Objective To evaluate the clinical effectiveness of the first metatarsophalangeal (MTP) joint arthroplasty versus arthrodesis for rheumatoid forefoot deformity. Methods The randomized controlled trials (RCTs) about the first MTP joint arthroplasty vs. arthrodesis for rheumatoid forefoot deformity published by February 2012 were searched in the databases such as CNKI, Ovid, MEDLINE, CBM, EMbase, WanFang Data, The Cochrane Library (Issue 1, 2012), and KJEBM. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then meta-analysis was conducted using RevMan 5.1 software. Results A total of 4 RCTs were included. Among total 206 (269 feet) patients involved in, 98 (130 feet) were in the arthroplasty group, while the other 108 (139 feet) were in the arthrodesis group. The results of meta-analysis showed that the arthrodesis group was superior to the arthroplasty group in the footwear (MD=−0.88, 95%CI −1.55 to −0.22, P=0.01), and the alignment (MD=−5.04, 95%CI −8.94 to −1.14, Plt;0.000 01) with significant differences. But there were no significant differences between the two groups in patient satisfaction, metastatic lesions, pain, activity and weight-bearing of Hallux. Conclusion Based on the current studies, arthrodesis is superior to arthroplasty in treating rheumatoid forefoot deformity. For the quality restrictions and possible publication bias of the included studies, more double blind, high quality RCTs are required to further evaluate the effects.
Objective To systematically review the effectiveness and safety of Tanreqing for curing the hand-foot-mouth disease. Methods Such databases as PubMed, EMbase, CENTRAL, CBM, CNKI, VIP and WanFang Data are electronically searched to collect the randomized controlled trials (RCTs) on the effectiveness and safety of Tanreqing for hand-foot-mouth disease till February 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2.7 software. Results Twelve RCTs on Tanreqing versus ribavirin involving 1 258 cases and 27 RCTs on Tanreqing plus ribavirin versus ribavirin involving 3 289 cases were included. The results of meta-analysis showed that, compared to ribavirin, Tanreqing has higher total efficiency in the treatment of hand-foot-mouth disease (OR=5.03, 95%CI 3.28 to 7.71, Plt;0.000 01), cooling time (MD= –1.09, 95%CI –1.51 to –0.68, Plt;0.000 01), simplex regression time (MD= –0.90, 95%CI –1.20 to –0.60, Plt;0.000 01), and healing time (MD= –1.76, 95%CI –2.52 to –0.99, Plt;0.000 01), with significant differences. Compared to ribavirin, the group of Tanreqing plus ribavirin has higher total efficiency on treatment of hand-foot-mouth disease (OR=5.32, 95%CI 4.02 to 7.06, Plt;0.000 01), cooling time (MD= –1.32, 95%CI –1.63 to –1.01, Plt;0.000 01), simplex regression time (MD= –0.5, 95%CI –0.98 to –0.2, Plt;0.000 01), and healing time (MD= –1.41, 95%CI –1.83 to –0.98, Plt;0.000 01), with significant differences. The results of indirect comparative analysis showed that, there was no significant difference in the treatment options of Tanreqing plus ribavirin and Tanreqing alone concerning total efficiency, cooling time, simplex regression time, and healing time. Conclusion The study shows that Tanreqing alone and Tanreqing plus ribavirin are similar for curing the hand-foot-mouth disease, and both groups have better clinical effectiveness than ribavirin alone.
Objective To assess the effectiveness of intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer. Methods We electronically searched CENTRAL (Issue 1, 2013), PubMed (1978-2013), EMbase (1978-2013), VIP (1989-2013) and WanFang Data (1980-2013), hand-searched correlated proceedings and retrieved the references of included studies, for the randomized controlled trials on intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer all over the world. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results Twelve trials involving 1 841 patients were finally included. The results of meta-analysis showed that: a) the incidence of diabetic foot ulcer in the intensive education group was lower than the routine group, with a significant difference (RR=0.51, 95%CI 0.30 to 0.84, P=0.008); b) two groups were alike in the amputation rate, with no significant difference (OR=0.54, 95%CI 0.17 to 1.67, P=0.28); and c) the score of knowledge on diabetes mellitus was higher in the intensive education group than in the routine education group, with a significant difference (MD=7.32, 95%CI 3.57 to 11.06, P=0.000 1). Conclusion Current evidence shows that: compared with routine education, intensive education could reduce the incidence of diabetic foot ulcer effectively. However, the above conclusion should be verified by conducting more high quality studies.
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.
【Abstract】 Objective To observe the effectiveness of limited operations and Ilizarov techniques for correction of congenital clubfoot (CCF) in adolescents, and to explore the new methods and new ideas for functional reconstruction of CCF. Methods Between September 2003 and July 2010, 25 adolescent patients (40 feet) with CCF were treated. Of the 25 patients, 14 were male (20 feet) and 11 were female (20 feet) with an age range from 12 to 25 years (mean, 15.7 years). The left feet were involved in 4 cases, the right feet in 6 cases, and both feet in 15 cases. According to Qin’s clubfoot deformity scale, 9 feet were rated as degree I, 17 feet as degree II, and 14 feet as degree III. In these cases, 9 feet were accompanied by internal rotation deformities of crus and 1 case by subluxation of right hip joint. After soft tissue release and osteotomy, 9 feet (degree I) were fixed by composite external fixation instruments, 31 feet by Ilizarov external fixation instruments. The deformity was corrected from 5 to 7 days after operation with distraction of 0.5-1.0 mm/d, then distraction stopped when the ankle was corrected at a hyperextension of 5 to 10° and light valgus. The affected limb might undergo weight bearing walking with external fixation at corrected position for 4 to 6 weeks. If one had both feet deformity, staged operation should be performed with a surgery interval of 3 to 6 months (mean, 4 months). Results The fixation time was 6-12 weeks (mean, 8 weeks) in 9 feet fixed by composite external fixation instruments, and it was 6-17 weeks (mean, 13 weeks) in 31 feet fixed by Ilizarov external fixation. All 25 patients were followed up 8 months to 6 years with an average of 37 months. During distraction process, slight pin track infection occurred in 6 cases (6 feet), which were cured after expectant management. One patient had recurrence of the deformity at 2 years postoperatively, who obtained satisfactory correction after Ilizarov external fixation for 4 weeks. The satisfactory correction and foot function were achieved in the other feet with walking on full weight-bearing. According to International Clubfoot Study Group (ICFSG) score, the results were excellent in 28 feet, good in 10 feet, and fair in 2 feet, with an excellent and good rate of 95% at last follow-up. Conclusion Combined limited operation with Ilizarov technique for correcting adolescent CCF is accord with biology principle and minimally invasive surgical principle, so it is a safe，minimally invasive, and effective method. It also can broaden the operative indications and correct degree III talipes equinovarus which is unattainable by traditional orthopedic surgery.
Objective To review the progress in clinical and biomechanical study on soft tissue reconstruction of adult-acquired flatfoot deformity (AAFD). Methods The recent original articles of soft tissue repair and tendon transfer for AAFD were extensively reviewed. Results The soft tissue procedures for AAFD can be divided into two components: static restoration of medial column stability and dynamic reconstruction of the posterior tibial tendon. The most important static structure to be repaired for AAFD is the spring ligament. On the other hand, various methods can be used for dynamic reconstruction. The flexor digitorum longus transfer is widely used, but results of biomechanical studies do not support the advantage of this method. For patients having normal function of the posterior tibial muscle, the Cobb procedure may be more suitable. Conclusion The soft tissue reconstruction procedures of AAFD should be chosen individually based on the stage and type of the deformity.
Objective To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Methods Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 ± 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. Results All patients got primary wound heal ing without any compl ication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain rel ief at 6 months after surgery and hadgood appearance of the feet. The AOFAS ankle-midfoot score was 90.4 ± 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus incl ination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P lt; 0.01). Conclusion The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.
【Abstract】 Objective To review the basic and clinical research progress of lateral column lengthening (LCL).Methods The recent literature concerning LCL at home and abroad was extensively reviewed, and the research and development were summarized. Results LCL is one of the important surgical procedures for flatfoot deformity, and it has two procedures. There are some disputes in surgical selection of the Evans osteotomy and calcaneocuboid distraction arthrodesis for the treatment of flatfoot deformity. Conclusion Lateral column lengthening has been used more widely in clinical practice, but biomechanical and the long-term follow-up are needed.
Objective To evaluate the surgical treatment and effectiveness of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. Methods Between January 2007 and August 2009, 7 patients with rheumatoid forefoot were treated by reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. They were all females with an average age of 62 years (range, 56-71 years) and with an average disease duration of 16 years (range, 5-30 years). All patients manifested hallux valgus, hammer toe or mallet toe of 2-5 toes, 5 feet complicated by subluxation of the second metatarsophalangeal joint. The improved American Orthopaedic Foot amp; Ankle Society (AOFAS) score was 36.9 ± 6.4. The hallux valgus angle was (46 ± 5)°, and the intermetarsal angle was (12 ± 2)° by measuring the load bearing X-ray films preoperatively. Results All incisions healed by first intention after operation. The X-ray films showed bone fusion of the first metatarsophalangeal joint at 3-4 months after operation. Seven patients were followed up 2.9 years on average (range, 2-4 years), gait was improved and pain was rel ieved. The hallux valgus angle decreased to (17 ± 4)° and the intermetarsal angle was (11 ± 2)° at 3 months postoperatively, showing significant differences when compared with preoperative values (P lt; 0.05). The improved AOFAS score was 85.3 ± 5.1 at 2 years postoperatively, showing significant difference when compared with preoperative score (t=4.501, P=0.001). One patient had recurrent metatarsalgia at 4 years after operation. Conclusion Arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads for rheumatoid forefoot reconstruction can correct hallux valgus, remodel the bearing surface of the forefoot, and rel ieve pain, so it can be considered as a procedure that provides improvement in the cl inical outcome.
Objective To evaluate the efficacy and safety of Bismuth Subgallate/Borneol (SuileTM) (BSB) dressing in the treatment of diabetic foot ulcers. Method s A two-center, randomized controlled parallel-group comparison study was conducted. Between September 2005 and November 2006, 35 patients with nonhealing diabetic foot ulcer (Wagner 2-3 grade) were recruited and divided randomly into the test group (BSB group, n=25) and control group (IG group, n=10). There was no significant difference in general data between 2 groups (P gt; 0.05). Based on the comprehensive therapy of diabetic foot, ulcers were topically treated by SuileTM dressing and Intrasite gel in the BSB group and IG group, respectively. The ulcer area was measured once a week. Ulcer bleeding was observed and acceptance of the dressing was inquired each week. Results Of the patients, 22 patients in the BSB group and 8 in the IG group completed the clinical trial. Intention to treat (ITT) analysis indicated that the results were excellent in 19 (76%) cases, good in 3 cases (12%), fair in 1 case (4%), and poor in 2 cases (8%) in the BSB group. In the IG group, the results were excellent in 8 cases (80%) cases, fair in 1 case (10%), and poor in 1 case (10%). Per-protocol (PP) analysis showed that the results were excellent in 19 cases (86%) and good in 3 cases (14%) in the BSB group, and were excellent in 8 cases (100%) in the IG group. The results of ITT and PP analysis all showed no significant difference between 2 groups (P gt; 0.05). The change trend of ulcer areas in the BSB group was similar to that in the IG group. There was no significant difference in the hemostatic effect between 2 groups (P gt; 0.05) and the patients were more likely to accept BSB dressings. Conclusion BSB dressings is an effective, safe, and generally well-tolerated therapy dressing in the treatment of diabetic foot ulcers.