The assimilated os sustentaculi

The assimilated os sustentaculi is a projection of bone from the medial aspect of the sustentaculum tali which is surmounted by a similar projection from the medial tubercle of the talus. The accessory joint so formed may develop secondary osteoarthritis changes. This congenital anomaly is very rate. The present report is of 2 additional cases.     

国人跟骨距关节面的形态研究

观察329块(男193,女136)国人成年跟骨的距关节面形态。其中A型出现率,男为45.08±3.58％,女为41.18±4.22％;B型出现率男为53.89±3.59％,女为58.82±4.22％;C型仅男性出现2例,占1.04±0.73％。成套标本中,距关节面左右对称的,男性90例中有81例,占90.00±3.16％;女性67例中有59例,占88.06±3.96％。经统计学处理,侧别间及性别间均无明显差异。文内结合观察结果提出自己的分型标准及类型,并与以往资料进行了比较。     

Characteristics of calcaneal bone infarction: an MR imaging investigation

Objective. Bone infarction (BI) of the calcaneus is an uncommon entity which has received little mention in the recent literature. In this paper, we review the MR images of six calcanei with BI, which demonstrate a pattern of presentation that may explain the etiology of BI at this unusual location. Design. A retrospective review was performed of the transcribed reports of the foot or ankle MR examinations at our institution. MR images of examinations with any marrow signal abnormality were reviewed for presence of BI and its distribution. Patients. Based on MRI criteria, four patients had calcaneal BI (none biopsy proven); they ranged in age from 37 to 51 years old. Two patients were diagnosed with systemic lupus erythematosus, one with fibrositis, and another with polymyositis. All were treated with corticosteroids. Results. Six calcanei (in four patients) contained a region of calcaneal BI. In five of the six, the lesions were entirely or predominantly located in the posterior half of the calcaneus. Conclusion. Two theories are proposed which may explain why BI predominantly occurs in the posterior half of the calcaneus. First, the convergence of the recurrent intraosseous calcaneal vessels may occasionally produce the equivalent of a single dominant vessel that is more prone to vascular accidents. Secondly, the region between the recurrent and the epiphyseal vessels may act as a watershed zone, increasing its susceptibility to ischemia.     

全关节镜下微创复位固定术治疗SandersⅡ、Ⅲ型跟骨关节内骨折的疗效分析

目的 探讨全关节镜下微创复位固定术治疗SandersⅡ、Ⅲ型跟骨关节内骨折的临床疗效。方法 前瞻性随机对照研究。纳入2017年3月—2020年12月徐州仁慈医院足踝外科Sanders Ⅱ、Ⅲ型跟骨骨折患者40例,其中男36例、女4例,年龄18~58（39.6±10.8）岁,左侧22例、右侧18例,Sanders Ⅱ型16例、Ⅲ型24例。40例患者数字表法随机分为关节镜组（采用关节镜下跟骨关节内骨折微创复位、经皮螺钉固定术治疗）、大“L”形切口组（采用传统的大“L”形切口跟骨骨折复位钢板内固定术治疗）,每组20例。观察指标：（1）比较2组患者性别、年龄、体质量指数（BMI）、骨折类型、术前美国足踝外科学协会（AOFAS）踝-后足功能评分等基线资料差异;（2）比较2组患者手术切口长度、手术时间、术中出血量、住院时间、术后切口愈合情况等围术期资料差异;（3）术后观察局部有无麻木感、是否钢板外露、切口皮肤坏死、术后1年是否有创伤性关节炎等手术并发症情况;（4）对比分析2组患者末次随访时AOFAS踝-后足功能评分、Gissnae角和Bohler角。结果 （1）2组患者性别、年龄、BMI、骨折类型、术前AOFAS踝-后足功能评分等基线资料比较,差异均无统计学意义（P值均>0.05）。（2）关节镜组患者的切口长度（0.94±0.08）cm、术中出血量（7.20±1.98）mL、手术时间（41.45±9.96）min、住院时间（8.45±2.01）d,大“L”形切口组患者的切口长度（14.35±1.63）cm、术中出血量（27.35±10.35）mL、手术时间（90.65±12.08）min、住院时间（17.15±6.72）d,关节镜组优于大“L”形切口组,差异均有统计学意义（t=-36.70、-8.54、-14.04、-5.54,P值均<0.001）。（3）术后平均随访12.3个月。术后关节镜组切口均甲级愈合,无创伤性关节炎、足背皮肤麻木。大“L”形切口组20例中,18例患者切口甲级愈合,2例患者切口皮缘坏死、钢板外露,予腓肠神经营养逆行岛状皮瓣修复后伤口愈合;有4例患者术后感足背外侧麻木,经治疗分别于术后8~14个月痊愈。（4）末次随访时AOFAS踝-后足功能评分关节镜组为（92.10±3.16）分、大“L”形切口组为（91.3±2.45）分,术后2组患者跟骨的Gissnae角和Bohler角均在正常范围内,组间比较差异均无统计学意义（P值均>0.05）。结论 与传统的切开复位内固定术相比较,全关节镜下微创手术治疗Sanders Ⅱ、Ⅲ型跟骨关节内骨折,具有手术切口小、手术时间短、内固定牢固、切口愈合好、疗程短、术后瘢痕不明显、功能恢复快等优势。     

经跗骨窦入路微创锁定钢板治疗跟骨关节内骨折疗效对比研究

目的:比较经跗骨窦入路使用微创锁定钢板与解剖型锁定钢板治疗跟骨关节内骨折的临床疗效。方法:回顾性分析2016年7月至2017年6月采用跗骨窦入路治疗的48例跟骨关节内骨折患者的临床资料,根据内固定方式不同分为微创锁定钢板组和解剖型锁定钢板组,每组24例。微创锁定钢板组,男14例,女10例;年龄27～46(38.70±5.58)岁;骨折Sanders分型,Ⅱ型18例,Ⅲ型6例。解剖型锁定钢板组,男17例,女7例;年龄26～46(37.10±6.44)岁;骨折Sanders分型,Ⅱ型16例,Ⅲ型8例。观察并比较两组患者手术时间,视觉模拟评分(visual analague scale,VAS),术后并发症情况,比较术后1周及末次随访时B?hler角、Gissane角、跟骨宽度和高度变化情况,采用Maryland足部功能评分进行功能评价。结果:所有患者获得随访,时间12～18(14.10±1.94)个月。48例患者获得骨性愈合,愈合时间8～16(10.60±2.25)周。微创锁定钢板组手术时间、VAS评分、并发症分别为(69.50±7.51) min、(2.80±1.07)分、2例,解剖型锁定钢板组分别为(77.50±7.15) min、(3.80±1.09)分、8例,两组比较差异有统计学意义(P0.05)。两组术后1周及末次随访时B?hler角、Gissane角、跟骨宽度、高度比较差异无统计学意义(P0.05)。两组Maryland足部功能评分比较差异无统计学意义(P0.05)。结论:对于SandersⅡ、Ⅲ型跟骨关节内骨折,经跗骨窦入路使用微创锁定钢板治疗可以达到与解剖型锁定钢板相似的牢靠固定及功能恢复,其操作更简便,手术时间更短,术后早期疼痛更轻,术后并发症更少。     

人工骨和自体骨在复杂跟骨骨折异形钢板内固定术中的病例对照研究

目的 :比较人工骨与自体骨在复杂跟骨骨折异形钢板内固定术中的临床疗效。方法:自2015年4月至2019年4月收治60例复杂跟骨骨折患者行切开复位异形钢板内固定术治疗,按照植骨材料不同分为试验组和对照组,每组30例。试验组男21例,女9例;年龄18～71(36.85±7.42)岁;SandersⅢ型19例,SandersⅣ型11例;采用人工骨植入。对照组男23例,女7例,年龄20～69(37.26±7.38)岁;SandersⅢ型18例,SandersⅣ型12例;采用自体骨植入。比较两组患者手术时间、术中出血量、术后切口干燥时间、愈合时间及并发症情况,比较术前及术后3个月B?hler角及Gissane角变化情况,采用Maryland评分评价患足功能恢复情况。结果:两组患者术后均获得随访,时间3～15(10.15±2.67)个月。试验组手术时间、术中出血量分别为(89.32±12.43) min、(101.64±5.13) ml,对照组分别为(112.45±13.82) min、(119.01±5.26) ml,两组比较差异有统计学意义(P0.05);两组术后切口干燥时间、愈合时间、并发症比较差异无统计学意义(P0.05)。试验组术前、术后3个月B?hler角分别为(14.19±2.47)°、(34.52±4.41)°,对照组分别为(14.08±2.35)°、(33.67±4.36)°;试验组术前及术后3个月Gissane角分别为(90.16±6.43)°、(131.45±9.83)°,对照组分别为(90.11±6.37)°、(130.87±9.24)°;两组术后3个月B?hler角、Gissane角与术前比较差异有统计学意义(P0.05);但两组术后3个月B?hler角、Gissane角比较差异无统计学意义(P0.05)。末次随访时,两组Maryland评分各项目评分、总分及优良率比较差异无统计学意义(P0.05)。结论:在复杂跟骨骨折异形钢板内固定术中,采用人工骨和自体骨在促进骨折恢复方面效果相当,且术后切口干燥时间、愈合时间及并发症发生情况相近,但使用人工骨可减少术中出血量,缩短手术时间。     

Isolierte Fraktur des Sustentaculum tali: ein Fallbericht

Case reportA 32 years old male patient slipped while going downhill and injured his right foot. The next day X-rays were taken in which no bony injury was seen. Because of persistent complaints additional diagnostic by MRI and CT were performed. These showed a displaced fracture of the sustentaculum tali. The sustentaculum tali was fixed with screws. The fracture healed with a congruent articular surface and good functional outcome.ConclusionFractures of the sustentaculum tali are rare and are overseen frequently because of overlapping structures on X-rays. Even low energy trauma can cause these fractures in young patients. In patients with persistent complaints of the foot an additional cross-sectional diagnostic is strongly recommended.     

跟骨骨折成因的力学分析

目的 通过理论分析方法和实验方法研究跟骨骨折的成因。方法 应用材料力学中的弯曲强度理论、剪切强度理论和主要应力理论分析跟骨的应力情况；应用动量原理研究跟骨受冲击时的载荷情况；应用静态压力试验方法测定跟骨的破坏载荷。结果 跟骨上凹坑尖角附近是跟骨最薄弱的环节；跟骨的破坏载荷约为体重的24倍；当人从1.5m高处跳下，足跟先着地时，作用在跟骨上的冲击力可达体重的36倍。结论 当人从高处跳下，足跟先着地时，作用在跟骨上的冲击力非常大，高度越高，则冲击力越大；人从高处跳下时所具有的初速度对作用在跟骨上的冲击力影响也非常大。     

Solitäre Kalkaneuszysten

Zusammenfassung Die Differentialdiagnose der solitären Kalkaneuszysten erstreckt sich von den solitären benignen Zysten bis zu malignen Tumoren. Im Zentrum des Fersenbeinkörpers sind 10–50% der Zysten als intraossäre Lipome situiert. Wir fanden in unserem Krankengut in einem Jahreszeitraum von mehr als 20 Jahren bei 4 operierten Fersenbeinzysten im histologischen Befund 3 Lipome und 1 Tuberkel. Das Durchschnittsalter entspricht der Studie nach Milgram. Zu bemerken wäre, daß alle 4 Patienten aus einem einzigen Siedlungsgebiet, in dem der Bergbau ehemals das zentrale wirtschaftliche Interesse war, stammen. Auch aus unserer Erfahrung sollten diese Zysten wegen der Gefahr der Spontanfraktur operativ ausgeräumt und mittels Spongiosaplastik aufgefüllt werden, um einerseits die Dignität der Zyste zu verifizieren und andererseits die drohende Spontanfraktur zu vermeiden.

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Solitary calcaneal cysts

Differential diagnosis of solitary calcaneal cysts extends from benign cysts to malignant tumours. In all, 10–50% of these cysts are located at the centre of the calcaneal body in the form of intraosseous lipomas. Among our patients treated over a period of more than 20 years, there were four who underwent surgery for calcaneal cysts; the respective histological findings showed three lipomas and one tuberculoma. The average age of these patients corresponded to that of Milgram's study. It should also be remarked that all four patients came from a region in which mining was of central economic importance. Our experience has shown that such cysts should be surgically removed and filled with plastic spongiosa material in order both to check whether the cysts are benign or malignant and to avoid an imminent spontaneous fracture of the heel bone.

     

妊娠期妇女超声跟骨骨密度测定分析

目的　通过测定孕妇跟骨骨密度 ,为防治孕妇骨密度下降 ,做好妇婴保健工作提供科学依据。方法利用超声骨密度仪对银川地区 2 2 2例不同孕期的妇女测定跟骨骨密度 (BMD) ,从而判断孕妇缺钙情况。结果　随着孕周的增加 ,与骨密度相关的指标SOS、Stiffness、T -score、Z -score均逐渐下降 ,差别有显著性或非常显著性。而且孕周与SOS、Stiffness、T -score、Z -score均呈明显负相关 ,其r值和P分别为 :r =- 0 .32 4 ,P <0 .0 1;r =- 0 .173,P <0 .0 5 ;r=- 0 .2 4 8,P <0 .0 1;r=- 0 .2 4 9,P <0 .0 1。结论　运用超声骨密度仪测定孕期BMD ,操作简便、安全 ,无创伤 ,无辐射 ,能正确指导孕妇及时合理补充钙剂。