Pub Date : 2019-04-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.02.019
Xinsheng Shen, Jia Su
Objective To elucidate the composition and precise attachment location of the forearm interosseous membrane ligament complex. Methods Thirty-two adult cadaveric forearm specimens were dissected to identify all ligaments of the interosseous membrane, measure the distance between the attachment site and the radius styloid process or the tip of the ulna head, and express the attachment location of the ligament by the percentage of the length to the length of the whole ulna and radius. Results The forearm interosseous membrane consists of five ligament components: central ligament, accessory ligament, distal oblique tract, proximal oblique cord and dorsal accessory oblique cord. The distal and proximal positions of the radius origin of the central ligament were 55% and 66% of the total radius length, respectively, and 30% and 42% of the total ulna length. The central points of the radius and ulna attachment location were 38% of the radius and 24% of the ulna for the accessory ligament, 10% of the radius and 16% of the ulna for the distal oblique tract, 78% of the radius and 82% of the ulna for the proximal oblique cord, and 63% of the radius and 65% of the ulna for the dorsal accessory oblique cord. Conclusion This study elucidates the precise attachment location of all the typical forearm interosseous membrane ligaments. This information is very useful for the biomechanical study of the interosseous membrane ligaments and the appropriate transplantation location of the interosseous membrane reconstruction surgery. Key words: Forearm; Anatomy; Interosseous membrane; Ligaments; Attachment location
{"title":"Anatomical study on the attachment location of forearm interosseous membrane ligament","authors":"Xinsheng Shen, Jia Su","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.019","url":null,"abstract":"Objective \u0000To elucidate the composition and precise attachment location of the forearm interosseous membrane ligament complex. \u0000 \u0000 \u0000Methods \u0000Thirty-two adult cadaveric forearm specimens were dissected to identify all ligaments of the interosseous membrane, measure the distance between the attachment site and the radius styloid process or the tip of the ulna head, and express the attachment location of the ligament by the percentage of the length to the length of the whole ulna and radius. \u0000 \u0000 \u0000Results \u0000The forearm interosseous membrane consists of five ligament components: central ligament, accessory ligament, distal oblique tract, proximal oblique cord and dorsal accessory oblique cord. The distal and proximal positions of the radius origin of the central ligament were 55% and 66% of the total radius length, respectively, and 30% and 42% of the total ulna length. The central points of the radius and ulna attachment location were 38% of the radius and 24% of the ulna for the accessory ligament, 10% of the radius and 16% of the ulna for the distal oblique tract, 78% of the radius and 82% of the ulna for the proximal oblique cord, and 63% of the radius and 65% of the ulna for the dorsal accessory oblique cord. \u0000 \u0000 \u0000Conclusion \u0000This study elucidates the precise attachment location of all the typical forearm interosseous membrane ligaments. This information is very useful for the biomechanical study of the interosseous membrane ligaments and the appropriate transplantation location of the interosseous membrane reconstruction surgery. \u0000 \u0000 \u0000Key words: \u0000Forearm; Anatomy; Interosseous membrane; Ligaments; Attachment location","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"136-138"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47952569","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 : 2019-04-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.02.018
Yang Chen, Jun Chen, J. Guan
Objective To investigate the clinical efficacy of combined suture of epineurium and perineurium on motor and sensory recovery of upper limbs with nerve injury. Methods From January 2017 to December 2017, 80 patients with upper limb nerve injury were retrospectively analyzed. Forty patients underwent epineurial suture repair (group A), and another 40 patients underwent combined epineurial and perineurial suture repair (group B). After 6 months of rehabilitation training, the clinical efficacy of nerve function, electrophysiological indexes and the improvement of quality of life of the two groups were compared and analyzed. Results The recovery of nerve function was compared between the two groups 6 months after operation. According to motor sensory grading criteria established by British Medical Research Institute, limb function was evaluated as excellent in 17 cases, good in 10 cases, fair in 6 cases and poor in 7 cases for group A with the excellent and good rate being 67.5%; evaluated as excellent in 22 cases, good in 11 cases, fair in 5 cases and poor in 2 cases for group B with the excellent and good rate being 82.5%. χ2 test showed that the excellent and good rate of group B was significantly higher than that of group A (P<0.05). The electrophysiological indexes including nerve conduction velocity and amplitude were better in group B than in group A (P<0.05). According to the quality of life assessment criteria established by WHO, the psychological function, social function, physical function and quality of life of the two groups were compared and analyzed. The results showed that the improvement degree of quality of life in group B was better than that in group A, and the difference was statistically significant (P<0.05). Conclusion The combined suture of epineurium and perineurium for nerve repair in patients with upper limb nerve injury can achieve satisfactory clinical efficacy. The motor and sensory functions of affected limbs recover well and can be widely used in clinic. Key words: Upper extremity; Peripheral nerves; Nerve suture; Motor sensory function of limbs
{"title":"Study on the motor and sensory recovery of upper limb in the treatment of upper extremity nerve injury with combined suture of epineurium and perineurium","authors":"Yang Chen, Jun Chen, J. Guan","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.018","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of combined suture of epineurium and perineurium on motor and sensory recovery of upper limbs with nerve injury. \u0000 \u0000 \u0000Methods \u0000From January 2017 to December 2017, 80 patients with upper limb nerve injury were retrospectively analyzed. Forty patients underwent epineurial suture repair (group A), and another 40 patients underwent combined epineurial and perineurial suture repair (group B). After 6 months of rehabilitation training, the clinical efficacy of nerve function, electrophysiological indexes and the improvement of quality of life of the two groups were compared and analyzed. \u0000 \u0000 \u0000Results \u0000The recovery of nerve function was compared between the two groups 6 months after operation. According to motor sensory grading criteria established by British Medical Research Institute, limb function was evaluated as excellent in 17 cases, good in 10 cases, fair in 6 cases and poor in 7 cases for group A with the excellent and good rate being 67.5%; evaluated as excellent in 22 cases, good in 11 cases, fair in 5 cases and poor in 2 cases for group B with the excellent and good rate being 82.5%. χ2 test showed that the excellent and good rate of group B was significantly higher than that of group A (P<0.05). The electrophysiological indexes including nerve conduction velocity and amplitude were better in group B than in group A (P<0.05). According to the quality of life assessment criteria established by WHO, the psychological function, social function, physical function and quality of life of the two groups were compared and analyzed. The results showed that the improvement degree of quality of life in group B was better than that in group A, and the difference was statistically significant (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000The combined suture of epineurium and perineurium for nerve repair in patients with upper limb nerve injury can achieve satisfactory clinical efficacy. The motor and sensory functions of affected limbs recover well and can be widely used in clinic. \u0000 \u0000 \u0000Key words: \u0000Upper extremity; Peripheral nerves; Nerve suture; Motor sensory function of limbs","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"133-135"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42871469","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 explore the clinical efficacy of modified pentagonal dorsal finger flap in the congenital syndactyly release. Methods From January 2010 to January 2014, 20 cases of simple cutaneous syndactyly were treated by modified pentagonal dorsal finger flap combined with finger Zigzag flap. The flap coverage scope, the occurrence of infection and necrosis of the skin flap and other early complications were recorded. The web depth and finger extension angle were measured and compared with the healthy side. Finger web creep and finger web scar were scored, and whether reoperation was performed due to the above complications was recorded. Questionnaire was used to evaluate parents' satisfaction. Results Twenty patients were follow-up for 30 to 75 months, with an average of 38 months. No complications such as infection and necrosis of skin flaps occurred after operation. The shape of the web was wide. The web depth of the affected side was (2.37±0.56) cm, and the finger extension angle was (24.50±4.74)°. There was no significant difference between the affected and healthy side. The reoperation rate due to web creep, web contracture and scar flexion contracture was 0. Family members were satisfied with the treatment outcome. Conclusion The modified pentagonal dorsal finger flap combined with finger Zigzag flap can reconstruct web space to the level of proximal interphalangeal joint, reduce the complications such as web creep and scar contracture after operation. Wide web is good for fingers to grasp large objects with high operative safety. Key words: Hand deformities,congenital; Syndactyly; Modified pentagonal dorsal finger flap; Web reconstruction; Web contracture
{"title":"Application of modified pentagonal dorsal finger flap in the congenital syndactyly release","authors":"Hongqiang Wu, Weiyang Gao, Jian Ding, Renhao Jiang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.017","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of modified pentagonal dorsal finger flap in the congenital syndactyly release. \u0000 \u0000 \u0000Methods \u0000From January 2010 to January 2014, 20 cases of simple cutaneous syndactyly were treated by modified pentagonal dorsal finger flap combined with finger Zigzag flap. The flap coverage scope, the occurrence of infection and necrosis of the skin flap and other early complications were recorded. The web depth and finger extension angle were measured and compared with the healthy side. Finger web creep and finger web scar were scored, and whether reoperation was performed due to the above complications was recorded. Questionnaire was used to evaluate parents' satisfaction. \u0000 \u0000 \u0000Results \u0000Twenty patients were follow-up for 30 to 75 months, with an average of 38 months. No complications such as infection and necrosis of skin flaps occurred after operation. The shape of the web was wide. The web depth of the affected side was (2.37±0.56) cm, and the finger extension angle was (24.50±4.74)°. There was no significant difference between the affected and healthy side. The reoperation rate due to web creep, web contracture and scar flexion contracture was 0. Family members were satisfied with the treatment outcome. \u0000 \u0000 \u0000Conclusion \u0000The modified pentagonal dorsal finger flap combined with finger Zigzag flap can reconstruct web space to the level of proximal interphalangeal joint, reduce the complications such as web creep and scar contracture after operation. Wide web is good for fingers to grasp large objects with high operative safety. \u0000 \u0000 \u0000Key words: \u0000Hand deformities,congenital; Syndactyly; Modified pentagonal dorsal finger flap; Web reconstruction; Web contracture","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"128-132"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45259696","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 : 2019-04-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.02.006
Liu Wei, Yang Zhi, XiaoFei Ding, F. Hu, H. Linke, Jinmin Zhao
Objective To investigate the clinical efficacy and surgical techniques of elastic intramedullary nail in the treatment of double forearm fractures in children. Methods From March 2014 to July 2017, 12 children with double forearm fractures were treated with titanium elastic intramedullary nails. The elastic intramedullary nails were inserted from the distal radius and proximal ulna, and the affected limb was fixed with plaster over elbow and wrist for 4 to 6 weeks. When X-ray showed that the callus was well formed, the plaster was removed for functional exercise. The elastic intramedullary nails were removed after fracture healing. Results The closed reduction of radius and ulnar was performed in 7 and 8 cases respectively. The open reduction of radius and ulnar was performed in 5 and 4 cases respectively. The average length of incision at nail entry point was (1.17±0.17) cm. The average length of incision for open reduction was (1.54±0.29) cm. The operation time was (1.71±0.63) hours. The average amount of bleeding during operation was (12.92±7.53) ml. The postoperative follow-up period was 8 to 48 months, with an average of (23.58±11.42) months. The duration of bone healing was 3 to 8 weeks with an average of (4.92±1.38) weeks. The pronation angle of forearm was (83.75±6.44)°, and the supination angle was (85.83±5.15)°. The flexion and extension activities of elbow and wrist joints were similar to those of the healthy side. No complications such as nonunion, malunion, epiphyseal injury and needle tail irritation symptoms occurred in all the cases. Conclusion The application of titanium intramedullary nail is effective and minimally invasive in the treatment of double forearm fractures in children. Key words: Child; Forearm; Fractures,bone; Intramedullary nails
{"title":"Minimally invasive treatment of double forearm fractures in children with elastic intramedullary nails","authors":"Liu Wei, Yang Zhi, XiaoFei Ding, F. Hu, H. Linke, Jinmin Zhao","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.006","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy and surgical techniques of elastic intramedullary nail in the treatment of double forearm fractures in children. \u0000 \u0000 \u0000Methods \u0000From March 2014 to July 2017, 12 children with double forearm fractures were treated with titanium elastic intramedullary nails. The elastic intramedullary nails were inserted from the distal radius and proximal ulna, and the affected limb was fixed with plaster over elbow and wrist for 4 to 6 weeks. When X-ray showed that the callus was well formed, the plaster was removed for functional exercise. The elastic intramedullary nails were removed after fracture healing. \u0000 \u0000 \u0000Results \u0000The closed reduction of radius and ulnar was performed in 7 and 8 cases respectively. The open reduction of radius and ulnar was performed in 5 and 4 cases respectively. The average length of incision at nail entry point was (1.17±0.17) cm. The average length of incision for open reduction was (1.54±0.29) cm. The operation time was (1.71±0.63) hours. The average amount of bleeding during operation was (12.92±7.53) ml. The postoperative follow-up period was 8 to 48 months, with an average of (23.58±11.42) months. The duration of bone healing was 3 to 8 weeks with an average of (4.92±1.38) weeks. The pronation angle of forearm was (83.75±6.44)°, and the supination angle was (85.83±5.15)°. The flexion and extension activities of elbow and wrist joints were similar to those of the healthy side. No complications such as nonunion, malunion, epiphyseal injury and needle tail irritation symptoms occurred in all the cases. \u0000 \u0000 \u0000Conclusion \u0000The application of titanium intramedullary nail is effective and minimally invasive in the treatment of double forearm fractures in children. \u0000 \u0000 \u0000Key words: \u0000Child; Forearm; Fractures,bone; Intramedullary nails","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49069753","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 : 2019-04-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.02.005
Bingqiang Han, Wanglin Zhang, Hai-qing Cai, Yunlan Xu, Yuchan Li
Objective To introduce the application value of elbow arthrography in severe radial neck fractures in children younger than 6 years old and to summarize its clinical efficacy. Methods From May 2012 to December 2016, 18 children under 6 years old with severe radial neck fractures were treated in our hospital, including 11 males and 7 females, aged 40 to 70 months, with an average of 59.7 months. The preoperative radiographs did not show any obvious ossification center and only a thin bone slice displaced from metaphysis could be seen. According to O'Brien classification, there were 8 cases of type Ⅱ and 10 cases of type Ⅲ. Under anesthesia, routine lateral elbow arthrography and manual reduction with Metaizeau technique were conducted. If manual reduction is unsatisfactory, percutaneous pin prying reduction with Metaizeau technique or open reduction was conducted. After the operation, the long arm plaster was used for fixation for 4 weeks. Postoperative evaluation was based on Tibone and Stotz scoring system. Radial head ischemic necrosis, epiphyseal premature closure, intra-articular calcification and joint fusion were evaluated by X-ray films of the healthy and the injured side. Results One child had minor skin allergy during operation, and the others did not have adverse effects. Elbow arthrography can clearly reveal the articular surface and the degree of fracture displacement. All the patients were successfully repositioned by closed and/or pin prying reduction without open reduction. X-ray examination showed that the fracture healed well. There was no malunion at the fracture site, no premature epiphyseal closure and necrosis of the radius head. According to Tibone and Stotz criteria, 13 cases were excellent and 4 cases were good. Conclusion The intraoperative arthrography can provide a clear judgment of the displacement degree of fracture and evaluation of reduction quality for the patients with severe radial neck fractures under 6 years old. The method is simple and effective, and the clinical effect is satisfactory. It is worth promoting. Key words: Fractures,bone; Child; Arthrography; Metaizeau technique
{"title":"Application of elbow arthrography in the treatment of severe radial neck fractures in children under 6 years old","authors":"Bingqiang Han, Wanglin Zhang, Hai-qing Cai, Yunlan Xu, Yuchan Li","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.005","url":null,"abstract":"Objective \u0000To introduce the application value of elbow arthrography in severe radial neck fractures in children younger than 6 years old and to summarize its clinical efficacy. \u0000 \u0000 \u0000Methods \u0000From May 2012 to December 2016, 18 children under 6 years old with severe radial neck fractures were treated in our hospital, including 11 males and 7 females, aged 40 to 70 months, with an average of 59.7 months. The preoperative radiographs did not show any obvious ossification center and only a thin bone slice displaced from metaphysis could be seen. According to O'Brien classification, there were 8 cases of type Ⅱ and 10 cases of type Ⅲ. Under anesthesia, routine lateral elbow arthrography and manual reduction with Metaizeau technique were conducted. If manual reduction is unsatisfactory, percutaneous pin prying reduction with Metaizeau technique or open reduction was conducted. After the operation, the long arm plaster was used for fixation for 4 weeks. Postoperative evaluation was based on Tibone and Stotz scoring system. Radial head ischemic necrosis, epiphyseal premature closure, intra-articular calcification and joint fusion were evaluated by X-ray films of the healthy and the injured side. \u0000 \u0000 \u0000Results \u0000One child had minor skin allergy during operation, and the others did not have adverse effects. Elbow arthrography can clearly reveal the articular surface and the degree of fracture displacement. All the patients were successfully repositioned by closed and/or pin prying reduction without open reduction. X-ray examination showed that the fracture healed well. There was no malunion at the fracture site, no premature epiphyseal closure and necrosis of the radius head. According to Tibone and Stotz criteria, 13 cases were excellent and 4 cases were good. \u0000 \u0000 \u0000Conclusion \u0000The intraoperative arthrography can provide a clear judgment of the displacement degree of fracture and evaluation of reduction quality for the patients with severe radial neck fractures under 6 years old. The method is simple and effective, and the clinical effect is satisfactory. It is worth promoting. \u0000 \u0000 \u0000Key words: \u0000Fractures,bone; Child; Arthrography; Metaizeau technique","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"93-96"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47655195","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 explore the feasibility and effect of autogenous cancellous bone graft wrapped by femoral fascia in the treatment of upper limb bone defects. Methods From June 2011 to December 2016, 12 patients with upper limb bone defects were treated with femoral fascia wrapping autogenous cancellous bone graft and internal fixation. Bone defect site: 3 cases in humerus, 5 cases in radius, and 4 cases in ulna. The length of bone defects ranged from 2.5 to 6.0 cm, with an average of 4.0 cm. Results Delayed wound healing occurred in 1 case and complications occurred in 2 cases. All the patients were follow-up for 12 to 36 months with an average of 19 months. Bone union occurred in all the patients. The clinical healing time ranged from 2.5 to 4.0 months, with an average of 2.9 months. No delayed union or nonunion occurred. The healing rate was 100%. There were no deep infection, internal fixation fracture and re-fracture in the transplantation area. At the last follow-up, limb function recovery was evaluated by DASH upper limb function questionnaire. The results were rated as excellent in 6 cases, good in 5 cases and fair in 1 case. Conclusion Femoral fascia has abundant sources and is convenient for harvesting. Femoral fascia wrapping autogenous cancellous bone graft for the treatment of upper limb bone defects is effective for small and large segmental defects. It has the advantages of simple operation, low cost, fast bone healing, high healing rate and satisfactory functional recovery. Key words: Upper extremity; Bone transplantation; Bone defects; Cancellous bone; Femoral fascia
{"title":"Treatment of upper limb bone defects with autogenous cancellous bone graft wrapped by femoral fascia","authors":"Xiao-Peng Han, Hai‐feng Li, Zi‐hong Zhou, Jijun Zhao, Yongjun Rui, Yajun Xu, Qudong Yin, San‐jun Gu, Zhenzhong Sun","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.016","url":null,"abstract":"Objective \u0000To explore the feasibility and effect of autogenous cancellous bone graft wrapped by femoral fascia in the treatment of upper limb bone defects. \u0000 \u0000 \u0000Methods \u0000From June 2011 to December 2016, 12 patients with upper limb bone defects were treated with femoral fascia wrapping autogenous cancellous bone graft and internal fixation. Bone defect site: 3 cases in humerus, 5 cases in radius, and 4 cases in ulna. The length of bone defects ranged from 2.5 to 6.0 cm, with an average of 4.0 cm. \u0000 \u0000 \u0000Results \u0000Delayed wound healing occurred in 1 case and complications occurred in 2 cases. All the patients were follow-up for 12 to 36 months with an average of 19 months. Bone union occurred in all the patients. The clinical healing time ranged from 2.5 to 4.0 months, with an average of 2.9 months. No delayed union or nonunion occurred. The healing rate was 100%. There were no deep infection, internal fixation fracture and re-fracture in the transplantation area. At the last follow-up, limb function recovery was evaluated by DASH upper limb function questionnaire. The results were rated as excellent in 6 cases, good in 5 cases and fair in 1 case. \u0000 \u0000 \u0000Conclusion \u0000Femoral fascia has abundant sources and is convenient for harvesting. Femoral fascia wrapping autogenous cancellous bone graft for the treatment of upper limb bone defects is effective for small and large segmental defects. It has the advantages of simple operation, low cost, fast bone healing, high healing rate and satisfactory functional recovery. \u0000 \u0000 \u0000Key words: \u0000Upper extremity; Bone transplantation; Bone defects; Cancellous bone; Femoral fascia","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"125-127"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42027055","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 : 2019-04-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.02.014
Wenqi Luo, Guang Yang, Shusen Cui, Qingsan Zhu, Rui Gu, Le Fang, Jingju Zhang, Jialong Guo, Min Luo
Objective To analyze the clinical characteristics of complex neck shoulder upper extremity pain cases and to classify and summarize the diagnosis outcomes in order to improve the doctors' understanding of neck shoulder upper extremity pain and provide valuable reference for clinical work. Methods A retrospective analysis was performed on the clinical data of patients with neck, shoulder and upper extremity pain who were treated in the multidisciplinary consultation center of neck, shoulder and upper extremity pain in our hospital from July 2015 to March 2017. The general information, symptoms, signs, auxiliary examinations and diagnosis of the patients were classified and summarized. Results A total of 91 patients, 41 males and 50 females, met the inclusion criteria. The medical history ranged from 5 days to 30 years, with an average of 25.4 months. The most common age group was 47 to 67 years old (53 cases, 58.2%). Apart from pain, numbness (35%), weakness (13%), muscle atrophy (11%) and activity limitation (7%) were common symptoms. Of the 24 cases with positive Spurling's sign, 17 cases (70.8%) had cervical spondylotic radiculopathy. Diagnostic block of anterior and middle scalene muscles was performed in 11 cases, and thoracic outlet syndrome was diagnosed in 7 out of 8 positive cases. Among 48 cases of single diagnosis, 10 cases (21%) were cervical spondylosis, 9 cases (19%) were thoracic outlet syndrome, 9 cases (19%) were peripheral nerve disease, 7 cases (15%) were central nervous system disorder, 4 cases (8%) were tumors, 3 cases (6%) were infections and 6 cases (12%) were others. Among the other 29 cases of complex diagnosis, 16 cases (55.2%) had thoracic outlet syndrome with other diseases, including 8 cases of thoracic outlet syndrome with cervical spondylotic radiculopathy. 7 cases (24.1%) of cervical spondylotic radiculopathy combined with other diseases. Conclusion Complex neck, shoulder and upper extremity pain is more common in the middle-aged and elderly people, especially in women. Cervical spondylosis is the most common cause of complex neck, shoulder and upper extremity pain, and thoracic outlet syndrome accounts for a certain proportion. Cervical spondylotic radiculopathy or thoracic outlet syndrome are the main diagnostic modalities for some patients with complex neck shoulder and upper extremity pain. Spurling's sign and diagnostic block of anterior and middle scalene muscles contribute to the diagnosis of complex neck, shoulder and upper extremity pain. Key words: Pain; Diagnosis; Clinical features; Cervical spondylotic radiculopathy; Thoracic outlet syndrome
{"title":"Clinical features and diagnosis analysis of 91 cases of neck shoulder upper extremity pain syndrome","authors":"Wenqi Luo, Guang Yang, Shusen Cui, Qingsan Zhu, Rui Gu, Le Fang, Jingju Zhang, Jialong Guo, Min Luo","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.02.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.02.014","url":null,"abstract":"Objective \u0000To analyze the clinical characteristics of complex neck shoulder upper extremity pain cases and to classify and summarize the diagnosis outcomes in order to improve the doctors' understanding of neck shoulder upper extremity pain and provide valuable reference for clinical work. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on the clinical data of patients with neck, shoulder and upper extremity pain who were treated in the multidisciplinary consultation center of neck, shoulder and upper extremity pain in our hospital from July 2015 to March 2017. The general information, symptoms, signs, auxiliary examinations and diagnosis of the patients were classified and summarized. \u0000 \u0000 \u0000Results \u0000A total of 91 patients, 41 males and 50 females, met the inclusion criteria. The medical history ranged from 5 days to 30 years, with an average of 25.4 months. The most common age group was 47 to 67 years old (53 cases, 58.2%). Apart from pain, numbness (35%), weakness (13%), muscle atrophy (11%) and activity limitation (7%) were common symptoms. Of the 24 cases with positive Spurling's sign, 17 cases (70.8%) had cervical spondylotic radiculopathy. Diagnostic block of anterior and middle scalene muscles was performed in 11 cases, and thoracic outlet syndrome was diagnosed in 7 out of 8 positive cases. Among 48 cases of single diagnosis, 10 cases (21%) were cervical spondylosis, 9 cases (19%) were thoracic outlet syndrome, 9 cases (19%) were peripheral nerve disease, 7 cases (15%) were central nervous system disorder, 4 cases (8%) were tumors, 3 cases (6%) were infections and 6 cases (12%) were others. Among the other 29 cases of complex diagnosis, 16 cases (55.2%) had thoracic outlet syndrome with other diseases, including 8 cases of thoracic outlet syndrome with cervical spondylotic radiculopathy. 7 cases (24.1%) of cervical spondylotic radiculopathy combined with other diseases. \u0000 \u0000 \u0000Conclusion \u0000Complex neck, shoulder and upper extremity pain is more common in the middle-aged and elderly people, especially in women. Cervical spondylosis is the most common cause of complex neck, shoulder and upper extremity pain, and thoracic outlet syndrome accounts for a certain proportion. Cervical spondylotic radiculopathy or thoracic outlet syndrome are the main diagnostic modalities for some patients with complex neck shoulder and upper extremity pain. Spurling's sign and diagnostic block of anterior and middle scalene muscles contribute to the diagnosis of complex neck, shoulder and upper extremity pain. \u0000 \u0000 \u0000Key words: \u0000Pain; Diagnosis; Clinical features; Cervical spondylotic radiculopathy; Thoracic outlet syndrome","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"118-122"},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48536282","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.2019.01.002
Xiaolei Wang, Min-chao Zhao, Zhu Jin, Cui Wang, Liang Zhao
Objective To evaluate the clinical outcomes of mini hook plate in the treatment of acute ulnar avulsion fracture at the base of proximal phalanx of thumb. Methods From February 2015 to February 2016, 20 cases of acute ulnar avulsion fracture at the base of proximal phalanx of thumb were treated by open reduction and mini hook plate fixation to correct the fracture deformity and reconstruct the collateral ligament attachment. Results All the patients were follow-up for 6 to 24 months with an average of 16.2 months. The time of fracture healing ranged from 4 to 7 weeks, averaging 5.2 weeks. According to Saetta functional assessment standard, the results were graded as excellent in 14 cases, good in 5 cases, and fair in 1 case. X-rays showed the line of avulsion fracture disappeared. Conclusion Application of mini hook plate in the treatment of acute ulnar avulsion fracture at the base of proximal phalanx of thumb can achieve strong fixation and lead to satisfactory postoperative function recovery of the first metacarpophalangeal joint. The clinical outcomes are reliable. Key words: Finger phalanges; Fracture fixation, internal; Metacarpophalangeal joint; Mini plate
{"title":"Application of mini hook plate in the treatment of acute ulnar avulsion fracture at the base of proximal phalanx of thumb","authors":"Xiaolei Wang, Min-chao Zhao, Zhu Jin, Cui Wang, Liang Zhao","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.002","url":null,"abstract":"Objective \u0000To evaluate the clinical outcomes of mini hook plate in the treatment of acute ulnar avulsion fracture at the base of proximal phalanx of thumb. \u0000 \u0000 \u0000Methods \u0000From February 2015 to February 2016, 20 cases of acute ulnar avulsion fracture at the base of proximal phalanx of thumb were treated by open reduction and mini hook plate fixation to correct the fracture deformity and reconstruct the collateral ligament attachment. \u0000 \u0000 \u0000Results \u0000All the patients were follow-up for 6 to 24 months with an average of 16.2 months. The time of fracture healing ranged from 4 to 7 weeks, averaging 5.2 weeks. According to Saetta functional assessment standard, the results were graded as excellent in 14 cases, good in 5 cases, and fair in 1 case. X-rays showed the line of avulsion fracture disappeared. \u0000 \u0000 \u0000Conclusion \u0000Application of mini hook plate in the treatment of acute ulnar avulsion fracture at the base of proximal phalanx of thumb can achieve strong fixation and lead to satisfactory postoperative function recovery of the first metacarpophalangeal joint. The clinical outcomes are reliable. \u0000 \u0000 \u0000Key words: \u0000Finger phalanges; Fracture fixation, internal; Metacarpophalangeal joint; Mini plate","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"4-6"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42384516","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.2019.01.007
Kun Wang, W. Lei, Jiang-hai Chen
Objective To explore the operative method and clinical efficacy of retrograde transfer of dorsal proximal phalanx fasciocutaneous island flap with anastomosis of cutaneous branch of the digital artery for repair of fingertip defect of the same finger. Methods From May 2014 to August 2016, 9 cases (9 fingers) of fingertip soft tissue defects were treated by retrograde transfer of dorsal proximal phalanx fasciocutaneous island flap with anastomosis of cutaneous branch of the digital artery. All the patients had bone exposure. The defect area ranged from 1.2 cm×1.3 cm to 1.7 cm×2.0 cm. Results All the flaps survived uneventfully with primary healing in the wounds. The postoperative follow-up period ranged from 8 to 14 months, with an average of 11 months. The function and appearance recovery of fingers were satisfactory. The fingertip flaps were full without bulky pedicle. The sensory function recovered well. The fingertip two-point discrimination was 5 to 8 mm. Conclusion The dorsal proximal phalanx fasciocutaneous island flaps with anastomosis of cutaneous branch of the digital artery have reliable blood supply without sacrificing the digital artery and little influence on the donor site. It is suitable for repairing fingertip defects with good appearance and sensory recovery. Key words: Finger injuries; Surgical flaps; Cutaneous branch of the digital artery; Fingertip defects
{"title":"Clinical application of dorsal proximal phalanx fasciocutaneous island flap with anastomosis of cutaneous branch of the digital artery","authors":"Kun Wang, W. Lei, Jiang-hai Chen","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.007","url":null,"abstract":"Objective \u0000To explore the operative method and clinical efficacy of retrograde transfer of dorsal proximal phalanx fasciocutaneous island flap with anastomosis of cutaneous branch of the digital artery for repair of fingertip defect of the same finger. \u0000 \u0000 \u0000Methods \u0000From May 2014 to August 2016, 9 cases (9 fingers) of fingertip soft tissue defects were treated by retrograde transfer of dorsal proximal phalanx fasciocutaneous island flap with anastomosis of cutaneous branch of the digital artery. All the patients had bone exposure. The defect area ranged from 1.2 cm×1.3 cm to 1.7 cm×2.0 cm. \u0000 \u0000 \u0000Results \u0000All the flaps survived uneventfully with primary healing in the wounds. The postoperative follow-up period ranged from 8 to 14 months, with an average of 11 months. The function and appearance recovery of fingers were satisfactory. The fingertip flaps were full without bulky pedicle. The sensory function recovered well. The fingertip two-point discrimination was 5 to 8 mm. \u0000 \u0000 \u0000Conclusion \u0000The dorsal proximal phalanx fasciocutaneous island flaps with anastomosis of cutaneous branch of the digital artery have reliable blood supply without sacrificing the digital artery and little influence on the donor site. It is suitable for repairing fingertip defects with good appearance and sensory recovery. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Surgical flaps; Cutaneous branch of the digital artery; Fingertip defects","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"16-18"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47884494","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.2019.01.010
Jun Wang, Hongwei Li, C. Bai, Dawei Li
Objective To explore the clinical efficacy of wrist arthroscopy combined with oblique ulnar shortening osteotomy for the treatment of ulnar impingement syndrome. Methods From March 2015 to March 2017, 16 patients with ulnar impingement syndrome (all unilateral lesions) were treated with wrist arthroscopy to clean up the triangular fibrocartilage complex (TFCC) and then with oblique ulnar shortening osteotomy and plate internal fixation. The postoperative regular follow-up was performed. The clinical efficacy was assessed by preoperative and postoperative ulna variation, modified Mayo wrist score and visual analogue scale (VAS). Results All the patients were follow-up for 6 to 12 months with an average of 10 months. All the oblique osteotomy of ulna achieved bony union. The average healing time was 12 weeks. X-ray examination outcome showed that the mean value of preoperative ulnar variation was (3.3±1.2) mm and decreased to (-0.2±0.5) mm after the operation. The mean preoperative VAS score was 8.2±0.8 and decreased to 3.1±1.6 postoperatively. The pain was completely relieved in 7 patients and significantly relieved in 9 patients. The modified Mayo Wrist Score was 60.8±12.5 preoperatively and increased to 82.3±11.8 postoperatively. The result was rated as excellent in 5 cases, good in 8 cases and fair in 3 cases. The difference was statistically significant before and after operation (P < 0.05). Conclusion Wrist arthroscopy combined with oblique ulnar shortening osteotomy for ulnar impingement syndrome has the advantages of fast functional recovery and effective relief of wrist pain. Meanwhile, oblique osteotomy reduces the risk of fracture nonunion. This treatment is worth promoting. Key words: Arthroscopes; Treatment outcome; Ulnar impingement syndrome; Oblique osteotomy
{"title":"Wrist arthroscopy combined with oblique ulnar shortening osteotomy for ulnar impingement syndrome","authors":"Jun Wang, Hongwei Li, C. Bai, Dawei Li","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.01.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.01.010","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of wrist arthroscopy combined with oblique ulnar shortening osteotomy for the treatment of ulnar impingement syndrome. \u0000 \u0000 \u0000Methods \u0000From March 2015 to March 2017, 16 patients with ulnar impingement syndrome (all unilateral lesions) were treated with wrist arthroscopy to clean up the triangular fibrocartilage complex (TFCC) and then with oblique ulnar shortening osteotomy and plate internal fixation. The postoperative regular follow-up was performed. The clinical efficacy was assessed by preoperative and postoperative ulna variation, modified Mayo wrist score and visual analogue scale (VAS). \u0000 \u0000 \u0000Results \u0000All the patients were follow-up for 6 to 12 months with an average of 10 months. All the oblique osteotomy of ulna achieved bony union. The average healing time was 12 weeks. X-ray examination outcome showed that the mean value of preoperative ulnar variation was (3.3±1.2) mm and decreased to (-0.2±0.5) mm after the operation. The mean preoperative VAS score was 8.2±0.8 and decreased to 3.1±1.6 postoperatively. The pain was completely relieved in 7 patients and significantly relieved in 9 patients. The modified Mayo Wrist Score was 60.8±12.5 preoperatively and increased to 82.3±11.8 postoperatively. The result was rated as excellent in 5 cases, good in 8 cases and fair in 3 cases. The difference was statistically significant before and after operation (P < 0.05). \u0000 \u0000 \u0000Conclusion \u0000Wrist arthroscopy combined with oblique ulnar shortening osteotomy for ulnar impingement syndrome has the advantages of fast functional recovery and effective relief of wrist pain. Meanwhile, oblique osteotomy reduces the risk of fracture nonunion. This treatment is worth promoting. \u0000 \u0000 \u0000Key words: \u0000Arthroscopes; Treatment outcome; Ulnar impingement syndrome; Oblique osteotomy","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"24-26"},"PeriodicalIF":0.0,"publicationDate":"2019-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42107992","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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