OBJECTIVE: To summarize the effectiveness of orthopedic surgery for patients with moderate and severe hallux valgus and analyze its related influencing factors. METHODS: A clinical data of 247 patients (287 feet) with moderate and severe hallux valgus, who were admitted between January 2013 and October 2024 and met the selection criteria, was retrospectively analyzed. There were 39 males and 208 females, with a median age of 57 years (range, 19-89 years). There were 207 cases of single-foot involvement and 40 cases of double-foot involvement; 159 feet were moderate hallux valgus and 128 feet were severe hallux valgus. The disease duration ranged from 3 months to 25 years, with a median of 5 years and 8 months. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), proximal articular set angle (PASA), and the American Orthopaedic Foot and Ankle Society (AOFAS) scores were measured before operation and at 6 months after operation, and the differences (change values) between pre- and post-operation were calculated. All patients were grouped according to the degree of preoperative hallux valgus deformity and age, and the patients with severe hallux valgus according to different surgical procedures, and the change values of HVA, IMA, and AOFAS scores were compared between groups. All patients were grouped according to postoperative HVA, then the postoperative AOFAS scores were compared between groups. RESULTS: All patients successfully completed the operations and were followed up 6 months to 11 years and 3 months, with an average of 4 years and 6 months. The HVA, IMA, PASA, and AOFAS scores at 6 months after operation showed significant improvement compared to preoperative levels, and the differences were significant ( P<0.05). The patients with severe hallux valgus had the higher change values of HVA, IMA, and AOFAS scores than the patients with moderate hallux valgus ( P<0.05). The elderly patients had the highest change values of HVA and AOFAS scores than the young and middle-aged patients ( P<0.05). The patients with postoperative HVA ranging from 0° to 5° had the highest AOFAS scores than the other patients at 6 months after operation ( P<0.05). Among different surgical procedures for severe hallux valgus, the metatarsophalangeal joint fusion had the highest change value of HVA, the Scarf osteotomy had the highest performance in correcting the IMA, and the first metatarsal base osteotomy had the highest improvement in the postoperative AOFAS score, and the differences were significant ( P<0.05). CONCLUSION Elderly patients show the better improvement in HVA and foot function after operation. The first metatarsal base osteotomy show the better improvement in foot function than other surgical procedures. A certain HVA is allowed to remain after hallux valgus correction, and the postoperative AOFAS score is higher when the corrected HVA is in the range of 0°-5°.
Humans ; Hallux Valgus/diagnostic imaging* ; Middle Aged ; Male ; Female ; Aged ; Retrospective Studies ; Adult ; Aged, 80 and over ; Treatment Outcome ; Osteotomy/methods* ; Severity of Illness Index ; Orthopedic Procedures/methods* ; Metatarsophalangeal Joint/surgery* ; Young Adult ; Metatarsal Bones/surgery*

Objective To explore the sen sation recovery of superficial palmar branc h of the radial artery flap with palmar branch of median nerve and donor si te. Methods From January, 2014 to June, 2016, 12 cases of finger soft tissue defects were repaired with sup erficial palmar branch of the radial artery flap with palmar branch of median nerve. The 2 g tactile sensation, 5 g pain sen sation, 30 g pressure sensation and static two-point discrimination (S2 -PD) of the flap was tested regularly. The S2 -PD of the palmar cutaneous branch of the median nerve were recorded respectively on the affected side and the unaffected side. The results were applied comparative t-test to perform statistical analysis, to observe the sensory recovery of the flap and donor site. Results The flaps survived.Twelve cases was followed-up for 6-18 mont hs. The pressure sensation of about 83.3％ of patients recovered after 2 months and 100％ of patients recovered after 3 months. The tactile sensation of about 91.7％ of patients recovered after 3 months and 100％ of patients recovered after 4 months. The pain sensation of about 91.7％ of patients recovered after 4 months of and 100％ of patients recovered after 5 months. S2-PD of the flap was the average of 8.3 mm in 6 months after operation. There were no significant differences in the S2-PD between the affected group [(12.08±2.15)mm] and unaffected group [(10.58±2.11)mm](P>0.05). And the sensory recovery of the control area of the palmar branch of the median nerve was S4 in 2 cases, S3+ in 9 cases, and S3 in 1 case. The sensory recovery was good. Conclusion Superficial palmar branch of the radial artery flap with palmar branch of median nerve can be used repair the skin defect of the fingers. The flap has a good sensery recovery, and the sensation of the donor area is gradually restored.

Objective To investigate the operative method and clinical rusults of repairing and reconstruction for bone and skin defect at medial malleolus.Methods Form January,2013 to January,2015,11 cases of patients with malleolus complex tissue defect were treated.According to the degree of damage to the cases were divided into four types,according to the type,selected flap,blood vessels,nerves,tendon graft,flap series connection iliac bone flap graft to repair,or direct ankle fusion,amputation to therapy.The Iliac flap donor site remained part of the anterior superior iliac spine and rebuild muscle starting and ending point,the donor sites wound was closed by skin graft.Results Followed-up of 1-24 months,in addition to amputation and ankle fusion each one exception,the remaining 9 patients underwent ankle reconstruction to reserve ankle.One case acquired infection,other 8 patients healed well,had different degree of recovery of the ankle function,the ankle function had recovery in different degree.AOFAS ankle-hindfoot score system:excellent in 4 cases,good in 4 cases,and poor in 1 case.Conclusion Ankle complex tissue defect classification method can be used to guide us to select the treatment options.Iliac bone flap series consisting mainly of composite tissue transplantation is a viable method of the medial malleolus defect reconstruction.

Objective To research the feasibility of the prefabrication of skin flap with frozen allogeneic bone.Methods From November 2010 to July 2011,fifteen miniature pigs were randomly divided into three groups(n =5) according to different implanted positions.Rewarming,deep-frozen allogenic bone was implanted in subcutaneous tissue,subfascial compartment and muscle respectively.Emission Computed Tomography (ECT) was used in the 4th week,the 8th week and the 12th week postoperatively.Angiography and pathological examination was used in the 12th week.Results The difference of the result of ECT was statistically significant betweent the 4th week and the 8th week (P ＜ 0.05),and there was not statistically significant difference betweent the 12th week and the 8th week (P ＞ 0.05).Angiography showed that all allogeneic bone was vascularized in each group.Pathological examination showed that the vascularization and the inducing osteogenesis of the allogeneic bone which was implanted in the subfascial compartment or muscle was better than that in the subcutaneous tissue.Conclusion The deep-frozen allogenic bone can be used for the prefabrication of the bone-skin flap.

BACKGROUND:Autologous bone-skin flap transplantation is the best method for the repair of composite tissue defect, but the repair ability is limited, with big trauma, new tissue defect and a certain dysfunction. Al ogeneic bone has the osteoinductive capacity, which can be used to prepare the bone-skin flap. OBJECTIVE:To research the pathological change of the al ogenic bone during the prefabrication of bone-skin flap with al ogeneic bone implant. METHODS:The experimental animals were Bama miniature pigs. Deep-frozen al ogenic bone was implanted in iliac artery-supported tissue flap compartment of miniature pigs. After operation, the local reactions were observed, the al ogenic bone were studied by general observation and histological analysis at 4, 8, 12 and 16 weeks after implantation respectively. RESULTS AND CONCLUSION:Obvious inflammation reaction was not observed in the surgical zone. The al ogeneic bone was vascularized at 4 weeks after implanted into the flap tissue without obvious osteoblast-like cells. The vascularization, bone resorption and uneven distributed osteoblast-like cells and osteoclast-like cells were observed at 8 weeks after implantation, and new bone formation was observed. At 12 weeks after implantation, new bone formation and bone absorption was strengthened, and the morphology of the bone graft was changed. At 16 weeks after implantation, al ogenic bone turned into fragments and absorbed, and no new bone formation was observed. The results indicated that during the prefabrication of bone-skin flap with al ogeneic bone implantation, the pathological changes of the al ogeneic bone was observed with time prolonging, and the bone-skin flap should be transplanted in time.