Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.021
Xiaoyan Zhang, Yongjun Rui, Tao Sheng, Xiao-yun Pan
Objective To research the effects and mechanisms of glycine with different concentration on flaps after ischemia reperfusion injury. Methods Fifty three-month old healthy male SD rats were randomly divided into 5 groups. The abdominal island flaps were made. And 30 minutes before blocking blood flow, 1.5 ml 0.9% saline (group A), 50 mmol/L glycine (group B), 100 mmol/L glycine (group C), 400 mmol/L glycine (group D) and 1000 mmol/L glycine (group E) were injected into the pedicle artery of the flaps respectively. After 6 hours of ischemia, 1.5 ml 0.9% saline or glycine with different concentration was injected intraperitoneally 5 minutes before reperfusion. Blood samples were collected from pedicle veins at 1, 6 and 12 hours after reperfusion to determine the plasma concentration of tumor necrosis factor α (TNF-α). The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured at 12 hours after reperfusion. Results The levels of TNF-alpha and MDA in different concentrations of glycine group were significantly lower than those in saline group, while the levels of SOD were significantly higher than those in saline group (P<0.05). The difference between D, E group with higher glycine concentration and B, C group with lower glycine concentration had statistical significance (P<0.05). Conclusion Glycine can alleviate the ischemia reperfusion injury of rat flaps by decreasing TNF-α and MDA levels in plasma and increasing SOD levels. Key words: Glycine; Reperfusion injury; Flaps; TNF-α
{"title":"Protective effects of glycine on flap after ischemia reperfusion injury: an experimental study in rats","authors":"Xiaoyan Zhang, Yongjun Rui, Tao Sheng, Xiao-yun Pan","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.021","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.021","url":null,"abstract":"Objective \u0000To research the effects and mechanisms of glycine with different concentration on flaps after ischemia reperfusion injury. \u0000 \u0000 \u0000Methods \u0000Fifty three-month old healthy male SD rats were randomly divided into 5 groups. The abdominal island flaps were made. And 30 minutes before blocking blood flow, 1.5 ml 0.9% saline (group A), 50 mmol/L glycine (group B), 100 mmol/L glycine (group C), 400 mmol/L glycine (group D) and 1000 mmol/L glycine (group E) were injected into the pedicle artery of the flaps respectively. After 6 hours of ischemia, 1.5 ml 0.9% saline or glycine with different concentration was injected intraperitoneally 5 minutes before reperfusion. Blood samples were collected from pedicle veins at 1, 6 and 12 hours after reperfusion to determine the plasma concentration of tumor necrosis factor α (TNF-α). The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured at 12 hours after reperfusion. \u0000 \u0000 \u0000Results \u0000The levels of TNF-alpha and MDA in different concentrations of glycine group were significantly lower than those in saline group, while the levels of SOD were significantly higher than those in saline group (P<0.05). The difference between D, E group with higher glycine concentration and B, C group with lower glycine concentration had statistical significance (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000Glycine can alleviate the ischemia reperfusion injury of rat flaps by decreasing TNF-α and MDA levels in plasma and increasing SOD levels. \u0000 \u0000 \u0000Key words: \u0000Glycine; Reperfusion injury; Flaps; TNF-α","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45840880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.014
Xubei Su, Jun Wang, Yongjun Rui, Y. Qiu
Objective To observe the rehabilitation efficacy of exercise prescription in the treatment after severed finger replantation and tenolysis. Methods Twenty patients were randomly divided into control group (10 cases, 27 fingers) and observation group (10 cases, 28 fingers). The control group received routine rehabilitation treatment, while the observation group received routine rehabilitation combined with targeted exercise generated by exercise prescription system. The total active motion (TAM) and the criteria of replantation function evaluation of severed fingers issued by the Hand Surgery Society of Chinese Medical Association were used to evaluate hand function before and after treatment. Results After the treatment, the criteria of replantation function evaluation of severed fingers was (69±21.43) points in the observation group and (52.00±22.43) points in the control group, while the TAM was (164.39±26.72) ° in the observation group and (138.92±25.95) ° in the control group. The excellent and good rate of TAM was 70.3% in the observation group and 53.6% in the control group. There was a statistically significant difference before and after the treatment (P<0.05). There was a statistically significant difference between the two groups (P<0.05). The observation group was superior to the control group. Conclusion For the patients performed severed finger replantation and tenolysis, we should pay close attention to the adhesion in the sheath of the flexor tendon zone Ⅱ. With practical exercise prescription guidance, patients were instructed to perform relative sliding exercises between tendons to help further rehabilitation of hand function. Key words: Replantation; Rehabilitation; Tenolysis; Exercise prescription; Tendon sliding
{"title":"Rehabilitation efficacy observation of exercise prescription in the treatment after severed finger replantation and tenolysis","authors":"Xubei Su, Jun Wang, Yongjun Rui, Y. Qiu","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.014","url":null,"abstract":"Objective \u0000To observe the rehabilitation efficacy of exercise prescription in the treatment after severed finger replantation and tenolysis. \u0000 \u0000 \u0000Methods \u0000Twenty patients were randomly divided into control group (10 cases, 27 fingers) and observation group (10 cases, 28 fingers). The control group received routine rehabilitation treatment, while the observation group received routine rehabilitation combined with targeted exercise generated by exercise prescription system. The total active motion (TAM) and the criteria of replantation function evaluation of severed fingers issued by the Hand Surgery Society of Chinese Medical Association were used to evaluate hand function before and after treatment. \u0000 \u0000 \u0000Results \u0000After the treatment, the criteria of replantation function evaluation of severed fingers was (69±21.43) points in the observation group and (52.00±22.43) points in the control group, while the TAM was (164.39±26.72) ° in the observation group and (138.92±25.95) ° in the control group. The excellent and good rate of TAM was 70.3% in the observation group and 53.6% in the control group. There was a statistically significant difference before and after the treatment (P<0.05). There was a statistically significant difference between the two groups (P<0.05). The observation group was superior to the control group. \u0000 \u0000 \u0000Conclusion \u0000For the patients performed severed finger replantation and tenolysis, we should pay close attention to the adhesion in the sheath of the flexor tendon zone Ⅱ. With practical exercise prescription guidance, patients were instructed to perform relative sliding exercises between tendons to help further rehabilitation of hand function. \u0000 \u0000 \u0000Key words: \u0000Replantation; Rehabilitation; Tenolysis; Exercise prescription; Tendon sliding","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"35-38"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45894123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.001
Kai Wang, J. Ju, G. Jin, Liping Guo
Objective To report the clinical efficacy of dorsal lateral supporting plate in the treatment of the fourth and fifth carpometacarpal joint fractures and dislocations. Methods From June 2010 to May 2017, 7 patients with the fourth and fifth carpometacarpal joint fractures and dislocations were treated by dorsal lateral supporting plate and Kirschner wire fixation. The fractures of the hamate bone were all Cain type Ⅱunstable fractures, including 1 case of type ⅡA, 4 cases of type Ⅱ B, and 2 cases of type Ⅱ C. Among them, 2 cases had the base of the fourth and fifth metacarpal bone fractures, and 2 cases had only the base of the fourth metacarpal bone fracture. Results All the wounds achieved primary healing. The fracture healing time ranged from 8 to 12 weeks. The internal fixation was taken out depending on the healing of the fracture. All the patients were follow-up from 5 to 12 months with an average of 7 months. The flexion and extension function of all the hand joints recovered well. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 4 cases and good in 3 cases. Conclusion The treatment of fractures and dislocations of the fourth and fifth carpometacarpal joints with dorsal supporting plate and Kirschner wire fixation can provide stable fixation in multiple planes and directions, which is helpful for early functional exercise. Key words: Hamate bone; Carpometacarpal joints; Fractures,bone; Dislocations
{"title":"Application of dorsal supporting plate for treatment of the fourth and fifth carpometacarpal joint fractures and dislocations","authors":"Kai Wang, J. Ju, G. Jin, Liping Guo","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.001","url":null,"abstract":"Objective \u0000To report the clinical efficacy of dorsal lateral supporting plate in the treatment of the fourth and fifth carpometacarpal joint fractures and dislocations. \u0000 \u0000 \u0000Methods \u0000From June 2010 to May 2017, 7 patients with the fourth and fifth carpometacarpal joint fractures and dislocations were treated by dorsal lateral supporting plate and Kirschner wire fixation. The fractures of the hamate bone were all Cain type Ⅱunstable fractures, including 1 case of type ⅡA, 4 cases of type Ⅱ B, and 2 cases of type Ⅱ C. Among them, 2 cases had the base of the fourth and fifth metacarpal bone fractures, and 2 cases had only the base of the fourth metacarpal bone fracture. \u0000 \u0000 \u0000Results \u0000All the wounds achieved primary healing. The fracture healing time ranged from 8 to 12 weeks. The internal fixation was taken out depending on the healing of the fracture. All the patients were follow-up from 5 to 12 months with an average of 7 months. The flexion and extension function of all the hand joints recovered well. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 4 cases and good in 3 cases. \u0000 \u0000 \u0000Conclusion \u0000The treatment of fractures and dislocations of the fourth and fifth carpometacarpal joints with dorsal supporting plate and Kirschner wire fixation can provide stable fixation in multiple planes and directions, which is helpful for early functional exercise. \u0000 \u0000 \u0000Key words: \u0000Hamate bone; Carpometacarpal joints; Fractures,bone; Dislocations","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44064019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.011
W. Feng, Danmou Xing, D. Ren, Yan Chen, Huan Wang, Zhiming Zhao, Zhihong Xiao, Ming Zhang
Objective To investigate the clinical efficacy, indications and precautions of dual intersecting trapezoid flaps and laterodigital flaps in the treatment of finger flexion deformity of scar contracture. Methods From February 2014 to October 2016, 14 patients (25 fingers) with finger flexion deformity of scar contracture were treated. According to the extension of scar contracture line, dual intersecting trapezoid flaps were used in 7 cases (12 fingers) (group A) and laterodigital flaps were used in 7 cases (13 fingers) (group B). The repair range, infection and necrosis rate, total active motion of inured finger (TAM), extension rate of scar contracture line and reoperation were compared between the two groups. Results All the flaps survived uneventfully. The repair range of group A reached the level of DIP and group B reached the level of PIP. There was no reoperation due to recurrence of scar contracture in both groups, but the satisfaction of group B was lower than that of group A. Conclusion The dual intersecting trapezoid flaps have reliable blood supply and the operation is simple, the repair range of which can reach the level of DIP. They can allow early joint movement. It is a more ideal method for the treatment of finger flexion deformity of trans-articular scar contracture. Key words: Surgical flaps; Finger injuries; Cicatrix; Contracture
{"title":"Comparison of two methods in the treatment of finger flexion deformity of scar contracture","authors":"W. Feng, Danmou Xing, D. Ren, Yan Chen, Huan Wang, Zhiming Zhao, Zhihong Xiao, Ming Zhang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.011","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy, indications and precautions of dual intersecting trapezoid flaps and laterodigital flaps in the treatment of finger flexion deformity of scar contracture. \u0000 \u0000 \u0000Methods \u0000From February 2014 to October 2016, 14 patients (25 fingers) with finger flexion deformity of scar contracture were treated. According to the extension of scar contracture line, dual intersecting trapezoid flaps were used in 7 cases (12 fingers) (group A) and laterodigital flaps were used in 7 cases (13 fingers) (group B). The repair range, infection and necrosis rate, total active motion of inured finger (TAM), extension rate of scar contracture line and reoperation were compared between the two groups. \u0000 \u0000 \u0000Results \u0000All the flaps survived uneventfully. The repair range of group A reached the level of DIP and group B reached the level of PIP. There was no reoperation due to recurrence of scar contracture in both groups, but the satisfaction of group B was lower than that of group A. \u0000 \u0000 \u0000Conclusion \u0000The dual intersecting trapezoid flaps have reliable blood supply and the operation is simple, the repair range of which can reach the level of DIP. They can allow early joint movement. It is a more ideal method for the treatment of finger flexion deformity of trans-articular scar contracture. \u0000 \u0000 \u0000Key words: \u0000Surgical flaps; Finger injuries; Cicatrix; Contracture","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"27-29"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44012401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.006
J. Qi, B. Sun, Linhai Liu, Yi-ming Chai, Jian Huang, Xuanliang Fang, Xu-hui Fan, Heyang Sun, Xin Wang
Objective To investigate the clinical effect of individualized free ilioinguinal flap in repairing hand skin and soft tissue defects. Methods From January 2013 to December 2017, 97 cases of hand skin and soft tissue defects were treated with free ilioinguinal flap. There were 63 cases of superficial circumflex iliac artery flap (26 cases of superficial circumflex iliac artery flap with iliac bone), 15 cases of superficial abdominal artery flap and 19 cases of combined flap of superficial circumflex iliac artery and superficial abdominal artery (7 cases of lobulated flap). The area of skin defects ranged from 4 cm×6 cm to 11 cm×23 cm. During the operation, end to end anastomosis of flap artery and the end branch of radial artery in 5 cases, end to side anastomosis of radial artery in 58 cases, end to side anastomosis of ulnar artery in 20 cases, end to side anastomosis of common digital artery in 14 cases. All the superficial circumflex iliac veins and superficial abdominal veins were repaired (a concomitant vein were repaired at the same time in 31 cases). The donor site was sutured directly after flexion of hip and knee without skin grafting. Three weeks, 1.5 months, 3 months, 6 months, 1 year and 2 years after the operation, the healing of donor area and the appearance and sensory recovery of recipient area skin flaps were observed. Results Postoperatively 94 cases survived successfully. Arterial crisis occurred in 1 case and venous crisis in 2 cases. 2 cases received surgical exploration and 1 case received conservative treatment. After that, 1 case survived smoothly and 2 cases suffered skin necrosis. Subcutaneous soft tissue survived after secondary escharectomy and survived after skin grafting. In one case of abdominal donor site, the incision dehiscence occurred in the first week of walking upright after operation, and healed after secondary suture. The remaining donor sites achieved primary healing. The follow-up period ranged from 0.5 to 1.5 years. The flaps were soft and slightly swollen, and the sensation returned to S2 or S3. There were only linear scars in the abdominal donor site. Conclusion According to the skin and soft tissue defects in the recipient area of the hand, the individualized free ilioinguinal flap transplantation can meet the different needs of the recipient area. The donor site is concealed, the cutting area is large, and it can be directly sutured. It belongs to the axial skin flaps. The blood vessels are constant, the cutting is convenient, the main blood vessels are not destroyed, and the operation time is short. Therefore, it is one of the ideal methods to repair the skin and soft tissue defects of limbs. Key words: Hand injuries; Surgical flaps; Skin and soft tissue defects; Free; Individualized
{"title":"Application of free ilioinguinal flap for repair of hand skin and soft tissue defects","authors":"J. Qi, B. Sun, Linhai Liu, Yi-ming Chai, Jian Huang, Xuanliang Fang, Xu-hui Fan, Heyang Sun, Xin Wang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.006","url":null,"abstract":"Objective \u0000To investigate the clinical effect of individualized free ilioinguinal flap in repairing hand skin and soft tissue defects. \u0000 \u0000 \u0000Methods \u0000From January 2013 to December 2017, 97 cases of hand skin and soft tissue defects were treated with free ilioinguinal flap. There were 63 cases of superficial circumflex iliac artery flap (26 cases of superficial circumflex iliac artery flap with iliac bone), 15 cases of superficial abdominal artery flap and 19 cases of combined flap of superficial circumflex iliac artery and superficial abdominal artery (7 cases of lobulated flap). The area of skin defects ranged from 4 cm×6 cm to 11 cm×23 cm. During the operation, end to end anastomosis of flap artery and the end branch of radial artery in 5 cases, end to side anastomosis of radial artery in 58 cases, end to side anastomosis of ulnar artery in 20 cases, end to side anastomosis of common digital artery in 14 cases. All the superficial circumflex iliac veins and superficial abdominal veins were repaired (a concomitant vein were repaired at the same time in 31 cases). The donor site was sutured directly after flexion of hip and knee without skin grafting. Three weeks, 1.5 months, 3 months, 6 months, 1 year and 2 years after the operation, the healing of donor area and the appearance and sensory recovery of recipient area skin flaps were observed. \u0000 \u0000 \u0000Results \u0000Postoperatively 94 cases survived successfully. Arterial crisis occurred in 1 case and venous crisis in 2 cases. 2 cases received surgical exploration and 1 case received conservative treatment. After that, 1 case survived smoothly and 2 cases suffered skin necrosis. Subcutaneous soft tissue survived after secondary escharectomy and survived after skin grafting. In one case of abdominal donor site, the incision dehiscence occurred in the first week of walking upright after operation, and healed after secondary suture. The remaining donor sites achieved primary healing. The follow-up period ranged from 0.5 to 1.5 years. The flaps were soft and slightly swollen, and the sensation returned to S2 or S3. There were only linear scars in the abdominal donor site. \u0000 \u0000 \u0000Conclusion \u0000According to the skin and soft tissue defects in the recipient area of the hand, the individualized free ilioinguinal flap transplantation can meet the different needs of the recipient area. The donor site is concealed, the cutting area is large, and it can be directly sutured. It belongs to the axial skin flaps. The blood vessels are constant, the cutting is convenient, the main blood vessels are not destroyed, and the operation time is short. Therefore, it is one of the ideal methods to repair the skin and soft tissue defects of limbs. \u0000 \u0000 \u0000Key words: \u0000Hand injuries; Surgical flaps; Skin and soft tissue defects; Free; Individualized","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"12-15"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48119829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.012
Xuan Zhang, Yongqing Zhuang, J. Lao, Hong-tao Xiong, Rui-xue Wei, Yingnan Liu, Guifen Wen, T. Xu, Zhaokang Liu, Chunling Chen
Objective To explore the anatomical basis and simulated operation of a new minimally invasive treatment for thoracic outlet syndrome (TOS) through supraclavicular approach. Methods Local dissection in both sides was performed at lateral and anterior neck region in 5 cadavers. The endoscopic approach and operative plane were determined according to their anatomical characteristics, and the distance from the approach point to the transverse cervical artery was measured. Endoscopic surgery was simulated on a fresh cadaver to observe the tissue level and perform the release of brachial plexus. Results The distance between sternum head of sternocleidomastoid muscle and mastoid process was (13.78±0.94) cm. The distance between the cross border of the posterior border of sternocleidomastoid muscle and the upper border of the 5th root of brachial plexus and sternal head was measured (7.79±0.60) cm, which account for (56.58±2.78)% of the total length of sternocleidomastoid muscle. The anatomical study showed the optimum surgical entrance point: 60% of the total length of sternal head to mastoid process, 60° to the healthy side of the head, and 1 cm of longitudinal incision. The incision was performed on fresh human specimens and the transverse cervical artery was the landmark anatomical structure under the endoscope. Conclusion Supraclavicular approach endoscopic minimally invasive treatment for TOS is feasible, which can clearly expose brachial plexus nerve to perform brachial plexus neurolysis operation. It has clinical application value. Key words: Thoracic outlet syndrome; Dissection; Endoscopes; Surgical approach
{"title":"Anatomic and clinical study of endoscopic assisted surgery via supraclavicular approach in thoracic outlet syndrome","authors":"Xuan Zhang, Yongqing Zhuang, J. Lao, Hong-tao Xiong, Rui-xue Wei, Yingnan Liu, Guifen Wen, T. Xu, Zhaokang Liu, Chunling Chen","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.012","url":null,"abstract":"Objective \u0000To explore the anatomical basis and simulated operation of a new minimally invasive treatment for thoracic outlet syndrome (TOS) through supraclavicular approach. \u0000 \u0000 \u0000Methods \u0000Local dissection in both sides was performed at lateral and anterior neck region in 5 cadavers. The endoscopic approach and operative plane were determined according to their anatomical characteristics, and the distance from the approach point to the transverse cervical artery was measured. Endoscopic surgery was simulated on a fresh cadaver to observe the tissue level and perform the release of brachial plexus. \u0000 \u0000 \u0000Results \u0000The distance between sternum head of sternocleidomastoid muscle and mastoid process was (13.78±0.94) cm. The distance between the cross border of the posterior border of sternocleidomastoid muscle and the upper border of the 5th root of brachial plexus and sternal head was measured (7.79±0.60) cm, which account for (56.58±2.78)% of the total length of sternocleidomastoid muscle. The anatomical study showed the optimum surgical entrance point: 60% of the total length of sternal head to mastoid process, 60° to the healthy side of the head, and 1 cm of longitudinal incision. The incision was performed on fresh human specimens and the transverse cervical artery was the landmark anatomical structure under the endoscope. \u0000 \u0000 \u0000Conclusion \u0000Supraclavicular approach endoscopic minimally invasive treatment for TOS is feasible, which can clearly expose brachial plexus nerve to perform brachial plexus neurolysis operation. It has clinical application value. \u0000 \u0000 \u0000Key words: \u0000Thoracic outlet syndrome; Dissection; Endoscopes; Surgical approach","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"30-33"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47631249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.004
Jie Fang, Wen-long Zhang, C. Xie
Objective To compare the clinical efficacy of closed reduction Kirschner wire transverse fixation, open reduction Kirschner wire cross fixation and open reduction plate screw fixation in the treatment of the fifth metacarpal neck fractures. Methods From March 2010 to January 2017, 83 patients with fresh closed fifth metacarpal neck fractures were treated by closed reduction Kirschner wire transverse fixation (34 cases as group A), open reduction Kirschner wire cross fixation (22 cases as group B) and open reduction plate screw fixation (27 cases as group C). According to the operation time, the number of C-arm fluoroscopy, complications, joint function recovery, grip strength and patient satisfaction, the efficacy of the three surgical methods was evaluated comprehensively. Results All the 83 patients were follow-up for 7 to 33 months with an average of 16.5 months. All the fractures achieved anatomical reduction and bone healing. At the last follow-up, there were no significant differences in grip strength, fracture healing time, complications and C-arm fluoroscopy frequency among the three groups (P>0.05). The operative time between group A and group B, group A and group C were significantly different (P 0.05). According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 27 cases, good in 4 cases and fair in 3 cases with the excellent and good rate being 91.2% for group A; the results were rated as excellent in 15 cases, good in 5 cases and fair in 2 cases with the excellent and good rate being 90.9% for group B; the results were rated as excellent in 16 cases, good in 7 cases and fair in 4 cases with the excellent and good rate being 85.2% for group C. Conclusion The application of closed reduction Kirschner wire transverse fixation in the treatment of fresh closed fifth metacarpal neck fractures has the advantages of easy operation, short operation time, stable fixation, little joint and tendon irritation and allowing early functional exercise. It has satisfactory efficacy and is worthy of clinical promotion. Key words: Metacarpal bones; Fractures,bone; Comparative study; Kirschner wire; Plate
{"title":"Comparison study of three fixation methods for the treatment of the fifth metacarpal neck fractures","authors":"Jie Fang, Wen-long Zhang, C. Xie","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.004","url":null,"abstract":"Objective \u0000To compare the clinical efficacy of closed reduction Kirschner wire transverse fixation, open reduction Kirschner wire cross fixation and open reduction plate screw fixation in the treatment of the fifth metacarpal neck fractures. \u0000 \u0000 \u0000Methods \u0000From March 2010 to January 2017, 83 patients with fresh closed fifth metacarpal neck fractures were treated by closed reduction Kirschner wire transverse fixation (34 cases as group A), open reduction Kirschner wire cross fixation (22 cases as group B) and open reduction plate screw fixation (27 cases as group C). According to the operation time, the number of C-arm fluoroscopy, complications, joint function recovery, grip strength and patient satisfaction, the efficacy of the three surgical methods was evaluated comprehensively. \u0000 \u0000 \u0000Results \u0000All the 83 patients were follow-up for 7 to 33 months with an average of 16.5 months. All the fractures achieved anatomical reduction and bone healing. At the last follow-up, there were no significant differences in grip strength, fracture healing time, complications and C-arm fluoroscopy frequency among the three groups (P>0.05). The operative time between group A and group B, group A and group C were significantly different (P 0.05). According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 27 cases, good in 4 cases and fair in 3 cases with the excellent and good rate being 91.2% for group A; the results were rated as excellent in 15 cases, good in 5 cases and fair in 2 cases with the excellent and good rate being 90.9% for group B; the results were rated as excellent in 16 cases, good in 7 cases and fair in 4 cases with the excellent and good rate being 85.2% for group C. \u0000 \u0000 \u0000Conclusion \u0000The application of closed reduction Kirschner wire transverse fixation in the treatment of fresh closed fifth metacarpal neck fractures has the advantages of easy operation, short operation time, stable fixation, little joint and tendon irritation and allowing early functional exercise. It has satisfactory efficacy and is worthy of clinical promotion. \u0000 \u0000 \u0000Key words: \u0000Metacarpal bones; Fractures,bone; Comparative study; Kirschner wire; Plate","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"8-11"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44223934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.018
Baoshan Liu, J. Kong, Shuang Li, Y. Gong, H. Ben, Qingzhong Chen
Objective To evaluate the efficacy of carpal tunnel release with small incision in wrist and palm for the treatment of carpal tunnel syndrome using evidence-based medicine method. Methods PubMed, Cochrane Library, EMBASE, CBM, CNKI and Wanfang databases were searched by computer for relevant studies from their establishment to March 2018. References of relevant articles were checked for additional articles. All relevant randomized controlled trials were collected and the methodological quality of the included studies was evaluated. Revman 5.3 software was used for meta-analysis to obtain the evidence of differences in the efficacy of carpal tunnel release through wrist and palm incisions in the treatment of carpal tunnel syndrome. Results Five randomized controlled trials were included for evaluation. Meta-analysis showed that there was no significant difference in BCTQ postoperative symptom score and operation time between wrist incision group and palm incision group (P>0.05). The BCTQ postoperative functional score and incidence of scar discomfort in wrist incision group were better than those in palm incision group (P<0.05). Conclusion Compared with the palm incision group, the wrist incision group has some advantages in promoting functional recovery and reducing the incidence of scar discomfort, but it still needs a large sample of high-quality randomized controlled trials to verify the results of this analysis. Key words: Carpal tunnel syndrome; Meta-analysis; Limited invasion; Randomized controlled trials
{"title":"A meta-analysis of clinical outcomes of limited wrist invasion versus limited palmar invasion for the treatment of carpal tunnel syndrome","authors":"Baoshan Liu, J. Kong, Shuang Li, Y. Gong, H. Ben, Qingzhong Chen","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.018","url":null,"abstract":"Objective \u0000To evaluate the efficacy of carpal tunnel release with small incision in wrist and palm for the treatment of carpal tunnel syndrome using evidence-based medicine method. \u0000 \u0000 \u0000Methods \u0000PubMed, Cochrane Library, EMBASE, CBM, CNKI and Wanfang databases were searched by computer for relevant studies from their establishment to March 2018. References of relevant articles were checked for additional articles. All relevant randomized controlled trials were collected and the methodological quality of the included studies was evaluated. Revman 5.3 software was used for meta-analysis to obtain the evidence of differences in the efficacy of carpal tunnel release through wrist and palm incisions in the treatment of carpal tunnel syndrome. \u0000 \u0000 \u0000Results \u0000Five randomized controlled trials were included for evaluation. Meta-analysis showed that there was no significant difference in BCTQ postoperative symptom score and operation time between wrist incision group and palm incision group (P>0.05). The BCTQ postoperative functional score and incidence of scar discomfort in wrist incision group were better than those in palm incision group (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000Compared with the palm incision group, the wrist incision group has some advantages in promoting functional recovery and reducing the incidence of scar discomfort, but it still needs a large sample of high-quality randomized controlled trials to verify the results of this analysis. \u0000 \u0000 \u0000Key words: \u0000Carpal tunnel syndrome; Meta-analysis; Limited invasion; Randomized controlled trials","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"44-47"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43366268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.01.008
Lin Xiaoke, Ling Jingjing, Xiao Ni, Gao-bao Zhuo, Y. Jin, Shenghu Du, Fangzheng Yu
Objective To investigate the application and efficacy of modified progressive static splinting (National Invention Patent No. 201610777015.8) in the treatment of traumatic metacarpophalangeal joint stiffness. Methods From October 2016 to December 2017, 32 cases (97 fingers) of traumatic metacarpophalangeal joint stiffness were treated in our hospital. Among them, 16 cases (48 fingers) were given routine rehabilitation and progressive static splinting (group A) and 16 cases (49 fingers) were given routine rehabilitation and modified progressive static splinting (group B). The active and passive range of motion (AROM, PROM), visual analogue scale (VAS), Minnesota Manual Dexterity Test (MMDT), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, Semmes-Weinstein Monofilaments Examination (SWME) of the two groups were compared before and 2, 4, 6 weeks after the treatment. Results Before the rehabilitation treatment, there was no significant difference in AROM, PROM, VAS, MMDT time, DASH and SWME value between the two groups (P>0.05). After the treatment, AROM and PROM increased significantly, MMDT time shortened significantly, DASH and VAS scores decreased significantly, and SWME value increased significantly (P< 0.05). After the treatment, AROM and PROM of group B were significantly greater than those of group A, MMDT time of group B was significantly shorter than that of group A, DASH and VAS scores of group B were significantly lower than those of group A, and SWME value of group B was significantly smaller than that of group A (P < 0.05). Conclusion The modified progressive static splinting is better than traditional progressive static splinting in the treatment of traumatic metacarpophalangeal joint stiffness. The treatment process is more comfortable. It is easier to improve the dexterity of the hand and the ability of daily activities. It is worthy of clinical application. Key words: Metacarpophalangeal joint; Rehabilitation; Splinting; 3D printing
{"title":"Application of modified progressive static splinting for treatment of traumatic metacarpophalangeal joint stiffness","authors":"Lin Xiaoke, Ling Jingjing, Xiao Ni, Gao-bao Zhuo, Y. Jin, Shenghu Du, Fangzheng Yu","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.008","url":null,"abstract":"Objective \u0000To investigate the application and efficacy of modified progressive static splinting (National Invention Patent No. 201610777015.8) in the treatment of traumatic metacarpophalangeal joint stiffness. \u0000 \u0000 \u0000Methods \u0000From October 2016 to December 2017, 32 cases (97 fingers) of traumatic metacarpophalangeal joint stiffness were treated in our hospital. Among them, 16 cases (48 fingers) were given routine rehabilitation and progressive static splinting (group A) and 16 cases (49 fingers) were given routine rehabilitation and modified progressive static splinting (group B). The active and passive range of motion (AROM, PROM), visual analogue scale (VAS), Minnesota Manual Dexterity Test (MMDT), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, Semmes-Weinstein Monofilaments Examination (SWME) of the two groups were compared before and 2, 4, 6 weeks after the treatment. \u0000 \u0000 \u0000Results \u0000Before the rehabilitation treatment, there was no significant difference in AROM, PROM, VAS, MMDT time, DASH and SWME value between the two groups (P>0.05). After the treatment, AROM and PROM increased significantly, MMDT time shortened significantly, DASH and VAS scores decreased significantly, and SWME value increased significantly (P< 0.05). After the treatment, AROM and PROM of group B were significantly greater than those of group A, MMDT time of group B was significantly shorter than that of group A, DASH and VAS scores of group B were significantly lower than those of group A, and SWME value of group B was significantly smaller than that of group A (P < 0.05). \u0000 \u0000 \u0000Conclusion \u0000The modified progressive static splinting is better than traditional progressive static splinting in the treatment of traumatic metacarpophalangeal joint stiffness. The treatment process is more comfortable. It is easier to improve the dexterity of the hand and the ability of daily activities. It is worthy of clinical application. \u0000 \u0000 \u0000Key words: \u0000Metacarpophalangeal joint; Rehabilitation; Splinting; 3D printing","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"19-22"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48365623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2018.06.006
Xu Tiantian, Lin Ping, Che Ailan, Zhi-Dan Huang, Wei-hua Xu
Objective To explore the clinical efficacy of infrared thermography combined with high frequency color Doppler ultrasound in locating perforator before anterolateral thigh perforator flap (ALTPF) transplantation. Methods From January 2016 to October 2017, 40 patients with free ALTPF transplantation were examined by infrared thermography and high-frequency color Doppler ultrasound before operation. The number of effective perforating branches and the body surface position from the two methods were compared. Results A total of 115 heat sources were observed in 40 patients, of which 111 heat sources were found in common. Their body surface positions were almost identical and the other 4 were not identical. The coincidence rate of the number and position of effective perforators in the two groups was 97%. Conclusion The infrared thermography combined with high frequency color Doppler ultrasound can effectively guide the surgeons to complete the preoperative evaluation of perforator vessels and detect the effective ones as accurately as possible. It also can play an active role in guiding surgeons to make the best flap transplantation scheme and minimize the risk of flap transplantation. Key words: Surgical flaps; Transplantation; Ultrasonography, Doppler; Infrared thermal imager; Locate
{"title":"Application of infrared thermography combined with high frequency color Doppler ultrasound in locating perforator before anterolateral thigh perforator flap transplantation","authors":"Xu Tiantian, Lin Ping, Che Ailan, Zhi-Dan Huang, Wei-hua Xu","doi":"10.3760/CMA.J.ISSN.1005-054X.2018.06.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2018.06.006","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of infrared thermography combined with high frequency color Doppler ultrasound in locating perforator before anterolateral thigh perforator flap (ALTPF) transplantation. \u0000 \u0000 \u0000Methods \u0000From January 2016 to October 2017, 40 patients with free ALTPF transplantation were examined by infrared thermography and high-frequency color Doppler ultrasound before operation. The number of effective perforating branches and the body surface position from the two methods were compared. \u0000 \u0000 \u0000Results \u0000A total of 115 heat sources were observed in 40 patients, of which 111 heat sources were found in common. Their body surface positions were almost identical and the other 4 were not identical. The coincidence rate of the number and position of effective perforators in the two groups was 97%. \u0000 \u0000 \u0000Conclusion \u0000The infrared thermography combined with high frequency color Doppler ultrasound can effectively guide the surgeons to complete the preoperative evaluation of perforator vessels and detect the effective ones as accurately as possible. It also can play an active role in guiding surgeons to make the best flap transplantation scheme and minimize the risk of flap transplantation. \u0000 \u0000 \u0000Key words: \u0000Surgical flaps; Transplantation; Ultrasonography, Doppler; Infrared thermal imager; Locate","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"34 1","pages":"414-417"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49031350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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