足关节的

PARTICIPANTS: Totally 3 cases of children idiopathic multiple contracture, 2 cases of idiopathic clubfoot in children aged more than 10 years old without treatment and 6 cases of postoperative recurrent idiopathic clubfoot were admitted by the Department of Orthopedics of Nanjing Children' s Hospital Affiliated to Nanjing Medical University during 1999 to 2000. All cases manifested abnormal ankylosis and shortening deformity in foot.

对象：1990/2000南京医科大学附属南京儿童医院骨科共收治儿童先天性多发性关节挛缩症3例、未经任何治疗10岁以上的大年龄儿童先天性马蹄内翻足2例、先天性马蹄内翻足术后复发6例，全部病例均表现为足畸形僵硬和短足畸形。

Methods Ten fresh-frozen foot specimens, three-dimensional kinematics of talonavicular joint were determined in the case of neutral position, dorsiflexion, plantoflexion, adduction, abduction, inversion and eversion motion by means of three-dimensional coordinate instrument （Immersion MicroScribe G2X） before and after calcaneocuboid arthrodesis under non-weight with moment of couple, bending moment, equilibrium dynamic loading.

方法10只新鲜尸体足标本，通过建立非负重位尸体足模型，结合力偶矩、弯矩及平衡加载方法，应用三维坐标仪测量分析跟骰关节融合前、后距舟关节在大体足背屈、跖屈、内收、外展、内翻及外翻运动中的三维运动度变化。

The rate of excellent and good clinical results was 83.3％. Mild forefoot adduction was left in 2 feet of 2 cases and quite obvious tarsal articular ankylosis was found in 4 feet of 4 cases; however, there were no significant differences of gait and load bearing between these patients and normal children.

有2例2足遗留轻度前足内收畸形，4例4足有较明显的跗骨间关节僵硬，但其步态和负重力线均与正常儿童无明显差别。

DM soft tissue less and stiffer than healthy group, it's the major factor to cause high forefoot pressure, the ankle dorsiflexion is the 2nd reason, the calcaneus tendon geometry shape was not different between two group.

左脚压力较右脚大之原因为惯用侧，神经病变受测者因本体感觉较差与关节活动度受限使接触时间增加，进而提高压力时间积分，糖尿病足的二、三和四跖骨大於正常足，糖尿病跖骨软组织厚度少於正常足且较硬，此为影响前足受压力影响的主因，背屈则次之，而跟腱的几何尺寸两者并无差异。

Method］from january 2003 to may 2006,32 patients were corrected with qin si-he's orthotics devices on the ilizarov principle of tension-stress,which involved 15 males and 17 females,the age ranged from 10 to 25 years.among these patients,2 were caused by peroneal nerve injury,l by tumor in the vertebral canal,5 by meningocele,11 were caused by poliomyelitis,13 by congenital talipes equino-varus.in accordance with deformities,external fixator and limitied operative methods were dertermined.the limited release of soft tissue were performed in 7 patients,limited osteotomy in 25 patients.the dynamic muscle balance operation were performed in 9 patients with imbalance of muscle strength.according to the ilizarov technique,the fixative rods were installed.the telescopic rods on the apparatus were rotated one week after the operation,the divices had corrective function in three-dimensional directions.the deformity of talipes equinovarus,internal rotation and drooping of the forefoot were gradually corrected,and the patients could bear weight and walked on the deformed foot.the mean duration of traction were 42 days,then removed the external fixator maintained with plaster for a site time.

方法］2003年1月～2006年5月，根据ilizarov张力应力法则，应用秦泗河改良的外固定矫形器，遵循ilizarov穿针固定的基本原则，共手术治疗马蹄内翻足32例，男15例，女17例；年龄10～25岁，平均17岁。病因：腓总神经损伤2例，腰椎管内肿瘤1例，硬脊膜膨出5例，小儿麻痹后遗症11例，先天性马蹄内翻足13例。术前用足掌的前外缘负重行走者11例，用足的外缘或足背外侧负重者21例。根据马蹄内翻足畸形程度、性质和患者年龄，确定实施有限矫形手术的方法和外固定矫形器治疗。本组7例同期实施有限的软组织松解术，25例同期实施了有限的截骨术和跗骨间关节融合术，9例合并踝关节内外翻肌力明显失衡者，同期行足部肌腱转移的肌力平衡术。然后安装外固定矫形器。术后按作者制定的管理程序，7 d开始旋转相应的螺纹牵拉杆，对器械进行三维空间的缓慢调整，先矫正前足内收和后足内翻，后矫正足下垂畸形，直至达到矫形要求的标准。在矫形的过程中定期进行x线检测，以防止发生踝关节前后移位，治疗期间允许患足负重行走。术后平均牵伸42 d，拆外固定器后患足再上石膏固定适当时间。

Methods The damaged second metacarpophalangeal joint,distal part of the second metacarpal and proximal part of the proximal phalanx were dissected.The metatarsophalangeal joint was transferred to the region of metacarpophalangeal joint of hand.The dorsal pedis artery Was anastomosed to the radial artery ,and the great saphenous vein Was anastomosed to the cephalic vein at anatomical snuf-box. The dissected bones of the hand removed of the cartilage of joint and soft tissue were grafted back to the donor site of the foot.

手术切除破坏的第二掌指关节及部分第二掌骨和近节指骨，将第二跖趾关节转移至手部第二掌指关节处，在鼻烟窝处将足背动脉与桡动脉吻合、大隐静脉与头静脉吻合，将切除的第二掌指关节的软骨关节面和骨骼的软组织剔除后回植到足部第二跖趾关节供区。

The flexor hallucis longus was about (3.24±2.32) mm lateral to the center of metatarsophalangeal joint. Dorsal skin of big toe was innervated by saphenous nerve, superficial and deep fibular nerve.

(1)正常与外翻足的比较中，伸肌腱的位置在足横纹及止点处无明显的差异，在跖附关节及跖趾关节处，外翻足的伸肌腱明显外移(P.05)：长屈肌腱也明显外移(P.05)。

Conclusion］The pristine cases could receive significant curative effects through open reduction and internal fixation, the late cases could also receive significant curative effects through instep re-establishment and tarsometatarsal joints Fusion.

结论］早期陈旧性跖跗关节骨折脱位可行切开复位内固定术，疗效满意，而晚期的陈旧性跖跗关节骨折脱位，行足弓重建跖跗关节原位融合术，也可取得较好的治疗效果。

But this may move the shoe's flex point toward the middle of the shoe, near your arch, rather than at the ball of the foot, where your foot naturally bends.

但这样可能会使鞋的弯曲点移到鞋的中部，接近足弓的位置，而不是跖球部（就是大脚趾关节的底部位置），它是你的脚自然弯曲的地方。

Methods:Nine patients with contraction of Achilles tendon were treated by Ilizarov retractors.The ankle retractors was assembled before surgery and put around leg and foot during the operation.The center of the hinges of the apparatus was pointed to the joint space firstly.Groups of Kirschner pin were penetrated through legs and another two groups through feet and then fixed with the steel rings of the retractors.

用Ilizarov踝关节牵伸器治疗跟腱挛缩9例，手术时先将预先组装好的踝关节牵伸器套在小腿与足部，牵伸器的铰链式关节对准踝关节的关节间隙，在小腿和足部各穿2组克氏针与牵伸器的钢环固定。

Breath, muscle contraction of the buttocks; arch body, as far as possible to hold his head, right leg straight towards the ceiling (peg-leg knee in order to avoid muscle tension).

呼气，收缩臀部肌肉；拱起身体，尽量抬起头来，右腿伸直朝向天花板（膝微屈，以避免肌肉紧张）。

The cost of moving grain food products was unchanged from May, but year over year are up 8%.

粮食产品的运输费用与5月份相比没有变化，但却比去年同期高8％。