BACKGROUND A recently developed method enables automated measurement of the hallux valgus angle(HVA)and the first intermetatarsal angle(IMA)from weightbearing foot radiographs.This approach employs bone segmentation t...BACKGROUND A recently developed method enables automated measurement of the hallux valgus angle(HVA)and the first intermetatarsal angle(IMA)from weightbearing foot radiographs.This approach employs bone segmentation to identify anatomical landmarks and provides standardized angle measurements based on established guidelines.While effective for HVA and IMA,preoperative radiograph analysis remains complex and requires additional measurements,such as the hallux interphalangeal angle(IPA),which has received limited research attention.AIM To expand the previous method,which measured HVA and IMA,by incorporating the automatic measurement of IPA,evaluating its accuracy and clinical relevance.METHODS A preexisting database of manually labeled foot radiographs was used to train a U-Net neural network for segmenting bones and identifying landmarks necessary for IPA measurement.Of the 265 radiographs in the dataset,161 were selected for training and 20 for validation.The U-Net neural network achieves a high mean Sørensen-Dice index(>0.97).The remaining 84 radiographs were used to assess the reliability of automated IPA measurements against those taken manually by two orthopedic surgeons(OA and OB)using computer-based tools.Each measurement was repeated to assess intraobserver(OA1 and OA2)and interobserver(O_(A2) and O_(B))reliability.Agreement between automated and manual methods was evaluated using the Intraclass Correlation Coefficient(ICC),and Bland-Altman analysis identified systematic differences.Standard error of measurement(SEM)and Pearson correlation coefficients quantified precision and linearity,and measurement times were recorded to evaluate efficiency.RESULTS The artificial intelligence(AI)-based system demonstrated excellent reliability,with ICC3.1 values of 0.92(AI vs OA2)and 0.88(AI vs O_(B)),both statistically significant(P<0.001).For manual measurements,ICC values were 0.95(OA2 vs OA1)and 0.95(OA2 vs OB),supporting both intraobserver and interobserver reliability.Bland-Altman analysis revealed minimal biases of:(1)1.61°(AI vs O_(A2));and(2)2.54°(AI vs O_(B)),with clinically acceptable limits of agreement.The AI system also showed high precision,as evidenced by low SEM values:(1)1.22°(O_(A2) vs O_(B));(2)1.77°(AI vs O_(A2));and(3)2.09°(AI vs O_(B)).Furthermore,Pearson correlation coefficients confirmed strong linear relationships between automated and manual measurements,with r=0.85(AI vs O_(A2))and r=0.90(AI vs O_(B)).The AI method significantly improved efficiency,completing all 84 measurements 8 times faster than manual methods,reducing the time required from an average 36 minutes to just 4.5 minutes.CONCLUSION The proposed AI-assisted IPA measurement method shows strong clinical potential,effectively corresponding with manual measurements.Integrating IPA with HVA and IMA assessments provides a comprehensive tool for automated forefoot deformity analysis,supporting hallux valgus severity classification and preoperative planning,while offering substantial time savings in high-volume clinical settings.展开更多
Clubfoot,medically termed congenital talipes equinovarus(CTEV),is a prevalent musculoskeletal birth defect,affecting approximately 0.3%of all live births.This serious congenital anomaly results from structural abnorma...Clubfoot,medically termed congenital talipes equinovarus(CTEV),is a prevalent musculoskeletal birth defect,affecting approximately 0.3%of all live births.This serious congenital anomaly results from structural abnormalities in the foot and lower leg,leading to abnormal positioning of the ankle and foot joints.This review provides a comprehensive overview of the causative factors associated with CTEV and evaluates current therapeutic approaches.Although variations in genes encoding contractile proteins of skeletal myofibers have been proposed as contributors to the etiology of CTEV,no definitive candidate genes have been conclusively linked to increased risk.However,genes such as TBX4,PITX1,and members of the HOXA,HOXC,and HOXD clusters,as well as NAT2,have been implicated in the condition’s development,playing critical roles in limb development,muscle formation,and tissue differentiation.Also,Axin1 plays a key role in joint formation and skeletal development by inhibiting β-catenin-BMP signaling.It could significantly serve as a therapeutic target for fibular hemimelia and multiple synostoses syndrome.The exact mechanisms and the extent of their physical and genetic interactions remain subjects of ongoing research.Understanding the genetic determinants and cellular pathways involved in CTEV is crucial for unravelling the pathophysiology of this complex deformity.展开更多
Background:Neurological injuries or diseases may cause ankle–foot deformities that seriously affect patients’quality of life.Objective:This study aimed to explore the feasibility of the Ilizarov technique for treati...Background:Neurological injuries or diseases may cause ankle–foot deformities that seriously affect patients’quality of life.Objective:This study aimed to explore the feasibility of the Ilizarov technique for treating complex ankle–foot deformity with neurotrophic disorders.Methods:In this retrospective study,10 patients,including 6 males and 4 females,with complex ankle–foot deformities with nerve injury were treated from January 2014 to May 2019.The age of the patients ranged from 13 to 57 years with an average of 27.9 years.The reasons of nerve injury were as follows:sequelae of spina bifida in five patients,post-traumatic injury of the common peroneal nerve and tibial nerve in four patients,and subacute degeneration of the spinal cord in one patient.Minimally invasive surgery was used for osteotomy,muscle strength balance,and external ring frame fixation,and various deformities were gradually corrected after the operation.The ankle–foot function was evaluated using the American Orthopedic Foot and Ankle Society(AOFAS)Ankle–Hindfoot Score before surgery and at long-term follow-up after surgery.Results:All 10 patients were followed up for 12 months to 3 years,with an average of 1.9 years.The deformities of all 10 patients were corrected;and of the 10 patients,three partially recovered their nerve function.A significant difference(p<0.001)between the AOFAS score(81.6±10.45)evaluated in the long-term follow-up and that evaluated preoperatively(31.1±14.69).The AOFAS comprehensive score was excellent in two patients,good in six patients,and fair in two patients.Conclusion:The Ilizarov technique combined with minimally invasive osteotomy and muscle strength balance could safely correct complex ankle–foot deformities with neurotrophic disorders.展开更多
Objective：To observe the clinical effect of acupuncture combined with low-frequency electric stimulation on scissor gait in children with spastic cerebral palsy. Methods：A total of 60 spastic cerebral palsy kids wer...Objective：To observe the clinical effect of acupuncture combined with low-frequency electric stimulation on scissor gait in children with spastic cerebral palsy. Methods：A total of 60 spastic cerebral palsy kids were allocated into two groups by random number table, 30 in each group. Cases in the control group were treated with physical exercise therapy, massage and hydrotherapy. Based on the therapies given to the control group, cases in the observation group were supplemented with acupuncture combined with low-frequency electric stimulation. Selected points included Zusanli （ST 36）, Sanyinjiao （SP 6）, Yanglingquan （GB 34）, Jiexi （ST 41）, Chengshan （BL 57）, Naoqing [Extra, locates at 2 cun directly above Jiexi （ST 41）] and Genping （Extra, locates at the midpoint of the line connecting medial and lateral malleolus）. The treatment was done once every other day and 10 d made up a treatment course. The low-frequency electric stimulation was applied to anterior tibia, 6 times a week and 20 times made up a treatment course. Cases were treated for a total of 3 courses and there was a 15-20 d interval between two courses. The low limb functions were assessed before and after treatment using the modified Ashworth scale （MAS） and composite spasticity scale （CSS）. In addition, the ankle dorsiflexion angles were measured before and after treatment. Results：After treatment, the ankle dorsiflexion angles and CSS scores in the observation group were better than those in the control group, showing statistical significances （P〈0.05）; the effective rate in the observation group calculated by MAS and ankle dorsiflexion angle were both higher than that in the control group, showing a statistical significance （P〈0.05）. Conclusion：Rehabilitation training combined with acupuncture and low-frequency electric stimulation can achieve better effect than rehabilitation training alone in improving scissor gait in kids with spastic cerebral palsy.展开更多
To analyze the principle mechanism of the arcus plantaris and its clinical application. Methods: The states of forces sustained by the arcus plantaris were analyzed and calculated according to the mechanism of the ...To analyze the principle mechanism of the arcus plantaris and its clinical application. Methods: The states of forces sustained by the arcus plantaris were analyzed and calculated according to the mechanism of the quadratic parabolic arch. Results: The aponeurosis plantaris corresponded to the pull rod of the arcus plantaris. The medial and lateral longitudinal arches formed by the pedal bones were stable with the rod, but unstable without the rod. In the latter condition, on loading, the force sustained by the parabolic arch became a force sustained by a simple beam, and the arcus plantaris tended to disappear and to be flattened. Clinically, 240 feet with talipes equinus were treated with triple arthrodesis. In 34 out of the reexamined 156 feet, the aponeurosis plantaris was cut in addition to the triple arthrodesis and was immobilized with cast for 3 months. One or two years later, their arcus plantaris disappeared, pain developed when walking, and some of them walked with the midtarsal joint against the ground. Then, the triple arthrodesis and shortening of the aponeurosis plantaris were applied on 18 cases, and osteotomy of the calcaneus and reconstruction of the aponeurosis plantaris were made on 10 cases and satisfactory effects were obtained. Conclusions: In order to achieve satisfactory therapeutic effects of the triple arthrodesis, we should reestablish the arcus plantaris and accurately treat the aponeurosis plantaris for the balance of the surrounding muscle force.展开更多
文摘BACKGROUND A recently developed method enables automated measurement of the hallux valgus angle(HVA)and the first intermetatarsal angle(IMA)from weightbearing foot radiographs.This approach employs bone segmentation to identify anatomical landmarks and provides standardized angle measurements based on established guidelines.While effective for HVA and IMA,preoperative radiograph analysis remains complex and requires additional measurements,such as the hallux interphalangeal angle(IPA),which has received limited research attention.AIM To expand the previous method,which measured HVA and IMA,by incorporating the automatic measurement of IPA,evaluating its accuracy and clinical relevance.METHODS A preexisting database of manually labeled foot radiographs was used to train a U-Net neural network for segmenting bones and identifying landmarks necessary for IPA measurement.Of the 265 radiographs in the dataset,161 were selected for training and 20 for validation.The U-Net neural network achieves a high mean Sørensen-Dice index(>0.97).The remaining 84 radiographs were used to assess the reliability of automated IPA measurements against those taken manually by two orthopedic surgeons(OA and OB)using computer-based tools.Each measurement was repeated to assess intraobserver(OA1 and OA2)and interobserver(O_(A2) and O_(B))reliability.Agreement between automated and manual methods was evaluated using the Intraclass Correlation Coefficient(ICC),and Bland-Altman analysis identified systematic differences.Standard error of measurement(SEM)and Pearson correlation coefficients quantified precision and linearity,and measurement times were recorded to evaluate efficiency.RESULTS The artificial intelligence(AI)-based system demonstrated excellent reliability,with ICC3.1 values of 0.92(AI vs OA2)and 0.88(AI vs O_(B)),both statistically significant(P<0.001).For manual measurements,ICC values were 0.95(OA2 vs OA1)and 0.95(OA2 vs OB),supporting both intraobserver and interobserver reliability.Bland-Altman analysis revealed minimal biases of:(1)1.61°(AI vs O_(A2));and(2)2.54°(AI vs O_(B)),with clinically acceptable limits of agreement.The AI system also showed high precision,as evidenced by low SEM values:(1)1.22°(O_(A2) vs O_(B));(2)1.77°(AI vs O_(A2));and(3)2.09°(AI vs O_(B)).Furthermore,Pearson correlation coefficients confirmed strong linear relationships between automated and manual measurements,with r=0.85(AI vs O_(A2))and r=0.90(AI vs O_(B)).The AI method significantly improved efficiency,completing all 84 measurements 8 times faster than manual methods,reducing the time required from an average 36 minutes to just 4.5 minutes.CONCLUSION The proposed AI-assisted IPA measurement method shows strong clinical potential,effectively corresponding with manual measurements.Integrating IPA with HVA and IMA assessments provides a comprehensive tool for automated forefoot deformity analysis,supporting hallux valgus severity classification and preoperative planning,while offering substantial time savings in high-volume clinical settings.
基金supported by the National Key Research and Development Program of China(No.2022YFA1207500)the National Natural Science Foundation of China(No.82394445,82161160342,82030067 to D.C.)the Shenzhen Science and Technology Innovation Bureau(Guangdong,China)(No.LCYSSQ20220823091402005-E-001)to D.C.
文摘Clubfoot,medically termed congenital talipes equinovarus(CTEV),is a prevalent musculoskeletal birth defect,affecting approximately 0.3%of all live births.This serious congenital anomaly results from structural abnormalities in the foot and lower leg,leading to abnormal positioning of the ankle and foot joints.This review provides a comprehensive overview of the causative factors associated with CTEV and evaluates current therapeutic approaches.Although variations in genes encoding contractile proteins of skeletal myofibers have been proposed as contributors to the etiology of CTEV,no definitive candidate genes have been conclusively linked to increased risk.However,genes such as TBX4,PITX1,and members of the HOXA,HOXC,and HOXD clusters,as well as NAT2,have been implicated in the condition’s development,playing critical roles in limb development,muscle formation,and tissue differentiation.Also,Axin1 plays a key role in joint formation and skeletal development by inhibiting β-catenin-BMP signaling.It could significantly serve as a therapeutic target for fibular hemimelia and multiple synostoses syndrome.The exact mechanisms and the extent of their physical and genetic interactions remain subjects of ongoing research.Understanding the genetic determinants and cellular pathways involved in CTEV is crucial for unravelling the pathophysiology of this complex deformity.
基金the National Natural Science Foundation of China(Grant No.82172439).
文摘Background:Neurological injuries or diseases may cause ankle–foot deformities that seriously affect patients’quality of life.Objective:This study aimed to explore the feasibility of the Ilizarov technique for treating complex ankle–foot deformity with neurotrophic disorders.Methods:In this retrospective study,10 patients,including 6 males and 4 females,with complex ankle–foot deformities with nerve injury were treated from January 2014 to May 2019.The age of the patients ranged from 13 to 57 years with an average of 27.9 years.The reasons of nerve injury were as follows:sequelae of spina bifida in five patients,post-traumatic injury of the common peroneal nerve and tibial nerve in four patients,and subacute degeneration of the spinal cord in one patient.Minimally invasive surgery was used for osteotomy,muscle strength balance,and external ring frame fixation,and various deformities were gradually corrected after the operation.The ankle–foot function was evaluated using the American Orthopedic Foot and Ankle Society(AOFAS)Ankle–Hindfoot Score before surgery and at long-term follow-up after surgery.Results:All 10 patients were followed up for 12 months to 3 years,with an average of 1.9 years.The deformities of all 10 patients were corrected;and of the 10 patients,three partially recovered their nerve function.A significant difference(p<0.001)between the AOFAS score(81.6±10.45)evaluated in the long-term follow-up and that evaluated preoperatively(31.1±14.69).The AOFAS comprehensive score was excellent in two patients,good in six patients,and fair in two patients.Conclusion:The Ilizarov technique combined with minimally invasive osteotomy and muscle strength balance could safely correct complex ankle–foot deformities with neurotrophic disorders.
基金supported by the Project of Guangdong Provincial Administration of Traditional Chinese Medicine,No.21031055~~
文摘Objective：To observe the clinical effect of acupuncture combined with low-frequency electric stimulation on scissor gait in children with spastic cerebral palsy. Methods：A total of 60 spastic cerebral palsy kids were allocated into two groups by random number table, 30 in each group. Cases in the control group were treated with physical exercise therapy, massage and hydrotherapy. Based on the therapies given to the control group, cases in the observation group were supplemented with acupuncture combined with low-frequency electric stimulation. Selected points included Zusanli （ST 36）, Sanyinjiao （SP 6）, Yanglingquan （GB 34）, Jiexi （ST 41）, Chengshan （BL 57）, Naoqing [Extra, locates at 2 cun directly above Jiexi （ST 41）] and Genping （Extra, locates at the midpoint of the line connecting medial and lateral malleolus）. The treatment was done once every other day and 10 d made up a treatment course. The low-frequency electric stimulation was applied to anterior tibia, 6 times a week and 20 times made up a treatment course. Cases were treated for a total of 3 courses and there was a 15-20 d interval between two courses. The low limb functions were assessed before and after treatment using the modified Ashworth scale （MAS） and composite spasticity scale （CSS）. In addition, the ankle dorsiflexion angles were measured before and after treatment. Results：After treatment, the ankle dorsiflexion angles and CSS scores in the observation group were better than those in the control group, showing statistical significances （P〈0.05）; the effective rate in the observation group calculated by MAS and ankle dorsiflexion angle were both higher than that in the control group, showing a statistical significance （P〈0.05）. Conclusion：Rehabilitation training combined with acupuncture and low-frequency electric stimulation can achieve better effect than rehabilitation training alone in improving scissor gait in kids with spastic cerebral palsy.
文摘To analyze the principle mechanism of the arcus plantaris and its clinical application. Methods: The states of forces sustained by the arcus plantaris were analyzed and calculated according to the mechanism of the quadratic parabolic arch. Results: The aponeurosis plantaris corresponded to the pull rod of the arcus plantaris. The medial and lateral longitudinal arches formed by the pedal bones were stable with the rod, but unstable without the rod. In the latter condition, on loading, the force sustained by the parabolic arch became a force sustained by a simple beam, and the arcus plantaris tended to disappear and to be flattened. Clinically, 240 feet with talipes equinus were treated with triple arthrodesis. In 34 out of the reexamined 156 feet, the aponeurosis plantaris was cut in addition to the triple arthrodesis and was immobilized with cast for 3 months. One or two years later, their arcus plantaris disappeared, pain developed when walking, and some of them walked with the midtarsal joint against the ground. Then, the triple arthrodesis and shortening of the aponeurosis plantaris were applied on 18 cases, and osteotomy of the calcaneus and reconstruction of the aponeurosis plantaris were made on 10 cases and satisfactory effects were obtained. Conclusions: In order to achieve satisfactory therapeutic effects of the triple arthrodesis, we should reestablish the arcus plantaris and accurately treat the aponeurosis plantaris for the balance of the surrounding muscle force.
