacement calcaneal osteotomy can effectively correct the stage ⅠAB PCFD, improve the abnormal distribution of plantar pressure and load, alleviate foot pain symptoms, and improve foot movement function. The patient's satisfaction is high. However, the long-term effectiveness still needs to be further observed and clarified.
Humans ; Female ; Male ; Osteotomy/methods* ; Adult ; Middle Aged ; Calcaneus/surgery* ; Young Adult ; Adolescent ; Tendon Transfer/methods* ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Foot Deformities/surgery* ; Ligaments, Articular/surgery*

Objective To evaluate the clinical efficacy and safety of anatomical repair and anatomical reconstruction through Meta-analysis.Methods Systematically search PubMed,Embase,Wanfang database,China National Knowledge Infrastructure and other databases were used to obtain the relevant literature in the treatment of chronic lateral instability of the ankle joint with anatomical repair and reconstruction from the establishment of each database to December 2022,and Revman 5.4 and R 4.2 software were used for Meta-analysis.Results Eight articles were finally included in this paper.All were randomized controlled trials.The results of Meta-analysis showed that:there were statistically significant differences between anatomical repair and anatomical reconstruction in the anterior talar translation (MD=0.54,95％CI:0.27-0.81,P<0.01),talus tilt angle (MD=0.36,95％CI:0.07-0.66,P=0.02),and American Orthopaedic Foot & Ankle Society scale (MD=-4.79,95％CI:-6.58--3.01,P<0.01),but there was no statistically significant difference in complications (RR=1.13,95％CI:0.32-3.97,P=0.85).Conclusion Anatomical reconstruction is superior to anatomical repair in clinical efficacy,while the risk of complications is comparable between two.

Objective:To systematically evaluate the correlation between C-reactive protein (CRP) and postmenopausal osteoporosis.Methods:PubMed, EMbase, Cochrane library, China biomedical literature database, China HowNet and Wanfang database were searched by computer to collect the clinical research literature related to CRP and postmenopausal osteoporosis. The retrieval period was from the establishment of the database to April 1, 2021. The two researchers screened the literature according to the inclusion and exclusion criteria, extracted the data and evaluated the quality, Revman5.3 software was used for meta-analysis.Results:A total of 12 studies were included, including 778 cases in postmenopausal osteoporosis group and 933 cases in non osteoporosis group. The results of combined analysis showed that the level of CRP in postmenopausal osteoporosis group was higher than that in non osteoporosis group, and the difference was statistically significant (standardized mean difference (SMD)=0.55, 95% CI (0.03, 1.07), P=0.04). Further subgroup analysis according to different grouping criteria and CRP detection methods showed that the level of CRP in patients with osteoporosis was higher than that in normal bone group ( SMD=0.88, 95% CI (0.07,1.69), P=0.03). There was no significant difference in CRP level between osteoporosis group and osteopenia Group (SMD=0.13, 95% CI (-0.05, 0.31), P=0.15). There was no correlation between CRP levels detected by automatic analyzer, chemiluminescence immunoassay and enzyme-linked immunosorbent assay and postmenopausal osteoporosis. The level of CRP in postmenopausal osteoporosis group detected by immunoturbidimetry was higher than that in non osteoporosis group (SMD=1.50, 95% CI (1.10,1.90), P<0.01). Conclusion:CRP level is related to postmenopausal osteoporosis. High CRP level may be a risk factor for postmenopausal osteoporosis.