RESUMO
Objective To evaluate the effect of wrist arthroscopy-assisted repair of stable or slightly unstable type Ⅰ B triangular fibrocartilage complex (TFCC) injury of distal radio-ulnar joint (DRUJ).Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with type Ⅰ B TFCC injuries admitted from May 2015 to August 2017,including 17 males and 25 females,aged 18-64 years,with an average of 38 years.Among the patients,20 were injured on the left side,and 22 on the right side.During the operation,if the injury was diagnosed as type Ⅰ B injury under wrist arthroscopy,outside in method with 3-0 purdis stitch was adopted to repair TFCC after joint cleaning.After the operation,the wrist joint was fixed in a neutral rotation position for 3 weeks with a long arm plaster over the elbow and then replaced with a short arm plaster for 2-3 weeks.Visual analogue scale (VAS),grip strength,joint mobility,modified Mayo wrist function score,and disabilities of arm,shoulder and hand score (DASH) before operation and at the last follow-up were compared.Results All patients were followed up for 6-24 months,with an average of 11 months.No infection or nerve injury occurred after operation.At the last follow up,wrist pain disappeared in 13 cases completely,while 29 cases still had pain during moderate activities.VAS was decreased from preoperative (2.7 ± 0.9) points to (1.2 ± 1.0) points (P ＜ 0.05).The grip strength was increased from preoperative (20.6 ± 8.3) kg to postoperative (22.5 ± 8.5) kg (P ＜ 0.05).The wrist flexion and extension,radial ulnar deviation,and forearm rotation were increased from preoperative (116.4 ± 26.0) °,(36.7 ± 10.7) °,and (137.9 ±29.1) ° to postoperative (119.4 ± 22.8) ° (P ＞ 0.05),(40.0 ± 10.6) ° (P ＜ 0.05),and (148.9 ±21.4) ° (P ＜ 0.05).The modified Mayo wrist function score increased from preoperative (67.3 ±9.6) points to postoperative (84.4 ± 6.7) points.The results were excellent in 13 cases,good in 24,and fair in five,with an excellent and good rate of 88％.The DASH score decreased from (34.6 ± 10.2)points to (10.4 ± 6.5) points after operation (P ＜ 0.05).Conclusion For patients with stable or slightly unstable type ⅠB TFCC injury of DRUJ,synovial membrane cleaning under wrist arthroscopy plus capsule repair combined with active rehabilitation training can effectively reduce wrist pain,and improve wrist radial ulnar deviation,forearm rotation and grip strength as well as improve wrist joint function.
RESUMO
Objective To investigate the effect of different levels of positive pressure (PEEP) during one-lung ventilation on blood gas and hemodynamics in patients with thoracoscopic lung bullae resection surgery.Methods Seventy-eight patients undergoing thoracoscopic lung bullae resection surgery were divided into three groups by random number table method,26 cases in each:group Ⅰ was only given one-lung intermittent positive pressure ventilation (IPPV) after two-lung ventilation,group Ⅱ was given one-lung IPPV and PEEP 5 cmH2O (1 cmH2O =0.098 kPa) after two-lung ventilation,group Ⅲ was given one-lung IPPV and PEEP 10 cmH2O after two-lung ventilation.Blood gas and hemodynamics were recorded and compared in the supine position and lateral position two-lung ventilation,one lung ventilation 10 and 30 min among three groups.Results Oxygen saturation was maintained at 0.99-1.00 in three groups.pH value,base excess,arterial carbondioxide partial pressure (PaCO2) and HCO3-at each time point in three groups had no statistical significance (P ＞ 0.05).Arterial oxygen partial pressure (PaO2) in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min was significantly higher than that in group Ⅰ [(336.2 ± 113.2),(348.5 ± 109.7) mmHg (1 mmHg =0.133 kPa) vs.(285.0 ± 103.5) mmHg,(357.6 ± 104.0),(358.9 ±103.2) mmHg vs.(276.0 ± 107.2) mmHg] (P ＜0.05),but were within the normal range,there was no statistical difference between group Ⅱ and group Ⅲ (p ＞ 0.05).Heart rate,mean arterial pressure,left ventricular ejection time,systemic vascular resistance at each time point in three groups had no statistical significance (P ＞0.05).Stroke volume,cardiac output in group Ⅱ and group Ⅲ at one-lung ventilation 10,30 min were lower than those in supine position and lateral position two-lung ventilation and the same period in group Ⅰ (P ＜ 0.05),but were within the normal range,there were no statistical differences between group Ⅱ and group Ⅲ (p ＞ 0.05).Conclusions Two-lung ventilation after one-lung IPPV and PEEP 5 cmH2O in thoracoscopic lung bullae resection surgery can maintain satisfactory PaO2 and PaCO2,hemodynamic change is not obvious; PEEP 5 cmH2O compares with only IPPV can further improve PaO2,but PEEP 10 cmH20 can't further improve PaO2.
RESUMO
Objective To introduce surgical repair methods of cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for complex lower leg defect and discuss its clinical feasibility.Methods The study included 12 patients with tibial defect larger than 8 cm (range,9-12 cm) combined with soft tissue defect of 17 cm × 12 cm to 20 cm × 18 cm treated from May 2008 to May 2012.Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula was performed at the first phase.The flap pedicled with subscapular vessel was anastomosed to posterior tibial artery and vein of normal lower leg.The flap pedicled with anterior serratus muscle of distal thoracodorsal artery was anastomosed to peroneal vessel of fibular flap.External fixators were used to immobilize the bilateral lower legs postoperatively.Results All patients were followed up for 13-32 months (mean 21 months).According to Enneking system,mean leg function was scored 23 points after tandem transplantation of free latissimus dorsi muscle and free fibula,with recovery rate of 77％.Conclusions Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula tackles the problem of recipient vessel limitation.Further,the technique is effective in repair of large area of complex defect in lower legs.
RESUMO
Objective To compare the torque resistance effect with different types of reconstruction of the distal radioulnar joint (DRUJ) dislocation,in order to explore biomechanical basis for clinical practice.Methods Six adult cadaver forearm were used,including 4 males and 2 females.The average death age was 64.9 years (range,36-78 years).Three were right side,3 were left side.The DRUJ dislocation model was made after the standardized resection of the palmar and dorsal DRUJ ligament.Clinic reconstruction methods of the DRUJ include trans-bone tunnel renconstruction (intra-articular reconstruction) and Looptie up reconstruction (extra-articular reconstruction).The mechanical properties as follows:torque velocity:5°/min,maximum torque angulation:90°,maximum torsion force:1 N· mm.Each limb was detected for the torque mechanic under four conditions:normal,DRUJ dislocation,intra-articular reconstruction and extra-articular reconstruction.Results Each limb was inspected for intact mechanic baseline and without the visual damage to the bone.The average pronation torque resistance on normal condition was (0.44±0.10) N·mm,(0.37±0.09) N·mm on DRUJ dislocation group,(0.45±0.09) N-mm on intra-articular reconstruction group,and (0.42±0.09) N·nun on extra-articular reconstruction group.Pronation torque resistance of DRUJ dislocation group was apparently lower than the normal group (t=2.043,P=-0.047).The pronation torque resistance reconstruction group had no significant difference with normal group.The average supination torque resistance on normal condition was (0.56±0.16) N·mm,while on DRUJ dislocation group was (0.42±0.11) N-mm,on intra-articular reconstruction group was (0.54±0.16) N·mm,on extra-articular reconstruction group was (0.51±0.13) N·mm.There were no apparent differences among four groups.Conclusion Both internal and external reconstruction could recover the rotation stability and normalize the torque resistance,without statistical difference.