ABSTRACT
Objective:To investigate the early effect of modified posterior tibialis muscle transfer in treating foot drop and varus deformity caused by common peroneal nerve injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 6 patients with foot drop of common peroneal nerve palsy and varus deformity admitted to Beijing Jishuitan Hospital from December 2017 to October 2019, including 4 males and 2 females, aged 33-48 years [(39.5±6.0)years]. The left side was involved in 4 patients and the right side in 2 patients. All patients underwent posterior tibial muscle transfer. The insertion of posterior tibial muscle was reconstructed in the fourth metatarsal with the tendon allograft to correct foot drop and varus deformity. The range of motion of active ankle dorsiflexion and plantar flexion and range of motion of varus and valgus of foot were measured before operation and at the last follow-up. The isokinetic torque peak value of ankle dorsiflexion and plantar flexion at 60°/s angular velocity and peak isokinetic torque of foot varus and valgus at 60°/s angular velocity were measured before operation and at the last follow-up. The postoperative foot imaging evaluation was performed at the last follow-up, including Meary angle, calcaneal projection and diameter of the fourth metatarsal. The American Orthopaedic Foot & Ankle Association (AOFAS) ankle-hindfoot score was used to evaluate the ankle function.Results:All patients were followed up for 6-17 months [10(6, 15)months]. At the last follow-up, the range of motion of dorsiflexion of the ankle [6(0, 10)°] and foot valgus [3(0, 5)°] were significantly improved compared with the preoperative level [-31(-33, -28)°, -10(-12, -8)°] ( P<0.05); the ankle dorsiflexion torque [(7.7±0.8)Nm] and foot valgus torque [(7.2±0.7)Nm] were significantly improved compared with the preoperative level [(0.0±0.0)Nm, (2.1±0.6)Nm]at 60°/s angular velocity ( P<0.01). Imaging examination showed no acquired flat foot deformity and deformation of the fourth metatarsal insertion. The AOFAS ankle-hindfoot score increased from 50-73 points [(61.3±8.4)points] before operation to 75-97 points [(86.8±7.2)points] at the last follow-up ( P<0.01). Conclusion:For foot drop and varus caused by common peroneal nerve injury, modified posterior tibialis muscle transfer can increase the torque of ankle dorsiflexion and valgus, improve the ankle range of motion, and accelerate the ankle function recovery.
ABSTRACT
Keratinocytes are the main constituent cells of the skin epidermis and the main target cells of arsenic act on the skin as well.Although it has been epidemiologically clarified that arsenic can cause palmoplantar hyperkeratosis and skin cancer,yet the mechanism is unclear and there's no ideal animal models so far.Currently,the studies of skin lesions induced by arsenic mainly focus on keratinocytes in vitro.In this paper,we summarize the related literatures and review the effects of arsenic on proliferation,differentiation,oxidative stress,DNA damage,apoptosis,epigenetic changes,and cancer stem cell activation of keratinocytes.We hope to deepen the understanding of skin lesions induced by arsenic and provide more basis and ideas for understanding the mechanism of endemic aRSenicosis.
ABSTRACT
Objective To observe the effect of arsenic exposure to drinking water on thelevel of histone 3 lysine 4 trimethylation (H3K4me3) and histone 3 lysine 79 trimethylation (H3K79me3) in peripheral blood leukocytes of human,and to analyze the relationship between arsenic exposure and H3K4me3,H3K79me3 modification levels.Methods A cluster sampling survey was carried out in typical endemic arsenicosis areas of Shanxi and Jilin provinces.Two hundred eighty-one local residents with a drinking water age of ≥ 10 years were selected as the survey subjects.According to the arsenic content of drinking water,the tested population was divided into control group (water arsenic content ≤0.01 mg/L,60 cases),low water arsenic exposure group (＞ 0.01-0.05 mg/L,61 cases),medium water arsenic exposure group (＞ 0.05-0.10 mg/L,50 cases),and 110 cases of high water arsenic exposure group (＞ 0.10 mg/L).Drinking water samples,immediate urine samples and peripheral blood samples were collected from the subjects.Arsenic content in drinking water and urinary arsenic content were determined via the atomic fluorescence method;histone H3K4me3 and H3K79me3 in peripheral blood leukocytes were determined by dot blot hybridization (Dot Blotting).Results There were no statistically significant differences in age (61.50,60.00,59.50,59.50 years old),different gender (male:20,27,17,40 cases,female:40,34,33,70 cases),body mass index (BMI),smoking and drinking status between the control group,low,medium and high water arsenic exposure groups.Water arsenic content in the control group,low,medium and high water arsenic exposure groups (median:0.005,0.024,0.076,0.150 mg/L),urinary arsenic content (0.011,0.018,0.061,0.134 mg/L),and water arsenic cumulative exposure levels (0.342,1.641,5.273,7.716 mg) were compared between groups,the differences were statistically significant (H =256.041,88.615,218.610,P ＜ 0.01).In the control group,low,medium and high water arsenic exposure groups,the modification levels of H3K4me3 (0.100,0.059,0.083,0.083)and H3K79me3 (0.049,0.036,0.055,0.052) in peripheral blood leukocytes were not significantly different (H =1.488,2.097,P ＞ 0.05).The levels of H3K4me3 and H3K79me3 in peripheral blood leukocytes were positively correlated with water arsenic content,urinary arsenic content,water arsenic cumulative exposure levels (r =0.245,0.221;0.299,0.318;0.149,0.149;P ＜ 0.01 or ＜ 0.05);there was a positive correlation between H3K4me3 and H3K79me3 modification levels (r =0.811,P ＜ 0.01).Conclusion There is a positive correlation between arsenic exposure through drinking water and the levels of H3K4me3 and H3K79me3 in the peripheral blood leukocytes of the population,but it is necessary to expand the sample size for further study.
ABSTRACT
Endemic arsenicosis is a kind of endemic diseases, which is caused by chronic arsenic exposure and is seriously harmful to human health. Skin is the important target organ of endemic arsenicosis. Clinical diagnosis for this endemic disease mainly depends on the cutaneous triad (hyperkeratosis on the palms and soles, cutaneous hyper-pigmentation and hypo-pigmentation).But the pathogenesis of this disease is still unclear.In-depth understanding of the skin lesions and the pathogenesis is greatly significant for the scientific explanation of endemic arsenicosis. Although there are some studies on the skin lesions caused by endemic arsenicosis, a systematic review is still lacking. In this paper, the epidemiology, pathological changes and pathogenesis of skin lesions caused by endemic arsenicosis are summarized. Here we expect this summarization will deepen the understanding on skin lesions caused by endemic arsenicosis and provide some new ideas and clues for other researchers.
ABSTRACT
Objective To evaluate the treatment effects of middle and proximal phalangeal fractures with lateral fixation of mini-titanium plate.Methods From December 2011 to April 2015,56 patients (64 phalanges) suffered from closed middle and proximal phalangeal fractures were treated with lateral fixation of mini-titanium plate.There were 48 males and 8 females,aged from 17 to 65 years (average,36.3 years).Fractures included 25 cases of middle phalangeal fracture and 39 cases of proximal phalangeal fracture.According to site of fracture,12 cases were middle phalangeal condyle fractur,7 cases were middle phalangeal shaft fracture,6 cases were middle phalangeal base fracture,10 cases were proximal phalangeal condyle fracture,22 cases were proximal phalangeaal shaft fracture and 7 cases were proximal phalangeal base fracture.According to the type of fracture,13 cases were transverse,9 cases were short oblique,11 cases were long oblique,6 cases were spiral and 25 cases were comminuted fracture.All phalangeal fractures were exposed by lateral approach,in which the lateral band and oblique fibers of proximal phalanx were excised to fully expose proximal phalangeal fracture.After the reduction,the fractures were fixed with mini-titanium plate laterally.The Disabilities of the Arm,Shoulder and Hand (DASH)and the bilateral fingers total active motion (TAM) were employed to evaluate the functions.All patients took X ray during follow-up.Results All 56 patients were followed up from 9 to 47 months,average (14 ± 6) months.Phalangeal fractures were healed from 7 to 14 weeks,average (8.8 ± 2.4) weeks without loss of fixation or malunion.At final follow-up,DASH score were from 1.7 to 7.5,with an average of 4.8 ± 2.2.TAM of the fingers was excellent (＞ 90％ TAM of the contralateral side) in 33/64 (51.5％) cases,good (75％-90％ TAM of the contralateral side) in 30/64 (46.9％) cas es,fair (50％-75％ TAM of the contralateral side) 1/64 (1.6％) cases.Conclusion Lateral approach fully exposes middle and proximal phalangeal fractures and less interferes with the extensor mechanism.Lateral fixation with mini-titanium plate could provide stability and allow early motion.This technique may be an optional choice in clinical practice.
ABSTRACT
<p><b>BACKGROUND</b>The Bennett fracture is either a common or a challenging problem to hand surgeons. It is still debated whether closed or open reduction gives optimal results. This study aimed to describe and assess a closed reduction and mini-external fixator fixation technique for the treatment of Bennett's fracture dislocation and to compare this technique versus open reduction and internal fixation.</p><p><b>METHODS</b>From October 2002 to December 2012, 56 patients with Bennett's fracture dislocation were treated by closed reduction and mini-external fixator fixation and 32 patients were treated by open reduction and internal fixation in Jishuitan Hospital. Patients with an articular step-off of more than 1 mm were excluded. All patients were assessed at a mean follow-up of 7 years (range 2-10 years) and the two groups were compared with pain levels, active range of trapeziometacarpal motion, grip strength and pinch strength, arthritic changes, and adduction deformity.</p><p><b>RESULTS</b>Based on primary closed reduction maintained , the rate of anatomic reduction is 63.6%. Radiographic fracture union was achieved in all patients at a mean time of 5 weeks. At the final follow-up, there was no difference between the two groups in mean union time and pain levels (P = 0.2). There was also no difference between the two groups regarding the active range of trapeziometacarpal motion (P = 0.3), grip stength (P = 0.6), pinch strength (P = 0.2), arthritic change and loss of reduction (P = 0.2). There was a significant correlation between adduction deformity and the development of arthritis (P = 0.02).</p><p><b>CONCLUSION</b>Closed reduction mini-external fixator fixation should be first tried to apply in the treatment of Bennett's fracture dislocation, and open reduction internal fixation should only be performed for irreducible fractures.</p>
Subject(s)
Adult , Female , Humans , Male , Arthritis , General Surgery , External Fixators , Fracture Fixation , Methods , Fracture Fixation, Internal , Methods , Fractures, Bone , General SurgeryABSTRACT
<p><b>BACKGROUND</b>Ligament reconstruction tendon interposition (LRTI) is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthritis. The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.</p><p><b>METHODS</b>From January 2008 to January 2011, 19 patients (21 thumbs) underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis (FCR) in Kleinert Kutz Hand Care Center of Louisville University, USA. The follow-up period was an average of 13.9 months. Pain, grip strength, tip pinch strength, range of motion, and radiographic measurements were recorded. Based on first metacarpal subsidence, the cases were classified in to mild, moderate, and severe. Clinical outcomes of the groups were evaluated and compared.</p><p><b>RESULTS</b>Grip strength improved from 18.6 kg to 20.5 kg, and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery. Radial abduction and palmar abduction improved after surgery. Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure. Visual analogue scores (VAS) were significantly reduced, from 6.6 to 0.5. Compared with the preoperative radiographs the first metacarpal had subsided about 54.6% of the arthroplasty space. The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively. Between the various groups (mild, moderate and severe metacarpal subsidence), there was no difference in grip strength, tip pinch strength, thumb range of motion, and VAS.</p><p><b>CONCLUSIONS</b>Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion. However, LRTI cannot maintain the arthroplasty space. Compared with the preoperative radiographs, the metacarpal subsided more than 50%. The amount of first metacarpal subsidence has no bearing on the results.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arthroplasty , Methods , Carpometacarpal Joints , General Surgery , Plastic Surgery Procedures , Methods , Thumb , General SurgeryABSTRACT
Objective To explore the clinical outcomes of Ligament reconstruction tendon interposition (LRTI) arthro-plasty for first carpometacarpal joint osteoarthritis. Methods From January 2008 to January 2011, 19 patients (21 thumbs) had surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radia-lis (FCR). There were 1 male and 18 were females with an average age of 60 years (range, 52-75 years);8 thumbs were on the left side and 13 thumbs on the right side. According to Eaton-Glickel classification, 1 thumb belonged to stageⅡ, 14 thumbs to stageⅢ, and 6 thumbs to stageⅣ. Pain level, grip strength, tip pinch strength, range of motion, and radiographic measurement were re-corded. According to the first metacarpal subsidence, the cases were classified in mild, moderate, and severe groups. Clinical out-comes of different group were evaluated and compared. Results All patients were followed up for 9-28 months with an average of 13.9 months. Comparision with the preoperative X-rays showed the first metacarpal had subsided 54.8% of the arthroplasty space after surgery. Grip strength improved from 18.6±10.1 kg to 20.5±11.9 kg, and tip pinch strength increased from 4.4±2.1 kg to 4.5 ± 1.9 kg after the surgery. Radial abduction increased from 55.7° ± 8.2° to 60.6° ± 7.2° and palmar abduction improved from 56.7° ± 8.5° to 63.5° ± 8.2° after the procedure. Patient pain levels (visual analogue scale, VAS) were significantly reduced, from 6.6 ± 1.4 to 0.5 ± 0.7. There was no difference of grip strength, tip pinch strength, thumbs range of motion, and VAS after LRTI in mild, moderate and severe groups. Conclusion LRTI resulted in excellent relief of pain and increase in range of motion. Howev-er, LRTI cannot sustain the arthroplasty space. Compared with the preoperative X-ray, the first metacarpal subsided more than 50%. Subsidence of the first metacarpal doesn't affect the pain relief, range of motion and strength improvement.
ABSTRACT
Objective To introduced the clinical application and indication of treatment the fractures of the base of the first metacarpal with mini external fixator. Methods From October 2002 to December 2004, 37 cases of different typical fractures of the base of the first metacarpal were treated with mini external fixator and followed up, which included type Ⅰ (Bennett fracture) 19 cases, type Ⅱ (Rolando fracture) 10 cases, type Ⅲ 8 cases. Defferent operations were applicated accroding to the fresh degree and classification of fractures. In type Ⅰ and fresh type Ⅱ fractures, closed reduction and fixation with mini external fixator were applicated at first. If the reduction was insatisfied, open reduction and fixation with Kirschner wire and external fixator were necessary. In old type Ⅱ fractures, open reduction associating internal and external fixation was applicated. In fresh type Ⅲ fractures, close and external fixation were applicated. In old type Ⅲ fractures, open reduction and external fixation were done. Results All the cases were followed up average 15 monthes and all the fractures were union successfully. The average union time were 5.5 weeks and 7.5 weeks in the fresh and old fractures. Function evaluation was made according to pain degree, thumb joint activity and proportion of traumatic arthritis. The overall good-excellent rate was 94.6%, the clinical results were satisfactory. Conclusion Treatment of fractures of the base of the first metacarpal with mini external fixator is better than conventional methods. This method is simple and reliable, and may shorten heal time, decrerase joint pain, limitation of joint movement and proportion of traumatic arthritis. It is an effective method in treatment of fractures of the base of the first metacarpal.