Minimally invasive treatment of Dupuytren's contracture by Pi needle percutaneous multi-segmental fasciotomy / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of Pi needle percutaneous multi-segmental fasciotomy as a minimally invasive treatment for Dupuytren's contracture.</p><p><b>METHODS</b>Sixteen patients(25 fingers: 4 middle fingers, 12 ring fingers, 9 little fingers) were involved in the study, including 11 males and 5 females. There were 2 cases on both hands and 14 cases of single hand disease, including 8 cases of left hand and 6 cases of right hand. The age ranged from 48 to 79 years old, with a mean age of 58.5 years old. The duration of the disease ranged from 1 to 15 years, with a mean time of 5.5 years. There were 12 cases of physical labor, 4 cases of non physical labor, with no family history of palmar fascial contracture. There were 9 cases of tobacco and alcohol addicts, 6 cases with hypertension history, and 3 cases of diabetes mellitus. According to Meyerding classification, 1 case was stage 0, 1 case was stage I, 10 cases were stage II, 4 cases were stage III and 0 case was stage IV. The postoperative function of Dupuytren's contracture patients was evaluated according to Adam efficacy evaluation criteria.</p><p><b>RESULTS</b>The time of incision healing time ranged from 7 to 14 days, 10 days on average. The 3 fingers incision skin cracked 3 to 4 mm during the loosening process, and 14 days after dressing changed, no skin necrosis and wound infection complication occurred. After treatment, fascia contracture of 24 fingers completely or almost disappeared. Limited extension of metacarpophalangeal joint and interphalangeal joint ranged from 0 to 10 degrees, 22 fingers showed normal function of finger extension, 2 fingers had more than 75% elongation function, and 1 finger recurred. According to the evaluation of Adam evaluable standard of curative effect on the postoperative function of Dupuytrens's contracture: 22 fingers got an excellent result, 2 fingers good and 1 finger recurred. The patients were satisfied with the results of the treatment.</p><p><b>CONCLUSIONS</b>Pi needle percutaneous multi-segmental fasciotomy for the treatment of Dupuytren's contracture is a simple, minimally invasive and effective method.</p>

Internal fixation with one-hole microplate for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of one-hole microplate internal fixation for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture.</p><p><b>METHODS</b>Twenty-two patients (16 males, 6 females) with collateral ligament injuries of the metacarpophalangeal joint of the thumb combined fracture were treated with one-hole microplate internal fixation. The age of the patients ranged from 18 to 53 years old with a mean age of 28.5 years old. The duration from injury to surgery ranged from 2 hours to 2 months, and the mean time was 6 days. All the patients had collateral ligament injuries combined with fracture of the metacarpophalangeal joint of the thumb. Thirteen patients had injuries in the right hand and 9 patients had injuries in the left hand. There were 18 cases of closed wound and 4 cases of open wound. Eighteen patients had fresh injuries (< 2 weeks) and 4 had old injuries (> 2 weeks). Sixteen patients had injuries in the ulnar collateral ligament of the thumb combined with fracture, 6 patients had radial collateral ligament injuries of the thumb combined with fracture, 4 cases of which were complicated with injuries of abductor pollicis brevis and the end of the flexor pollicis brevis tender. The size of the avulsed fragment was about 3.0 mm x 4.0 mm to 6.0 mm x 7.0 mm.</p><p><b>RESULTS</b>The incisions of 22 patients healed by first intention. The follow-up periods ranged from 6 months to 5 years old,with an average of 2.5 years old. The thumb function was evaluated by Saetta and other evaluation criteria, and 20 patients got an excellent result and 2 good.</p><p><b>CONCLUSION</b>The application of one-hole microplate internal fixation in treating collateral ligament injuries with fracture of the metacarpophalangeal joint of the thumb is an effective method.</p>

Impact of migraine attacks on the blood-brain barrier / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cortical spreading depression can cause migraine attack, and up-regulate matrix metalloproteinase-9 (MMP-9) expression in animal. This study aimed to determine the impact on the structure and function of the blood-brain barrier by measuring plasma MMP-9 levels in patients at the acute and late stages of migraine attacks in order to elucidate the pathological mechanisms involved.</p><p><b>METHODS</b>We recruited a case-control cohort of 38 adult migraine patients and 20 age- and gender-matched healthy control subjects. Five milliliter blood samples were collected at the acute and late stages of migraine (days 1 - 7), and also from the control subjects. Solid phase double antibody sandwich enzyme-linked immunosorbent assay was used to determine plasma MMP-9 levels. Statistical analysis was performed using the SAS version 9.1.</p><p><b>RESULTS</b>Initial plasma MMP-9 levels of migraine patients were significantly higher than those of controls ((12.612 ± 0.016) µg/L vs. (6.069 ± 0.023) µg/L, respectively, P < 0.05). High MMP-9 expression was observed during days 1 - 6 of migraine attacks, with highest expression occurring on day 3 ((17.524 ± 0.035) µg/L). During attacks, MMP-9 levels were similar in migraine patients with and without aura (P > 0.05); in addition, levels were not correlated with degree of headache pain (P > 0.05).</p><p><b>CONCLUSIONS</b>We hypothesize that migraine could lead to increased plasma MMP-9 levels resulting in blood-brain barrier damage. MMP-9 levels increase during days 1 - 6 of migraine attacks, peaking on day 3. Therefore, MMP-9 could be used as a biological marker to guide treatment of migraine attacks.</p>