首页 > 最新文献

HAND最新文献

英文 中文
Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach. 月骨关节置换术的临床效果:逆行单螺钉方法
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-27 DOI: 10.1177/15589447231174041
Ather Mirza, Justin B Mirza, Luke C Zappia, Terence L Thomas, Jagger Corabi, Zachary Dusckas, John D Lubahn

Background: A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist.

Methods: We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores.

Results: We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture.

Conclusions: We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.

背景:我们设计了一项单病例回顾性研究,以评估采用逆行方法进行单螺钉月状关节置换术(LCA)治疗肩胛骨晚期塌陷(SLAC)腕关节的临床效果:我们回顾性地确定了2010年9月至2019年12月期间接受单螺钉LCA治疗的31例SLAC腕关节病变患者(33例)。客观结果包括融合时间、结合率、活动范围、握力和夹力恢复情况。主观结果包括手臂、肩部和手部残疾(DASH)评分:我们报告了 33 例接受 LCA 的 SLAC 腕关节病例(7 例女性),平均年龄 58.4 岁(41-85 岁)。我们的队列报告了94%的结合率和90天的平均融合时间。最终的腕关节活动范围为:外翻 38°、外展 35°、桡侧偏斜 17°、尺侧偏斜 17°、前倾 82°、后仰 83°(平均:450.8 天)。与对侧相比,最终恢复的握力和捏力为:粗握 75%、侧捏 84%、精确捏 75%(平均:379.0 天)。术后 DASH 评分平均为 27 分(平均:1203.9 天)。观察到两处不榫接。出现了两种硬件并发症:一种是螺钉无症状,一种是螺钉疲劳断裂:我们发现逆行单螺钉 LCA 是一种有效的 SLAC 腕关节挽救手术。逆行单螺钉腕关节置换术是一种有效的腕关节SLAC抢救方法,手术创伤小,手术时间短,活动范围、握力和捏力的恢复与四角关节置换术相当。此外,单螺钉固定的可行性可能会降低与硬件相关的手术成本,而不影响结合率。
{"title":"Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach.","authors":"Ather Mirza, Justin B Mirza, Luke C Zappia, Terence L Thomas, Jagger Corabi, Zachary Dusckas, John D Lubahn","doi":"10.1177/15589447231174041","DOIUrl":"10.1177/15589447231174041","url":null,"abstract":"<p><strong>Background: </strong>A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist.</p><p><strong>Methods: </strong>We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores.</p><p><strong>Results: </strong>We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture.</p><p><strong>Conclusions: </strong>We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9526772","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
A Comparative Study of 2-Corner, 3-Corner, and 4-Corner Arthrodesis for Midcarpal Arthritis. 两角、三角和四角关节成形术治疗中腕关节炎的比较研究
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-06-02 DOI: 10.1177/15589447231174046
Justine Ring, Tod A Clark, Jennifer L Giuffre

Background: Four-corner fusion (4CF) is a common treatment for midcarpal arthritis; however, alternatives including 2-corner fusion (2CF) and 3-corner fusion (3CF) have been described. Limited literature suggests 2CF and 3CF may improve range of motion but have higher complication rates. Our objective is to compare function and patient-reported outcomes following 4CF, 3CF, and 2CF at our institution.

Methods: Adult patients undergoing 4CF, 3CF, and 2CF from 2011 to 2021 who attended at least one follow-up were included. Four-corner fusion patients were compared with those who underwent either 3CF or 2CF using staple fixation. Outcomes include nonunion rate, reoperation rate, progression to wrist fusion, range of motion, and patient-reported pain, satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.

Results: A total of 58 patients met inclusion criteria. There were 49 4CF and 9 2CF or 3CF patients. Nonunion rates, progression to wrist fusion, and repeat surgery for any indication were not significantly different among groups. Range of motion (flexion-extension, radial-ulnar deviation) and grip strength at postoperative visits were not significantly different. Significantly more 4CF patients required bone grafting. Pain, overall satisfaction, and DASH scores were similar.

Conclusions: Although prior studies suggest increased risk of nonunion and hardware migration after 2CF/3CF, we did not observe higher complication rates compared with 4CF. Range of motion, strength, and patient-reported outcomes were similar. While 4CF is traditionally the procedure of choice for midcarpal fusion, we found that when using a staple fixation technique, 2CF and 3CF have comparable clinical and patient-reported outcomes yet decrease the need for autologous bone grafting.

背景:四角融合术(4CF)是治疗中腕关节炎的常用方法,但也有包括二角融合术(2CF)和三角融合术(3CF)在内的替代方法。有限的文献表明,2CF 和 3CF 可改善活动范围,但并发症发生率较高。我们的目的是比较本院接受 4CF、3CF 和 2CF 术后的功能和患者报告的结果:方法:纳入2011年至2021年期间接受4CF、3CF和2CF手术且至少参加过一次随访的成年患者。将四角融合术患者与使用订书钉固定的 3CF 或 2CF 患者进行比较。结果包括不愈合率、再手术率、腕部融合进展、活动范围、患者报告的疼痛、满意度以及手臂、肩部和手部残疾(DASH)评分:共有 58 名患者符合纳入标准。结果:共有58名患者符合纳入标准,其中4CF患者49名,2CF或3CF患者9名。各组间的非愈合率、进展为腕关节融合术以及因任何指征而再次手术的情况无明显差异。术后访视时的活动范围(屈伸、桡尺偏移)和握力无明显差异。需要植骨的 4CF 患者明显较多。疼痛、总体满意度和DASH评分相似:尽管之前的研究表明 2CF/3CF 术后发生骨不连和硬件移位的风险会增加,但与 4CF 相比,我们并未观察到更高的并发症发生率。活动范围、力量和患者报告的结果相似。虽然 4CF 是传统的中腕骨融合术的首选,但我们发现,在使用钉书针固定技术时,2CF 和 3CF 的临床和患者报告结果相当,而且减少了对自体骨移植的需求。
{"title":"A Comparative Study of 2-Corner, 3-Corner, and 4-Corner Arthrodesis for Midcarpal Arthritis.","authors":"Justine Ring, Tod A Clark, Jennifer L Giuffre","doi":"10.1177/15589447231174046","DOIUrl":"10.1177/15589447231174046","url":null,"abstract":"<p><strong>Background: </strong>Four-corner fusion (4CF) is a common treatment for midcarpal arthritis; however, alternatives including 2-corner fusion (2CF) and 3-corner fusion (3CF) have been described. Limited literature suggests 2CF and 3CF may improve range of motion but have higher complication rates. Our objective is to compare function and patient-reported outcomes following 4CF, 3CF, and 2CF at our institution.</p><p><strong>Methods: </strong>Adult patients undergoing 4CF, 3CF, and 2CF from 2011 to 2021 who attended at least one follow-up were included. Four-corner fusion patients were compared with those who underwent either 3CF or 2CF using staple fixation. Outcomes include nonunion rate, reoperation rate, progression to wrist fusion, range of motion, and patient-reported pain, satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.</p><p><strong>Results: </strong>A total of 58 patients met inclusion criteria. There were 49 4CF and 9 2CF or 3CF patients. Nonunion rates, progression to wrist fusion, and repeat surgery for any indication were not significantly different among groups. Range of motion (flexion-extension, radial-ulnar deviation) and grip strength at postoperative visits were not significantly different. Significantly more 4CF patients required bone grafting. Pain, overall satisfaction, and DASH scores were similar.</p><p><strong>Conclusions: </strong>Although prior studies suggest increased risk of nonunion and hardware migration after 2CF/3CF, we did not observe higher complication rates compared with 4CF. Range of motion, strength, and patient-reported outcomes were similar. While 4CF is traditionally the procedure of choice for midcarpal fusion, we found that when using a staple fixation technique, 2CF and 3CF have comparable clinical and patient-reported outcomes yet decrease the need for autologous bone grafting.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9568813","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 Role of Surgery in the Management of Radiation-Induced Brachial Plexopathy. 手术在治疗辐射引起的臂丛神经病中的作用。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-09-16 DOI: 10.1177/15589447231196902
Mira Shoukry, Shelley S Noland

Radiation-induced brachial plexopathy (RIBP) is a rare long-term complication of radiation therapy often causing pain, motor deficit, and overall quality of life reduction for affected patients. While a standard treatment for RIBP is yet to be established, management consists mostly of symptom management through the use of medications and physical therapy. There is a lack of evidence regarding the efficacy of surgical treatment. Omentoplasties and other vascularized flaps are commonly discussed options for eliminating neuropathic pain associated with RIBP. However, these approaches show no meaningful improvement in motor function. While limited, current literature suggests that nerve transfers may be an option for relief of neuropathic pain as well as restoration of motor function. This review of literature explores the options available to those affected by RIBP with a focus on the role of surgery.

放疗诱发的臂丛神经病(RIBP)是一种罕见的长期放疗并发症,通常会导致患者疼痛、运动障碍和整体生活质量下降。虽然 RIBP 的标准治疗方法尚未确立,但主要是通过使用药物和物理治疗来控制症状。手术治疗的疗效尚缺乏证据。网膜成形术和其他血管瓣是常用的消除 RIBP 相关神经性疼痛的方法。但是,这些方法对运动功能没有明显改善。目前的文献表明,神经转移可能是缓解神经病理性疼痛和恢复运动功能的一种选择,尽管这种方法很有限。这篇文献综述探讨了受 RIBP 影响的患者可以选择的方法,重点关注手术的作用。
{"title":"The Role of Surgery in the Management of Radiation-Induced Brachial Plexopathy.","authors":"Mira Shoukry, Shelley S Noland","doi":"10.1177/15589447231196902","DOIUrl":"10.1177/15589447231196902","url":null,"abstract":"<p><p>Radiation-induced brachial plexopathy (RIBP) is a rare long-term complication of radiation therapy often causing pain, motor deficit, and overall quality of life reduction for affected patients. While a standard treatment for RIBP is yet to be established, management consists mostly of symptom management through the use of medications and physical therapy. There is a lack of evidence regarding the efficacy of surgical treatment. Omentoplasties and other vascularized flaps are commonly discussed options for eliminating neuropathic pain associated with RIBP. However, these approaches show no meaningful improvement in motor function. While limited, current literature suggests that nerve transfers may be an option for relief of neuropathic pain as well as restoration of motor function. This review of literature explores the options available to those affected by RIBP with a focus on the role of surgery.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617913","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
Decreased Complication Rate Using Partially Threaded Compared With Fully Threaded Compression Screws in 4 Corner Arthrodesis: A Retrospective Study. 在四角关节置换术中使用部分螺纹加压螺钉比使用全螺纹加压螺钉降低并发症发生率:一项回顾性研究。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-02 DOI: 10.1177/15589447231167883
Tammam Hanna, Nathan Smith, Chibuzo Akalonu, Jack Simmons, Priyanka V Nehete, Mark Dodson

Background: Scapho-lunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) of the wrist are the most common types of wrist arthritis. We compared the union rate and complication profile of patients with SLAC and SNAC wrist undergoing 4 corner arthrodesis with partially threaded or fully threaded headless compression screws.

Methods: A single-center retrospective review was conducted to identify all patients treated for SLAC and SNAC with 4 corner fusion using headless compression screws from 2016 to 2021. A total of 33 patients undergoing surgery on 35 wrists were identified and included in the study. Demographics, comorbidities, complication profile, and radiographs were collected and compared between groups.

Results: One hundred percent (16/16) of partially threaded and 84.2% (16/19) of fully threaded screws demonstrated union by minimum 10-week follow-up. The total complication rate (avascular necrosis of lunate, screw loosening, etc.) was 31.4%; 52.6% of wrists implanted with fully threaded screws experienced complications compared with a 6.3% complication rate with partially threaded screws. The difference was statistically significant between the 2 groups (P = .004).

Conclusions: Four corner arthrodesis using antegrade compression screws is an effective, reproducible method to achieve fusion in the wrist. The use of fully threaded screws was associated with more complications than with partially threaded screws, although union rate was not significantly different. Future studies with larger sample sizes would be useful to fully elucidate differences between these 2 constructs.

背景:腕关节的肩月状晚期塌陷(SLAC)和肩胛骨未愈合晚期塌陷(SNAC)是最常见的腕关节炎类型。我们比较了使用部分螺纹或完全螺纹无头加压螺钉进行四角关节置换术的 SLAC 和 SNAC 患者的结合率和并发症情况:方法: 对2016年至2021年期间使用无头加压螺钉进行4角融合术治疗的所有SLAC和SNAC患者进行了单中心回顾性研究。共有 33 名患者接受了 35 只手腕的手术并被纳入研究。研究人员收集了各组患者的人口统计学资料、合并症、并发症情况和X光片,并进行了比较:结果:在至少10周的随访中,100%(16/16)的部分螺纹螺钉和84.2%(16/19)的完全螺纹螺钉显示出结合。总并发症发生率(月骨血管性坏死、螺钉松动等)为31.4%;52.6%植入全螺纹螺钉的手腕出现并发症,而部分螺纹螺钉的并发症发生率为6.3%。两组之间的差异具有统计学意义(P = .004):结论:使用前向加压螺钉进行四角关节固定是实现腕关节融合的一种有效、可重复的方法。与部分螺纹螺钉相比,使用全螺纹螺钉的并发症更多,但骨结合率并无显著差异。未来样本量更大的研究将有助于全面阐明这两种结构之间的差异。
{"title":"Decreased Complication Rate Using Partially Threaded Compared With Fully Threaded Compression Screws in 4 Corner Arthrodesis: A Retrospective Study.","authors":"Tammam Hanna, Nathan Smith, Chibuzo Akalonu, Jack Simmons, Priyanka V Nehete, Mark Dodson","doi":"10.1177/15589447231167883","DOIUrl":"10.1177/15589447231167883","url":null,"abstract":"<p><strong>Background: </strong>Scapho-lunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) of the wrist are the most common types of wrist arthritis. We compared the union rate and complication profile of patients with SLAC and SNAC wrist undergoing 4 corner arthrodesis with partially threaded or fully threaded headless compression screws.</p><p><strong>Methods: </strong>A single-center retrospective review was conducted to identify all patients treated for SLAC and SNAC with 4 corner fusion using headless compression screws from 2016 to 2021. A total of 33 patients undergoing surgery on 35 wrists were identified and included in the study. Demographics, comorbidities, complication profile, and radiographs were collected and compared between groups.</p><p><strong>Results: </strong>One hundred percent (16/16) of partially threaded and 84.2% (16/19) of fully threaded screws demonstrated union by minimum 10-week follow-up. The total complication rate (avascular necrosis of lunate, screw loosening, etc.) was 31.4%; 52.6% of wrists implanted with fully threaded screws experienced complications compared with a 6.3% complication rate with partially threaded screws. The difference was statistically significant between the 2 groups (<i>P</i> = .004).</p><p><strong>Conclusions: </strong>Four corner arthrodesis using antegrade compression screws is an effective, reproducible method to achieve fusion in the wrist. The use of fully threaded screws was associated with more complications than with partially threaded screws, although union rate was not significantly different. Future studies with larger sample sizes would be useful to fully elucidate differences between these 2 constructs.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9451538","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
Surgical Management of Dupuytren Disease: A Systematic Review and Network Meta-analyses. 杜普伊特伦病的手术治疗:系统综述与网络元分析》。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-28 DOI: 10.1177/15589447231174175
Silas Nann, Joshua Kovoor, James Fowler, James Kieu, Aashray Gupta, Joseph Hewitt, Christopher Ovenden, Suzanne Edwards, Stephen Bacchi, Jonathan Henry W Jacobsen, Richard Harries, Guy Maddern

Background: Dupuytren disease is a common fibroproliferative disease that affects the palmar fascia of the hands. Currently, there is limited consensus regarding the optimal therapy for this condition, with treatment decisions based largely on surgeon preference. Therefore, the aim of this study was to determine which treatments are the most effective for Dupuytren disease.

Method: A systematic review and network meta-analyses were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Medline, EMBASE, and Web of Science were searched for randomized trials comparing treatments for Dupuytren disease in adults. Eligible treatments included open limited fasciectomy, collagenase injection, and percutaneous needle fasciotomy. Study selection, data extraction, and quality appraisal were performed in duplicate. The methodological quality was evaluated with the Cochrane risk-of-bias critical appraisal tool.

Results: Eleven randomized clinical trials were included in this study. At short-term (1-12 weeks) and long-term (2-5 years) time points, fasciectomy improved contracture release more than collagenase and needle fasciotomy as inferred by a lower total passive extension deficit. However, there was no difference between the groups regarding the best possible outcome at any time point. Fasciectomy was also superior in terms of recurrence and patient satisfaction compared with collagenase and needle fasciotomy, but only at later time points. There was no difference in skin damage-related and nerve damage-related complications following fasciectomy compared with other modalities. Risk of bias was generally moderate.

Conclusions: Fasciectomy provides superior long-term advantages in terms of patient outcomes when compared with collagenase and needle fasciotomy. Larger trials with better blinding of outcome assessors are needed in the future.

背景介绍杜普伊特伦病是一种影响手掌筋膜的常见纤维增生性疾病。目前,关于这种疾病的最佳治疗方法尚未达成共识,治疗决定主要取决于外科医生的偏好。因此,本研究旨在确定哪些疗法对杜普伊特伦病最有效:方法:根据《2020 年系统综述和荟萃分析首选报告项目》指南进行了系统综述和网络荟萃分析。研究人员在 Medline、EMBASE 和 Web of Science 上检索了比较成人杜普伊特伦病治疗方法的随机试验。符合条件的治疗方法包括开放式有限筋膜切除术、胶原酶注射和经皮针式筋膜切开术。研究选择、数据提取和质量评估一式两份。方法学质量采用 Cochrane 偏倚风险关键评估工具进行评估:本研究共纳入了 11 项随机临床试验。在短期(1-12 周)和长期(2-5 年)时间点上,筋膜切除术比胶原酶和针式筋膜切开术更能改善挛缩的松解,这可以从较低的总被动伸展缺损推断出来。不过,在任何时间点的最佳结果方面,各组之间均无差异。在复发率和患者满意度方面,筋膜切除术也优于胶原酶和针式筋膜切开术,但仅限于较晚的时间点。与其他方法相比,筋膜切除术在皮肤损伤相关并发症和神经损伤相关并发症方面没有差异。偏倚风险一般为中等:结论:与胶原酶和针式筋膜切开术相比,筋膜切除术在患者预后方面具有长期优势。未来需要进行更大规模的试验,并对结果评估者进行更好的盲法评估。
{"title":"Surgical Management of Dupuytren Disease: A Systematic Review and Network Meta-analyses.","authors":"Silas Nann, Joshua Kovoor, James Fowler, James Kieu, Aashray Gupta, Joseph Hewitt, Christopher Ovenden, Suzanne Edwards, Stephen Bacchi, Jonathan Henry W Jacobsen, Richard Harries, Guy Maddern","doi":"10.1177/15589447231174175","DOIUrl":"10.1177/15589447231174175","url":null,"abstract":"<p><strong>Background: </strong>Dupuytren disease is a common fibroproliferative disease that affects the palmar fascia of the hands. Currently, there is limited consensus regarding the optimal therapy for this condition, with treatment decisions based largely on surgeon preference. Therefore, the aim of this study was to determine which treatments are the most effective for Dupuytren disease.</p><p><strong>Method: </strong>A systematic review and network meta-analyses were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Medline, EMBASE, and Web of Science were searched for randomized trials comparing treatments for Dupuytren disease in adults. Eligible treatments included open limited fasciectomy, collagenase injection, and percutaneous needle fasciotomy. Study selection, data extraction, and quality appraisal were performed in duplicate. The methodological quality was evaluated with the Cochrane risk-of-bias critical appraisal tool.</p><p><strong>Results: </strong>Eleven randomized clinical trials were included in this study. At short-term (1-12 weeks) and long-term (2-5 years) time points, fasciectomy improved contracture release more than collagenase and needle fasciotomy as inferred by a lower total passive extension deficit. However, there was no difference between the groups regarding the best possible outcome at any time point. Fasciectomy was also superior in terms of recurrence and patient satisfaction compared with collagenase and needle fasciotomy, but only at later time points. There was no difference in skin damage-related and nerve damage-related complications following fasciectomy compared with other modalities. Risk of bias was generally moderate.</p><p><strong>Conclusions: </strong>Fasciectomy provides superior long-term advantages in terms of patient outcomes when compared with collagenase and needle fasciotomy. Larger trials with better blinding of outcome assessors are needed in the future.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9534955","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
Risk Factors for Secondary Revision After Finger Amputations. 手指截肢后二次翻修的风险因素。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-06-03 DOI: 10.1177/15589447231174480
Nikhil Adapa, Zachary B Adkins, Krystin A Hidden, Kanu S Goyal

Background: Digit amputations are relatively simple and are often performed in the setting of trauma or infection. However, it is not uncommon for digit amputations to undergo secondary revision due to complications or patient dissatisfaction. Identifying factors associated with secondary revision may alter treatment strategy. We hypothesize that the secondary revision rate is affected by digit, initial level of amputation, and comorbidities.

Methods: A retrospective chart review was conducted on patients undergoing digit amputations in operating rooms at our institution from 2011 to 2017. Secondary revision amputations were defined as a separate return to the operating room following initial surgical amputation, excluding emergency room amputations. Patient demographics, comorbidities, level of amputation, and complications were collected.

Results: In all, 278 patients were included with a total of 386 digit amputations and mean follow-up of 2.6 months. Three hundred twenty-six primary digit amputations were performed in 236 patients (group A). Sixty digits were secondarily revised in 42 patients (group B). The secondary revision rate was 17.8% for patients and 15.5% for digits. Patients with heart disease and diabetes mellitus were associated with secondary revision, with wound complications being the leading indication overall (73.8%). Medicare covered 52.4% of patients in group B versus 30.1% in group A (P = .005).

Conclusion: Risk factors for secondary revision include Medicare insurance, comorbidities, previous digit amputations, and initial amputation of either the index finger or the distal phalanx. These data may serve as a prediction model to aid surgical decision-making by identifying patients at risk of secondary revision amputation.

背景:截肢相对简单,通常在创伤或感染的情况下进行。然而,由于并发症或患者不满意而进行二次翻修的情况并不少见。确定与二次翻修相关的因素可能会改变治疗策略。我们假设二次翻修率受截肢部位、初始截肢程度和合并症的影响:我们对 2011 年至 2017 年在本院手术室接受截肢手术的患者进行了回顾性病历审查。二次翻修截肢定义为初次手术截肢后再次返回手术室,不包括急诊室截肢。收集了患者的人口统计学资料、合并症、截肢程度和并发症:共有 278 名患者接受了 386 例截肢手术,平均随访时间为 2.6 个月。236名患者(A组)接受了326例初次截肢。42名患者(B组)进行了60个数位的二次修正。患者的二次翻修率为 17.8%,截肢率为 15.5%。心脏病和糖尿病患者与二次翻修有关,而伤口并发症是主要的适应症(73.8%)。B组52.4%的患者享受医疗保险,而A组为30.1%(P = .005):结论:二次翻修的风险因素包括医疗保险、合并症、既往截肢以及食指或远端指骨的初次截肢。这些数据可作为一个预测模型,通过识别有二次翻修截肢风险的患者来帮助手术决策。
{"title":"Risk Factors for Secondary Revision After Finger Amputations.","authors":"Nikhil Adapa, Zachary B Adkins, Krystin A Hidden, Kanu S Goyal","doi":"10.1177/15589447231174480","DOIUrl":"10.1177/15589447231174480","url":null,"abstract":"<p><strong>Background: </strong>Digit amputations are relatively simple and are often performed in the setting of trauma or infection. However, it is not uncommon for digit amputations to undergo secondary revision due to complications or patient dissatisfaction. Identifying factors associated with secondary revision may alter treatment strategy. We hypothesize that the secondary revision rate is affected by digit, initial level of amputation, and comorbidities.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients undergoing digit amputations in operating rooms at our institution from 2011 to 2017. Secondary revision amputations were defined as a separate return to the operating room following initial surgical amputation, excluding emergency room amputations. Patient demographics, comorbidities, level of amputation, and complications were collected.</p><p><strong>Results: </strong>In all, 278 patients were included with a total of 386 digit amputations and mean follow-up of 2.6 months. Three hundred twenty-six primary digit amputations were performed in 236 patients (group A). Sixty digits were secondarily revised in 42 patients (group B). The secondary revision rate was 17.8% for patients and 15.5% for digits. Patients with heart disease and diabetes mellitus were associated with secondary revision, with wound complications being the leading indication overall (73.8%). Medicare covered 52.4% of patients in group B versus 30.1% in group A (<i>P</i> = .005).</p><p><strong>Conclusion: </strong>Risk factors for secondary revision include Medicare insurance, comorbidities, previous digit amputations, and initial amputation of either the index finger or the distal phalanx. These data may serve as a prediction model to aid surgical decision-making by identifying patients at risk of secondary revision amputation.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9568590","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
Wassel VI Thumb Duplication With Triphalangeal Radial and Ulnar Thumbs: Anatomy and Surgical Reconstruction. Wassel VI拇指与延髓桡骨和尺骨拇指的复制:解剖学和外科重建。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-11-02 DOI: 10.1177/15589447231207982
Meaghan L Barr, Nirbhay S Jain, Neil F Jones

A 6-year-old otherwise healthy girl presented with a Wassel VI duplication of the left thumb metacarpal and triphalangeal radial and ulnar thumbs. The patient underwent successful thumb reconstruction by transposition of the distal ulnar thumb onto the radial thumb metacarpal. To the best of our knowledge, this case report represents the first published anatomical dissection and surgical reconstruction of a Wassel VI duplication with triphalangeal radial and ulnar thumbs.

一名6岁的健康女孩出现了左拇指掌骨和三指桡骨和尺骨拇指的Wassel VI复制。患者通过将尺侧拇指远端移位到拇指桡掌骨上,成功地进行了拇指重建。据我们所知,本病例报告代表了首次发表的Wassel VI三指桡骨和尺骨拇指复制的解剖解剖和外科重建。
{"title":"Wassel VI Thumb Duplication With Triphalangeal Radial and Ulnar Thumbs: Anatomy and Surgical Reconstruction.","authors":"Meaghan L Barr, Nirbhay S Jain, Neil F Jones","doi":"10.1177/15589447231207982","DOIUrl":"10.1177/15589447231207982","url":null,"abstract":"<p><p>A 6-year-old otherwise healthy girl presented with a Wassel VI duplication of the left thumb metacarpal and triphalangeal radial and ulnar thumbs. The patient underwent successful thumb reconstruction by transposition of the distal ulnar thumb onto the radial thumb metacarpal. To the best of our knowledge, this case report represents the first published anatomical dissection and surgical reconstruction of a Wassel VI duplication with triphalangeal radial and ulnar thumbs.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71423184","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
Isolated Fourth Carpometacarpal Joint Injury in High-Level Baseball Players: A Case Series. 高水平棒球运动员的孤立性第四掌腕关节损伤:病例系列。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-18 DOI: 10.1177/15589447231167584
William P Stults, Gary M Lourie, Jeremy T Royal

Background: We present a case series of high-level baseball players having sustained a rare, isolated injury to the fourth carpometacarpal joint of the nondominant or bottom hand during a jammed swing.

Methods: Ten patients were evaluated for ulnar-sided wrist pain and were subsequently diagnosed with fourth carpometacarpal joint synovitis based on physical examination and magnetic resonance imaging revealing increased signal intensity within the joint.

Results: Conservative treatment modalities including rest, nonsteroidal anti-inflammatory medications, splinting, and corticosteroid injections resulted in return to play within 4 weeks for all patients.

Conclusions: We propose a mechanism of injury involving the bottom hand in relative pronation receiving a dorsally directed force from bat during a jammed swing resulting in isolated injury to the fourth carpometacarpal joint. This report serves to highlight this rare injury in high-level baseball players and recommend a treatment algorithm for early return to play.

背景:我们介绍了一个高水平棒球运动员的病例系列,这些运动员在一次卡位挥棒过程中,非支配手或下位手的第四腕掌关节受到了罕见的、孤立的损伤:十名患者因尺侧腕部疼痛接受了评估,随后根据体格检查和磁共振成像显示关节内信号强度增高确诊为第四腕掌关节滑膜炎:保守治疗方法包括休息、非甾体抗炎药物、夹板和皮质类固醇注射,所有患者均在 4 周内恢复比赛:我们提出了一种损伤机制,即在卡位挥棒过程中,处于相对前倾位的下侧手部受到球棒向背侧的作用力,从而导致第四腕掌关节的孤立性损伤。本报告旨在强调这种在高水平棒球运动员中罕见的损伤,并为早日重返赛场推荐一种治疗算法。
{"title":"Isolated Fourth Carpometacarpal Joint Injury in High-Level Baseball Players: A Case Series.","authors":"William P Stults, Gary M Lourie, Jeremy T Royal","doi":"10.1177/15589447231167584","DOIUrl":"10.1177/15589447231167584","url":null,"abstract":"<p><strong>Background: </strong>We present a case series of high-level baseball players having sustained a rare, isolated injury to the fourth carpometacarpal joint of the nondominant or bottom hand during a jammed swing.</p><p><strong>Methods: </strong>Ten patients were evaluated for ulnar-sided wrist pain and were subsequently diagnosed with fourth carpometacarpal joint synovitis based on physical examination and magnetic resonance imaging revealing increased signal intensity within the joint.</p><p><strong>Results: </strong>Conservative treatment modalities including rest, nonsteroidal anti-inflammatory medications, splinting, and corticosteroid injections resulted in return to play within 4 weeks for all patients.</p><p><strong>Conclusions: </strong>We propose a mechanism of injury involving the bottom hand in relative pronation receiving a dorsally directed force from bat during a jammed swing resulting in isolated injury to the fourth carpometacarpal joint. This report serves to highlight this rare injury in high-level baseball players and recommend a treatment algorithm for early return to play.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9472852","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
External Fixation Prior to Fasciectomy Leads to Substantial Improvement of Advanced Dupuytren's PIP Contractures at Mean Follow-up 15 Months. 在筋膜切除术前进行外固定,可在平均随访 15 个月后显著改善晚期杜普伊特伦趾挛缩症。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-06-02 DOI: 10.1177/15589447231175512
Bowen Qiu, Warren Hammert, Danielle Wilbur

Background: The Digit Widget is an external fixation device that can be used to reverse proximal interphalangeal joint (PIPJ) contractures in the hand. Our hypothesis is that usage of the Digit Widget prior to fasciectomy in patients with severe Dupuytren's proximal interphalangeal (PIP) contractures will result in short-term improvement and maintenance of the PIPJ contracture after fasciectomy.

Methods: Patients who underwent placement of the Digit Widget soft tissue distractor prior to fasciectomy for Dupuytren's disease were identified between January 2015 and December 2018. Multiple fingers were considered separately. Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Pain Interference, and Depression scores were collected. Patients treated for contractures from etiologies other than Dupuytren's were not included. Multiple linear regression was used to compare initial PIP contractures, PF scores, and final contractures.

Results: There were 28 fingers in 24 patients with average age of 56 ± 12 (30.5-69.9) years. Initial mean PIPJ contracture was 81° (50°-120°), which had corrected to 23° at time of removal. Average time between application and fasciectomy was 58 (28-112) days. At final follow-up, average 449 (58-1641) days, the average contracture was 39° (0°-105°). Contracture immediately following fasciectomy was found to be strongly correlated with the contracture at final follow-up. There was no statistical relationship between final PROMIS PF scores and final change in contracture.

Conclusions: Digit Widget external fixation is an effective treatment for the correction of advanced PIPJ contractures related to Dupuytren's disease, with an average of 52% improvement in contracture at 15 months.

背景:Digit Widget是一种外固定装置,可用于扭转手部近端指间关节(PIPJ)挛缩。我们的假设是,在对患有严重杜普伊特伦氏近端指间关节(PIP)挛缩的患者进行筋膜切除术之前使用 Digit Widget,将在短期内改善并在筋膜切除术后维持 PIPJ挛缩:在2015年1月至2018年12月期间,确定了因杜普伊特伦氏病在筋膜切除术前接受Digit Widget软组织牵引器置入术的患者。多指分别考虑。收集了患者报告结果测量信息系统(PROMIS)的身体功能(PF)、疼痛干扰和抑郁评分。除杜普伊特伦氏症外,因其他病因导致挛缩而接受治疗的患者不包括在内。采用多元线性回归比较最初的PIP挛缩、PF评分和最终的挛缩:24名患者共有28个手指,平均年龄为56±12(30.5-69.9)岁。最初的 PIPJ 平均挛缩度为 81°(50°-120°),切除时已矫正为 23°。从使用到筋膜切除的平均时间为 58(28-112)天。在最后平均 449(58-1641)天的随访中,平均挛缩度为 39°(0°-105°)。研究发现,筋膜切除术后的挛缩与最终随访时的挛缩密切相关。最终的PROMIS PF评分与最终的挛缩变化之间没有统计学关系:Digit Widget外固定是矫正杜普伊特伦氏病相关晚期PIPJ挛缩的有效治疗方法,15个月时挛缩平均改善52%。
{"title":"External Fixation Prior to Fasciectomy Leads to Substantial Improvement of Advanced Dupuytren's PIP Contractures at Mean Follow-up 15 Months.","authors":"Bowen Qiu, Warren Hammert, Danielle Wilbur","doi":"10.1177/15589447231175512","DOIUrl":"10.1177/15589447231175512","url":null,"abstract":"<p><strong>Background: </strong>The Digit Widget is an external fixation device that can be used to reverse proximal interphalangeal joint (PIPJ) contractures in the hand. Our hypothesis is that usage of the Digit Widget prior to fasciectomy in patients with severe Dupuytren's proximal interphalangeal (PIP) contractures will result in short-term improvement and maintenance of the PIPJ contracture after fasciectomy.</p><p><strong>Methods: </strong>Patients who underwent placement of the Digit Widget soft tissue distractor prior to fasciectomy for Dupuytren's disease were identified between January 2015 and December 2018. Multiple fingers were considered separately. Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Pain Interference, and Depression scores were collected. Patients treated for contractures from etiologies other than Dupuytren's were not included. Multiple linear regression was used to compare initial PIP contractures, PF scores, and final contractures.</p><p><strong>Results: </strong>There were 28 fingers in 24 patients with average age of 56 ± 12 (30.5-69.9) years. Initial mean PIPJ contracture was 81° (50°-120°), which had corrected to 23° at time of removal. Average time between application and fasciectomy was 58 (28-112) days. At final follow-up, average 449 (58-1641) days, the average contracture was 39° (0°-105°). Contracture immediately following fasciectomy was found to be strongly correlated with the contracture at final follow-up. There was no statistical relationship between final PROMIS PF scores and final change in contracture.</p><p><strong>Conclusions: </strong>Digit Widget external fixation is an effective treatment for the correction of advanced PIPJ contractures related to Dupuytren's disease, with an average of 52% improvement in contracture at 15 months.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9565613","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
Rapid Functional Recovery After Thoracic Outlet Decompression in a Series of Adolescent Athletes With Chronic Atraumatic Shoulder-Girdle Pain, Scapular Winging/Dyskinesis, and Normal Electrodiagnostic Studies. 对一系列肩腰部慢性创伤性疼痛、肩胛翼/运动障碍且电诊断正常的青少年运动员进行胸廓出口减压术后的快速功能恢复。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-07-31 DOI: 10.1177/15589447231187088
Jackson S Burton, Susan E Mackinnon, Paul B McKee, Karen M Henderson, Danita M Goestenkors, Robert W Thompson

Background: Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS).

Methods: We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.

Results: There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity.

Conclusions: A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic "Sunderland-zero" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management.

背景:自发性肩腰痛和肩胛翼/运动障碍可由多种神经肌肉疾病引起,这些疾病可通过电诊断检查(EDX)确定。我们描述了一组具有这种临床表现但 EDX 正常的青少年运动员,他们后来患上了神经源性胸廓出口综合征(NTOS):我们确定了转诊评估 NTOS 的患者,他们都有慢性肩腰部外伤性疼痛、肩胛翼/运动障碍的病史,且 EDX 正常。这些患者均因保守治疗无效而接受锁骨上减压术和臂丛神经切断术治疗 NTOS。功能障碍通过手臂、肩部和手部快速残疾(QuickDASH)评分进行量化:5名女性患者的平均发病年龄为(14.2±0.4)岁,包括肩部、肩胛骨和手臂的自发性剧烈疼痛,肩胛骨突出/运动障碍,EDX正常。转诊前症状已持续 18.9 ± 4.0 个月,并伴有明显的上肢残疾(QuickDASH 平均值为 54.6 ± 6.9)。在对NTOS进行手术治疗3个月后,所有5名患者的症状几乎完全消失,包括肩胛翼/运动障碍,功能明显改善(QuickDASH平均值为2.2 ± 1.3),并恢复了正常活动:结论:一部分肩腰部慢性外伤性疼痛、肩胛翼/运动障碍和 EDX 正常的患者可能会出现 NTOS 特征性的动态臂丛神经压迫,表现出缺血性 "桑德兰零点 "神经传导阻滞,手术减压可使临床症状得到快速、显著的改善。对于保守治疗无效的长期肩胛翼/运动障碍患者,应考虑是否存在可通过手术治疗的 NTOS。
{"title":"Rapid Functional Recovery After Thoracic Outlet Decompression in a Series of Adolescent Athletes With Chronic Atraumatic Shoulder-Girdle Pain, Scapular Winging/Dyskinesis, and Normal Electrodiagnostic Studies.","authors":"Jackson S Burton, Susan E Mackinnon, Paul B McKee, Karen M Henderson, Danita M Goestenkors, Robert W Thompson","doi":"10.1177/15589447231187088","DOIUrl":"10.1177/15589447231187088","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS).</p><p><strong>Methods: </strong>We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.</p><p><strong>Results: </strong>There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity.</p><p><strong>Conclusions: </strong>A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic \"Sunderland-zero\" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9898323","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
期刊
HAND
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1