Objective To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root, and explore its clinical efficacy. Methods From January 2016 to September 2018, 12 patients with 13 distally severed fingers at nail root were replanted. There were no veins to anastomose the two severed ends. The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches. The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux. Results In 13 replanted fingers, 1 finger had partial necrosis due to serious tissue contusion, and the other 12 fingers survived completely. No venous crisis occurred after operation. The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months. The skin texture of replanted finger was good, the nail grew well, and the sensation recovered to over S3. The patient was satisfied with the appearance and function. Conclusion The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root. It is an effective way to reconstruct venous reflux in the absence of severed veins. Key words: Replantation; Treatment outcome; Arterial venalization; Venous reflux
{"title":"Application of modified arterial venalization in replantation of distally severed finger at nail root without venous anastomosis","authors":"Jianjun Zhao, Zhenjun Xie, Huawei Sun, Zheng Liang, Jianhua Zhang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.005","url":null,"abstract":"Objective \u0000To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root, and explore its clinical efficacy. \u0000 \u0000 \u0000Methods \u0000From January 2016 to September 2018, 12 patients with 13 distally severed fingers at nail root were replanted. There were no veins to anastomose the two severed ends. The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches. The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux. \u0000 \u0000 \u0000Results \u0000In 13 replanted fingers, 1 finger had partial necrosis due to serious tissue contusion, and the other 12 fingers survived completely. No venous crisis occurred after operation. The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months. The skin texture of replanted finger was good, the nail grew well, and the sensation recovered to over S3. The patient was satisfied with the appearance and function. \u0000 \u0000 \u0000Conclusion \u0000The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root. It is an effective way to reconstruct venous reflux in the absence of severed veins. \u0000 \u0000 \u0000Key words: \u0000Replantation; Treatment outcome; Arterial venalization; Venous reflux","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"412-414"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48788489","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 : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.003
Zhao Gang, Rui Yong-jun, Jing-yi Mi, Yao Qun, Qiu Yang, Hua Yong, Q. Jun
Objective To explore the clinical efficacy of anastomosis of nailfold vein in reconstruction of reflux of fingertip replantation. Methods From November 2016 to December 2017, 18 patients with 23 fingers of fingertip amputation in IshikawaⅡ area (from middle nail to nail root plane) were replanted. The parathyroidal longitudinal incision was used to explore and anastomose the nailfold vein to reconstruct the severed finger reflux, and the clinical efficacy was followed up. Results The follow-up period ranged from 8 to 15 months, with an average of 11.1 months. Twenty-one of the 23 fingers survived and two were necrotic. The survival rate was 91.3%. The protective sensation was restored in all surviving fingertips. The two-point discrimination was (8.8±2.4) mm. The active range of motion of distal interphalangeal joint was (49.8±12.3)°, which was 63.4% of the healthy side. The average blood perfusion volume of finger pulp was 89.3% of the healthy side. The complications included cicatricial contracture (5/23), nail deformity (7/23), nonunion (1/23), distal interphalangeal joint dysfunction (4/23), and cold intolerance (4/23). Conclusion The nailfold vein can provide reliable venous reflux in fingertip replantation and restore the good appearance and function of replanted fingertips. Key words: Finger injuries; Replantation; Vein; Microsurgery
{"title":"Reconstruction of reflux in fingertip replantation by anastomosis of nailfold vein","authors":"Zhao Gang, Rui Yong-jun, Jing-yi Mi, Yao Qun, Qiu Yang, Hua Yong, Q. Jun","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.003","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of anastomosis of nailfold vein in reconstruction of reflux of fingertip replantation. \u0000 \u0000 \u0000Methods \u0000From November 2016 to December 2017, 18 patients with 23 fingers of fingertip amputation in IshikawaⅡ area (from middle nail to nail root plane) were replanted. The parathyroidal longitudinal incision was used to explore and anastomose the nailfold vein to reconstruct the severed finger reflux, and the clinical efficacy was followed up. \u0000 \u0000 \u0000Results \u0000The follow-up period ranged from 8 to 15 months, with an average of 11.1 months. Twenty-one of the 23 fingers survived and two were necrotic. The survival rate was 91.3%. The protective sensation was restored in all surviving fingertips. The two-point discrimination was (8.8±2.4) mm. The active range of motion of distal interphalangeal joint was (49.8±12.3)°, which was 63.4% of the healthy side. The average blood perfusion volume of finger pulp was 89.3% of the healthy side. The complications included cicatricial contracture (5/23), nail deformity (7/23), nonunion (1/23), distal interphalangeal joint dysfunction (4/23), and cold intolerance (4/23). \u0000 \u0000 \u0000Conclusion \u0000The nailfold vein can provide reliable venous reflux in fingertip replantation and restore the good appearance and function of replanted fingertips. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Replantation; Vein; Microsurgery","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"406-408"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47355230","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 : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.019
Gangyi Liu, X. Rong, Zong-liang Liu, Junquan Gou, D. Shi, Yongbin Song, Guangbing Ma, Zhihong Li, R. Xie
Objective To summarize the operative method and clinical efficacy of anterolateral thigh flow-through flap for simultaneous repair of soft tissue and main vascular defects of extremities. Methods From April 2009 to May 2017, 7 patients with soft tissue defects and main vessel defects were treated with anterolateral thigh flow-through flaps. The anterolateral thigh flow-through flaps were used to cover the skin and soft tissue defects of limbs, and the descending branch of the lateral circumflex femoral artery was bridged with the defective main artery to reconstruct the blood circulation. The skin and soft tissue defects ranged from 5.0 cm×4.5 cm to 21.0 cm×11.0 cm. The trunk vascular defects ranged from 2.5 to 11.0 cm. The area of skin flaps ranged from 6.5 cm×5.5 cm to 23.0 cm×12.0 cm. For those with major nerve or muscle or tendon defect or dead space, sural nerve or lateral femoral muscle or rectus femoris muscle tendon flaps were transplanted to repair the defect. Results The perforator vessels were accidentally injured in the process of free flap in one case, and anastomosis was performed immediately. The vascular crisis occurred in one case and was relieved after surgical exploration. The remaining flaps and limbs survived smoothly. The postoperative follow-up ranged from 6 to 36 months, with an average of 12 months. One patient suffered from mild atrophy of the distal limb half a year after operation, but there was no significant functional impact. The follow-up for 1 or 2 years showed no aggravation. The rest of the limbs recovered their basic shape and flexion and extension function. The appearance and texture of the skin flaps were good, and the sensation of protection was restored. The donor site had no functional effect except linear scar or pigmentation. According to the Berton criteria, the upper limb function was evaluated as excellent in 2 cases, good in 1 case and fair in 2 cases. According to the Maryland criteria of the American foot and ankle surgery association, the lower limb function was evaluated as excellent in 1 case and good in 1 case. Conclusion The anterolateral thigh flow-through flap can be used to repair the soft tissue and main vessel defect of the extremity simultaneously. It can bridge and reconstruct the main vessel of the extremity while repairing the wound or composite tissue defect of the extremity. The operation that should be performed by stages or at the expense of multiple donor sites should be performed by one donor site at a time. It shortens the course of disease, gains time for the recovery of extremity function, and reduces the pain of patients and the economic burden of families. It's worth promoting. Key words: Extremities; Microsurgery; Flow-through; Anterolateral thigh flap; Transplantation repair
{"title":"Application of anterolateral thigh flow-through flaps for simultaneous repair of soft tissue and main vascular defects of extremities","authors":"Gangyi Liu, X. Rong, Zong-liang Liu, Junquan Gou, D. Shi, Yongbin Song, Guangbing Ma, Zhihong Li, R. Xie","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.019","url":null,"abstract":"Objective \u0000To summarize the operative method and clinical efficacy of anterolateral thigh flow-through flap for simultaneous repair of soft tissue and main vascular defects of extremities. \u0000 \u0000 \u0000Methods \u0000From April 2009 to May 2017, 7 patients with soft tissue defects and main vessel defects were treated with anterolateral thigh flow-through flaps. The anterolateral thigh flow-through flaps were used to cover the skin and soft tissue defects of limbs, and the descending branch of the lateral circumflex femoral artery was bridged with the defective main artery to reconstruct the blood circulation. The skin and soft tissue defects ranged from 5.0 cm×4.5 cm to 21.0 cm×11.0 cm. The trunk vascular defects ranged from 2.5 to 11.0 cm. The area of skin flaps ranged from 6.5 cm×5.5 cm to 23.0 cm×12.0 cm. For those with major nerve or muscle or tendon defect or dead space, sural nerve or lateral femoral muscle or rectus femoris muscle tendon flaps were transplanted to repair the defect. \u0000 \u0000 \u0000Results \u0000The perforator vessels were accidentally injured in the process of free flap in one case, and anastomosis was performed immediately. The vascular crisis occurred in one case and was relieved after surgical exploration. The remaining flaps and limbs survived smoothly. The postoperative follow-up ranged from 6 to 36 months, with an average of 12 months. One patient suffered from mild atrophy of the distal limb half a year after operation, but there was no significant functional impact. The follow-up for 1 or 2 years showed no aggravation. The rest of the limbs recovered their basic shape and flexion and extension function. The appearance and texture of the skin flaps were good, and the sensation of protection was restored. The donor site had no functional effect except linear scar or pigmentation. According to the Berton criteria, the upper limb function was evaluated as excellent in 2 cases, good in 1 case and fair in 2 cases. According to the Maryland criteria of the American foot and ankle surgery association, the lower limb function was evaluated as excellent in 1 case and good in 1 case. \u0000 \u0000 \u0000Conclusion \u0000The anterolateral thigh flow-through flap can be used to repair the soft tissue and main vessel defect of the extremity simultaneously. It can bridge and reconstruct the main vessel of the extremity while repairing the wound or composite tissue defect of the extremity. The operation that should be performed by stages or at the expense of multiple donor sites should be performed by one donor site at a time. It shortens the course of disease, gains time for the recovery of extremity function, and reduces the pain of patients and the economic burden of families. It's worth promoting. \u0000 \u0000 \u0000Key words: \u0000Extremities; Microsurgery; Flow-through; Anterolateral thigh flap; Transplantation repair","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"448-451"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45159072","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 : 2019-10-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.05.014
Fei Yin, Jun Wang, Xiao-fang Shen, Weifeng Lin, C. Zou, Shuai Liu, Yongjun Rui
Objective To analyze the clinical efficacy of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children. Methods From January 2014 to January 2019, 7 cases of children with skin and soft tissue defects on the dorsum of hand ware covered by anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels by preoperative color Doppler ultrasound. The area of the flaps ranged from 4 cm×6 cm to 5 cm×7 cm. The donor sites were sutured directly. Results There were no infection, vascular crisis and necrosis of skin flaps after operation. All the children were follow-up for 6 to 42 months, with an average of 23.5 months. The skin flaps had satisfactory shape, soft texture, moderate thickness, good elasticity, good sweating function, partial superficial sensation recovery, good thumb web function and no complications such as thumb web skin contracture. Five children underwent liposuction at 5 months after operation. Mild scar hyperplasia of donor sites occurred in 4 cases. Conclusion The anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels is safe and effective in repairing the dorsal hand wound in children. It can shorten the time of skin flap removal, reduce the injury of donor site and not sacrifice the dorsal metacarpal branch of the radial artery. It is suitable for clinical promotion. Key words: Hand injuries; Surgical flaps; Repair; Microsurgery
{"title":"The clinical application of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children","authors":"Fei Yin, Jun Wang, Xiao-fang Shen, Weifeng Lin, C. Zou, Shuai Liu, Yongjun Rui","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.014","url":null,"abstract":"Objective \u0000To analyze the clinical efficacy of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children. \u0000 \u0000 \u0000Methods \u0000From January 2014 to January 2019, 7 cases of children with skin and soft tissue defects on the dorsum of hand ware covered by anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels by preoperative color Doppler ultrasound. The area of the flaps ranged from 4 cm×6 cm to 5 cm×7 cm. The donor sites were sutured directly. \u0000 \u0000 \u0000Results \u0000There were no infection, vascular crisis and necrosis of skin flaps after operation. All the children were follow-up for 6 to 42 months, with an average of 23.5 months. The skin flaps had satisfactory shape, soft texture, moderate thickness, good elasticity, good sweating function, partial superficial sensation recovery, good thumb web function and no complications such as thumb web skin contracture. Five children underwent liposuction at 5 months after operation. Mild scar hyperplasia of donor sites occurred in 4 cases. \u0000 \u0000 \u0000Conclusion \u0000The anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels is safe and effective in repairing the dorsal hand wound in children. It can shorten the time of skin flap removal, reduce the injury of donor site and not sacrifice the dorsal metacarpal branch of the radial artery. It is suitable for clinical promotion. \u0000 \u0000 \u0000Key words: \u0000Hand injuries; Surgical flaps; Repair; Microsurgery","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"358-360"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46372958","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 : 2019-10-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.05.006
Zhiwu Zhang, Benjun Bi, Yu-qing Ji, Shengjun Yu, F. Gao
Objective To explore the clinical efficacy of modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx. Methods From March 2015 to February 2018, 22 patients with fractures of the base of the middle phalanx were treated with close reduction and self-made modified dynamic external fixator traction. Among them, 5 patients suffered from comminuted fracture of the base of the middle phalanx, and 17 patients suffered from palmar edge fractures. The joint mobility and hand grip were measured at the last follow-up. Results All the patients achieved bony union. The flexion and extension exercises were performed after operation, and the flexion and extension of interphalangeal joints were good. No nail infection, pain and joint stiffness occurred. All the patients were follow-up from 8 to 20 months with an average 11.5 months. According to the total active motion (TAM) score system, the results were rated as excellent in 16 cases, good in 5 cases and fair in 1 case. Conclusion The modified dynamic external fixator traction is reliable in the treatment of intra-articular fractures of the base of the middle phalanx. It does not destroy the blood supply and soft tissue at the fracture end. It is conducive to fracture healing. The external fixator has simple structure and does not need to fix joints. It can exercise flexion and extension function of interphalangeal joint in early stage, and is conducive to restoring hand function as soon as possible. Key words: Finger phalanges; External fixators; Intra-articular fracture
{"title":"Modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx","authors":"Zhiwu Zhang, Benjun Bi, Yu-qing Ji, Shengjun Yu, F. Gao","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.006","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx. \u0000 \u0000 \u0000Methods \u0000From March 2015 to February 2018, 22 patients with fractures of the base of the middle phalanx were treated with close reduction and self-made modified dynamic external fixator traction. Among them, 5 patients suffered from comminuted fracture of the base of the middle phalanx, and 17 patients suffered from palmar edge fractures. The joint mobility and hand grip were measured at the last follow-up. \u0000 \u0000 \u0000Results \u0000All the patients achieved bony union. The flexion and extension exercises were performed after operation, and the flexion and extension of interphalangeal joints were good. No nail infection, pain and joint stiffness occurred. All the patients were follow-up from 8 to 20 months with an average 11.5 months. According to the total active motion (TAM) score system, the results were rated as excellent in 16 cases, good in 5 cases and fair in 1 case. \u0000 \u0000 \u0000Conclusion \u0000The modified dynamic external fixator traction is reliable in the treatment of intra-articular fractures of the base of the middle phalanx. It does not destroy the blood supply and soft tissue at the fracture end. It is conducive to fracture healing. The external fixator has simple structure and does not need to fix joints. It can exercise flexion and extension function of interphalangeal joint in early stage, and is conducive to restoring hand function as soon as possible. \u0000 \u0000 \u0000Key words: \u0000Finger phalanges; External fixators; Intra-articular fracture","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"334-336"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45015331","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 : 2019-10-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.05.018
Wang Zifang, Ligong Ming, Wang Xinde, W. Meng, Yangyang Li, Xiaowen Wang
Objective To investigate the long-term clinical efficacy of modified Sauve-Kapandji procedure in the treatment of degenerative arthritis of distal radioulnar joint (DRUJ). Methods From June 2010 to April 2015, 16 patients with DRUJ degenerative arthritis were treated with modified Sauve-Kapandji procedure. The ulna of 1.0 to 1.5 cm length was excised at 2 to 3 cm proximal to the ulna head. The distal ulna and DRUJ were fused with the radius. The proximal ulna was suspended with a splited 1/2 extensor carpi ulnaris tendon. After operation, the long arm plaster was fixed for 3 to 4 weeks, then functional exercise was performed, and normal work was restored after bone healing. Results After the operation all the patients were follow-up for 3.3 to 7.0 years with an average of 4.2 years. Postoperative pain relieved, grip strength increased, forearm rotation had no significant effect, and no instability of ulna stump occurred. The pain was improved from 6.2 to 1.5 points by using the visual analogue scales (VAS). The grip strength of both hands was measured by Jamar gripper, and the percentage of grip strength of the affected hand to the healthy side recovered from an average of 30% to 85% after the operation. The total wrist function was assessed by Mayo score from 56 preoperatively to 87 postoperatively, and DASH score from 67 preoperatively to 28 postoperatively. Conclusion The application of modified Sauve-Kapandji procedure for treatment of DRUJ degenerative arthritis can stabilize ulnar stump, prevent wrist instability, relieve wrist-ulnar pain and improve forearm rotation. The clinical effect is satisfactory after operation. Key words: Osteoarthritis; Treatment outcome; Distal radioulnar joint; Sauve-Kapandji procedure
{"title":"Long-term efficacy of modified Sauvé-Kapandji procedure for treatment of degenerative arthritis of distal radioulnar joint","authors":"Wang Zifang, Ligong Ming, Wang Xinde, W. Meng, Yangyang Li, Xiaowen Wang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.018","url":null,"abstract":"Objective \u0000To investigate the long-term clinical efficacy of modified Sauve-Kapandji procedure in the treatment of degenerative arthritis of distal radioulnar joint (DRUJ). \u0000 \u0000 \u0000Methods \u0000From June 2010 to April 2015, 16 patients with DRUJ degenerative arthritis were treated with modified Sauve-Kapandji procedure. The ulna of 1.0 to 1.5 cm length was excised at 2 to 3 cm proximal to the ulna head. The distal ulna and DRUJ were fused with the radius. The proximal ulna was suspended with a splited 1/2 extensor carpi ulnaris tendon. After operation, the long arm plaster was fixed for 3 to 4 weeks, then functional exercise was performed, and normal work was restored after bone healing. \u0000 \u0000 \u0000Results \u0000After the operation all the patients were follow-up for 3.3 to 7.0 years with an average of 4.2 years. Postoperative pain relieved, grip strength increased, forearm rotation had no significant effect, and no instability of ulna stump occurred. The pain was improved from 6.2 to 1.5 points by using the visual analogue scales (VAS). The grip strength of both hands was measured by Jamar gripper, and the percentage of grip strength of the affected hand to the healthy side recovered from an average of 30% to 85% after the operation. The total wrist function was assessed by Mayo score from 56 preoperatively to 87 postoperatively, and DASH score from 67 preoperatively to 28 postoperatively. \u0000 \u0000 \u0000Conclusion \u0000The application of modified Sauve-Kapandji procedure for treatment of DRUJ degenerative arthritis can stabilize ulnar stump, prevent wrist instability, relieve wrist-ulnar pain and improve forearm rotation. The clinical effect is satisfactory after operation. \u0000 \u0000 \u0000Key words: \u0000Osteoarthritis; Treatment outcome; Distal radioulnar joint; Sauve-Kapandji procedure","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"370-372"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42215518","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 : 2019-10-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.05.013
Liangang Qi, Tao Wang, Zhihao Cui, Zhengdao Xu, Tonghua Zhang, Ben Wang, Zongbao Liu
Objective To explore the diagnostic advantages and clinical application value of 3D MRI neurovascular fusion technique in brachial plexus with subclavian artery lesions caused by tumor compression. Methods From December 2014 to December 2017, 5 patients were treated, including 2 cases of breast cancer metastasis, 2 cases of schwannoma and 1 case of lung cancer metastasis. The pathological changes of brachial plexus and subclavian artery caused by tumor compression were preliminarily considered by clinical examination, electromyography, ultrasound and CT. All the patients underwent three-dimensional reconstruction using 3D MRI neurovascular fusion technique. The abnormal condition of brachial plexus and subclavian artery was determined according to three-dimensional anatomical model, and the treatment plan was worked out. Results Three-dimensional reconstruction and digital fusion were performed in 5 patients with tumors and anatomical structures of brachial plexus and subclavian artery. The reconstructed images of blood vessels and nerves were well displayed, and the treatment plan was formulated on the basis of these images. There were 4 cases of operation and 1 case of conservative treatment. The intraoperative manifestations of the patients were consistent with the imaging manifestations, and the therapeutic effect reached the expected goal. The patients performed conservative treatment can timely understand the condition and choose other treatment options. Conclusion 3D MRI can clearly and vividly display the structure of the tumors, such as the brachial plexus and the subclavian artery, and provide the imaging basis for diagnosis and treatment. This technique can be further studied and applied. Key words: Brachial plexus; Neoplasms; 3D MRI; Subclavian artery
{"title":"Clinical application of 3D MRI in diagnosis and treatment of brachial plexus and subclavian artery compression by tumors","authors":"Liangang Qi, Tao Wang, Zhihao Cui, Zhengdao Xu, Tonghua Zhang, Ben Wang, Zongbao Liu","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.013","url":null,"abstract":"Objective \u0000To explore the diagnostic advantages and clinical application value of 3D MRI neurovascular fusion technique in brachial plexus with subclavian artery lesions caused by tumor compression. \u0000 \u0000 \u0000Methods \u0000From December 2014 to December 2017, 5 patients were treated, including 2 cases of breast cancer metastasis, 2 cases of schwannoma and 1 case of lung cancer metastasis. The pathological changes of brachial plexus and subclavian artery caused by tumor compression were preliminarily considered by clinical examination, electromyography, ultrasound and CT. All the patients underwent three-dimensional reconstruction using 3D MRI neurovascular fusion technique. The abnormal condition of brachial plexus and subclavian artery was determined according to three-dimensional anatomical model, and the treatment plan was worked out. \u0000 \u0000 \u0000Results \u0000Three-dimensional reconstruction and digital fusion were performed in 5 patients with tumors and anatomical structures of brachial plexus and subclavian artery. The reconstructed images of blood vessels and nerves were well displayed, and the treatment plan was formulated on the basis of these images. There were 4 cases of operation and 1 case of conservative treatment. The intraoperative manifestations of the patients were consistent with the imaging manifestations, and the therapeutic effect reached the expected goal. The patients performed conservative treatment can timely understand the condition and choose other treatment options. \u0000 \u0000 \u0000Conclusion \u00003D MRI can clearly and vividly display the structure of the tumors, such as the brachial plexus and the subclavian artery, and provide the imaging basis for diagnosis and treatment. This technique can be further studied and applied. \u0000 \u0000 \u0000Key words: \u0000Brachial plexus; Neoplasms; 3D MRI; Subclavian artery","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"354-357"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44181398","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}
Objective To compare the clinical efficacy of supercutaneous locking plate, Kirschner wire and external fixator in the treatment of open metacarpal fractures, and to analyze the advantages and disadvantages of the three different fixation methods. Methods From March 2015 to February 2017, 62 cases of open metacarpal fractures with poor soft tissue conditions were treated with cross Kirschner wire (group A with 23 cases), external fixator (group B with 20 cases) and supercutaneous locking plate (group C with 19 cases). The clinical effects of the three methods were analyzed from the operation time, plaster external fixation time, fracture healing time, finger joint range of motion and postoperative complications. Results All the three groups were follow-up for 8 to 26 months with an average of 10.6 months. The mean operation time was (25.6±2.6) minutes in group A, (42.3±3.4) minutes in group B and (43.1±4.3) minutes in group C. The mean plaster external fixation time was (5.1±1.0) weeks in group A, (3.6±0.6) weeks in group B and (1.8±0.4) weeks in group C. The mean fracture healing time was (8.5±1.0) weeks in group A, (8.2±0.9) weeks in group B and (6.1±0.7) weeks in group C. The excellent and good rates of finger joint range of motion at 4 and 24 weeks after the operation were 34.8% and 73.9% in group A, 40.0% and 80.0% in group B and 89.5% and 94.7% in group C respectively. The incidence of postoperative complications was 34.8% in group A, 25.0% in group B and 5.3% in group C, respectively. Except the operation time of group C was longer than that of group A and group B, the other indexes were better. Except for the excellent and good rate of finger joint range of motion at 24 weeks after the operation, the other differences had statistical significance (P<0.05). Conclusion For the open metacarpal fractures with severe contamination or soft tissue injuries, the supercutaneous locking plate fixation can achieve better clinical results than cross Kirschner wire and external fixator. Key words: Metacarpal bones; Fractures,bone; Kirschner wire; External fixator; Locking plate
{"title":"A comparative study of supercutaneous locking plate, Kirschner wire and external fixator in the treatment of open metacarpal fractures","authors":"Ting-gang Chu, Zongwei Zhou, J. Xue, An-yuan Wang, Liang-fu Jiang, Jian Ding, Xinglong Chen, Weiyang Gao","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.001","url":null,"abstract":"Objective \u0000To compare the clinical efficacy of supercutaneous locking plate, Kirschner wire and external fixator in the treatment of open metacarpal fractures, and to analyze the advantages and disadvantages of the three different fixation methods. \u0000 \u0000 \u0000Methods \u0000From March 2015 to February 2017, 62 cases of open metacarpal fractures with poor soft tissue conditions were treated with cross Kirschner wire (group A with 23 cases), external fixator (group B with 20 cases) and supercutaneous locking plate (group C with 19 cases). The clinical effects of the three methods were analyzed from the operation time, plaster external fixation time, fracture healing time, finger joint range of motion and postoperative complications. \u0000 \u0000 \u0000Results \u0000All the three groups were follow-up for 8 to 26 months with an average of 10.6 months. The mean operation time was (25.6±2.6) minutes in group A, (42.3±3.4) minutes in group B and (43.1±4.3) minutes in group C. The mean plaster external fixation time was (5.1±1.0) weeks in group A, (3.6±0.6) weeks in group B and (1.8±0.4) weeks in group C. The mean fracture healing time was (8.5±1.0) weeks in group A, (8.2±0.9) weeks in group B and (6.1±0.7) weeks in group C. The excellent and good rates of finger joint range of motion at 4 and 24 weeks after the operation were 34.8% and 73.9% in group A, 40.0% and 80.0% in group B and 89.5% and 94.7% in group C respectively. The incidence of postoperative complications was 34.8% in group A, 25.0% in group B and 5.3% in group C, respectively. Except the operation time of group C was longer than that of group A and group B, the other indexes were better. Except for the excellent and good rate of finger joint range of motion at 24 weeks after the operation, the other differences had statistical significance (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000For the open metacarpal fractures with severe contamination or soft tissue injuries, the supercutaneous locking plate fixation can achieve better clinical results than cross Kirschner wire and external fixator. \u0000 \u0000 \u0000Key words: \u0000Metacarpal bones; Fractures,bone; Kirschner wire; External fixator; Locking plate","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"321-324"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45756555","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 : 2019-10-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.05.016
Y. Kang, Yong-wei Wu, Yunhong Ma, J. Gu, Peng Xu, T. Hui, Yongjun Rui
Objective To establish a precise three-dimensional finite element model of the second to fifth metacarpophalangeal joints to simulate the stress distribution of the second to fifth metacarpal and phalangeal bones under different loads. Methods A healthy male volunteer was selected to perform 64-slice spiral CT scanning on his right hand. The data were extracted by Mimics 17.0 software. The second to fifth metacarpal and phalangeal bones and cartilage joint models were reconstructed. After the model was modified and assembled, it was imported into Hypermesh 13.0 software in iges format for meshing, and the BDF format file was derived. Finally, the data were put into the MSC. Patran/Nastran2012 software. Ten, twenty, thirty, forty and fifty Newton loads were applied along the longitudinal direction of phalanges to analyze the stress distribution of metacarpal and phalangeal bones. Results A high-precision three-dimensional finite element model of metacarpophalangeal joints was established, with a total of 40 070 nodes and 178 903 tetrahedral elements. The solid element meshes were used for metacarpal and phalangeal bones and cartilage joints. With the increase of load, the peak stress of metacarpal and phalangeal bones ranges from 0.64 to 8.65 MPa, and the overall stress of the fourth metacarpal and phalangeal bone was significantly higher than that of other metacarpal and phalangeal bones, of which the third metacarpal and phalangeal bone suffered the least stress. Conclusion The finite element model established by Mimics and MSC. Patran/Nastran software has higher accuracy and can better simulate the biomechanical properties of metacarpophalangeal joints, which can be used in biomechanical analysis experiments. Key words: Metacarpophalangeal joint; Finite element analysis; Stress; Three-dimensional reconstruction; Digital orthopaedics
{"title":"Establishment of three-dimensional finite element model and biomechanical analysis of normal metacarpophalangeal joint","authors":"Y. Kang, Yong-wei Wu, Yunhong Ma, J. Gu, Peng Xu, T. Hui, Yongjun Rui","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.016","url":null,"abstract":"Objective \u0000To establish a precise three-dimensional finite element model of the second to fifth metacarpophalangeal joints to simulate the stress distribution of the second to fifth metacarpal and phalangeal bones under different loads. \u0000 \u0000 \u0000Methods \u0000A healthy male volunteer was selected to perform 64-slice spiral CT scanning on his right hand. The data were extracted by Mimics 17.0 software. The second to fifth metacarpal and phalangeal bones and cartilage joint models were reconstructed. After the model was modified and assembled, it was imported into Hypermesh 13.0 software in iges format for meshing, and the BDF format file was derived. Finally, the data were put into the MSC. Patran/Nastran2012 software. Ten, twenty, thirty, forty and fifty Newton loads were applied along the longitudinal direction of phalanges to analyze the stress distribution of metacarpal and phalangeal bones. \u0000 \u0000 \u0000Results \u0000A high-precision three-dimensional finite element model of metacarpophalangeal joints was established, with a total of 40 070 nodes and 178 903 tetrahedral elements. The solid element meshes were used for metacarpal and phalangeal bones and cartilage joints. With the increase of load, the peak stress of metacarpal and phalangeal bones ranges from 0.64 to 8.65 MPa, and the overall stress of the fourth metacarpal and phalangeal bone was significantly higher than that of other metacarpal and phalangeal bones, of which the third metacarpal and phalangeal bone suffered the least stress. \u0000 \u0000 \u0000Conclusion \u0000The finite element model established by Mimics and MSC. Patran/Nastran software has higher accuracy and can better simulate the biomechanical properties of metacarpophalangeal joints, which can be used in biomechanical analysis experiments. \u0000 \u0000 \u0000Key words: \u0000Metacarpophalangeal joint; Finite element analysis; Stress; Three-dimensional reconstruction; Digital orthopaedics","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"364-367"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49604710","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 : 2019-10-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.05.008
Chengke Li, Xiang Wu, Jun-bo Xiao, Chunhui Wu, Yan-wen Lei, Langye Liu, Songgen Peng, Z. Cheng, Shengshan Li
Objective To investigate the clinical efficacy of autologous flexor digitorum profundus tendon transposition for repair of mallet finger with extensor digitorum tendon defect in zone Ⅰ. Methods From September 2016 to September 2018, 30 patients with extensor digitorum tendon defect in zone Ⅰ were treated with autologous flexor digitorum profundus tendon transposition. The postoperative follow-up was performed. The function of the affected finger was evaluated by Dargan and Crawford functional assessment criteria. Results All the patients were follow-up for 6 to 12 months. The average operation time was (44.2±4.7) minutes. There was no incision infection after operation, and the wounds healed well. No complications such as joint stiffness, skin necrosis or finger deformity occurred. The function of affected fingers was evaluated according to Dargan functional assessment criteria as excellent in 12 cases, good in 14 cases, fair in 4 cases with the excellent and good rate being 86.7%; according to Crawford functional assessment criteria as excellent in 11 cases, good in 15 cases, fair in 4 cases with the excellent and good rate being 86.7%. Conclusion The application of autologous flexor digitorum profundus tendon transposition for repair of mallet finger with extensor digitorum tendon defect in zone Ⅰ can achieve good clinical efficacy. The operation is simple and easy to perform, and it is worthy of clinical promotion. Key words: Tendon injuries; Treatment outcome; Flexor digitorum profundus tendon; Mallet finger
{"title":"Repair of mallet finger with extensor digitorum tendon defect in zone I by autologous flexor digitorum profundus tendon transposition","authors":"Chengke Li, Xiang Wu, Jun-bo Xiao, Chunhui Wu, Yan-wen Lei, Langye Liu, Songgen Peng, Z. Cheng, Shengshan Li","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.05.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.05.008","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of autologous flexor digitorum profundus tendon transposition for repair of mallet finger with extensor digitorum tendon defect in zone Ⅰ. \u0000 \u0000 \u0000Methods \u0000From September 2016 to September 2018, 30 patients with extensor digitorum tendon defect in zone Ⅰ were treated with autologous flexor digitorum profundus tendon transposition. The postoperative follow-up was performed. The function of the affected finger was evaluated by Dargan and Crawford functional assessment criteria. \u0000 \u0000 \u0000Results \u0000All the patients were follow-up for 6 to 12 months. The average operation time was (44.2±4.7) minutes. There was no incision infection after operation, and the wounds healed well. No complications such as joint stiffness, skin necrosis or finger deformity occurred. The function of affected fingers was evaluated according to Dargan functional assessment criteria as excellent in 12 cases, good in 14 cases, fair in 4 cases with the excellent and good rate being 86.7%; according to Crawford functional assessment criteria as excellent in 11 cases, good in 15 cases, fair in 4 cases with the excellent and good rate being 86.7%. \u0000 \u0000 \u0000Conclusion \u0000The application of autologous flexor digitorum profundus tendon transposition for repair of mallet finger with extensor digitorum tendon defect in zone Ⅰ can achieve good clinical efficacy. The operation is simple and easy to perform, and it is worthy of clinical promotion. \u0000 \u0000 \u0000Key words: \u0000Tendon injuries; Treatment outcome; Flexor digitorum profundus tendon; Mallet finger","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"340-342"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47169360","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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