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指浅屈肌腱套索腱性固定术治疗爪形指畸形

目的 总结应用指浅屈肌腱套索腱性固定术矫正爪形指畸形的临床疗效。 方法 1990 年5 月－2005 年3 月，收治5 例单侧尺神经损伤致爪形指畸形患者。男4 例，女1 例；年龄28 ～ 37 岁。左侧3 例，右侧2 例。3 例腕部挤压伤，2 例前臂绞伤。病程21 ～ 37 个月，平均27.5 个月。Froment 征、Fowler 试验均为阳性。依据Stevens 标准分度均为重度神经损伤。经神经修复、松解治疗后，尺神经运动功能均无明显恢复。应用指浅屈肌腱套索腱性固定术，纠正爪形指畸形。 结果 5 例术后获随访，随访时间10 个月～ 11 年。掌指关节过伸、指间关节屈曲的畸形均得到矫正，无复发及并发症发生。环小指伸屈功能良好，但各指内收、外展功能无明显改善。 结论 指浅屈肌腱套索腱性固定术可矫正爪形手畸形，手术操作简便，损伤小，临床疗效较满意。

足母趾部分甲皱襞和甲床楔形切除治疗嵌甲

拇长伸肌腱自发性断裂的临床分析及治疗

Effectiveness analysis of channel-assisted minimally invasive repair technique combined with flexor hallucis longus tendon transfer for Achilles tendon sleeve avulsion

ObjectiveTo evaluate the effectiveness of the channel-assisted minimally invasive repair (CAMIR) technique combined with flexor hallucis longus (FHL) tendon transfer in the treatment of Achilles tendon sleeve avulsion. Methods A retrospective analysis was conducted on 17 patients with Achilles tendon sleeve avulsion who underwent CAMIR technique combined with FHL transfer between January 2019 and January 2023. The cohort comprised 13 males and 4 females, aged 32 to 65 years (mean, 49.7 years). Etiologies included sports-related injuries in 15 cases and blunt trauma in 2 cases. The interval from injury to surgery ranged from 4 to 368 days (median, 15 days). All patients exhibited calcification at the Achilles tendon insertion site, with 7 cases complicated by Haglund deformity. Postoperative complications were meticulously monitored, and tendon healing was assessed via MRI. Clinical outcome were evaluated using the visual analogue scale (VAS) score for pain, Tegner activity level rating scale, ankle activity score (AAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Victorian Institute of Sport Assessment-Achilles (VISA-A) score, and subjective clinical scoring systems preoperatively and at last follow-up. Results The operation time was 50-62 minutes (mean, 56 minutes), and the intraoperative blood loss was 5-50 mL (mean, 19.7 mL). All patients were followed up 12-67 months (mean, 38 months). No postoperative complication, such as Achilles tendon re-rupture, incision infection, deep vein thrombosis, heel raise insufficiency, or sural nerve injury, was observed. At last follow-up, MRI examination confirmed satisfactory tendon healing in all cases. Significant improvements were noted in VAS scores, Tegner activity level rating scale, AAS scores, AOFAS ankle-hindfoot scores, and VISA-A scores compared to preoperative ones (P<0.05). At last follow-up, the subjective clinical score ranged from 6 to 10 (median, 9).ConclusionThe CAMIR technique combined with FHL tendon transfer is a good treatment for repair of Achilles tendon sleeve avulsion, with good recovery of ankle function and few complications.

Anatomical research of positional relationship between protective channel and sural nerve during Achilles tendon repair using channel assisted minimally invasive repair technique

Objective To evaluate the positional relationship between protective channel and sural nerve while treating acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique based on anatomical observations of cadaver specimens. Methods Twelve adult cadaveric lower limb specimens (6 left, 6 right) were utilized. A CAMIR device was implanted at a distance of 4 cm from the proximal end of the specimen to the Achilles tendon insertion. The skin was incised along the tendon’s medial side, the sural nerve was dissected, and the positional relationship with the protective channel was observed. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion, the vertical distance between protective channel and the calcaneal insertion, and the horizontal distance between the sural nerve and protective channel were measured by using vernier caliper. Results Anatomical examination demonstrated a variable positional relationship between the sural nerve and protective channel, with the sural nerve positioned above (8 specimens) or below (4 specimens) the protective channel. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion was (105.67±14.94) mm, the vertical distance between protective channel and the calcaneal insertion was (93.20±9.57) mm, and the horizontal distance between the sural nerve and protective channel was (0.31±0.14) mm. Conclusion The use of CAMIR technique for the treatment of acute Achilles tendon rupture can effectively avoid iatrogenic injury to the sural nerve.

A comparative study of dynamic versus static rehabilitation protocols after acute Achilles tendon rupture repair with channel assisted minimally invasive repair technique

Objective To explore the difference in effectiveness between a dynamic rehabilitation protocol and a traditional static rehabilitation protocol after the treatment of acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique through a prospective comparative trial, aiming to provide a reference for clinically selecting a feasible treatment regimen. Methods Patients with acute Achilles tendon rupture admitted between June 2021 and June 2022 were included in the study, with 60 patients meeting the selection criteria. They were randomly divided into a dynamic rehabilitation group (n=30) and a static rehabilitation group (n=30) using a computer-generated random number method. There was no significant difference in baseline data such as gender, age, body mass index, smoking history, injured side, cause of injury, and disease duration between the two groups (P>0.05). After Achilles tendon anastomosis by using CAMIR technique, the dynamic rehabilitation group implemented early partial weight-bearing training with the assistance of an Achilles heel boot and controlled ankle joint exercises for 6 weeks, while the static rehabilitation group maintained a non-weight-bearing status during this period. Complications in both groups were recorded. At 3 and 6 months after operation, the Achilles tendon total rupture score (ATRS) was used to evaluate the degree of functional limitation of the Achilles tendon in the affected limb, and the 12-Item Short Form Health Survey (SF-12 scale) was used to assess the patients’ quality of life, including physical component summary (PCS) and mental component summary (MCS) scores. Results No sural nerve injury occurred during operation in both groups. All patients were followed up 12-18 months (mean, 14 months). The dynamic rehabilitation group had significantly higher ATRS scores at 3 and 6 months after operation compared to the static rehabilitation group (P<0.05). At 3 months after operation, the dynamic rehabilitation group had significantly lower PCS, MCS, and SF-12 total scores compared to the static rehabilitation group (P<0.05). At 6 months, all quality of life scores in the two groups were similar (P>0.05). Two cases (6.6%) in the dynamic rehabilitation group and 5 cases (16.7%) in the static rehabilitation group developed complications, with no significant difference in incidence of complications (P>0.05). Conclusion For acute Achilles tendon rupture, the dynamic rehabilitation protocol after Achilles tendon anastomosis by using CAMIR technique can improve early functional recovery and maintains comparable safety and effectiveness compared to static rehabilitation.

创伤骨科远程手术机器人系统远程治疗Tile C1.3型骨盆环损伤一例

目的报道采用创伤骨科远程手术机器人系统远程治疗1例Tile C1.3型骨盆环损伤经验。方法 2024年8月收治1例交通事故伤致Tile C1.3型骨盆环损伤的67岁女性患者，合并全身多处骨折。采用创伤骨科远程手术机器人系统进行手术。术中远程专家通过混合智能远程操作系统指导术者复位并实时追踪复位质量，通过控制Holosight知见创伤手术机器人规划螺钉路径并选取匹配螺钉，最后由手术室术者在机器人辅助下完成操作。结果手术时间90 min，复位时间35 min，单枚螺钉规划及植入时间5 min，术中透视2次。使用Keshishyan交叉测量法监测术中复位效果达解剖复位，采用Matta标准监测复位效果为优；采用螺钉切出Lonstein标准评价示螺钉无切出。术后经疼痛视觉模拟评分（VAS）评估疼痛情况，术后1周为6分、3周为3分。结论创伤骨科远程手术机器人系统可用于远程治疗Tile C1.3型骨盆环损伤，有待多临床中心、前瞻性病例对照研究，进一步验证该系统优势。