可吸收螺钉与金属螺钉治疗中重度拇外翻的临床应用效果

目的:探讨可吸收螺钉与金属螺钉治疗中重度拇外翻的临床应用效果。方法:选取2016年1月至2018年1月我院收治的28例中重度拇外翻患者作为研究对象,按照随机数字表法分为2组,分别采用金属螺钉或可吸收螺钉治疗对照组和观察组拇外翻患者。比较两组患者围手术期指标,手术前后拇外翻角(HVA),第1、2跖骨间夹角(IMA),美国矫形足踝学会足功能评分(AOFAS),以及并发症发生情况。结果:两组患者手术时间、术中出血量、住院时间比较无统计学差异(P0.05)。两组患者术后HVA、IMA、AOFAS均优于术前,比较具有统计学差异(P0.05);两组患者术后HVA、IMA、AOFAS比较无统计学差异(P0.05)。对照组治疗优良率为88.46%,观察组治疗优良率为92.31%,两组间无统计学差异(P0.05)。两组患者截骨端延迟愈合或不愈合发生率比较无统计学差异(P0.05);两组患者切口感染、拇外翻复发或者术后丢失矫正度数、跖骨发生背侧移位、出现转移性跖痛、拇内翻发生率比较无统计学差异(P0.05)。结论:拇外翻截骨后采用可吸收螺钉固定,可提供稳定固定,治疗效果显著,不增加并发症发生风险,值得广泛应用于临床。     

Fibrodysplasia ossificans progressiva and associated osteochondroma of the coronoid process in a child

The article reports the occurrence of osteochondroma in a fibrodysplasia ossificans progressiva patient. A 5-year-old boy presented with limited mouth opening and firm swelling of the right zygomatic complex area. The boy had bilateral hallux valgus of the great toes and heterotopic endochondral ossification of facial and neck regions. Associated osteochondroma of the coronoid process and aggressive heterotopic ossification of masticatory and neck muscles were found in response to traumatic injuries. Natural and clinical histories of fibrodysplasia ossificans progressiva were reviewed. An early diagnosis and avoidance of factors that aggravate ossification are key factors in reducing the expected degree of physical disabilities of patients. An early recognition of congenital skeletal deformities, early detection of abnormal ossification, and awareness of the disease by the involved physicians are important factors in the early diagnosis of the disease and in reducing any unnecessary trauma. Bone scintigrams and CT scans are effective noninvasive tools for an early detection of ossification and for monitoring the progression of the disease. Further investigation of its pathogenesis at a molecular level is important to understand better the nature of the disease and to develop an effective treatment protocol.     

Developmental perspectives on neurocranial proportions in Japan

This study employs juvenile cranial data derived from collections dating to between about 5000 years ago and the present in order to investigate how differences in cranial growth trajectories contributed to inter-group variation in cranial shape among temporally defined Japanese populations. As gene influx from the Asian mainland was insignificant after the Yayoi period (c. CE 300), differences in adult cranial shape among later assemblages from Japan are probably related to developmental adaptations to environmental change. Comparing cranial growth trajectories among groups from different time periods allows indirect testing of several hypotheses about secular changes in cranial growth, including thermoregulatory adaptation, change in levels of masticatory stress, and change in levels of physiological stress.Differences in neurocranial proportions among groups with contrasting adult cranial shapes were found to be already pronounced for the infant cohort (0-3 years of age) and actually tended to decline slightly within later age ranges; differences in mandibular shape were unremarkable early in life, but became more pronounced after infancy. Consequently, changes in chewing stress are unlikely to have been the principal factor driving inter-group differences in cranial proportions. The cranial growth pattern reconstructed from a Medieval Japanese skeletal series showed the greatest magnitude of difference from those reconstructed for other time periods. Unlike in the other groups, there was no marked decline of cephalic index with age for the Medieval series. The unusual trajectory of cranial growth evident in the Medieval sample may result from a high degree of physiological stress due to overall poor nutrition.     

Secondary centers of ossification of the human toes: exceptional polymorphism and evolutionary perspectives

As great morphological variability characterizes the phalanges of the human toes in adults, we hypothesized for a possible variability in the presence or absence of their secondary (= epiphyseal) centers of ossification linked to the unique morphology of the human foot within primates. The aim of this study was thus to provide original and detailed data on the occurrence of these centers. Classically, the big toe or hallux (I) presents two secondary centers and the lateral toes (II-V) three centers, and consequently the five toes present a total of 14 secondary centers. The material studied consisted of 261 foot radiographs from 261 young individuals of European origin (202 males and 59 females; 6-16 years). The presence (or absence) of the secondary centers of the phalanges of the toes was assessed for each foot. Feet presenting a biphalangeal variant in one or more lateral toes were studied separately. The theoretical possibilities of association of the three secondary centers in a given lateral toe (II-V) are eight in number; these eight patterns were studied and coded in the present study by types A-H. An exceptional variability in the occurrence of the secondary centers in lateral toes (II-V) was observed, and the classic pattern of phalangeal ossification was never observed. The absence of one or more secondary centers seems to be observed only in the human species, and we suggest that this could be a derived pattern specific to the human species, i.e., autapomorphic pattern. These results are of interest in the characterization and understanding of the reduction in size of the lateral toes which characterizes the specific evolution of the human foot.     

Stature in archeological samples from central Italy: methodological issues and diachronic changes

Stature reconstructions from skeletal remains are usually obtained through regression equations based on the relationship between height and limb bone length. Different equations have been employed to reconstruct stature in skeletal samples, but this is the first study to provide a systematic analysis of the reliability of the different methods for Italian historical samples. Aims of this article are: 1) to analyze the reliability of different regression methods to estimate stature for populations living in Central Italy from the Iron Age to Medieval times; 2) to search for trends in stature over this time period by applying the most reliable regression method. Long bone measurements were collected from 1,021 individuals (560 males, 461 females), from 66 archeological sites for males and 54 for females. Three time periods were identified: Iron Age, Roman period, and Medieval period. To determine the most appropriate equation to reconstruct stature the Delta parameter of Gini (Memorie di metodologia statistica. Milano: Giuffre A. 1939), in which stature estimates derived from different limb bones are compared, was employed. The equations proposed by Pearson (Philos Trans R Soc London 192 (1899) 169-244) and Trotter and Gleser for Afro-Americans (Am J Phys Anthropol 10 (1952) 463-514; Am J Phys Anthropol 47 (1977) 355-356) provided the most consistent estimates when applied to our sample. We then used the equation by Pearson for further analyses. Results indicate a reduction in stature in the transition from the Iron Age to the Roman period, and a subsequent increase in the transition from the Roman period to the Medieval period. Changes of limb lengths over time were more pronounced in the distal than in the proximal elements in both limbs.     

Plantar ROI Characterization during the Stance Phase of Gait Based on a Low-cost Pressure Acquisition Platform

Plantar Region of Interest (ROI) detection is important for the early diagnosis and treatment of morphologic defects of the foot and foot bionic research.Conventional methods have employed complex procedures and expensive instruments which prohibit their widespread use in healthcare.In this paper an automatic plantar ROIs detection method using a customized low-cost pressure acquisition device is proposed.Plantar pressure data and 3D motion capture data were collected from 28subjects (14 healthy subjects and 14 subjects with hallux valgus).The maximal inter-frame difference during the stance phase was calculated.Consequently,the ROIs were defined by the first-order difference in combination with prior anatomic knowledge.The anatomic locations were determined by the maximal inter-frame difference and second maximal inter-frame difference,which nearly coincided.Our system can achieve average recognition accuracies of 92.90％,89.30％,89.30％,92.90％,92.90％,and 89.30％ for plantar ROIs hallux and metatarsi Ⅰ-Ⅴ,respectively,as compared with the annotations using the 3Dmotion capture system.The maximal difference of metatarsus heads Ⅱ-Ⅴ,and the impulse of the medial and lateral heel features made a significant contribution to the classification of hallux valgus and healthy subjects with ≥ 80％ sensitivity and specificity.Furthermore,the plantar pressure acquisition system is portable and convenient to use,thus can be used in home- or community-based healthcare applications.     

Metatarsophalangeal fusion for hallux valgus: indications and effect on the first metatarsal ray.

Arthrodesis of metatarsophalangeal joint was performed in 31 cases of severe hallux valgus. With the surgical technique used, which is described in detail, internal fixation and plaster cast immobilization were not necessary. Analysis of the results suggested that the operation is indicated for severe deformities in elderly patients, preferably women. The basic metatarsal deformity was corrected by the procedure.     

Maxillary sinusitis in Medieval Chichester,England

Maxillary sinusitis is a common medical complaint, affecting more than 30 million people per year in the United States alone. Very little palaeopathological work on this disease has been carried out, probably because of the enclosed nature of the sinuses in intact skulls and the lack of a suitable method for examination. This study tested the hypothesis that maxillary sinusitis was more common in people with leprosy than in people without it in Medieval England. The prevalence of maxillary sinusitis by age and sex was recorded in 133 individuals, some diagnosed as being leprous, derived from a later Medieval (12th to 17th centuries AD) urban hospital population at Chichester, Sussex, England using both macroscopic and endoscopic methods of examination. Of the 133 individuals with one or both sinuses available for examination, 54.9% (73) had evidence of bone change within the sinuses. There was no difference in prevalence between those with leprosy and those without, although clinical studies suggest that over 50% of lepromatous leprous individuals may develop sinusitis. Comparison with another study on Medieval British sites with a 3.6% prevalence (3 of 83) indicates that the prevalence at Chichester is much greater. The problems with diagnosing sinusitis are addressed and reasons behind the high frequency in this study are discussed. Aetiological factors predisposing to maxillary sinusitis are considered with reference to possible environmental conditions prevailing in the later Medieval period in Britain. © 1995 Wiley-Liss, Inc.     

Influence of proximal articular set angle on the result of surgical treatment for hallux valgus: an X-ray aspect

Surgery correcting talipes varus and hallux valgus was conducted in 128 female patients (150 feet). The group of the patients was studied in accordance with the proximal articular set angle (PASA). The results of treatment were assessed, by taking into account this index; they were found to depend on the outcome of PASA correction. It has been concluded that the efficiency of surgery is determined only by the procedures used with regard to the individual anatomic features of each foot and the PASA calculated from preoperative X-ray films is one of the most important factors. Intraoperative normalization of this index with congruency recovery in the hallus metatarsophalangeal articulation yields long-term good results of treatment in most patients.     

Surgical treatment of bunions; distal metatarsal osteotomy

The operation of Hawkins, Mitchell and Hedrick for the correction of metatarsus primus varus, bunion, and hallux valgus provides an eminently satisfactory solution both functionally and cosmetically. The procedure is applicable to any degree of deformity. Gratifying results were obtained in 43 operations on 25 patients.     

Effect of heel height on in-shoe localized triaxial stresses

Abnormal and excessive plantar pressure and shear are potential risk factors for high-heeled related foot problems, such as forefoot pain, hallux valgus deformity and calluses. Plantar shear stresses could be of particular importance with an inclined supporting surface of high-heeled shoe. This study aimed to investigate the contact pressures and shear stresses simultaneously between plantar foot and high-heeled shoe over five major weightbearing regions: hallux, heel, first, second and fourth metatarsal heads, using in-shoe triaxial force transducers. During both standing and walking, peak pressure and shear stress shifted from the lateral to the medial forefoot as the heel height increased from 30 to 70mm. Heel height elevation had a greater influence on peak shear than peak pressure. The increase in peak shear was up to 119% during walking, which was about five times that of peak pressure. With increasing heel height, peak posterolateral shear over the hallux at midstance increased, whereas peak pressure at push-off decreased. The increased posterolateral shear could be a contributing factor to hallux deformity. It was found that there were differences in the location and time of occurrence between in-shoe peak pressure and peak shear. In addition, there were significant differences in time of occurrence for the double-peak loading pattern between the resultant horizontal ground reaction force peaks and in-shoe localized peak shears. The abnormal and drastic increase of in-shoe shear stresses might be a critical risk factor for shoe-related foot disorders. In-shoe triaxial stresses should therefore be considered to help in designing proper footwear.     

Pattern of dental eruption,skeletal maturation and stress in a Medieval Population from Sudanese Nubia

The present research represents a comparison of dental and skeletal development as a means for determining nutritional stress in a Medieval Christian population from Nubia’sBatn el Hajar. The sample consists of 21 individuals from an early Christian (c 550–750) and 23 individuals from a late Christian cemetery (c mid-16th century) excavated from the site of Kulubnarti, Sudan. Ages at death ranged from 12 to 23 years. For the combined sample, a large majority (70.5%) of individuals had skeletal ages younger than their dental ages. However, a comparison of those individuals that could be sexed revealed that the pattern was not consistent for males and females. Females showed no difference between skeletal and dental age while males showed significant skeletal retardation. This pattern of sex differences is consistent with that observed for modern living children and subadults experiencing nutritional stress. A comparison by cemetry also suggests a reduction in stress from early to late Christian times with later Christians showing a closer correspondence between skeletal and dental ages. While not statistically significant, this apparent reduction is consistent with previous research on the subadult remains.     

Migration to the Medieval Middle East with the Crusades

During the 12th and 13th centuries thousands of people moved from Europe to the Middle East to fight, undertake pilgrimage, or settle and make a new life. The aim of this research is to investigate two populations from the Crusader kingdom of Jerusalem, by determining who was born in Europe and who came from the Middle East. Oxygen and strontium stable isotope analyses were conducted on the enamel of teeth from skeletal remains excavated from Crusader contexts. Twenty individuals from the coastal city of Caesarea (10 high status and 10 low status), and two local Near Eastern Christian farmers from the village of Parvum Gerinum (Tel Jezreel) were analyzed as a control sample. Results were compared with known geographic values for oxygen and strontium isotopes. The population of the city of Caesarea appears to have been dominated by European‐born individuals (probably 19/20, but at least 13/20), with few locals. This was surprising as a much higher proportion of locals were expected. Both controls from the farming village of Parvum Gerinum had spent their childhood in the area of the village, which matches our understanding of limited mobility among poor Medieval farmers. This is the first time that stable isotope analysis has been applied to the study of the migration of peoples between Medieval Europe and the Middle East at the time of the crusades. In view of these findings, we must now rethink past estimations of population social structure in Levantine coastal Medieval cities during the Crusader period. Am J Phys Anthropol 2009. © 2009 Wiley‐Liss, Inc.     

Fractures in late medieval skeletal populations from Serbia

Bone fractures were analyzed from skeletal remains of 861 adult individuals from six cemeteries dating to the Late Medieval period in Serbia. Results of the study were compared to other cemetery populations (635 individual skeletons) of the same date and region in an attempt to understand fracture patterns. The association of types of fractures and their prevalence with sex, age at death, cemetery site, and information deriving from historical sources are discussed. Results showed that the long bone fracture frequency was 0.7%, and the majority of the fractures were the result of direct force. This rate is similar to some studies of contemporary British skeletal samples. However, it is much lower than for some other Old World sites. Cranial vault fractures had a rate of 6.7%, and of the facial skeleton, 1.3%; the frontal bone was the most affected of bones of the cranial vault. Injuries were more common on the upper extremities (0.8%) compared to the lower (0.6%). However, the fibula was the most fractured bone (2.8%), followed by the ulna (2.4%). This pattern is similar to three of six Late Medieval urban sites in Britain. These findings suggest that this rural community was exposed to a low risk of trauma, probably related mostly to accidents sustained during farming, and rarely to interpersonal violence.     

Brief communication: When Adam delved. An activity-related lesion in three human skeletal populations

A rare, activity-related lesion, the clay-shoveller's fracture, was identified during osteological analysis in three human populations dating from the Roman to the later Medieval period in England, circa fourth to 14th centuries A.D. The prevalence of this fracture in these populations suggests an osteological indicator for several possible manual activities, but also one that may be the result of a long-standing human subsistence adaptation requiring digging in the soil. Since males as opposed to females appear to be preferentially affected, the occurrence of such injuries has the potential to provide an insight into the sexual division of labor in earlier human populations. © 1996 Wiley-Liss, Inc.     

Human impact on mid- and late Holocene vegetation in south Cumbria, UK

The use of 9 pollen sampling sites and 56 14C dates has identified hitherto unsuspected or poorly-defined sequences of mid- to late Holocene (late Neolithic to post-Medieval) anthropogenic vegetation changes in south Cumbria, U.K. A series of small-scale, but significant woodland clearance episodes are recorded throughout the Bronze Age, followed by a marked recession in activity during the early Iron Age. The late Iron Age-Roman periods witnessed the first major clearance of woodland in the region which was succeeded by woodland regeneration in the post-Roman/early Medieval period. Woodland clearance intensified in the later Medieval period culminating in large areas of permanently open landscape. The results show that high-resolution, independently date pollen analysis is necessary to reveal regional evidence of small, temporary Bronze Age clearances. A well-documented prehistoric wooden trackway from Foulshaw Moss is shown to be significantly older than previously thought, dating to the mid-Bronze Age, ca. 1550–1250 cal B.C. Pre-Roman cereal cultivation in the area is also confirmed.The Department of Earth Sciences     

The formation of leg or wing specific structures by leg bud cells grafted to the wing bud is influenced by proximity to the apical ridge

When quail or chick leg bud mesoderm was grafted to a chick wing bud, toes developed from grafts placed in direct contact with the wing apical ridge. The toes were primarily derived from quail leg cells, with variable participation of host wing cells. Donor cells also integrated into wing-specific structures, such as cartilage of the wing digits and the surrounding connective tissues. In addition to forming toes, the grafted leg mesoderm expressed its leg origin by enlarging skeletal elements in the host wing. In all cases, enlargements were derived of both quail donor and chick host cells, and were not the result of the addition of mass to the host bud. Grafts placed further than 162 microns from the ridge formed neither toes nor enlargements; rather, they integrated into wing-specific structures. Under the influence of the apical ridge, the grafted leg mesoderm cells are able to maintain their leg character and to form toes and skeletal enlargements. Grafts outside the range of ridge influence (162 microns) are affected by their surroundings to integrate into wing-specific structures. The formation of leg-specific structures by leg bud mesoderm grafted to the wing bud has been used to support the principle of nonequivalence, which states that, because of their different developmental histories, wing and leg cells are restricted to form structures specific for their respective limbs. However, we have shown that leg cells can form wing-specific structures, and therefore limb cells are not restricted in their development.     

Hand before foot? Cortical somatotopy suggests manual dexterity is primitive and evolved independently of bipedalism

People have long speculated whether the evolution of bipedalism in early hominins triggered tool use (by freeing their hands) or whether the necessity of making and using tools encouraged the shift to upright gait. Either way, it is commonly thought that one led to the other. In this study, we sought to shed new light on the origins of manual dexterity and bipedalism by mapping the neural representations in the brain of the fingers and toes of living people and monkeys. Contrary to the ‘hand-in-glove’ notion outlined above, our results suggest that adaptations underlying tool use evolved independently of those required for human bipedality. In both humans and monkeys, we found that each finger was represented separately in the primary sensorimotor cortex just as they are physically separated in the hand. This reflects the ability to use each digit independently, as required for the complex manipulation involved in tool use. The neural mapping of the subjects’ toes differed, however. In the monkeys, the somatotopic representation of the toes was fused, showing that the digits function predominantly as a unit in general grasping. Humans, by contrast, had an independent neurological representation of the big toe (hallux), suggesting association with bipedal locomotion. These observations suggest that the brain circuits for the hand had advanced beyond simple grasping, whereas our primate ancestors were still general arboreal quadrupeds. This early adaptation laid the foundation for the evolution of manual dexterity, which was preserved and enhanced in hominins. In hominins, a separate adaptation, involving the neural separation of the big toe, apparently occurred with bipedality. This accords with the known fossil evidence, including the recently reported hominin fossils which have been dated to 4.4 million years ago.     

Finite element modeling of the first ray of the foot: a tool for the design of interventions

Disorders of the first ray of the foot (defined as the hard and soft tissues of the first metatarsal, the sesamoids, and the phalanges of the great toe) are common, and therapeutic interventions to address these problems range from alterations in footwear to orthopedic surgery. Experimental verification of these procedures is often lacking, and thus, a computational modeling approach could provide a means to explore different interventional strategies. A three-dimensional finite element model of the first ray was developed for this purpose. A hexahedral mesh was constructed from magnetic resonance images of the right foot of a male subject. The soft tissue was assumed to be incompressible and hyperelastic, and the bones were modeled as rigid. Contact with friction between the foot and the floor or footwear was defined, and forces were applied to the base of the first metatarsal. Vertical force was extracted from experimental data, and a posterior force of 0.18 times the vertical force was assumed to represent loading at peak forefoot force in the late-stance phase of walking. The orientation of the model and joint configuration at that instant were obtained by minimizing the difference between model predicted and experimentally measured barefoot plantar pressures. The model were then oriented in a series of postures representative of push-off, and forces and joint moments were decreased to zero simultaneously. The pressure distribution underneath the first ray was obtained for each posture to illustrate changes under three case studies representing hallux limitus, surgical arthrodesis of the first ray, and a footwear intervention. Hallux limitus simulations showed that restriction of metatarsophalangeal joint dorsiflexion was directly related to increase and early occurrence of hallux pressures with severe immobility increasing the hallux pressures by as much as 223%. Modeling arthrodesis illustrated elevated hallux pressures when compared to barefoot and was dependent on fixation angles. One degree change in dorsiflexion and valgus fixation angles introduced approximate changes in peak hallux pressure by 95 and 22 kPa, respectively. Footwear simulations using flat insoles showed that using the given set of materials, reductions of at least 18% and 43% under metatarsal head and hallux, respectively, were possible.     

小切口改良Mc Bride矫形术治疗足踇外翻畸形的临床疗效观察

目的:评估和总结使用小切口改良Mc Bride矫形术治疗足踇外翻畸形的临床疗效。方法:选择2010-2014年我院收治的明确诊断为踇外翻畸形的104例患者,所有患者均行小切口改良Mc Bride矫形术,观察和比较患者手术前和手术后3周、6个月时的VAS疼痛评分、踇外翻角测量(HVA)、跖骨间角测量(IMA)及足踝AOFAS评分。结果:所有患者均至少随访至术后6月,优良率为96.2%,患者术后3周、6月VAS评分、HVA与IMA的角度、AOFAS评分均较术前均明显改善,差异均具有统计学意义(P0.05)。仅3例患者在术后6个月时畸形复发,6例出现足部轻度疼痛,1例出现切口延迟愈合,余无明显并发症出现。结论:小切口改良Mc Bride矫形术能够有效纠正踇外翻畸形,并减轻患者的疼痛。