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Objective:To investigate the clinical efficacy of da Vinci Xi surgical system assisted laparoscopic exocytosis for hepatic echinococcosis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 7 patients who underwent da Vinci Xi surgical system assisted laparoscopic exocytosis for hepatic echinococcosis in Xinjiang Uiger Municipal People′s Hospital from October 2019 to July 2021 were collected. There were 3 males and 4 females, aged (43±12)years. Observation indicators: (1) surgical situations; (2) complications; (3) follow-up. Mea-surement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All 7 patients underwent da Vinci Xi surgical system assisted laparoscopic exocytosis for hepatic echinococcosis successfully, without conversion to laparotomy and laparoscopic surgery. None of the 7 patients underwent intraoperative blood transfusion and the operation time, volume of intraoperative blood loss, time to postoperative first and flatus, time to postoperative initial liquid food intake, time to postoperative abdominal drainage tube removal, time to postoperative urethral catheter removal, duration of postoperative hospital stay of 7 patients was (225±45)minutes, 100(range, 50-200)mL, (1.9±0.7)days, (4.2±1.2)days, (7±4)days, (2.9±0.8)days, (7±4)days, respectively. (2) Complications. None of the 7 patients had postoperative complications such as bile leakage, abdominal hemorrhage, incision infection, hydatid cavity infection, secondary operation, intestinal obstruction, pulmonary infection and deep venous thrombosis of lower limbs. (3) Follow-up. All 7 patients were followed up for 7 (range, 3-12) months. None of the 7 patients had recurrence of hepatic echinococcosis or peritoneal implantation and incision implantation, and all patients survived during follow-up.Conclusion:da Vinci Xi surgical system assisted laparoscopic exocytosis for hepatic echinococcosis is safe and feasible.
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Objective:To investigate the effects of parallel reconstruction with titanium cable fixation and concentric reconstruction with plate fixation in the reconstruction of femoral shaft continuity after resection of malignant tumor.Methods:From September 2013 to December 2017, the data of 11 consecutive patients with thigh malignancies and related complications were retrospectively analyzed, including 10 males and 1 female. The mean age of the 11 patients was 27.1±15.6 years (range, 7-49 years). These case series included 6 cases of primary bone defect reconstruction after resection of femoral shaft malignant tumor, 4 cases of nonunion or allogeneic bone fracture after massive bone allograft for femoral malignant tumor, and 1 case of femoral fracture caused by radiotherapy after resection of thigh soft tissue sarcoma. Vascularized fibular autograft combined with massive bone allograft or devitalized bone graft was used for reconstruction. The patients were divided into two groups according to reconstruction method, namely parallel reconstruction group and concentric reconstruction group. In the parallel reconstruction group, the vascularized fibula was placed on the medial side of the femur and the allograft and fixed with titanium cable. In the concentric reconstruction group, the vascularized fibula was placed in the medullary cavity of the allogeneic bone or devitalized bone and further fixed with the plate and screws.Results:There were 5 patients with 7 allograft-host junctions or fracture were treated with parallel reconstruction. The grafted length of fibula was 15.0±4.3 cm (range, 10-20 cm). The follow-up duration was 33.2±15.6 months (range, 20-53 months). Six patients with 10 allograft-host junctions were treated by concentric reconstruction. The grafted length of fibula was 15.5±2.3 cm (range, 12-18 cm). The follow-up duration was 45.8±15.3 months (range, 22-62 months). There was no significant difference during follow-up between the two groups ( t=1.36, P=0.208). The union rate in parallel reconstruction group was 100% (7/7), and the union duration was 15.9±6.8 months (range, 3-22 months). The union rate in the concentric reconstruction group was 70% (7/10), and the union duration was 18.9±6.4 months (range, 11-30 months). There was no significant difference in the union rate ( P=0.228) or the union duration ( t=0.846, P=0.414) between the two groups. Conclusion:Both parallel reconstruction and concentric reconstruction of vascularized fibular autograft are important methods for reconstruction of femoral shaft continuity after resection of malignant tumor. There might be no significant difference in union rate or union duration between the two methods.
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Objective:To investigate the association between hepatic echinococcus granulosus infection and necrosis with gene polymorphism of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α), and to identify the related factors at the gene level.Methods:A total of 106 patients with hepatic echinococcosis who underwent surgical treatment in the department of hepatobiliary surgery, People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2020 were selected. Patients with necrosis caused by hepatic echinococcus granulosus infection were selected as the observation group, and patients without necrosis caused by hepatic echinococcus granulosus infection were selected as the control group, with 53 cases in each group. The serum levels of IL-10 and TNF-α were detected by enzyme-linked immunosorbent assay (ELISA). The polymorphisms of IL-10 (-592, -1082) and TNF-α (rsl800630) were detected by polymerase chain reaction (PCR). The levels of IL-10 and TNF-α and their gene polymorphisms were analyzed.Results:The levels of serum IL-10 and TNF-α in the observation group were significantly higher than those in the control group (all P<0.05); There was significant difference in genotype and allele frequency of IL-10 (-592, -1082) and TNF-α (rsl800630) (all P<0.05). The serum IL-10 level of CC genotype patients with IL-10 gene -592C/A locus in the observation group was higher than that of CA+ AA genotype patients, with statistically significant difference ( P<0.05). The serum IL-10 level in patients with TT genotype at -1082T>A of IL-10 gene in the observation group was higher than that in patients with TA+ AA genotype, with statistically significant difference ( P<0.05). The serum TNF-α level in patients with CC genotype at rsl800630C/A locus of TNF-α gene in the observation group was higher than that in patients with CA+ AA genotype, with statistically significant difference ( P<0.05). Conclusions:The changes of IL-10 (-592, -1082) and TNF-α (rsl800630) gene polymorphisms may be associated with hepatic echinococcus granulosus infection and necrosis.
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Objective:To explore the utility of the muscle redistribution technique (MRT) in the signal recognition of an intelligent bionic prosthesis.Methods:Between December 2016 and April 2017, 4 male patients were treated with muscle redistribution procedures. Among them, 3 were upper limb amputees of the distal 1/3 of the forearm, at the carpometacarpal joint and at the midcarpal joint. One was a lower limb amputee at the distal 1/3 of the lower leg. In each case, 4-6 muscles and tendons in the stump were transferred and the tendons were anchored in different areas of the skin. When the muscle contracted actively, the tendon pulled the skin, resulting in obvious deformation of the skin in different areas. The skin′s deformation, capacitance signal data and postoperative complications were used as indicators in the evaluations. To measure the capacitance signals the patients were asked to grip, flex and extend the wrist, and flex and extend the fingers , or dorsi- and plantar-flex the ankle, and flex and extend the toes. With the help of capacitance sensors the limb′s deformation was analyzed.Results:Three months after the surgery the patients were able to actively control contraction of the transferred muscle and produce skin deformation. At the final follow-up, the effective deformation rate was 80% (16/20). Two kinds of classifiers were identified by linear discriminant analysis and quadratic discriminant analysis. In the upper limb, the overall recognition accuracies were 97.27% and 100% respectively, and the recognition accuracy of each action was 100%. In the lower limb, the overall recognition accuracies were 95.32% and 100%, and the recognition accuracy of each action was again 100%. In one case wound healing was delayed and several dressing changes were required.Conclusions:MRT can effectively output motion intentions and increase the number and intensity of motion signals. The procedure provides a novel way for better control of intelligent bionic prostheses.
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Objective Verification the changes in expression and mechanism of serum inflammatory factor IL-1 beta and related biomarkers by establishing an animal model of deep vein thrombosis (DVT) in lower extremity of rats.Methods Seventy male SPF SD rates,weighing (200 ± 20) g,randomly divided into groups of ten and made each group of rats equal in weight.Recorded as control group,sham operation group,model experiment 2,8,24,48,72 h group.The control group was fed normally without any treatment;the sham operation group,laparotomy was performed without vein ligation;the model experimental group was divided into different groups according to different time periods.The model of venous thrombosis of lower extremities was established through venous ligation surgery in rats,they were sacrificed at the 2 hours,8 hours,24 hours,48 hours and 72 hours after the modeling,and blood samples and tissues were collected.The expression levels of IL-1 β,tissue factor and xanthine oxidase (XOD) in blood samples of 7 groups of rats were measured by ELISA.DVT morphology were analyzed by Pathology,flow cytometry were used to count peripheral blood circulating endothelial cells in rats separated after injury.The expressions of IL-1 β,tissue factor,XOD,pathological and flow results were compared between the normal control group,the sham operation group and the lower extremity deep vein thrombosis model group at different time periods.All data were represented by mean standard deviation (Mean ± SD).One-way anova was performed on the measurement data,and the LDS method was used to compare the two pairs.The test level was α =0.05.Results IL-1β,tissue factor,XOD showed no significant difference between the control group and the sham operation group,P ＞ 0.05.The model experimental group showed an upward trend in the process of 2 h-24 h and reached a peak value at 24 h.The histopathology showed that red thrombus and mixed thrombus could be seen within 2 h-48 h in the thrombosis model experiment group.The blood vessel wall was accompanied by inflammatory cell infiltration.After 72 h,the thrombus was obviously organized.The CD31 concentration of the control group and the sham operation group were (4.04 ± 1.00),(4.82 ± 1.12),and the difference between the two difference between the two groups was not statistically significant (P ＜ 0.05);the CD31 concentration of model experimental group had significant differences from 2 h,(5.188 ±0.895);8 h,(5.614 ± 1.243);24 h,(9.785 ± 1.996);48 h,(14.198 ± 2.172);72 h,(18.118 ± 1.025),it continued to increase,P ＜ 0.05.Conclusion High expression of inflammatory IL-1β and related markers tissue factor,XOD confirmed the mechanism of injury of deep venous endothelial cells in lower extremities caused by IL-1β and the mechanism of further aggravation of thrombosis after injury.
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Objective To analysis the role of hydrogen sulfide in the process of venous thrombosis and the correlation with homocysteine.Methods A retrospective case-control study was carried on deep venous thrombosis patients and healthy population in the People's Hospital of Xinjiang Uygur Automous Region from March 2015 to November 2016,which including 169 patients and 169 health persons.Detected the concentration of hydrogen sulfide and homocysteine in plasma of study population,compared their differences in the two groups by using single-factor analysis,and analysed the correlation of the concentration between hydrogen sulfide and homocysteine.The median and quartile spacing were used to express values with abnormal distribution,and Mann-Whitney U test was performed between groups.Pearson or Spearman correlation coefficient were used to describe the correlation between two variables.Results The Plasma concentrations of hydrogen sulfide in both groups were 29.30 nmol/ml (23.89,37.82),32.99 nmol/ml (26.29,39.68) and the plasma concentrations of homocysteine were 15.37 μmol/L(11.64,19.68),12.13 μmol/L(9.65,15.95),their concen trations in two groups have statistic difference (P ＜ 0.05) and were risk factors for deep venous thrombosis;the plasma concentration of hydrogen sulfide and homocysteine was negatively correlated(P ＜ 0.05).Conclusion The plasma concentration of hydrogen sulfide is associated with deep venous thrombosis and a protective factor for deep venous thrombosis;there is a negative correlation between plasma homocysteine and hydrogen sulfide,they may play an interactional role in the process of thrombosis.
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Triangular fibrocartilage complex (TFCC) plays an important role in maintaining stability of the distal radioulnar joint (DRUJ),buffering the ulnar carpal axial impaction and holding the proximal carpal bones.Patients with injured TFCC may suffer pain over the ulnar side of the wrist and DRUJ instability.Many of them may have difficulty in undertaking daily activities,leading to even psychological problems.With the development of arthroscopic technology and updated understanding of the mechanisms of TFCC injury,great progress has been made in the diagnosis and treatment of the traumatic injury,especially in the arthroscopy-assisted treatment.
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Objective: To evaluate the role of the deep radioulnar ligament in the stability of the distal radioulnar joint (DRUJ).Methods: In the study, 14 fresh cadaver upper extremities were randomly divided into two groups.After exposuring the palmar and dorsal deep distal radioulnar ligament, one group was marked as palmar deep radioulnar ligament, and the other group was marked as dorsal deep radioulnar ligament.The pronator teres and the supinator were exposed.A Kirschner wire perpendicular to the bone on Lister tubercle of radius was inserted, then another Kirschner wire on the same level of ulnar inserted when the forearm was in neural position, which was kept parallel to the first Kirschner wire.These specimens were mounted on a specially designed jig which held the limb rigidly, keeping the elbow fle-xion and the ulnar fixation.The radius could freely rotate around the ulnar.Then 50 N force on the pronator teres was applied to simulate the active pronation, and 60 N force on the supinator to simulate the active supination.The active pronation was stimulated, and the displacement of the distal radius was measured with respect to the ulna.The active supination was atimulated, and the displacement of the distal radius was measured with respect to the ulna.The palmar deep radioulnar ligament in one group was cut, then the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.The dorsal deep radioulnar ligament in the other group was cut, and the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.Results: After resection of the palmar deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was statistically significantly different when the forearm was in pronation (t=5.591, P=0.001), but there was no difference when the forearm was in supination (t=0.433, P=0.680).After resection of the dorsal deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was not different when the forearm was in pronation (t=1.000, P=0.356), but there was statistically significant difference when the forearm was in supination (t=6.225, P=0.001).Conclusion: DRUJ is unstable when the forearm is in pronation after resection of the palmar deep ra-dioulnar ligament, and DRUJ is unstable when the forearm is in supination after resection of the dorsal deep radioulnar ligament.
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Objective:To investigate the outcomes of applying microvascular anastomotic coupling de-vices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical out-come.Methods:From March to September 2013,19 injured arteries from 18 male patients who presen-ted at Department of Hand Surgery,Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures.COUPLER,a microvascular anastomotic coupling device was applied in these artery injury repair operations.The 19 repaired arteries included 3 brachial arteries,6 ulnar arteries and 10 radial arteries.After the procedures,all the 18 patients were then fol-lowed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality.Results:The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was (71.5 ± 40.9)d with the longest follow-up time as 116 d and shortest as 14 d.No patient returned to the opera-ting room after the procedures and after being dismissed from the hospital.None of the 18 cases were re-ported to have problems with circulation and thrombosis formation in their upper extremities.Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends.Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis;while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery.These evidences indicated that the outcomes of our initial evalua-tion for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were posi-tive.Conclusion:Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures.The procedures are quick,effective and safe. The clinical application of this microvascular anastomotic coupling device in artery injures is promising, however,additional evidences through further clinical investigation with more cases are warranted.
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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.
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Objective To evaluate the method and outcomes of radiocarpal joint reconstruction via nonvascularized and vascularized fibular bone graft after distal radius bone and joint defect.Methods Between November,1966 and March,2009,27 cases with distal radius bone and joint defect due to tumor en bolc excision (24 cases) or AO C3 type fractures (3 cases) were treated with nonvascularized or vascularized fibular bone graft.There were 9 males and 18 females.The mean age of these patients at the time of surgery was 27 years (rage from 16 to 67 years).There were 14 left sides and 12 right sides and 1 bilateral side.Nine cases with vascularized and 18 cases with nonvascularized fibular bone graft for radiocarpal joint reconstruction.The bone fixed with plate or/and k-wire.DASH scores,G/W wrist scores,PRWE scores were applied for writ function evaluation and the grasp power recovery rate and bone healing time was also compared during postoperative follow up.Results All 27 patients were followed with an average follow-up time being 9 years (range from 3.5 years to 44.0 years).The average length of fibular bone harvested was 10 cm for vascularized bone graft and 9 cm for nonvascularized.The all fibular bone was healed and the average healing time was 4.7 months (range from 3-8 months).No tumor recurrence or distance metastasis occurred during the follow-up.The average DASH scores was 7.97 (2.5-17.0),G/W scores of 24 patients ranged from 1 to 2,the wrist function result was excellent,account for 88.9％,and 3 cases from 3 to 7,function was good,account for 11.1％; the average grasp power recovery rat was 85.81％ (75％-104％); the average PRWE scores were 25.3(10.5-38.0).Comparison outcomes between the nonvascularized and vascularized fibular bone graft for radiocarpal wrist joint reconstruction,there was no significant statistics difference for bone healing time,DASH,G/W,PRWE scores and grasp power recovery rate (P ＞ 0.05).There were no other complications occurred except 3 patients had mild leg pain after long distance walking and 1 case fracture following patient's accident postoperative 11 years,and healed through conservative treatment.Conclusion The nonvascularized or vascularized fibular bone graft is an excellent choice and has less complication with maximal wrist function recovery for radiocarpal joint reconstruction following distal radius bone and joint defect due to all kinds of reasons,such as tumor en bloc excision,distal radius AOC3 type comminuted fracture.The vascularized fibular graft is recommended for larger than 12 cm bone graft.
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<p><b>OBJECTIVE</b>To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.</p><p><b>METHODS</b>Six patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps. Afterwards, a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.</p><p><b>RESULTS</b>All six free scapular flaps survived without signs of infection. Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex, which resolved after six weeks with only conservative therapy. All the incisions healed without other complications. At six-month follow-up, the patients regained full shoulder function.</p><p><b>CONCLUSION</b>With the assistance of an adjacent pedicled flap, the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar. It can achieve positive outcomes in both reconstructive and aesthetic aspects.</p>
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Adult , Female , Humans , Male , Arm Injuries , General Surgery , Debridement , Drainage , Hand Injuries , General Surgery , Plastic Surgery Procedures , Methods , Scapula , Soft Tissue Injuries , General Surgery , Surgical Flaps , Treatment OutcomeABSTRACT
Objective To evaluate the preliminary clinical outcome of the screw fixation of minimally displaced scaphoid fracture assisted by computerized imaging reconstruction and preoperative planning system.Methods From March 2013 to Feburary 2014,Five screws on five patients were treated.We calculated and designed the position of scaphoid screw guide wire and ensured the guide wire centrally placed in the scaphoid by using the computerized imaging reconstruction and preoperative planning system software.The appropriate length of the screw was measured too in the software.We also identified the entry and exit points of the guide wire on the custom orthoses splinting the wrist joint.Five patients with scaphoid fractures were treated with percutaneous screw fixation under the guidance of a C-arm fluoroscopy and a guide wire were inserted based on the entry and exit points calculated preoperatively.All of the scaphoid fracture was nondisplaced or less than 1 mm.The modified MAYO wrist scoring system was used to evaluate the pain,function and range of motion for the wrist joint during follow up.Results Total surgical time was 28.8 min (25-39 min)and Fluoroscopy time was 18.4 s (11-23 s).The fracture healing was observed at routine 8 weeks follow up.No complication such as infection or fixation failure was reported.Modified MAYO wrist score was 83.8 (81-88)at average followup at 15 months (6-12 months).Conclusion Computer assisted percutaneous screw fixation is an effective method for the treatment of nondisplaced scaphoid fractures.It leads to significantly reduced guidewire placement time and radiological exposure time while provides accurate placement of the screw.
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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.
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<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>
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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>
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Aged , Female , Humans , Male , Middle Aged , Arthroplasty , Methods , Carpometacarpal Joints , General Surgery , Plastic Surgery Procedures , Methods , Thumb , General SurgeryABSTRACT
Objective To investigate the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC) and three-ligament tenodesis for chronic scapholunate dissociation,and to determine its recurrence rate and time after operation.Methods From January 2008 to January 2011,23 patients with chronic scapholunate dissociation were treated in our hospital.Among them,19 patients underwent DILC and 4 underwent three-ligament tenodesis.The average duration of follow-up was 10.1 months.The clinical and radiographic outcomes were recorded preoperatively,at 1 month after pin removal,and at final follow-up.The VAS and DASH questionnaire were used to assess the pre-and post-operative pain,improvement of function and degree of patient satisfaction,respectively.Results The radiographic outcome showed that the abnormal carpal alignment was reduced completely in all patients during operation.At 1 month after pin removal,the mean scapholunate gap was 4.0 mm,and average scapholunate angle was 75°.Compared with those before operation,the scapholunate gap and scapholunate angle were improved.At final follow-up,the mean scapholunate gap was 4.3 mm,and the mean scapholunate angle was 78°; they were worse compared with those at 1 month after pin removal,while there was no statistical difference in both results.The other three radiographic results at final follow-up remain unchanged.The wrist flexion,wrist extension and grip strength decreased from preoperative 66％,69％ and 71％ of the contralateral side to postoperative 52％,50％ and 66％ of the contralateral side.Conclusion Soft tissue reconstruction cannot withstand the large and repetitive forces.Carpal collapse recurs in a short time after dorsal capsulodesis and three-ligament ten-odesis,which mostly happens in 1 month after pin removal.The best way to treat scapholunate dissociation is still unknown.
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Objective Retrospective analysis of experience of distal upper limb autologous arteriovenous fistula for hemodialysis access and treatment of arteriovenous fistula occlusion was conducted.Methods To summarize the clinical data of 214 cases of initial autologous arteriovenous fistula and 22 cases of treatment of arteriovenous fistula occlusion were carried out from Aug.2007 to Mar.2011,comparing the success rate and long-term patency rate.Results Two hundred and fourteen cases of initial autologous arteriovenous fistula,in which 168 cases were cephalic vein-radial artery side-to-side anastomosis at snuffbox,46 cases were cephalic vein-radial artery end-toside anastomosis at proximal wrist,the success cases were 203 (94.8％),the failed cases were 11 (5.2％),limb edema in 82 cases and there was no steal syndrome and heart failure.The primary patency rate was 95.2％ at 1 year and 91.3％ at 2 years.There were 22 patients accepted treatment of arteriovenous fistula occlusion,in which,8 cases were embolectomy due to acute occlusion,8 cases were thrombectomy and balloon dilation because of anastomotic stricture and thrombosis and 1 failed,5 cases were proximal anastomosis again after chronic occlusion.Conclusions Autologous arteriovenous fistula of the distal upper limb,especially from the place of snuffbox which is the preferred method for autologous arteriovenous fistula.And deal with arteriovenous fistula occlusion actively can often extend the usage time of the autologous blood vessels and improve the life quality of patients.
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ObjectiveTo introduce the indications and operative procedure of anatomic reconstruction of the distal radioulnar ligaments in patients with chronic instability of the distal radioulnar joint(DRUJ),and report its preliminary clinical results.Methods From October 2008 to June 2009,6 patients with instability of the DRUJ underwent anatomical reconstruction using a free palmaris longus tendon graft,including 4 males and 2 females with an average age of 22 years.A 5 cm dorsal incision was made between the fifth and sixth extensor compartments.An L-shaped flap was created in the DRUJ capsule.This flap is then elevated proximally to expose the articular surface of the DRUJ and the proximal triangular fibular cartilage complex(TFCC).A tunnel was made through the radius.The other tunnel was made between the ulnar neck and the fovea of the ulnar head.A whole-length palmaris longus tendon graft was taken.The volar opening of the radius tunnel was exposed through a longitudinal incision radial to the flexor carpi ulnaris tendon.One end of the graft was pulled to the palmar side easily through the tunnel.A hemostat was penetrated through the volar capsule to the volar side proximal to the remaining TFCC.The end of the graft was grasped with the hemostat and pulled back along this tract.Both graft limbs were passed through the ulnar tunnel to exit at the ulnar neck.One limb of the tendon was passed around the ulnar neck and deep to the ECU sheath.With the forearm in neutral rotation,the limbs were pulled taut,tied together,and secured with sutures.Immobilize the extremity in a long-arm plaster splint with the forearm in neutral position for 4 weeks,and changed to a short arm cast for an additional four weeks.ResultsThe average follow-up period for all 6 patients was 14 months(range,9-24).No infection and sensory nerve branch disturbance occurred.The pain symptom was reduced and the grip force was improved significantly.A functional evaluation was performed using the modified Mayo wrist scoring system.All patients had better wrist scores postoperatively in the short (mean,95) term compared to preoperatively(mean,69).Five patients satisfied with the final result.Conclusion Anatomic reconstruction of the distal radioulnar ligaments is indicated for chronic DRUJ instability without osteoarthritis,it is a reliable method with a very good short term follow up result.Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints and kinematics.
ABSTRACT
Objective To investigate the anticoagulant factors that Kazakh women are prone to develop deep vein thrombosis before or after delivery.MethodsThe protein C,protein S,antithrombin Ⅲ (AT-Ⅲ) activity,activated protein C resistance ratio (APCR) of 36 Kazakh women cases and 39 Hans women cases before and after delivery were determined.ResultsThe protein S (43.13±11.36,58.05±17.10) was significant changed (P＜0.01)in Kazakh women before and after delivery.The protein C (97.34±18.37,118.02±23.46) and protein S (58.05±17.10,67.97±19.22) were statistically different between Kazakh women and Han women after delivery(P＜0.05,which protein C was P＜0.01).The anticoagulant indexes of Kazak women after delivery was still within normal range.ConclusionsNormal women have prothrombotic state before and after delivery,especially the Kazakh women.It may be an important factor of deep vein thrombosis-prone before and after delivery that protein C and protein S in Kazakh women have lower activity than that in Han women.The detection of anti-coagulation have some clinical significance on the prevention of the deep vein thrombosis in Kazakh women before and after delivery.