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OBJECTIVE: To investigate the factors affecting shoulder joint functions following artificial humeral head replacement. METHODS: A total of 22 patients with complex fracture of proximal humerus, managed by humeral head replacement in Changhai Hospital of The Second Military Medical University from June 2006 to December 2008 were collected, including 12 males and 10 females, with average age of 67 years (52-86 years). During the procedure, soft tissue damage was minimized, the bone of the tuberosity was reserved as much as possible, appropriate matching size of humerus head prosthesis was selected, and early staging functional rehabilitation was performed. Neer's scoring system was used to evaluate the treatment results after replacement. RESULTS: The 22 patients were followed up for 10-30 months, mean 22.6 months. The shoulder joint functions of 14 cases were recovered more quickly through early post-operative staging rehabilitation, No shoulder joint unstable and stiff occurred. The shoulder joint functions of 8 cases were recovered slowly as they complained pain and did not perform early physical therapy after surgery, shoulder joint of 2 cases presented little unstable and 1 case presented stiff. Only 4 cases of all complained occasionally slight shoulder pain, but could continue daily work. The mean movement ranges of shoulder were as follow: mean flexion for 96°(80°-103°), mean extension for 38° (32°-45°), mean abduction for 86°(80°-110°), mean adduction for 31°(30°-35°), mean external rotation for 32°(30°-37°) and internal rotation for 42° (10°-75°). No vasculardamage, nerve damage, lessening prosthesis or prosthesis dislocation was found in all cases. Based on Neer's scoring system, 5 cases were rated as excellent, 11 as good and 4 as fair, with excellent rate of 82% and case satisfaction rate of 87%. CONCLUSION: In order to recover maximally the shoulder joint functions for post-artificial humeral head replacement, we must try our best to avoid soft tissue damage, reserve the bone of the tuberosity, select appropriate humerus head prosthesis, perform early post-operative staging rehabilitation, as well as maintain a normal retroversion of the prosthesis.
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Objective To explore the effect of anterior decompression plus posterior intradural release in treatment of old thoracolumbar fractures with paraparesis. Methods A total of 22 patients with old thoracolumbar fractures with paraparesis were admitted to our hospital since January 2004 to Jan-uary 2008. Before admission, all patients were treated with decompression and internal fixation with pos-terior pedicle system, with bony compression to the spinal cord found through CT scanning and intact spi-nal cord found by MRI but without obvious neurofunction recovery. Of all, 20 patients were kept with the original posterior fixation except for two patients that were fixed with Z-plate after removal of posterior hardware. Autologous bone grafts from iliac were utilized in all patients. Intradural release was done 3-6 months after anterior decompression. Results Of all, 19 patients were followed up for 17-49 months (average 28 months). Twenty patients obtained varied recovery of neurofunction after anterior decompres-sion, with ASIA motor scores increasing from average 59.4 points before decompression to 71.3 after de-compression. The followed-up patients won further recovery after secondary posterior intradural release, with ASIA motor scores further increasing to average 80.6 points. Conclusion For patients with old thoracolumbar fractures combined with paraparesis, the release of intradural sear and fibrocompression is also important besides anterior decompression.
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BACKGROUND: It is often found in the clinic that apart from oppression and instability, there is much difference in sensibility and motion function recovery in patients who have similar imageological changes. Studies show that adhesion in the dura mater of spinal cord, traction of fibrous strip,traumatic scar, malacosis and cyst are the main causes.OBJECTIVE: To investigate the clinical effects of spinal decompression and nerve tissue implantation for obsolete incomplete paralysis.DESIGN: Self-control observation.SETTING: Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA.PARTICIPANTS: We selected 28 patients with traumatic obsolete incom plete paralysis from the Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA, from June 1994 to August 2002. Injured vertebral segments were T7-T9 (5 cases), T10-T12 (12 cases), and L1-2(11 cases). Sixteen patients had undergone decompression, fusion and internal fixation. Thirteen cases of them had undergone posterior decompression and pedicle screw internal fixation. The internal fixation devices had been removed in 7 patients before this procedure. Six cases of traumatic obsolete incomplete paralysis had been treated by hyperbaric oxygen. According to the classification of Frankel, 16 cases were degree B and 12 cases were degree C.METHODS: The dura mater of spinal cord was opened, and the fibrous bands adhering to the spinal cord from arachnoid, pia mater spinalis, ligamenta denticulatum, initial part of nerve root were complete relieved. Then the spinal cord with scar fibers contracted was opened by 3-6 incisions,which were 0.1-0.2 mm deep and longer than the scar part. Cyst found in the spinal cord in 6 cases was opened and the liquid in it was sucked. After that, we denuded spineurium and perineurium of the autogenous sural nerve graft, making the texture and appearance of the nerve look like cauda equine. The nerve was lined in several strips and longitudinally implanted into the incised spinal cord and cyst, and then it was sutured with pia mater spinalis with 9-0 scatheless wire. Finally the endorachis was sutured or covered by sacrospinal muscle.RESULTS: Sixteen cases were followed up for an average of 2.5 years, and all the patients entered the result analysis. The sensibility and motion func tion increased above one grade. Eleven patients who had suffered gatism had obvious progress. The strength of main muscle was increased by 2 grades and reached grade 4 in 16 cases, and walking capability was recovered. In 10 cases it was increased by 1 grade Only sensation had progress in 2 cases.CONCLUSION: Relieving adhesion in the endorhachis, incising the cicatricial spinal cord and bridging the autogenous peripheral nerve have good therapeutic results for gatism and recovering the muscle power of the ex-tremities for the patients with traumatic obsolete incomplete paralysis.
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BACKGROUND: Independent urination and defection functions do not exist in patients with paraplegia above T12 because the injury disrupts the connection to the brain.OBJECTIVE: To reconstruct urination and defecation functions in patients with paraplegia with vascularized intercostal nerve transfer to sacral nerve roots with selected interfascicular anastomosis.DESIGN: Self-control observation.SETFING: Department of Orthopedics, Changhai Hospital of the Second Military Medical University of Chinese PLA.PARTICIPANTS: We recruited 30 patients with traumatic paraplegia at T9-L2 who received treatment in the Department of Orthopedics,Changhai Hospital of the Second Military Medical University of Chinese PLA, from January 1990 to December 2000. Paraplegia plane at T9-T11was found in 17 cases and paraplegia plane at T12-L2 in 13 cases. All the cases had undergone vertebral lamina decompression and internal fixation, 24 of whom had an additional operation to remove the internal fixation.METHODS: Two normal vascularized intercoastal nerves and artery and vein (intercostals nerves were generally at ribs 7 and 8 or 9 and10)above the spinal cord injury site were harvested by cutting in at their distal ends at the midclavicular line and separating the proximal ends from the levatores costarum. The nerves were then transferred to the vertebral canal through a submuscular tunnel. A sural nerve segment that had been harvested and sheared into two segments was sutured to the intercostal nerves by epiperineurial neurorrhaphy and then to the S2-4nerve roots by interfascicular neurorrhaphy. For patients with spinal injury plane below T11, intercostal nerve or subcostal nerve among the 10th and 11th ribs were harvested from the incision of abnormal wall. The nerves were transferred to the lumbar part through the channel of lateral abdominal wall. The transplanted sural nerve was conrected to S2-4 nerve root of partial nerve tract cut alternatively and exposed from S1,2 plane posterior. Defecation function of the patients was evaluated at postoperative 1, 3, 6, 12 and 24 months and follow-up; urodynamic examination was performed before and after operation.patients.RESULTS: A total of 30 patients were followed up for 5 years on average,tion and defecation functions of the patients: 26 (86.6%) had recovered defecation and urination sensation, 23 (76.7%)regained the micturition reflex and uriesthesis; 19 (63%) had recovered function of the detrusor The postoperative maximum urine flow ratio, surplus urine volume, and the maximum systolic pressure of detrusor muscle were obviously improved as compared with those before operation [(12.0±3.0) vs (2.0±0.3) mL/s,(80±12) vs (150±30) mL, (11.76±3.43) vs (5.88±1.47) kPa, P ＜ 0.05]. Postoperative low compliance was found in 9 cases, and detrusor areflexia in 7cases. The number was both significantly decreased as compared with that of preoperative cases (26 and 27 respectively).CONCLUSION: Transfer of vascularized intercostal nerve to S2-4 nerve roots with selected interfascicular anastomosis can reconstruct partial urination and defecation functions, and sensation in buttock, perineal region and cunnus region in paraplegia.
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Objective To evaluate the effects of external fixators combined with vascularized bone graft in treatment of talar neck fractures. Methods We retrospectively reviewed the records of seven patients who were treated for fractures of talar neck from January 2004 to March 2005 in our department. Of them, six were type Ⅱ and one was type Ⅲ according to the Hawkin s classification. One case was managed with closed reduction and six with open reduction and internal fixation with percutaneous cannulated screws. In addition, all the patients were treated with transarticular external fixators combined with vascularized bone graft. Bone healing, osteonecrosis and hindfoot functional recovery were documented. Results All the patients were followed up for 13 to 24 months (average, 17 months). All of them achieved bony union. According to the Maryland hindfoot scoring system, five cases were excellent and two were good. No avascular necrosis was found. One patient complicated with talar body fracture developed posttraumatic arthritis that was later managed by tibiotalar fusion. Conclusions External fixators combined with vascularized bone graft can effectively prevent avascular necrosis of the talus, but the long-term effects of this method need further observation.
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The aim of this procedure is to reconstruct the defecation and urinary functions in paraplegic patients. In 30 patients, two normal vascularized intercoastal nerves above the paraplegic level were isolated and their distal ends divided. They were transferred to the vertebral canal through a submuscular tunnel. The sural nerve was harvested with enough length and separated into two segments, which were sutured as a bridge with S 2-4 nerve roots by interfascicular neurorrhaphy in patients with spinal cord injury above T 11 or with S 2-4 nerve roots outside of the vertebral canal in patients with spinal cord injury below T 12. After 2 to 11-year (mean 5 years) follow-up, 26 (86.6%) patients regained partial micturition reflex and defecation reflex, and partial sensation (S1-2) in buttock, perineal and vulva regions. In 23 (76.7%) patients had also recovery of the function of voluntary urination, and 8 (27%) of them showed partial recovery of function of the detrusor muscle, urethral sphincter, and anal sphincter. The results showed that the procedure described above could be used as an alternative method to reconstruct the function of defecation and urination, and also partial sensation of perineal and vulval region in a part of paraplegic patients.
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Objective To determine the efficacy of side-to-side anastomosis in the treatment o f peripheral nerve injury.Methods Ten cases of peripheral nerve injury which could not be repaired by the routine methods were selected in thi s study by using the side-to-side anastomosis.The average time between injury to operation was 4months(1to 10months).The injured nerve trunk was kept abr east of neighbor donor nerve at suitable segment,the opposite epineurium and fascicle of two nerve were cut open 1-2cm until nerve fiber was seen.Two segments were clo sed together tightly and the side-to-side anastomosis was performed wit h9/0-11/0threads.Clinical and EMG e xamination were carried on in each case.Results Nine of ten cases were followed-up for 3months t o 3years,with an average of 16months.M3S3or b etter of their main nerve control area were found in 6/9c ases,and M2S3 - in 3/9.No obvious motion or sensory f unction loss was seen after the surgery,or the dec rease from M5S5down to M4S4of the don or nerve postoperatively re-covered in 3weeks to 3months.Conclusion Side-to-side anastomosis of peripheral nerve is a new remedy measure to treat those peripheral nerve injury which can not be treated by routine procedures.[
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0.05). Conclusion The injured peripheral nerve is able to regenerate after side-to-side neurorrhaphy.
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A new method for finger reconstruction in multiple loss (more than 3) of fingers with the use of one of the remnant stumps together with its metacarpophalangeal joint has been successfully used in 6 cases (8 fingers) since September 1983. Common digital artery, dorsal veins and digital nerves were anastomosed (or with a pedical of arcus palmaris superficialis without artery anastomosis), and the flexor and extensor tendons united individually. Follow-up of 12-24 months showed a good appearance,circulation and sensation. The reconstructed finger, 4.5-7.0cm long had interphalangeal joint. Functions of the fingers were satisfactory. The transplant was obtained from the injured hand only, so that there was no tissue loss of tissue from any normal limb. It was relatively simple and the patient accepted this method readily.