Background: Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion. Objective: To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis. Methods: We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software. Results: A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = −2.31, 95% CI:−4.63, −2.21), intraoperative blood loss (MD = −43.37, 95%CI: −48.49, −38.25), hospital stay (MD = −1.80, 95%CI: −2.28, −1.33), and visual analog scale score (MD = −1.75, 95%CI: −2.04, −1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion ( P < .00001). Conclusion: Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application. PROSPERO registration number: CRD42020195727.
The aim of the present study was to evaluate commonly used approaches for detection of radiographic angles in hallux valgus deformity patients. Methods: This retrospective study was conducted in patients with hallux valgus deformity at Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2016 to January 2019. The inclusion criteria were: (i) postoperative dorsoplantar weight-bearing radiographs for the feet of patients with the hallux valgus; (ii) patients had been managed with a distal osteotomy of the first metatarsal and the osteotomized bone ends recovered. The exclusion criteria applied were as follows: (i) age > 65 years or < 18 years old; (ii) blurry image; (iii) previous history of severe foot trauma and surgery. Postoperative radiographs for hallux valgus were analyzed using six methods: by a line drawn through the long axis of the first metatarsal bone (method 1); an extended line drawn to bisect the shaft of the metatarsal at two levels with joined points of bisection (method 2); a line drawn to connect the center of the articular surface of the metatarsal head and the center of the proximal articulation (method 3); a line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4); a line drawn through the center of the head and the center of the proximal shaft (method 5); and a line drawn from the center of the head of the first metatarsal head through the center of the proximal articulation (method 6). The measurement results obtained were subjected to Bland-Altman analysis and consistency evaluation. Results: A total number of 20 radiographs were collected for measurement. No statistically significant differences were found in the measurement values among the six methods (P > 0.05). The lowest values of the average measurement, standard deviation, and confidence interval were established in method 3, followed by those in methods 1 and 4. The standard deviation of the measurement value and the confidence interval in method 2 were the largest. Methods 1 and 4 had similar confidence intervals and were with a high consistency. Due to the nature of the retrospective study, no follow-up and complications were applicable in the present study. Conclusion: Line drawn through the long axis of the first metatarsal bone (method 1) and line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4) were reliable and well repeatable, and may be used for postoperative radiographs.
IntroductionPrevious observational studies have reported that thyroid dysfunction is associated with hallux valgus (HV). However, the causal effect of thyroid dysfunction on hallux valgus is still unknown. To assess whether there is a causal relationship between thyroid dysfunction and hallux valgus, we performed a two-sample Mendelian randomization (MR) study.MethodsThe data of the two-sample Mendelian randomization study were obtained from public databases. In this study, hypothyroidism, hyperthyroidism, free thyroxine (FT4), and thyrotropin (TSH) were chosen as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for FT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. HV was used as the outcome. The SNPs associated with HV were selected from a GWAS of 202,617 individuals in the fignngen database. The inverse variance weighted (IVW) method was used as the primary analysis. Four complementary methods were applied, including MR-presso, MR-Egger, and weighted median. In addition, Cochran’s Q test, MR-presso, MR-Egger regression, and the leave-one-out test were used as sensitivity analysis, and the MR-pleiotropy test was performed to examine pleiotropy.ResultsAccording to the results of IVW, we found that there was a causal relationship between hypothyroidism and HV, and hypothyroidism increased the incidence of HV (OR = 2.838 (95% CI: 1.116–7.213); p = 0.028). There were no significant causal effects of hyperthyroidism, FT4, and TSH on HV (p > 0.05). Sensitivity analyses showed that the results were robust and reliable, and no horizontal pleiotropy was detected.ConclusionsOur findings provided genetic support that hypothyroidism might increase the risk of HV. It will predict the occurrence of HV in patients with hypothyroidism and provide suggestions for early prevention and intervention.
Objective To investigate the quantitative correlation between the osteotomy end displacement and the occurrence of transfer metatarsalgia in percutaneous minimal invasion surgery of bunion in the forefoot loading pattern.Methods The simulation of the operation of minimally invasive treatment of hallux valgus using the established finite element model with the period of forefoot load mode facilitated the correction of the distal end of the first metatarsal head after osteotomy by steps of 0–6 mm from inside to outside and from top to bottom; each displacement distance was 2 mm. The stress data were collected and analyzed at the osteotomy end and under each metatarsal head in the gait cycle, the quantitative correlation between the vertical and horizontal displacement and between the stress changes under the first and second metatarsal heads was clarified. Then, the correlation between the pressure changes of the first and second metatarsal heads in the gait cycle and the occurrence of postoperative transfer metatarsalgia was analyzed, and accurate quantitative indicators of displacement during the operation were identified.Results The forefoot loading pattern of the gait cycle assessed in the finite element model before and after percutaneous minimal invasion surgery of hallux valgus showed that when the horizontal displacement is 4 mm, the correlation between the pressure x at the distal end of the osteotomy (under the first metatarsal) and the corresponding pressure y under the second metatarsal is negative, the R value is -0.894, and the quantitative correlation is y=-0.6504x + 0.5232 with increasing vertical displacement. When the vertical displacement is 4 mm, the stress under the first metatarsal increases with the increase in horizontal displacement. Conversely, the pressure under the second metatarsal decreases. Both have a high correlation with horizontal displacement, with R values of 0.981 and − 0.890. Also, in this interval, the pressure x at the distal end of the osteotomy (under the first metatarsal) has the highest correlation with the corresponding pressure y under the second metatarsal head, the R value is -0.830, and the quantitative correlation equation is y=-0.4528x + 0.4159.Conclusion When the distal end of the first metatarsal osteotomy is shifted outwards by 4 mm, and the metatarsal side is shifted by 4 mm through bone setting manipulation during operation, percutaneous minimal invasion surgery of hallux valgus can reduce or cure hallux valgus. This might elevate the metatarsal pain during forefoot loading and avoid transfer metatarsalgia after hallux valgus operation.
Objective To investigate the quantitative correlation between the osteotomy end displacement and the occurrence of transfer metatarsalgia in percutaneous minimal invasion surgery of bunion during forefoot loading pattern. Methods The preoperative and postoperative finite element models of the foot were established during the forefoot loading pattern period of percutaneous minimal invasion surgery of hallux valgus, followed by simulation of the displacement of the osteotomy end of hallux valgus during percutaneous minimal invasion surgery. Thus, maximum pressure was obtained under the first and second metatarsal before and after the operation, and analyze the quantitative correlation between the displacement direction and displacement of the distal end of osteotomy and the occurrence of transfer metatarsalgia. Results The forefoot loading pattern of the gait cycle assessed in the finite element model before and after percutaneous minimal invasion surgery of hallux valgus showed that when the horizontal displacement is 4 mm, the correlation between the pressure x at the distal end of osteotomy (under the first metatarsal) and the corresponding pressure y under the second metatarsal is negative, the R value is -0.894, and the quantitative correlation is y=-0.6504x + 0.5232 with the increase of vertical displacement. When the vertical displacement is 4 mm, the stress under the first metatarsal increases with the increase in horizontal displacement. Conversely, the pressure under the second metatarsal decreases. Both have a high correlation with horizontal displacement, with R values of 0.981 and − 0.890. Also, in this interval, the pressure x at the distal end of osteotomy (under the first metatarsal) has the highest correlation with the corresponding pressure y under the second metatarsal head, the R value is -0.830, and the quantitative correlation equation is y=-0.4528x + 0.4159. Conclusion When the distal end of the first metatarsal osteotomy is shifted outwards by 4 mm and the metatarsal side is shifted by 4 mm through bone setting manipulation during operation, percutaneous minimal invasion surgery of hallux valgus can reduce or cure hallux valgus and complicated metatarsal pain during forefoot loading pattern and avoid the occurrence of transfer metatarsalgia after hallux valgus operation in traditional Chinese and Western medicine.
Background Minimally invasive treatment of hallux valgus is one of the better surgical methods,which still has the shortcomings of insufficient correction of deformities and poor correction of hallux rotation. Therefore, we have improved the surgical method to further improve the clinical efficacy. Methods 186 patients(328 feet) who were diagnosed as hallux valgus from January 2019 to January 2020 and underwent DMMO were included in this retrospective study. The preoperative and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal articular set angle (DASA) of the patients were collected and compared to evaluate the correction of deformity. To explore the safety and effectiveness of DMMO in improving the function of hallux valgus based on American Orthopaedic Foot & Ankle Society (AOFAS) and visual analogue score (VAS). Results The preoperative HVA, IMA and DASA of the subjects were (33.63°±8.74°,12.95°±2.42°,9.46°±1.88°), postoperative HVA, IMA and DASA were (11.18°±2.04°,7.61°±1.46°,3.25°±1.15°); The preoperative AOFAS and VAS were (49.65 ± 9.32,5.61 ± 2.12), and the postoperative were (90.21 ± 7.65,1.65 ± 0.48).The postoperative(12 months) of HVA, IMA, DASA, AOFAS and VAS were better than those before operation (P < 0.05). No postoperative complications were found in all cases. Conclusion Distal metatarsophalangeal mini-invasive osteotomy in the treatment of hallux valgus is safety, scientific and effective. It is worthy of clinical application promotion. Level of Evidence:Level III
Cloud-based workflow technology has played an important role in the development of large scale healthcare applications with high flexibility to meet variety of healthcare process requirements. Among all the factors affecting the healthcare applications on cloud-based workflow, the tasks scheduling is the crucial one. This paper aims at the cloud-based workflow tasks scheduling with deadline constraints and its implementation in two approaches: heuristic scheduling algorithm (HSA) and meta heuristic scheduling algorithm (HSA-ACO). HSA decomposes the workflow according to its structure and divide the deadline into the level deadlines. Tasks in each level get scheduling priority according to the earliest start time under the constraint of level deadline. In another method, HSA-ACO integrates HSA with ant colony algorithm to achieve better performance. In the last part, we launch the experiment to compare HSA and HSA-ACO with algorithms like Prolis, LACO and ICPCP in three types of workflow with different scales. The experiment results show that HSA-ACO is better than the other algorithms.
To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors. Methods: A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group. Results: Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1-2 (IMA1-2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer-Lemeshow test showed a good degree of calibration (χ 2 = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737-0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%-70%. Conclusion: Second metatarsal length, second metatarsal peak pressure, HVA, IMA1-2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.
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