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1.
Chinese Journal of Trauma ; (12): 961-967, 2021.
Article in Chinese | WPRIM | ID: wpr-909963

ABSTRACT

The development of hand surgery in China began from the 1950s. Although it started late compared with the Western countries,it has developed rapidly. It has made remarkable achievements,such as the world's first severed finger replantation,the first severed arm replantation,the first second toe transplantation for thumb reconstruction,and the first contralateral C 7 nerve root transfer,etc. It has been gradually popularized,developed and expanded in whole China,and has now steadily moved to the world and is gradually surpassing the international standards. On the 100th anniversary of the founding of the Communist Party of China,the authors review the history and achievements in hand surgery to show the spirit of hard struggle,persistent development and continuous progress of Chinese hand surgeons,to forge ahead the spirit of persistance,unity,inheritance and innovation for the development of hand surgery in China.

2.
Article in Chinese | WPRIM | ID: wpr-871193

ABSTRACT

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.

3.
Chinese Journal of Trauma ; (12): 143-147, 2020.
Article in Chinese | WPRIM | ID: wpr-867686

ABSTRACT

Objective:To investigate the value of high-resolution 3T MRI in the detection of triangular fibrocartilage complex (TFCC) injuries through a diagnostic test.Methods:A retrospective case series analysis was performed in 133 patients with ulnar wrist pain admitted in Beijing Jishuitan Hospital from January 2013 to April 2018. There were 68 males and 65 females, aged 14-69 years (mean 32.6 years). The patients was examined with the wrist MRI with consistent parameters and then received wrist arthroscopic detection or treatment. The TFCC injuries were classified as central injury, namely triangular fibrocartilage disc injury and peripheral injury, namely the tear of ulnar attachment, radial attachment, distal radioulnar ligaments and ulnocarpal ligaments. Take the results of wrist arthroscopy as the gold standard, the MRI and arthroscopic findings were compared and the sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were determined.Results:Wrist arthroscopy confirmed TFCC injuries in 122 patients, among which 72 patients were with central injury and 102 with peripheral injury. Meanwhile, TFCC injuries were diagnosed with MRI in 124 patients, among which 75 patients were central injury and 111 cases were peripheral injury. As for central injury, the sensitivity/specificity, positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.972/0.918, 0.933/0.966 and 11.85/0.03, respectively; when the target pathology was peripheral injury, the sensitivity/specificity, positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.882/0.323, 0.811/0.45 and 1.30/0.37, respectively.Conclusions:High-resolution 3T MRI is accurate in detection of central injury of TFCC, no matter the injury is traumatic or degenerated. In the diagnosis of peripheral injury of the TFCC, MRI can provide some help for its high sensitivity. However, the positive findings of MRI on peripheral structures should be cautious because of the poor specificity, and hence the results of history, physical examination and MRI should be considered together to attain an accurate diagnosis.

4.
Article in Chinese | WPRIM | ID: wpr-797699

ABSTRACT

Objective@#To present the clinical result of a procedure using pedicle posterior interosseous perforator adipofascial flaps for the treatment of congenital proximal radioulnar synostosis (CPRUS).@*Methods@#Eight forearms (from eight patients) with CPRUS were treated by the operation during December 2013 to January 2018 at Beijing Jishuitan Hospital. The average age of the children are seven years old (range: five years old to twelve years old). There were six boys and two girls. Seven forearms were classified as the Cleary type Ⅲ, and one forearm was classified as the Cleary type Ⅱ. Five children were suffered with bilateral CPRUS, and three children were unilateral. The average fixed forearm pronation angle was 43° (range: 0° to 80°). The operating procedure: a dorsal incision from olecranon to the distal 1/3 part of the middle axial of forearm was designed. Then the pedicle posterior interosseous perforator adipofascial flap was harvested. Elevated the anconeus muscle retrogradely, and the location of the osseous synostosis was exposed. Then the radial volar Henry incision just below the elbow joint crease was designed, the insertion part of the biceps brachii was exposed and elevated. The osseous synostosis was exposed and removed with the help of burr at the dorsal side. The cartilage part of the radial head was remolded. A trapeziform osteotomy was made at the site of radial tubercle due to the deformity angle of the radial shaft to reduce the dislocated radial head, then the distal and proximal part of radius was reduced and fixed with plate and screw. The pronator quadratus and the adipofascial flap were pulled to the volar side, and sutured to the deep fascia. The tendon of the biceps brachii was pulled dorsally and reattached to the radial tubercle. Postoperatively, an above-the-elbow splint was applied to keep the elbow in 90° of flexion and the forearm in 80° of supination. Three days later, the other splint was used to keep the forearm in 80° of pronation. Two splints were worn every other day alternatively. At four weeks after the operation, the ROM exercises were initiated both actively and passively, with the splints worn every other night alternatively. The splint was worn for six months.@*Results@#All patients received follow-up, the average duration of follow-up was 27 months (average: 6-48 months). The space of the proximal radioulnar joint could be seen clearly in seven patients, without the sign of recurrence of the synostosis. The synostosis was occurred in one child. Removed the synostosis part and the implant six months after operation, and placed an allograft tendon ball as the interposition tissue simultaneously. The problem was resolved successfully after that. Fingers extension weakness was happened in two patients, and recovered spontaneously and completely in three months. Limitation of elbow extension was occurred in two patients (range: 15° and 20°). The average pronation was 32.5° (range: 10°-65°), and the average supination was 31.9° (range: 10°-70°).@*Conclusions@#Using the perforator adipofascial flap pedicled with posterior interosseous vessels to treat the CPRUS is an easier method compared with classical Kanaya method . It could prevent the recurrence of synostosis effectively, and the treatment result is satisfied. The possibility of injury of the deep branch of radial nerve may be the potential problem.

5.
Article in Chinese | WPRIM | ID: wpr-797697

ABSTRACT

Objective@#To investigate the efficacy and the technical details of utilizing a long segment of vein graft to bridge the vascular defect when a free flap is used to repair extensive injuries in lower extremities.@*Methods@#For the reconstruction of extensive leg defect caused by serious composite injury, a local flap is unavailable or cannot fulfill the requirements. The main vessels of the leg could be damaged. It is challenging work to find an ideal recipient vessels for a free flap. The saphenous vein was harvested from the contralateral lower extremities and utilized to bridge the vascular gap between the recipient vessels and flap pedicle vessels. A latissimus dorsi myocutaneous or anterolateral thigh free flap was used to reconstruct the leg defect. The distal end of the grafted vein was anastomosed to the superficial femoral artery in an end-to-side fashion, and the proximal end to the artery of flap pedicle in an end-to-end fashion. When a vein insufficiency was present, the proximal and distal ends of the additional grafted vein were anastomosed to the recipient vein and vein of flap pedicle in an end-to-end fashion.@*Results@#From July 2010 to April 2019, 27 patients underwent reconstruction of leg using the above-mentioned method. There were 20 males and 7 females. The patients′ age ranged from 16 to 54 years with an average of 30.6 years. There were 19 latissimus dorsi myocutaneous flaps and eight anterolateral thigh flaps. The grafted saphenous vein was used to bridge the arterial gap in 21 cases and to bridge both the arterial and venous gaps in 6 cases. The length of the grafted vein for arterial and venous defects was ranged from 14 cm to 43 cm (mean, 24.8 cm) and 5 cm to 12 cm (mean, 8.6 cm), respectively. 26 flaps completely survived after surgery. Venous congestion occurred in the remaining one flap and the flap eventually lost. The patient eventually opted for amputation. All patients were followed up for 3 to 14 months with an average of 9 months. Functional and aesthetic outcomes were obtained in both the recipient and donor sites. No obvious edema of lower extremities was observed.@*Conclusions@#For patients with a severe and large soft-tissue defect of the leg, fining an ideal recipient vessels for a free flap is crucial for a successful reconstructive surgery. It is a reliable and an additional option to choose the superficial femoral artery and/ or saphenous vein as the recipient vessels by using the grafted vein to bridge the vascular gaps.

6.
Chinese Journal of Microsurgery ; (6): 423-428, 2019.
Article in Chinese | WPRIM | ID: wpr-792080

ABSTRACT

To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result. Methods From September, 2016 to November, 2018, 17 patients (21 hips) with ANFH had undergone robot-assisted free fibular grafting. There were 14 males and 3 females, of which, 8 cases were associated with the right side, 5 cases the left side, and 4 cases with both sides. The average age was 35 (ranged from 17 to 55) years. There were 7 patients suffered from idiopathic ischemic necrosis of femoral head, 4 patients who had cannulated screws fixed after a femoral neck fracture, 4 patients who had a history of alcohol consumption, 1 patient who had taken corticosteroids for 6 months to treat nephritis, and 1 patient who had a history of alcohol consumption and had also taken corticosteroids. Seventeen hips were in Ficat stage II, and 4 hips were in Ficat stage III. The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation, to place a cannula in the optimal position. Then a bone window was created and the fibula was placed into the bone tunnel.Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula. Finally, the vessels were anastomosed. The patient remain in bed completely for a week with the use of vasodilator. The follow-up was accomplished with phone call and outpatient clinic, and Harris score was evaluated. Results All 21 surgical procedures were successful. The guide pins and fibula were accurately placed according to the robot’s plan, and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads, 4 to 6 mm from the articular surface. Conventional anticoagulant, anti-infective therapy was performed after the pro-cedure. Ten patients were followed-up postoperatively more than 1 year, with an average of 15 (from 12 to 24) months. The function of the hip joint recovered smoothly for 9 patients.Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region, 4 to 6 mm from the articular surface.One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation.However, joint move-ment was restricted for the left hip and the pain was significant.An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula.The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum.The Harris score was 62.4±13.6 before operation, and 84.5±4.5 at the last time of followed-up after opera-tion.The difference in Harris scores was statisticly significant (P<0.05). Conclusion With the assistance of an or-thopaedic robot system, the guide pin can be accurately positioned, thereby allowing the tip of the fibula to be inserted in-to the optimal anatomical position and maximising its mechanical efficacy.In theory, it is the best choice for performing fibular bone transplantation in ANFH.And the early effect of treatment is good.

7.
Article in Chinese | WPRIM | ID: wpr-745088

ABSTRACT

Objective To evaluate conventional wrist physical examination in detecting injury to the triangular fibrocartilage complex (TFCC).Methods A retrospective study was conducted of the 118 patients (119 wrists) who had been admitted from January 2013 to October 2017 to Hand Surgery Department,Beijing Jishuitan Hospital for wrist arthroscopic surgery.All of them underwent wrist physical examination preoperatively for conventional index tests for TFCC injury like ulnar fovea sign,piano-key test,distal ulnar ballottement test and ulnocarpal stress test.They were 68 males and 50 females with a mean age of 32 years.The results of physical examination were compared with the arthroscopic findings to calculate the sensitivity,specificity,positive/negative predictive value (PPV/NPV) and +/-likelihood ratio (LR) of each index test.In addition,we combined the results of any 2 tests to increase the capability of detecting peripheral TFCC injury.Results The diagnostic values of each index test were achieved by comparison between the results of physical examination and the arthroscopic findings:(1) ulnar fovea sign:sensitivity =0.648,specificity =0.742;(2) piano key test:sensitivity =0.817,specificity =0.735;(3) distal ulnar ballottement test:sensitivity =0.927,specificity =0.647;(4) ulnocarpal stress test:sensitivity =0.825,specificity =0.500.The combination of any 2 tests produced 3 new index tests,of which the most valuable combination was ulnar fovea sign & distal ulna ballottement test,with a sensitivity of 0.598,a specificity of 0.941,a PPV of 0.961and a + LR of 10.14,Conclusions The signs elicited in physical examination and special tests can be helpful in the diagnosis of TFCC injuries.However,as the value of any single test is not enough,we should clinically combine the results of ulna fovea sign and distal ulna ballottement test to increase the capability of detecting peripheral TFCC injury.

8.
Chinese Journal of Trauma ; (12): 241-246, 2019.
Article in Chinese | WPRIM | ID: wpr-745048

ABSTRACT

Objective To investigate the clinical efficacy of dry arthroscopy in the treatment of wrist joint injury. Methods A retrospective case series study was conducted to analyze the clinical data of 59 patients with wrist joint injuries admitted from January 2013 to January 2016. There were 48 males and 11 females, aged 15-69 years, with an average age of 34 years. Among the patients, there were 32 patients with old scaphoid fractures ( including delayed diagnosis and treatment of scaphoid fractures or scaphoid fracture nonunion) , 23 patients with intra articular fractures of distal radius, and four patients with chronic instability of lower ulnar radial joint. All patients were treated with dry arthroscopic surgery. During the operation, the operation time of bone grafting and the swelling degree of soft tissue around the joint which needed simultaneous incision were observed. Fracture healing, and joint stability were recorded after operation, and wrist function was evaluated by Mayo wrist function score. Results The average operation time of scaphoid bone grafting was 7 minutes. In patients with distal radius fractures requiring simultaneous incision and reconstruction of the lower ulnar radial ligament, there was no significant periarticular swelling, with normal anatomical layer and clear visual field. All patients were followed up for 6-28 months ( average 9 months) . All the old scaphoid fractures were healed, with the average healing time of 12. 6 weeks. All distal radius fractures were anatomically repositioned during operation. All patients with chronic instability of the lower ulnar radial joint were seen stable recovery of the joint, with negative impact test of the lower ulnar and radial joints. The Mayo wrist function score of all patients averaged 95 points. Conclusion Dry arthroscopic technique can improve the efficiency of bone grafting under wrist arthroscopy, reduce the swelling of soft tissue around the joint, maintain clear anatomical layers of soft tissue, promote fracture healing and improve wrist function, especially applicable for wrist arthroscopy with minimally invasive bone grafting and wrist incision at the same time.

9.
Article in Chinese | WPRIM | ID: wpr-754734

ABSTRACT

Objective To explore the effectiveness of wide awake local anesthesia no tourniquet (WALANT) in arthroscopy for diagnosis and treatment of wrist injuries and conditions.Methods Between January 2012 and January 2016,WALANT approach was used in wrist arthroscopy for 22 patients with wrist injury or condition at Department of Hand Surgery,Beijing Jishuitan Hospital.They were 10 males and 12 females,aged from 19 to 56 years(average,34 years).Arthroscopic exploration was conducted in 7 cases,arthroscopic synovectomy in 6,dorsal wrist ganglionectomy in 3,triangular fibrocartilage complex (TFCC) debridement in 5 and TFCC repair in one.All the patients were anesthetized using portal site local anesthesia (PSLA) technique.Additional local infiltration around ulnar-sided wrist incisions was performed in 2 TFCC repairs.Bupivacaine was used for both techniques.The effects were evaluated using a ten-point visual analogue scale (VAS).Results Desired objectives were achieved in all patients.No operative complication was observed.Mild pain was noted in all the patients when local anesthetic was injected to the portal sites,with an average VAS score of 2.5 points (from 1 to 3 points).In the following arthroscopic procedures,most of the patients did not report any discomfort.Only one patient undergoing TFCC repair reported mild pain (VAS score of 3 points) during ulnar-carpal suture procedure.Conclusion The new WALANT technique is safe,time-saving,economical and capable of pain control during arthroscopy for numerous wrist injuries and conditions.

10.
International Journal of Surgery ; (12): 684-687, 2018.
Article in Chinese | WPRIM | ID: wpr-693302

ABSTRACT

Objective To explore the related factors which affect the prognosis of traumatic brain injury (TBI) patients and provide the basis for clinical diagnosis and treatment.Methods One hundred and thirty-four TBI patients were selected from May 2017 to April 2018 in the Department of Neurosurgery of Wuwei Liangzhou Hospital.Death and discharge were used as endpoint events.The patients were divided into survival group (n =103) and death group (n =31) according to their prognosis.The abbreviated injury scale (AIS),glasgow coma scale (GCS),vital signs,thrombelastography,coagulation function and Chinese DIC scoring system (CDSS) of the patients at the time of admission was completed.The measurement data were compared with the t test,the count data were compared with chi-square test and logistic regression was used for multivariate regression analysis.Results The AIS was (4.7 ± 0.9) scores,CDSS was (7.8 ± 1.1) scores,GCS was (5.8 ± 1.4) scores,the R time of thrombelastography was (15.1 ± 5.6) min in death group.The AIS was (4.3 ± 0.8) scores,CDSS was (6.6 ± 0.6) scores,GCS was (8.6 ± 1.7) scores,the R time of thrombelastography was (8.6 ± 3.4) min in survival group.Single factor analysis showed that the AIS and CDSS were higher,GCS was lower and the R time of thrombelastography was longer in death group than in survival group,and there were statistical differences between the two groups (P < 0.05).The multivariate logistic regression analysis showed that GCS,CDSS and R time were the independent risk factors of the prognosis of TBI patients.The area under the receiver operating characteristic curves of GCS,CDSS and R time were 0.731,0.648 and 0.635,respectively.Conclusion GCS,CDSS and R time can be used as predictive risk factors for prognosis of TBI patients.

11.
Article in Chinese | WPRIM | ID: wpr-667766

ABSTRACT

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.

12.
Article in Chinese | WPRIM | ID: wpr-612538

ABSTRACT

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.

13.
Chinese Journal of Orthopaedics ; (12): 1294-1301, 2016.
Article in Chinese | WPRIM | ID: wpr-502027

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.

14.
Article in Chinese | WPRIM | ID: wpr-486603

ABSTRACT

Objective:To evaluate the outcomes of lesser arc perilunate injuries (Perilunate disloca-tions)treated with arthroscopically assisted mini-invasive reduction and fixation.Methods:Between 2012 and 2014,5 patients who had a perilunate dislocation were treated with arthroscopically assisted re-duction and percutaneous fixation.The mean follow-up was 17.8 months (range,10 to 32 months). Clinical outcomes were evaluated on the basis of range of motion;grip strength;Mayo wrist score;Quick disabilities of the arm,shoulder and hand questionnaire;and patient-rated wrist evaluation score.Radio-graphic evaluations included carpal alignments and any development of arthritis.Results:The range of flexion-extension motion of injured wrist averaged 84% of the values for contralateral wrist.The grip strength of the injured wrist averaged 90% of the values for the contralateral wrists.The mean Quick Disabilities of the arm,shoulder and hand score was 1 ,and the mean Patient-Rated Wrist Evaluation score was 5 .According to the Mayo wrist scores,the overall functional outcomes were rated as excellent in all the patients.Reduction obtained during the operation was maintained within normal ranges in all the patients.Arthritis had not developed in any patient at the end of the follow-up.Conclusion:Arthroscopic mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate dislocations according to our early results.

15.
Article in Chinese | WPRIM | ID: wpr-486586

ABSTRACT

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.

16.
Article in Chinese | WPRIM | ID: wpr-469308

ABSTRACT

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.

17.
Article in Chinese | WPRIM | ID: wpr-465433

ABSTRACT

Objective:To investigate the validity and the outcome of a new surgery method that utilizes lateral great toe flap to decoratively reconstruct the thumb pulp loss.Methods:From Jan.2009 to Jan. 2014 , 22 cases with unilateral thumb pulp defect were included, for whom, lateral great toe flap was de-ployed to reconstruct the thumb.Blood circulation was re-established by the anastomosis of the digital vessels of toes and fingers in 18 cases, the other 4 cases were conducted by a dorsal metatarsal artery and vein anastomosed to the deep branch of the radial artery and the dorsal metacarpal vein respectively; as for the nerve repair, toe-to-finger digital nerve anastomosis was performed.The donor sites were covered by full-thickness inguinal skin grafts.Results:All the 22 flaps survived without complications.With 6 to 12 months follow-up, the surviving fingers all presented aesthetically pleasant appearance with vivid loops and whorls.Normal functions like sweating were restored as well, and the two-point-discrimination ranged 3.0 to 6.0 mm (4.2 mm in average).The skin grafts to the donor sites healed uneventfully, the appearance and functions of the feet were unaffected.Conclusion: Lateral toe flap should be the first-line choice for reconstructing thumb defect, as it conveniently restores both functions and outlook.

18.
Chinese Journal of Microsurgery ; (6): 334-337, 2014.
Article in Chinese | WPRIM | ID: wpr-455868

ABSTRACT

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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Chinese Journal of Microsurgery ; (6): 328-333, 2014.
Article in Chinese | WPRIM | ID: wpr-455867

ABSTRACT

Objective To evaluate the feasibility,technique and preliminary clinical results of the intraoperative three-dimensional (3-D) computer navigation system assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.Methods From October 2010 to April 2013,14 patients (18 hips) with osteonecrosis of the femoral head were treated by free vascularized fibular graft transfer,assisted by intraoperative3-D computer navigation system.Of 18 hips,8 were classified as stage Ⅱ ;6 as stage Ⅲ,4 as stage Ⅳ according to Steinberg system.The entire procedures were visualized and guided by the 3-D navigation system,including location of optimal entry point,exploration of the field,excision of the necrotic bone tissues,and the fibular grafting transfer with vessel anastomosis.The follow-up records included the results of X-ray,the Harris score of the hip,and the complications.Results Operations of all 14 patients (18 hips) were smooth and successful with patent vessel and umcompromised grafts evidenced by ECT scan at day 7 postoperatively.Postoperative X-ray confirmed the complete eradication of necrotic focuses with surrounding calcified bone and the accurate positioning of fibular grafts.The mean follow-up period was 23.6 months (8-29 months).Harris scores significantly improved from 57.5 ± 14.5 before operations to 87.5 ±2.5 after,with 6 hips' scores classified as Excellent,and 11 as Good.X-ray obtained more than 1 year after operation suggested improvement was achieved in 15 hips.Conclusion Intraoperative 3-D computer navigation system has multiple merits in assisting free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head,including clear anatomic structure,better accuracy,less damage,and reliable functional recovery,which imply it is a highly applicable approach.

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Chinese Journal of Orthopaedics ; (12): 1030-1036, 2014.
Article in Chinese | WPRIM | ID: wpr-453902

ABSTRACT

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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