Objective To explore the effectiveness of modified percutaneous mini-incision Achilles tendon lengthening for the treatment of Achilles contracture syndrome by comparing with traditional open Achilles tendon lengthening. Methods Between May 2008 and May 2012, 42 patients with Achilles contracture syndrome were treated and the clinical data were retrospectively analyzed according to the inclusion criteria. The modified percutaneous mini-incision Achilles tendon lengthening was used in 19 cases (19 feet, trial group); 0.5 cm incisions were designed at medial and lateral Achilles tendon according to the degree of Achilles contracture syndrome; and percutaneous double hemi-section was done according to the deformity range of varus and valgus foot. The traditional open Achilles tendon lengthening was used in 23 cases (24 feet, control group). There was no significant difference in age, gender, disease duration, motion of ankle dorsiflexion, and Hannover Achilles tendon score (P gt; 0.05). Results The operation time, postoperative hospitalization days, and intraoperative blood loss in the trial group were less than those in the control group, showing significant differences (P lt; 0.05). After operation, incision healing by first intention was obtained in the other cases except 1 case which had infection in the control group. The patients were followed up 6-35 months in the trial group and 8-34 months in the control group. Correction of varus deformity foot was not obvious in 1 case of the trial group, correction of varus and valgus deformity feet were satisfactory in the other cases. There was no significant difference in motion of ankle dorsiflexion and Hannover Achilles tendon score between 2 groups at last follow-up (P gt; 0.05), but significant differences were found between preoperation and last follow-up in 2 groups (P lt; 0.05). There were significant differences in motion of ankle dorsiflexion and Hannover Achilles tendon score between normal and affected sides in 2 groups at last follow-up (P lt; 0.05). Conclusion Modified percutaneous mini-incision Achilles tendon lengthening has similar effectiveness to the traditional open Achilles tendon lengthening for Achilles tendon contracture syndrome. And it can effectively correct varus and valgus deformities of the foot with less trauma and fast recovery.
Objective To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle. Methods Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 ± 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 ± 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot). Results The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 ± 14.7 and 75.8 ± 14.5, respectively; SF-36 scores were 76.6 ± 13.1 and 75.5 ± 13.2, respectively; and significant differences were found when compared with preoperative scores (P lt; 0.05), but no significant difference between postoperative 6 months and last follow-up (P gt; 0.05). Conclusion For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.