The association of three anatomical factors with ulnar-sided wrist pain: a radiological study.

BACKGROUND: Ulnar-sided wrist pain is associated with the development of multiple wrist pathologies. But the anatomical etiologies have not been fully understood. PURPOSE: To determine the association of three anatomical factors with ulnar-sided wrist pain, including ulnar variance (UV), distal ulnar volar angle (DUVA), and pisiform-ulnar distance (PUD). MATERIAL AND METHODS: A total of 64 patients who had ulnar-sided wrist pain associated with training injuries were retrospectively studied. A control group included 64 healthy athletes from the same unit. The UV, DUVA, and PUD of each individual was measured on radiographs. RESULTS: The average UV and DUVA of those in the ulnar-sided pain group were 0.84 mm and 174.65°, respectively; the control group values were 0.39 mm and 175.11°. The differences between the two groups had no statistical significance (P > 0.05). The average PUD of the ulnar-sided wrist pain group was shorter than that of the control group (2.37 cm vs. 2.65 cm); the difference had statistical significance (P < 0.05). PUD had a negative correlation with ulnar-sided pain; it was an anatomical protective factor (odds ratio = 0.01; P < 0.00; 95% confidence interval=0.00-0.05). Both UV and DUVA had no significant correlations with ulnar-sided wrist pain (P > 0.05). CONCLUSION: PUD has a significant correlation with ulnar-sided wrist pain. It is the anatomical protective factor. Both the UV and DUVA have no statistical association with ulnar-sided wrist pain, but we cannot ignore their potential pathogenic effects on wrists, and further studies are needed to confirm the results.

Changes of Short-Term Heart Rate Variability and Vertebral Artery Magnetic Resonance Angiography in Patients with Cervical Vertigo.

Cervical vertigo refers to a clinical syndrome with sudden vertigo as the main symptom caused by the hemodynamic disturbance of the extracranial segment of the vertebral artery (VA) affected by cervical vertebral lesions. Small differences in pulse intervals in a patient's continuous sinus rhythm are called heart rate variability (HRV). Heart rate variability refers to the small rise and fall of instantaneous heart rate between consecutive beats and is one of the most important physiological indicators of cardiac function. Small changes between successive beats reflect some information about the heart. So, it can be used to diagnose heart disease; its parameters can be used to identify emotions. Therefore, it is possible to use the characteristics of heart rate variability to find some patterns in the high-stress state and use the computer and ECG signals to describe the high-stress state. Since the ECG signal is a universal and objective model, it is practical and convenient to use it to describe stress states. Magnetic resonance angiography (MR angiography, MRA) is a noninvasive vascular imaging method that does not require intubation and contrast agents. At present, it has been widely used in clinical practice. In order to explore the changes of short-term heart rate variability and vertebral arterial magnetic resonance angiography (MRA) in patients with cervical vertigo and their clinical significance, this paper introduces two basic analysis methods of heart rate variability and commonly used MRA techniques, TOF technology. In the analysis of heart rate variability in patients with cervical vertigo, the statistical values of time and spectrum domain parameters were found to be lower in the experimental group than in the control group1. MRA showed that the abnormal rate of VA in the PCI group and the cervical vertigo group was similar. In the RMSSD index, the male experimental group reached 29, and the control group 1 reached 22.

[Case-control study on remnant-preserving strategy for preservation and reconstruction of anterior cruciate ligament].

OBJECTIVE: To investigate and compare the clinical efficacies of remnant-preserving and remnant-non-preserving, remnant-non-preserving remnant segment preserving and remnant root preserving with anterior cruciate ligament reconstruction. METHODS: From March 2014 to December 2017, 204 patients with anterior cruciate ligament (ACL) injuries were treated by single-bundle ACL reconstruction with hamstring tendon autograft. According to the different methods of remnant preservation, the procedures were divided into remnant segment preserving group (A), remnant root preserving group (B), and remnant-non-preserving group (C). There were 37 males and 39 femalesin group A aged from 16 to 43 years old with an average of (28.80±5.41) years old. The time from injury to operation ranged from 2 to 11 weeks with an average of (3.68±1.04) weeks. In group B, there were 39 males and 25 females aged from 18 to 41 years old with an average of (28.42±5.60) years old. The time from injury to operation ranged from 2 to 10 weeks with an average of (3.36±1.68) weeks. In group C, there were 37 males and 27 females aged from 18 to 43 years old with an average of (29.10±6.11) years old. The time from injury to operation ranged from 3 to 11 weeks with an average of (3.54±1.46) weeks. The range of motion (ROM) of the knee was used to assess the range of extension and flextion of the knee at pre-operation and 24 months after operation. Lysholm score and the international knee documentation committee (IKDC) score were used to assess the knee function. The differences among three procedures were judged by comparing among the three groups at 6, 12 and 24 months postoperatively. RESULTS: All incisions got a one stage healing, and no complications, such as vascular injury, nerve damage and articular infect or the like, occurred. All the patients were followed up, and the follow-up duration of group A ranged from 24.00 to 45.96 months with a mean of (35.52±14.40) months;the follow up duration of group B ranged from 27.96 to 48.00 months with a mean of (37.56±10.68) month;and the follow up duration of group C ranged from 24.00 to 66.00 months with a mean of (37.08±13.44) month. There were no significant differences in follow up time among three groups (P>0.05). Six months after operation, Lysholm score 80.74±3.14 and IKDC score 79.92±3.44 in group A were higher than those in group B 80.74±3.14 and 78.21±4.63, and higher than those in group C 79.22±3.63 and 76.63±3.80 (P<0.05);12 months after operation, Lysholm score 89.84± 5.13 and IKDC score 87.90±3.93 in group A were higher than those in group B 85.74±6.04 and 83.62±5.64, and higher than those in group C 82.83±3.43 and 79.21±4.04(P<0.05). CONCLUSION: Compared with remnant-non-preserving group, the residual tissue of anterior cruciate ligament is preserved, which is conducive to promote the healing and remodeling of tendon graft and accelerate the recovery of joint function. Proper fixation of residual tissue and restoration of its tension are the key factors affecting the postoperative efficacy.

[Biomechanical study on different high-strength sutures and suture site for repairing posterior root tear of the medial meniscus].

OBJECTIVE: To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique. METHODS: Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed. RESULTS: All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group Ultrabraid suture group >FiberWire suture group, and had statistical differences among groups (P<0.05);the results showed the suture strength in Ethibond was the best, Ultrabraid suture took the second place, and FiberWire suture was the worst. (2)As for different suture sites, comparison of the maximum failure load, yield load and stiffness showed that red zone fixation group >red-white region fixation group, and had statistical difference between two groups(P< 0.05);comparison of cyclic displacement at 100, 500 and 1 000 cycles showed that red zone fixation group

The effect of radial shortening on wrist joint mechanics in cadaver specimens with inherent differences in ulnar variance.

PURPOSE: To assess load changes in the wrist and forearm resulting from surgically-induced radial shortening in wrists with inherent differences in ulnar variance. METHODS: Eleven fresh cadaver upper extremities, 4 with ulnar-plus variance of 2 mm or greater and 7 with ulnar-minus variance of 2 mm or greater were used. The radius and ulna of each specimen were instrumented with load cells, a 15-mm segment of the radius was resected and replaced with aluminum blocks of various sizes, and the specimens were loaded with 143 N (32 lb) at 1-mm differences of radial length. The load distribution between the radius and ulna was measured. RESULTS: The load distribution in the specimens with an ulnar-plus variance averaged 69% through the radius and 31% through the ulna. In the wrists with ulnar-minus variance, the load distribution averaged 94% through the radius and 6% through the ulna. The mean force in the ulna increased and the mean force in the radius decreased with incremental shortening of the distal end of the radius. The mean force through the ulna in the ulnar-plus-variance group was always higher than that of the ulnar-minus-variance group. When compared not by the number of millimeters of radial shortening but by the adjusted ulnar variance, there was no difference between the ulnar-plus-variance and the ulnar-minus-variance groups. CONCLUSIONS: Wrists with ulnar-minus variance could accommodate radial shortening without as much increase in the ulna load as wrists with ulnar-plus variance. The clinical relevance is that a patient with an ulnar-minus variance may accommodate more radial shortening after a wrist fracture without developing an ulnar impaction syndrome than a patient with an ulnar-plus-variant wrist.