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Managing Major Peripheral Nerves in Forearm-Level Amputations With TMR and RPNI: What's the Best Recipe? 用 TMR 和 RPNI 管理前臂截肢者的主要外周神经:最佳配方是什么?
IF 16.4 Q2 ORTHOPEDICS Pub Date : 2024-09-12 DOI: 10.1177/15589447241277842
Andrew B Rees, Julia C Mastracci, Samuel L Posey, Bryan J Loeffler, R Glenn Gaston

Background: Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) prevent symptomatic neuroma formation in amputees. Forearm-level amputations present multiple muscular targets, making it challenging to determine the ideal treatment. The purpose of this study was to evaluate the best TMR targets, role of RPNI, and appropriate patient-selection criteria in forearm-level amputations. We hypothesized that deep and distal TMR targets would best prevent symptomatic neuromas, RPNI would prove a success adjunct, and patients with poorly controlled diabetes would not develop symptomatic neuromas regardless of nerve management.

Methods: We retrospectively identified forearm-level amputations performed between 2017 and 2022. Patients with TMR by outside providers, follow-up <6 months, or insufficient documentation were excluded. Demographics, surgical nerve management, and postoperative complications were collected. The primary outcome was development of a painful neuroma determined by the Eberlin criteria. Patients undergoing TMR were divided a priori into two groups, superficial and proximal versus deep and distal TMR targets, and were compared.

Results: Thirty-nine patients met inclusion criteria, and 16 developed a symptomatic neuroma. No patients with a deep or distal TMR target developed a symptomatic neuroma. One nerve out of 12 treated with RPNI developed a symptomatic neuroma. No patient with poorly controlled diabetes developed a symptomatic neuroma, despite no advanced nerve management.

Conclusions: In a case series of forearm amputations, deep and distal TMR targets prevented symptomatic neuroma formation more than superficial and proximal targets. Regenerative peripheral nerve interface is a useful adjunct for neuroma control, especially for the radial sensory nerve. Patients with poorly controlled diabetes may not require advanced nerve management.

Level of evidence: Level IV retrospective case series.

背景:靶向肌肉神经支配(TMR)和再生外周神经接口(RPNI)可预防截肢者症状性神经瘤的形成。前臂水平截肢有多个肌肉靶点,因此确定理想的治疗方法具有挑战性。本研究的目的是评估前臂截肢的最佳 TMR 靶点、RPNI 的作用以及适当的患者选择标准。我们假设,深部和远端 TMR 靶点能最好地预防症状性神经瘤,RPNI 将被证明是一种成功的辅助治疗方法,而糖尿病控制不佳的患者无论采用何种神经管理方法都不会出现症状性神经瘤:我们回顾性地确定了2017年至2022年期间进行的前臂水平截肢手术。由外部医疗机构进行 TMR 的患者,随访结果:39例患者符合纳入标准,16例出现了症状性神经瘤。没有深部或远端 TMR 目标患者出现症状性神经瘤。在接受 RPNI 治疗的 12 条神经中,有一条出现了症状性神经瘤。尽管没有对神经进行晚期处理,但没有控制不佳的糖尿病患者出现症状性神经瘤:在一系列前臂截肢病例中,深部和远端 TMR 靶点比浅部和近端靶点更能防止症状性神经瘤的形成。再生外周神经接口是控制神经瘤的有效辅助手段,尤其是对于桡侧感觉神经。糖尿病控制不佳的患者可能不需要高级神经管理:证据级别:IV 级回顾性病例系列。
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引用次数: 0
Efficacy of Direct Versus Peripheral Adjuvant Dexamethasone on Duration and Rebound Pain in Regional Anesthesia for Outpatient Distal Radius Fracture Fixation: A Prospective Randomized Controlled Blinded Study. 在门诊桡骨远端骨折固定术的区域麻醉中,直接与外周辅助地塞米松对持续时间和反跳痛的疗效:前瞻性随机对照盲法研究》。
IF 16.4 Q2 ORTHOPEDICS Pub Date : 2024-09-11 DOI: 10.1177/15589447241270678
Alexis A Kasper, Kyle Plusch, Armen Voskerijian, David Barnabei, Michael Rivlin, Pedro K Beredjiklian, Mark L Wang

Background: Despite increasingly wider use, there remains controversy among anesthesiologists regarding preferred formulations and the role of steroid adjuvants in regional anesthesia. There is also uncertainty in the role of dexamethasone when administered directly versus peripherally. We hypothesize that directly mixing dexamethasone into the regional nerve block rather than peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy concerning duration and rebound pain, decreased postoperative pain scores, or opioid consumption within the short-term postoperative period.

Methods: A prospective, randomized controlled blinded study was conducted for patients undergoing open reduction and internal fixation with a volar plate technique for distal radius fractures. Patients were randomized for their preoperative anesthesia. One group had ultrasound-guided supraclavicular block with ropivacaine with a direct mix of dexamethasone 4 mg (Direct group), while the other group had ultrasound-guided supraclavicular block with ropivacaine and peripheral intravenous dexamethasone 4 mg (Indirect group). Data was collected pre, intra, and postoperatively.

Results: Fifty patients consented and participated in the study, with 27 participants in the direct group and 23 participants in the indirect group. Compared to intravenous administration, directly administered dexamethasone demonstrated a significant difference in the average time for the block to fade, onset of motor and sensory recovery, and block resolution.

Conclusion: Our findings prove that directly mixing dexamethasone compared to peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy with regards to duration and rebound pain, but do not prove that there will be a difference in decreased postoperative pain scores or opioid consumption within the 24-hour postoperative period.

Level of evidence: Prognosis Level I.

背景:尽管类固醇在区域麻醉中的应用越来越广泛,但麻醉医生对其首选配方和作用仍存在争议。地塞米松直接给药与外周给药的作用也存在不确定性。我们假设,在区域神经阻滞中直接混入地塞米松,而不是外周静脉注射地塞米松,在持续时间和反跳痛、术后疼痛评分降低或术后短期内阿片类药物用量等方面的疗效会有所不同:对桡骨远端骨折患者进行了一项前瞻性随机对照盲法研究。患者的术前麻醉被随机分配。一组在超声引导下使用罗哌卡因进行锁骨上阻滞,并直接混合地塞米松 4 毫克(直接组);另一组在超声引导下使用罗哌卡因进行锁骨上阻滞,并外周静脉注射地塞米松 4 毫克(间接组)。收集了术前、术中和术后的数据:50名患者同意并参与研究,其中直接组27人,间接组23人。与静脉给药相比,直接给药地塞米松在阻滞消退的平均时间、运动和感觉恢复的开始时间以及阻滞解除的时间上都有显著差异:我们的研究结果证明,直接混用地塞米松与外周静脉注射地塞米松相比,在持续时间和反跳痛方面的疗效存在差异,但不能证明术后疼痛评分或术后24小时内阿片类药物用量的减少存在差异:预后 I 级。
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引用次数: 0
Opioid Consumption After Upper Extremity Surgery: A Systematic Review. 上肢手术后阿片类药物的使用:系统回顾
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-03-23 DOI: 10.1177/15589447231160211
Minh N Q Huynh, Morgan Yuan, Lucas Gallo, Oluwatobi R Olaiya, Jouseph Barkho, Matthew McRae

There is currently an overprescription of opioids, which may result in abuse and diversion of narcotics. The aim of this systematic review was to investigate opioid prescription practices and consumption by patients after upper extremity surgery. This review was registered a priori on Open Science Framework (osf.io/6u5ny) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search strategy was performed using MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases (from their inception to October 17, 2021). Prospective studies investigating opioid consumption of patients aged 18 years or older undergoing upper extremity surgeries were included. The Risk of Bias in Nonrandomized Studies of Interventions and Risk of Bias 2.0 tools were used for quality assessment. In total, 21 articles met the inclusion criteria, including 7 randomized controlled trials and 14 prospective cohort studies. This represented 4195 patients who underwent upper extremity surgery. Most patients took less than half of the prescribed opioids. The percentage of opioids consumed ranged from 11% to 77%. There was moderate to severe risk of bias among the included studies. This review demonstrated that there is routinely excessive opioid prescription relative to consumption after upper limb surgery. Additional randomized trials are warranted, particularly with standardized reporting of opioid consumption and assessment of patient-reported outcomes.

目前阿片类药物处方过量,可能会导致麻醉剂的滥用和转移。本系统性综述旨在调查上肢手术后患者的阿片类药物处方使用情况。本综述事先已在开放科学框架(osf.io/6u5ny)上注册,并遵循了系统综述和元分析首选报告项目指南。我们使用 MEDLINE、Embase、PubMed 和 Cochrane Central Register of Controlled Trials 数据库(从开始到 2021 年 10 月 17 日)执行了检索策略。研究纳入了对接受上肢手术的 18 岁或以上患者阿片类药物消耗情况进行调查的前瞻性研究。采用 "干预措施非随机研究中的偏倚风险 "和 "偏倚风险 2.0 "工具进行质量评估。共有 21 篇文章符合纳入标准,其中包括 7 项随机对照试验和 14 项前瞻性队列研究。这代表了 4195 名接受上肢手术的患者。大多数患者服用的阿片类药物不到处方的一半。阿片类药物的用量比例从11%到77%不等。纳入的研究存在中度到严重的偏倚风险。本综述表明,上肢手术后阿片类药物的处方量与用量相比通常过高。有必要进行更多的随机试验,尤其是对阿片类药物消耗量进行标准化报告并对患者报告的结果进行评估。
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引用次数: 0
A "Clear" Carpal Tunnel Syndrome Diagnosis on Ultrasound Examination Does Not Predict Improved Outcomes When Compared With a "Borderline" Diagnosis. 与 "边缘 "诊断相比,超声波检查对腕管综合征的 "明确 "诊断并不能预示更好的结果。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-03-01 DOI: 10.1177/15589447231154026
Robert C Vernick, John R Fowler

Background: Nerve conduction studies (NCS) and ultrasound (US) remain imperfect compared with clinical diagnosis and/or diagnostic tools such as carpal tunnel syndrome-6 (CTS-6) for diagnosis of carpal tunne syndrome (CTS). One potential reason for the discrepancy between clinical diagnosis and testing is "borderline" case inclusion. This study aims to compare clinical outcomes after carpal tunnel release (CTR) between "borderline" and "clear" patients with CTS determined by NCS and US.

Methods: This was a retrospective review of patients who underwent CTR. We collected NCS and US measurements of the median nerve cross-sectional area (MNCSA) at the carpal tunnel inlet, and the Boston Carpal Tunnel Questionnaire (BCTQ) scores comprised of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). Ultrasound measurements defined patients as having "borderline" (MNCSA < 13 mm2) or "clear" (MNCSA ≥ 13 mm2) CTS.

Results: The study included 94 unilateral patients with CTS. "Borderline" CTS was diagnosed in 58 patients (62%), and "clear" CTS was diagnosed in 36 patients (38%). No significant differences in BCTQ scores were found between groups. At greater than 6-month follow-up, the mean FSS was 1.44 and 1.45 for clear and borderline groups, respectively (P = .97) and the mean SSS was 1.47 and 1.51, respectively (P = .84). However, a significant difference between groups when comparing distal motor latency (DML) and distal sensory latency (DSL) existed. The mean DSL was 3.71 and 4.44 for the clear and borderline groups, respectively (P = .02). The mean DML was 4.59 and 5.36 (P = .048).

Conclusion: Categorizing CTS diagnosis into "borderline" and "clear" based on preoperative US and NCS testing did not correlate with BCTQ changes after CTR. It remains unclear whether the BCTQ is a valid postoperative assessment tool, despite its frequent use in literature.

背景:在诊断腕管综合征(CTS)时,神经传导研究(NCS)和超声波(US)与临床诊断和/或诊断工具(如腕管综合征-6(CTS-6))相比仍不完善。临床诊断与检测之间存在差异的一个潜在原因是纳入了 "边缘 "病例。本研究旨在比较腕管松解术(CTR)后 "边缘 "和 "明确 "CTS患者的临床疗效:这是一项对接受腕管松解术患者的回顾性研究。我们收集了腕管入口处正中神经横截面积(MNCSA)的NCS和US测量值,以及由症状严重程度量表(SSS)和功能状态量表(FSS)组成的波士顿腕管问卷(BCTQ)得分。超声测量将患者定义为 "边缘型"(MNCSA < 13 mm2)或 "清晰型"(MNCSA ≥ 13 mm2)CTS:研究纳入了 94 名单侧 CTS 患者。58名患者(62%)被诊断为 "边缘型 "CTS,36名患者(38%)被诊断为 "明确型 "CTS。两组患者的 BCTQ 评分无明显差异。在超过 6 个月的随访中,明确组和边缘组的平均 FSS 分别为 1.44 和 1.45(P = .97),平均 SSS 分别为 1.47 和 1.51(P = .84)。然而,在比较远端运动潜伏期(DML)和远端感觉潜伏期(DSL)时,组间存在明显差异。清晰组和边缘组的平均感觉潜伏期分别为 3.71 和 4.44(P = .02)。DML 的平均值分别为 4.59 和 5.36(P = .048):结论:根据术前 US 和 NCS 测试将 CTS 诊断分为 "边缘 "和 "明确 "两类与 CTR 后 BCTQ 的变化无关。尽管文献中经常使用 BCTQ,但它是否是有效的术后评估工具仍不清楚。
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引用次数: 0
Experience With Proximal Median Nerve Entrapment by the Lacertus Fibrosus. 拉塞尔特斯肌纤维对正中神经近端卡压的经验。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-03-01 DOI: 10.1177/15589447231153233
Justin A Cline, Lisa M Frantz, Jessica M Adams, Bernard F Hearon

Background: Unconscious bias of the clinician favors the diagnosis of carpal tunnel syndrome (CTS) in patients with median paresthesia. We hypothesized that more patients in this cohort would be diagnosed with proximal median nerve entrapment (PMNE) by strengthening our cognitive awareness of this alternative diagnosis. We also hypothesized that patients with PMNE may be successfully treated with surgical release of the lacertus fibrosus (LF).

Methods: In this retrospective study, cases of median nerve decompression at the carpal tunnel and in the proximal forearm for the 2-year periods before and after adopting strategies to mitigate cognitive bias for CTS were enumerated. Patients diagnosed with PMNE and treated by LF release under local anesthesia were evaluated to determine surgical outcome at minimum 2-year follow-up. Primary outcome measures were changes in preoperative median paresthesia and proximal median-innervated muscle strength.

Results: There was a statistically significant increase in PMNE cases identified after our heightened surveillance was initiated (z = 3.433, P < .001). In 10 of 12 cases, the patient had previous ipsilateral open carpal tunnel release (CTR) but experienced recurrent median paresthesia. In 8 cases evaluated an average of 5 years after LF release, there was improvement in median paresthesia and resolution of median-innervated muscle weakness.

Conclusions: Owing to cognitive bias, some patients with PMNE may be misdiagnosed with CTS. All patients with median paresthesia, particularly those with persistent or recurrent symptoms after CTR, should be assessed for PMNE. Surgical release limited to the LF may be an effective treatment for PMNE.

背景:临床医生的无意识偏见倾向于将正中神经麻痹的患者诊断为腕管综合征(CTS)。我们假设,通过加强我们对正中神经近端卡压(PMNE)这一替代诊断的认知,将有更多患者被诊断为正中神经近端卡压。我们还假设,正中神经卡压患者可以通过手术松解纤维条索(LF)获得成功治疗:在这项回顾性研究中,我们列举了在腕管和前臂近端进行正中神经减压术的病例,这些病例是在采用减轻认知偏差的策略治疗 CTS 前后两年期间发生的。对确诊为 PMNE 并在局部麻醉下接受 LF 松解术治疗的患者进行评估,以确定至少 2 年随访的手术效果。主要结果指标为术前正中神经麻痹和近端正中神经支配肌力的变化:结果:在我们开始加强监控后,发现的 PMNE 病例明显增加(z = 3.433,P < .001)。在 12 例病例中,有 10 例患者曾接受过同侧开放性腕管松解术 (CTR),但再次出现正中麻痹。在 LF 术后平均 5 年进行评估的 8 个病例中,正中神经麻痹有所改善,正中神经支配的肌无力也得到缓解:结论:由于认知偏差,一些 PMNE 患者可能会被误诊为 CTS。所有正中神经麻痹患者,尤其是在 CTR 后症状持续或复发的患者,都应接受 PMNE 评估。仅限于低频的手术松解可能是治疗 PMNE 的有效方法。
{"title":"Experience With Proximal Median Nerve Entrapment by the Lacertus Fibrosus.","authors":"Justin A Cline, Lisa M Frantz, Jessica M Adams, Bernard F Hearon","doi":"10.1177/15589447231153233","DOIUrl":"10.1177/15589447231153233","url":null,"abstract":"<p><strong>Background: </strong>Unconscious bias of the clinician favors the diagnosis of carpal tunnel syndrome (CTS) in patients with median paresthesia. We hypothesized that more patients in this cohort would be diagnosed with proximal median nerve entrapment (PMNE) by strengthening our cognitive awareness of this alternative diagnosis. We also hypothesized that patients with PMNE may be successfully treated with surgical release of the lacertus fibrosus (LF).</p><p><strong>Methods: </strong>In this retrospective study, cases of median nerve decompression at the carpal tunnel and in the proximal forearm for the 2-year periods before and after adopting strategies to mitigate cognitive bias for CTS were enumerated. Patients diagnosed with PMNE and treated by LF release under local anesthesia were evaluated to determine surgical outcome at minimum 2-year follow-up. Primary outcome measures were changes in preoperative median paresthesia and proximal median-innervated muscle strength.</p><p><strong>Results: </strong>There was a statistically significant increase in PMNE cases identified after our heightened surveillance was initiated (<i>z</i> = 3.433, <i>P</i> < .001). In 10 of 12 cases, the patient had previous ipsilateral open carpal tunnel release (CTR) but experienced recurrent median paresthesia. In 8 cases evaluated an average of 5 years after LF release, there was improvement in median paresthesia and resolution of median-innervated muscle weakness.</p><p><strong>Conclusions: </strong>Owing to cognitive bias, some patients with PMNE may be misdiagnosed with CTS. All patients with median paresthesia, particularly those with persistent or recurrent symptoms after CTR, should be assessed for PMNE. Surgical release limited to the LF may be an effective treatment for PMNE.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"904-911"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10819117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Computed Tomography Neurography for Visualization of the In Vivo Nervous System: A Proof of Concept. 用于活体神经系统可视化的计算机断层扫描神经成像技术:概念验证。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-04-19 DOI: 10.1177/15589447231164735
James E McCarthy, Natalie J Serkova

Background: The human peripheral nervous system embodies anatomical, physiologic, and diagnostic perplexities that remain unexplained. Yet in the course of human history, there are no mechanisms, such as computed tomography (CT) or radiography, by which to image the peripheral nervous system in vivo using a contrast agent that is identified by ionizing radiation, which would aid in surgical navigation, diagnostic radiology, and basic science thereof.

Methods: A novel class of contrast was created by linking iodine to lidocaine. The radiodensity of 0.5% experimental contrast molecule was compared with a control of 1% lidocaine by placing 1.5-mL aliquots of each liquid into centrifuge tubes and performing micro-computed tomography (micro-CT) synchronously under identical settings. Physiologic binding to the sciatic nerve was evaluated by injecting 10 mg of the experimental contrast and 10 mg of the control into the contralateral sciatic nerve, and documenting loss of hindlimb function and recovery. In vivo visualization of the sciatic nerve was evaluated by injecting 10 mg of experimental contrast or control into either sciatic nerve and imaging the hindlimbs under identical conditions using micro-CT.

Results: The mean Hounsfield unit of the contrast was 56.09 compared with -0.48 for control (116-fold increase, P = .0001). Hindlimb paresis revealed similar degree of paresis, baseline recovery, and time to recovery. In vivo enhancement between the contralateral sciatic nerves was similar.

Conclusion: Iodinated lidocaine offers a viable mechanism for in vivo peripheral nerve imaging using CT; however, it requires modification to improve in vivo radiodensity.

背景:人类的周围神经系统在解剖学、生理学和诊断学方面都存在着至今仍无法解释的难题。然而,在人类历史上,还没有一种机制,如计算机断层扫描(CT)或放射摄影,可以利用电离辐射识别的造影剂对周围神经系统进行活体成像,这将有助于手术导航、放射诊断及其基础科学:方法:通过将碘与利多卡因连接,制造出一种新型造影剂。方法:通过将碘与利多卡因连接,制造出一类新型对比剂。将每种液体 1.5 毫升的等分量放入离心管中,在相同设置下同步进行微型计算机断层扫描(micro-CT),比较 0.5%实验对比剂分子与 1%利多卡因对照组的辐射强度。通过向对侧坐骨神经注射 10 毫克实验用对比剂和 10 毫克对照组对比剂,评估坐骨神经的生理性结合,并记录后肢功能的丧失和恢复情况。通过向任一坐骨神经注射 10 毫克实验用对比剂或对照组对比剂,并在相同条件下使用微型计算机断层扫描对后肢成像,对坐骨神经的体内可视化进行评估:对比剂的平均 Hounsfield 单位为 56.09,而对照组为 -0.48(增加 116 倍,P = .0001)。后肢瘫痪显示出相似的瘫痪程度、基线恢复和恢复时间。对侧坐骨神经的体内增强效果相似:碘化利多卡因为使用 CT 进行体内周围神经成像提供了一种可行的机制;但是,需要对其进行改进,以提高体内放射密度。
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引用次数: 0
What Surgical Technique to Perform for Isolated Ulnar Shortening Osteotomy After Distal Radius Malunion: A Systematic Review. 桡骨远端骨不连后应采用何种手术技术进行孤立肘缩短截骨术?系统性综述。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-02-16 DOI: 10.1177/15589447231152587
Charlotte L E Laane, Koen D Oude Nijhuis, Jonne Spil, Inger N Sierevelt, Job N Doornberg, Ruurd L Jaarsma, Michael H J Verhofstad, Mathieu M E Wijffels

Background: Unstable fractures of the distal radius fractures (DRFs) may result in malunion, usually consisting of subsequent shortening and angular deviations. Ulnar shortening osteotomy (USO) is assumed to be a simpler procedure than radial correction osteotomy, resulting in fewer complications and comparable outcomes. The aim of this study was to identify the best surgical technique to perform USO to restore distal radioulnar joint congruency after DRF malunion.

Methods: A systematic review of the literature is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in February 2022 to identify studies reporting outcomes and surgical technique for isolated USO. The primary outcome was complication rates. Secondary outcomes included functional, radiologic, and patient-rated outcomes. The methodological index for nonrandomized studies criteria were used to assess the quality of evidence.

Results: Included were 12 cohorts (185 participants). Due to substantial heterogeneity, a meta-analysis could not be performed. The overall complication rate was 33% (95% confidence interval, 16% to 51%). The most reported complication was implant irritation (22%), often requiring removal of the implant (13%). Only 3% nonunions were mentioned. Functional and patient-rated outcomes improved in most patients after USO. Quality of evidence of the papers was low to very low. Common methodological flaws were related to retrospective research.

Conclusion: No evident differences in complication rates and functional outcomes between the surgical techniques were observed. Based on this literature, most complications are related to implant irritation. Nonunion and infection rates were rare. Therefore, a surgical technique with a buried implant might be preferred. This hypothesis requires further investigation.

背景:桡骨远端骨折(DRFs)的不稳定骨折可能导致愈合不良,通常包括随后的缩短和角度偏差。与桡骨矫正截骨术相比,尺骨缩短截骨术(USO)被认为是一种更简单的手术,因此并发症较少,疗效相当。本研究的目的是确定在 DRF 畸形后实施截骨术恢复桡肘关节远端同形的最佳手术技巧:方法:根据2022年2月《系统综述和荟萃分析首选报告项目》指南,对文献进行了系统综述,以确定报告孤立USO的结果和手术技术的研究。主要结果是并发症发生率。次要结果包括功能、放射和患者评分结果。采用非随机研究的方法学指数标准来评估证据质量:结果:共纳入 12 个队列(185 名参与者)。由于存在大量异质性,因此无法进行荟萃分析。总体并发症发生率为 33%(95% 置信区间为 16% 至 51%)。报告最多的并发症是植入物刺激(22%),通常需要移除植入物(13%)。仅有 3% 的患者提到了非关节挛缩。大多数患者在接受 USO 后,功能和患者评价结果均有所改善。论文的证据质量较低或很低。常见的方法缺陷与回顾性研究有关:结论:两种手术技术在并发症发生率和功能预后方面没有明显差异。根据这些文献,大多数并发症与植入物刺激有关。不愈合和感染的发生率很低。因此,埋入植入物的手术技术可能更受欢迎。这一假设还需要进一步研究。
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引用次数: 0
The Medial Femoral Trochlea Osteochondral Flap for Scaphoid Reconstruction: A Systematic Review. 用于肩胛骨重建的股骨内侧踝骨软骨瓣:系统回顾
IF 16.4 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-02-13 DOI: 10.1177/15589447231151430
Brahman Sivakumar, Richard Lawson, David J Graham

Background: The medial femoral trochlea flap has been used to resurface scaphoids with recalcitrant proximal pole fractures or avascular necrosis, providing vascularized osteochondral tissue with similar morphological characteristics. This article aims to review the contemporary literature on its use for scaphoid reconstruction.

Methods: A systematic review of Embase, PubMed, Cochrane Central Register of Controlled Trials, and MEDLINE assessed the use of medial femoral trochlea flaps in scaphoids.

Results: Eight studies were included, with 76 patients at a mean age of 26 years. Forty-three patients underwent clinical review, and 10 patients underwent radiographic evaluation, at a mean 23.3 months of follow-up. Flaps were generally performed for proximal pole fractures, avascular necrosis, nonunion, or failure of prior fixation; 94.4% of the flaps united. No marked change in sagittal plane motion was noted; reductions were seen in axial and coronal plane motion. The Disabilities of the Arm, Shoulder, and Hand scores improved from a mean of 25.2 to 11.5. Radiographic markers also improved. A total of 12.3% of patients had unplanned return to theater. Three patients required early revision for vascular thrombosis, and 1 patient suffered a volar carpal dislocation. Three patients underwent salvage procedures for ongoing pain.

Conclusions: Although technically demanding, promising early-term to medium-term results are noted with the use of medial femoral trochlea flaps in the scaphoid.

背景:股骨内侧套骨瓣已被用于复位近端骨折或血管性坏死的肩胛骨,提供具有类似形态特征的血管化骨软骨组织。本文旨在回顾将其用于肩胛骨重建的现代文献:方法:对Embase、PubMed、Cochrane Central Register of Controlled Trials和MEDLINE进行系统综述,评估股骨内侧套骨瓣在肩胛骨中的应用:结果:共纳入八项研究,76名患者,平均年龄26岁。43名患者接受了临床复查,10名患者接受了放射学评估,平均随访时间为23.3个月。皮瓣一般用于近端极骨折、血管性坏死、不愈合或之前的固定失败;94.4%的皮瓣愈合。矢状面运动没有明显变化;轴向和冠状面运动有所减少。手臂、肩部和手部残疾评分从平均 25.2 分降至 11.5 分。放射学指标也有所改善。共有 12.3% 的患者意外重返手术室。三名患者因血管血栓形成而需要进行早期翻修,一名患者发生了腕关节侧脱位。三名患者因持续疼痛接受了挽救手术:尽管技术要求较高,但在肩胛骨上使用股骨内侧套骨皮瓣的早期和中期效果良好。
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引用次数: 0
Carpal Tunnel Anthropometrics Using Acrylic Casts: A Cadaveric Study With Implications for Carpal Tunnel Release. 使用丙烯酸铸模的腕管人体测量学:尸体研究对腕管松解术的启示
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-03-22 DOI: 10.1177/15589447231160209
José D Carmo, Rui C Cardoso, Helder V Silva, Rui F Jesus

Background: Abundant literature exists on the morphology of the carpal tunnel. Despite this, the shape of the carpal tunnel has been reported erratically, and most studies did not attempt to correlate findings with measurements taken from cadavers. The objective of this study was to perform a morphological analysis, determine the shape and mean dimensions of the carpal tunnel, determine the level of the narrowest area of the tunnel, and establish a set of values capable of serving as a reference for carpal tunnel release.

Methods: The carpal tunnels of 20 fresh cadaveric hands were dissected, and acrylic casts were created and measured using industrial computed tomography.

Results: Of the 20 casts, 19 were shaped like elliptic cylinders, with little variation in their measurements along the length. The location of the narrowest section of the carpal tunnel is very different among casts, and the length of the roof of the carpal tunnel ranged from 21.26 to 29.86 mm.

Conclusions: The most common shape of the carpal tunnel is an elliptic cylinder. Because of the unpredictability of the location of the narrowest area of the carpal tunnel, carpal tunnel release must continue through all extension of its roof. We advise that the release should rarely be extended distally more than 30 mm from the distal palmar wrist crease, which corresponds, in most cases, to the middle of the pisiform.

背景:关于腕管形态的文献很多。尽管如此,有关腕管形态的报道并不稳定,而且大多数研究并未尝试将研究结果与尸体测量结果进行关联。本研究的目的是进行形态分析,确定腕管的形状和平均尺寸,确定腕管最窄区域的水平,并建立一套可作为腕管松解参考的数值:方法:解剖 20 只新鲜尸体手的腕管,制作丙烯酸模型,并使用工业计算机断层扫描进行测量:结果:在 20 个模型中,19 个的形状像椭圆形圆柱体,沿长度方向的测量值变化不大。不同模型腕管最窄部分的位置差异很大,腕管顶端的长度从 21.26 毫米到 29.86 毫米不等:结论:腕管最常见的形状是椭圆形圆柱体。结论:腕管最常见的形状是椭圆形圆柱体。由于腕管最窄区域的位置难以预测,因此腕管松解必须持续到腕管顶端的所有延伸部分。我们建议,腕管松解的远端距离腕掌远端皱襞应很少超过 30 毫米,在大多数情况下,这相当于腕桡骨的中部。
{"title":"Carpal Tunnel Anthropometrics Using Acrylic Casts: A Cadaveric Study With Implications for Carpal Tunnel Release.","authors":"José D Carmo, Rui C Cardoso, Helder V Silva, Rui F Jesus","doi":"10.1177/15589447231160209","DOIUrl":"10.1177/15589447231160209","url":null,"abstract":"<p><strong>Background: </strong>Abundant literature exists on the morphology of the carpal tunnel. Despite this, the shape of the carpal tunnel has been reported erratically, and most studies did not attempt to correlate findings with measurements taken from cadavers. The objective of this study was to perform a morphological analysis, determine the shape and mean dimensions of the carpal tunnel, determine the level of the narrowest area of the tunnel, and establish a set of values capable of serving as a reference for carpal tunnel release.</p><p><strong>Methods: </strong>The carpal tunnels of 20 fresh cadaveric hands were dissected, and acrylic casts were created and measured using industrial computed tomography.</p><p><strong>Results: </strong>Of the 20 casts, 19 were shaped like elliptic cylinders, with little variation in their measurements along the length. The location of the narrowest section of the carpal tunnel is very different among casts, and the length of the roof of the carpal tunnel ranged from 21.26 to 29.86 mm.</p><p><strong>Conclusions: </strong>The most common shape of the carpal tunnel is an elliptic cylinder. Because of the unpredictability of the location of the narrowest area of the carpal tunnel, carpal tunnel release must continue through all extension of its roof. We advise that the release should rarely be extended distally more than 30 mm from the distal palmar wrist crease, which corresponds, in most cases, to the middle of the pisiform.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"924-930"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9150380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Risk of Lymphedema After Breast Cancer Surgery Should Not Restrict Necessary Hand Surgery Interventions. 乳腺癌手术后出现淋巴水肿的风险不应限制必要的手部手术干预。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-02-21 DOI: 10.1177/15589447231155583
Michael J Fitzgerald, Jesse Galina, Emily Kolodka, Ariel Henig, Sayyida Hasan, Susan Maltser, Lewis B Lane, Kate W Nellans

Background: The purpose of this study was to evaluate the incidence of lymphedema onset or exacerbation in patients undergoing upper extremity interventions, both nonoperative and operative, after breast cancer surgery.

Methods: The study inclusion criteria were the following: (1) prior history of breast cancer surgery or lymphedema from the cancer; (2) upper extremity intervention, ipsilateral to the breast cancer side; and (3) follow-up of at least 1 month. Patients were evaluated for demographic information, type of breast cancer procedure and hand intervention, number of lymph nodes dissected, preexisting lymphedema, exacerbation of lymphedema, and new-onset lymphedema.

Results: A total of 161 patients undergoing 385 hand interventions (300 injections, 85 surgeries) were reviewed. Median follow-up was 31 months (range: 1-110). Nineteen patients had preexisting lymphedema ipsilateral to the hand procedure and none experienced an exacerbation of their lymphedema. Three patients developed new-onset lymphedema ipsilateral to their hand intervention at an average follow-up of 30 months (range: 4-67). One patient had a single injection and developed lymphedema over 5 years later. One had 2 injections in the same hand on the same date and developed lymphedema 3 months later. The third patient had 2 injections in the right hand, 1 injection and 1 surgery in the left hand, and developed either lymphedema or swelling due to rheumatoid arthritis in the right hand 1 year after the injections.

Conclusions: Patients who have undergone breast cancer surgery can safely undergo upper extremity intervention with low risk of lymphedema exacerbation or onset.

背景:本研究旨在评估乳腺癌手术后接受上肢介入治疗(包括非手术治疗和手术治疗)的患者淋巴水肿发生或加重的情况:本研究旨在评估乳腺癌术后接受上肢介入治疗(包括非手术和手术)的患者淋巴水肿发生或加重的发生率:研究纳入标准如下:(1)既往有乳腺癌手术史或因癌症引起的淋巴水肿;(2)上肢介入治疗,同侧为乳腺癌一侧;(3)随访至少 1 个月。对患者的人口统计学信息、乳腺癌手术和手部干预的类型、淋巴结清扫数量、原有淋巴水肿、淋巴水肿加重和新发淋巴水肿进行评估:共有161名患者接受了385次手部干预(300次注射、85次手术)。中位随访时间为 31 个月(范围:1-110)。19名患者在接受手部手术的同侧已有淋巴水肿,但没有人出现淋巴水肿加重的情况。三名患者在平均 30 个月的随访期间(范围:4-67),在手部干预手术的同侧出现了新发淋巴水肿。一名患者只接受了一次注射,5 年后出现了淋巴水肿。一名患者于同一天在同一只手上进行了 2 次注射,3 个月后出现淋巴水肿。第三位患者在右手进行了2次注射,在左手进行了1次注射和1次手术,注射1年后右手出现淋巴水肿或类风湿性关节炎引起的肿胀:结论:接受过乳腺癌手术的患者可以安全地接受上肢干预,淋巴水肿加重或发病的风险较低。
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引用次数: 0
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HAND
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