Objective:To investigate the application value of 3D MRI in the diagnosis of brachial plexus injuries combined with large vascular injuries.Methods:From June 2006 to December 2019, 55 patients with brachial plexus injuries were treated in our department. For 13 patients suspected of having vascular injuries, 3D MRI of brachial plexus and its accompanying blood vessels were performed simultaneously to understand the location and extent of nerve and blood vascular injury, so as to provide reliable evidence for accurate diagnosis and treatment. The application value of this imaging diagnostic technique in brachial plexus injury was evaluated by comparing with the intraoperative findings.Results:The brachial plexus and its accompanying blood vessels of 13 patients were reconstructed and digitally fused. The 3D MRI results of 7 patients who underwent surgery were consistent with the clinical examination and intraoperative findings.Conclusion:The 3D MRI simultaneous imaging of the brachial plexus and its accompanying vessels can clearly show the shape, location and injury of the brachial plexus and vessels, and show a three-dimensional relationship in anatomical structure, which is of great value in the diagnosis and treatment of brachial plexus injuries combined with adjacent vascular injuries.
目的 探讨应用第二趾胫侧Flow-through皮瓣修复指腹缺损并重建指动脉弓的临床效果.方法 我院自2015年6月至2021年5月对18例18指腹缺损患者,采用第二趾胫侧Flow-through皮瓣修复,通过皮瓣内趾动脉的远端与受区对侧指动脉吻合重建指动脉弓,重建指动脉弓长度1.0～1.6 cm,皮瓣切取面积为1.3 cm×2.7 cm～1.9 cm×3.2 cm.足趾供区采用小腿全厚皮片植皮.结果 18例皮瓣全部存活,术后随访2～18个月,平均9个月,皮瓣质地、外形满意,手指功能恢复优良,远指间关节活动度0°～70°,皮瓣两点分辨觉为8～14 mm.供区植皮愈合满意.采用中华医学会手外科学会上肢部分功能评定试用标准评定:优14例,良4例.结论 第二趾胫侧Flow-through皮瓣修复指腹缺损并重建指动脉弓,尽可能恢复指腹生理性解剖结构,可以增加指腹血流,避免出现萎缩,预后外观、功能恢复满意,是一种较好的修复指腹缺损的方法.
目的 探讨散发型复拇畸形致病的相关危险因素.方法 自2014年6月至2022年6月我院诊治复拇畸形患儿710例,选取同时期非肢端畸形患儿710例为健康对照组,采用二分类Logistic回归模型对散发型复拇畸形的22种可能致病危险因素进行单因素及多因素分析.结果 单因素及多因素分析结果显示,出生体质量、胎次、孕周、高龄产妇、被动吸烟、物理危险因素、化学危险因素为苏皖鲁地区散发型复拇畸形致病的危险因素(P＜0.05).结论 低体重、早产、胎次＞1次、高龄产妇、被动吸烟、接触理化危险因素是苏皖鲁地区散发型复拇畸形的危险因素;提醒我们需针对性加强备孕前期的宣教并鼓励提倡妇女适龄生育,孕期要避免接触理化危险因素并采取预防措施.
Objective To analyze and evaluate the clinical efficacy of interphalangeal joint clearance,osteophyte resection,and cyst lesion exclusion surgery in the treatment of recurrent finger mucocele.Methods From January 2016 to February 2020,21 patients with recurrent finger mucocele were treated in our hospital.Among them,3 cases recurred after needle aspiration and injection of steroid hormones,5 cases recurred after cyst resection and local skin grafting repair,and 13 cases recurred after simple cyst resection.All patients were treated with interphalangeal joint clearance,osteophyte resection,and cyst lesion exclusion under brachial plexus block anesthesia.Only the collateral ligaments and extensor tendons on both sides of the interphalangeal joint were preserved,and the affected finger was fixed with a splint in the extension position for 3 weeks after surgery.The postoperative wound healing and recurrence of mucocele were followed up and observed,and the visual analog score(VAS)and range of motion(ROM)of interphalangeal joint were compared before and after surgery.Results All 21 patients had good postoperative incision healing.No infection,skin necrosis,and recurrence of cysts occurred.All patients were follow-up for 18 to 24 months,with an average of(21.0±1.9)months.The VAS of interphalangeal joint at the last follow-up(1.93±0.46)was significantly lower than that before surgery(3.07±0.83),and the difference was statistically significant(P＜0.05).There was no significant change in the postoperative ROM(70.29±7.05)° of interphalangeal joint compared to preoperative ROM(69.60±5.40)°,and the difference was not statistically significant(P＞0.05).Conclusion The application of interphalangeal joint clearance,osteophyte resection,and cyst lesion exclusion surgery to treat recurrent mucocele of the finger can avoid skin necrosis and cyst recurrence caused by cyst resection,and is a safe and effective treatment method.
Objective To explore the clinical efficacy of surgical treatment of carpal tunnel syndrome(CTS)caused by chronic synovitis.Methods From February to October 2022,our hospital underwent surgical treatment for 7 cases of carpal tunnel syndrome caused by chronic synovitis.During the surgery,the synovial lesion tissue was extensively removed,the transverse carpal ligament was completely released,and the excised specimens were sent for pathological,bacterial culture,and molecular biology testing.After the surgery,symptomatic treatments such as swelling reduction,pain relief,and nutrition were given.The clinical efficacy was evaluated based on the improvement of postoperative symptoms,whether synovitis recurred,and the improvement of pain.Results The pathological results showed synovial tissue hyperplasia and inflammatory cell infiltration.One case was confirmed astuberculous synovitis after surgery and received anti-tuberculosis treatment.The postoperative follow-up ranged from 6 to 14 months showed significant improvement in median nerve compression symptoms,no recurrence of synovitis,no local pain,and normal finger flexion and extension.Conclusions The surgical treatment for carpal tunnel syndrome caused by chronic synovitis has a satisfactory effect.The extensive resection of synovial lesion tissue and release of the median nerve during surgery are key to preventing recurrence and ensuring clinical efficacy.
Objective To explore the risk factors for wrist dysfunction 1year after internal fixation of distal radius fracture.Methods According to the inclusion and exclusion criteria,a retrospective analysis was conducted on the data of 183 patients with distal radius fractures who received volar locking plate internal fixation treatment in our department from October 2016 to October 2021.The PRWE score ≥20 after 1 year of fracture was used as the criterion for wrist joint dysfunction.Firstly,a chi square test was used to conduct a univariate test on relevant factors,and then factors with statistically significant diferences(P＜0.05)were selected for multivariate logistic regression analysis to determine the independent risk factors for wrist joint dysfunction.Results The postoperative patients were follow-up for 12 to 18 months,with an average of 14.6 months.At the last follow-up,27 patients had wrist joint dysfunction,accounting for approximately 14.8％.The results of multivariate logistic regression analysis showed that TFCC injury,poor three-dimensional matching of the fracture end,and poor matching of the coronal bone structure were independent risk factors for wrist joint dysfunction in patients with distal radius fractures at 1 year after surgery.Conclusion The wrist joint dysfunction after surgery for distal radius fractures is the result of a combination of multiple factors.Orthopedic surgeons should comprehensively evaluate,scientifically prevent and treat,and improve the patient's functional prognosis during the diagnosis and treatment process.
Objective To report the clinical efficacy of 1.5 mm locking compression plate(LCP)for biplane fixation of comminuted proximal phalangeal fractures.Methods From January 2018 to December 2021,15 patients with comminuted proximal phalangeal fractures were treated by 1.5 mm LCP biplane fixation.X-ray films were reviewed at 4,12,and 24 weeks after surgery to assess fracture healing and measure the range of motion(ROM)of the healthy and affected sides of the patient's joints.At the last follow-up,total active motion(TAM)was used to assess finger function.Results All the patients were follow-up for 6 to 18 months,with an average of(9.3±2.4)months.All the fractures achieved anatomical reduction.The fracture healing time was 1.5 to 3.0 months,with an average of(2.1±1.1)months.There was no significant difference in the range of motion of the metacarpophalangeal and interphalangeal joints between the affected and healthy sides(P＞0.05).At the last follow-up,according to TAM standard,the functional results were rated as excellent in 11 cases,good in 2 cases,and fair in 2 cases.All the patients had no nonunion,displacement,dysfunction,or deformity of the fracture.Conclusion The application of 1.5 mm LCP biplane fixation for comminuted proximal phalangeal fractures has a high fixation strength and low extensor tendon interference,which is conducive to early postoperative rehabilitation and exercise for patients,and can achieve satisfactory results.
Objective To report the clinical efficacy of absorbable suture assisted fixation in the treatment of elbow joint cartilage fractures.Methods The clinical data of 21 patients with cartilage fractures of the elbow joint admitted from June 2016 to March 2021 were retrospectively analyzed,including 1 case of dislocation of the elbow joint with fracture of the medial condyle of humerus and radial capitulum,6 cases of fracture of the radial capitulum with partial cartilage detachment,6 cases of fracture of the radial capitulum with fracture of the capitulum of humerus,3 cases of intra-articular fracture of the distal humerus,and 4 cases of dislocation of the elbow joint with fracture of the ulna coronoid process and the radial capitulum,1 case of fracture of ulna olecranon,radial capitulum and ulna coronoid process.All the patients were conducted by absorbable sutures to assist in the fixation of articular cartilage fracture blocks during surgery.After surgery,the elbow function was evaluated according to the Broberg-Morrey elbow function scoring standard,and the elbow flexion and extension activity and forearm rotation activity were recorded.Results All the patients were follow-up from 13 to 64 months with an average of 23 months.One patient underwent secondary arthrolysis due to ectopic ossification around the joint.One case had calcification of the medial collateral ligament and stiffness of the elbow joint.At the last follow-up,the average flexion of the affected elbow joint was 119.8°(90° to 140°),and the extension was-3.8°(-45° to 0°).The forearm pronation averaged 78.3°(46° to 84°)and supination averaged 79.6°(62° to 87°).The Broberg-Morrey score of the elbow joint was 59 to 95 points,with an average of 91.2 points.There were 12 excellent cases,8 good cases,and 1 poor case.Conclusion The repair of elbow joint cartilage fractures with suture fixation technology can maximize the preservation of articular cartilage integrity,and early joint functional exercise can achieve satisfactory results.
Objective To screen the optimal transfection efficiency and biocompatibility evaluation of nonviral vector nanospheres on primary tendon cells.Methods The nanospheres with different NP ratios were prepared.The tendon cells of chicken,rat,and mouse were performed primary culture and transfected with different doses of siRNA.And 12 hours after transfection,fluorescence photography and flow cytometry analysis were performed on the cells.CCK-8 was used to detect the viability of the cells after transfection for 24,48,and 72 hours,and WB was used to detect the expression level of GAPDH protein.Non transfected cells were used as negative controls,while liposomes were used as positive controls.Results For the three primary tendon cells of chicken,rat,and mouse,the transfection efficiency of liposomes significantly increased with the increase of transfection reagent dosage.The transfection efficiency of nanospheres did not significantly change,but the transfection efficiency of all nanospheres was higher than that of liposomes.Compared to liposomes,nanospheres have a greater cytotoxic response to cells,and the toxic effects gradually disappear over time.Conclusion Compared with liposomes,nanospheres have higher transfection efficiency for chicken,rat,and mouse tendon cells,and are ideal transfection reagents for siRNA in animal tendon cells.
Objective To report the early clinical efficacy of double incision closed reduction technique of TightRope for the treatment of Rockwood type Ⅲ to Ⅴ acute acromioclavicular joint dislocation.Methods From January 2019 to December 2021,31 patients with acute acromioclavicular joint dislocation were treated by double incision closed reduction technique of TightRope.According to the Rockwood classification,there were 5 cases of type Ⅲ,17 cases of type Ⅳ and 9 cases of type Ⅴ.The visual analogue score(VAS)and Constant-Murley score(CMS)were compared before and 6 months after the operation.Results All the patients were follow-up for 6 to 14 months,with an average of 7.94 months.All the incisions achieved primary healing,without complications such as coracoid process and clavicle fractures,and without loop plate detachment.The preoperative VAS was(6.29±0.46)points and 6 months after the operation the score was(1.19±0.40)points.Using Wilcoxon signed rank test,the difference between the two groups was statistically significant(P=0.001).The preoperative CMS was(39.65±2.54)points and 6 months after the operation the score was(91.45±1.84)points.Using paired t-test,the difference between the two groups was statistically significant(P＜0.001).Conclusion The treatment of Rockwood type Ⅲ to Ⅴ acute acromioclavicular joint dislocation with double incision closed reduction technique of TightRope can achieve satisfactory functional recovery of the shoulder joint which is worthy of clinical promotion.
Objective To analyze the clinical efficacy of using the inducted membrane technique for the treatment of suppurative tenosynovitis through fabrication of bone cement spacer in vitro.Methods From October 2021 to October 2022,the clinical data of 20 patients with suppurative tenosynovitis admitted to our hospital were retrospectively analyzed.All the patients underwent debridement surgery completely on the first stage of operation,repaired with the inducted membrane technique through fabrication of bone cement spacer in vitro.After the inducted membrane formation,the bone cement was removed and the chronic ulcer wound was repaired on the second stage of operation.Results After primary thorough debridement,the induced membrane formed well in all the patients,and the bone cement was removed.The infected wound healed completely.All the patients were follow-up from 2 to 3 months with an average of 2.4 months.The infection did not recur.According to the total active motion(TAM)evaluation criteria,the finger motion was evaluated as excellent in 12 cases,good in 6 cases,and poor in 2 cases.Conclusion The inducted membrane technique is a safe and effective surgical method for the treatment of suppurative tenosynovitis through fabrication of bone cement spacer in vitro.It has the advantages of simple operation,short hospital stay,less pain for patients,and low infection recurrence rate.
Objective To explore the clinical efficacy of antegrade elastic intramedullary nail fixation in the treatment of distal radius diaphyseal metaphyseal junction fracture(DRDMJ)in children.Methods From January 2019 to December 2022,25 children with DRDMJ were treated with antegrade elastic intramedullary nail fixation.All cases were closed injuries and 21 cases were complicated with ulnar fractures.The surgery was performed under C-arm X-ray fluoroscopy.After reduction,pre bent elastic intramedullary nails were inserted into the medullary cavity to fix the fracture end.If the reduction failed,Kirschner wire prying and pulling were used to assist in reduction.In this group,9 cases were treated with Kirschner wire prying and pulling as auxiliary reduction,while 18 cases were treated with elastic intramedullary nail anterograde fixation of the ulna.Results The postoperative follow-up was 10 to 24 months,with an average of 15 months.The healing time was 4 to 6 weeks,with an average of 5.2 weeks.There was no cases of delayed or abnormal healing,no cases of epiphyseal or nerve injury,and no cases of nail tail irritation symptoms.The Gartland-Werley scoring system was used to evaluate the efficacy.At last follow-up,the wrist joint function was excellent in 23 cases and good in 2 cases,with an excellent and good rate being 100％.Conclusion The DRDMJ in children has difficulty in reduction and fixation.Closed reduction and antegrade intramedullary nail fixation are used for treatment.After reduction,the elastic intramedullary nail conforms to the physiological characteristics of the radius and has the advantages of minimal trauma and minimal intervention on epiphyseal growth.It is an ideal method.
患者 男,54岁,农民.因发现左手中指逐渐增大肿物5年余,伴手指麻木半年余入院.患者5年前发现左手中指肿物,初始约绿豆大小,无活动受限、无感觉异常等不适症状,肿物逐渐增大,近半年来出现手指感觉麻木,偶有串电样疼痛不适,一直未予诊治,未曾自行穿刺、抽吸.
Objective To investigate the changes in contact stress of the distal radioulnar joint(DRUJ)after osteotomy of the metaphyseal shortening of the ulnar shaft through finite element analysis.Methods A healthy male volunteer was examined by CT scanning of his right upper limb in the neutral and pronation-extension positions respectively,and a three-dimensional finite element model of the wrist joint was established by a series of software,including Mimics Medical 21.0,Geomagic Design X and Ansys workbench 19.0.The simulated shortening osteotomy of 2,3,4 and 5 mm was performed on the ulnar metaphyseal.The contact stress on the DRUJ was analyzed under non-weight-bearing condition and a 100 N longitudinal stress load,and the results were expressed as cartilage equivalent stress nephogram and pressure data.Results In the neutral position,the maximum contact stress on DRUJ was distributed in the distal palmar region of the articular surface and increased gradually after 2 to 5 mm shortening osteotomy.The stress under the longitudinal load was consistent with that under non-load-bearing condition(2.460 to 5.842 MPa VS 2.152 to 5.765 MPa).In pronation-extension position,the maximum contact stress of DRUJ was distributed in the distal proximal dorsal region of the articular surface,which was greater than that in neutral position and gradually increased with the length of shortening osteotomy.The stress under longitudinal load was higher than that under non-weight bearing condition(11.620 to 24.658 MPa VS 7.652 to 19.273 MPa).Conclusion The contact stress of DRUJ increases gradually with the shortening of the metaphyseal end of the ulna after osteotomy.The maximum contact stress in pronation-extension position is higher than that in the neutral position,especially under axial stress,and the effect of axial load on the maximum contact stress of DRUJ in the neutral position is relatively small.
Objective To investigate the clinical efficacy of partial transposition of flexor carpi radialis tendon for multiple ligament reconstruction through a small incision in the treatment of first carpometacarpal joint dislocation.Methods From November 2019 to August 2022,7 patients with dislocation of the first carpometacarpal jointweretreated by cutting 1/2 of the flexor carpi radialis tendon and transposing it to reconstruct the dorsal ligament complex and anterior oblique ligament of the first carpometacarpal joint.After surgery,functional exercise was guided,and regular follow-up was conducted to compare the pain,daily life assessment,and joint function before and after treatment.Results All the patients were follow-up for 3 to 36 months,with an average of(14.7±12.0)months.Pain was evaluated using the visual analogue scale(VAS),with a preoperative score of 6.9±0.7 and the last follow-up of 1.0±1.3.The daily living condition was evaluated using Quick DASH score,with a preoperative score of 49.7±12.0 and the last follow-up of 11.4± 7.2.The joint function was evaluated using the Krimmer score,with a preoperative score of 45.7±13.7 and the last follow-up of 84.3±6.7.There were statistically significant differences in the results of preoperative and the last follow-up(P=0.002).At the last follow-up,there was no re-dislocation of the joint on the X-ray film.The postoperative pain of the patient was significantly relieved compared to that before the operation,and the life evaluation and joint function were significantly improved compared to that before the operation.Conclusion The application of partial transposition of flexor carpi radialis tendon through a small incision to reconstruct the dorsal and anterior oblique ligaments of the first carpometacarpal joint can improve joint stability,alleviate symptoms,improve joint function,and have minimal trauma,which is worthy of clinical application.
患者 男,21岁,10年前发现左手中环小指屈曲畸形,症状不严重未予重视及处理;随着年龄增加,屈曲畸形逐渐加重,严重影响日常生活.专科检查:左手中环小指屈曲畸形,左腕中立位下左环指近指间关节屈曲100°、远指间关节屈曲40°、掌指关节正常,左中指近指间关节屈曲45°、远指间关节呈屈曲40°、掌指关节正常,左小指近指间关节屈曲40°、远指间关节屈曲30°、掌指关节正常,左腕中立位时左中环小指主被动屈伸活动受限明显,左腕屈曲位时中环小指可伸直,余指活动良好,右手各指无异常,各指感觉良好,血运良好(图1).
Objective To investigate the clinical efficacy of dynamic external fixator for the treatment of middle phalangeal basal fractures in elder children.Methods From November 2018 to March 2022,our hospital treated 17 elder children with middle phalangeal basal fractures.All patients were treated with closed reduction of middle segment basal fractures and continuous traction with dynamic external fixators.The preoperative X-ray diagnosis and Salter-Harris classification were performed,including 8 cases of metaphyseal fractures,7 cases of type Ⅱ fractures,and 2 cases of type Ⅳ fractures.The X-ray examination of fracture alignment was conducted within 1 week after surgery,and it of fracture healing was conducted 3 and 6 weeks after surgery.At the last follow-up,the range of motion of the interphalangeal joint was measured and compared with the healthy side.The evaluation was based on the total active range of motion(TAM)scoring system recommended by the American Association of Hand Surgeons.Results All 17 patients were follow-up for 4 to 15 months,with an average of 8.5 months.All fractures achieved bone healing,with good finger flexion and extension activity,no angular or rotational deformities,and no complications such as joint stiffness and pain.The TAM score showed that 14 fingers were excellent,2 fingers were good and 1 finger was fair.Conclusion Under the condition of mastering the indications,the application of dynamic external fixators to treat middle phalangeal basal and metaphyseal fractures in elder children can achieve satisfactory treatment results.
目的 探讨拇短伸肌腱转位治疗陈旧性拇指掌指关节脱位的治疗方法及临床疗效.方法 自2008年8月至2021年10月,我们共收治陈旧性拇指掌指关节脱位患者13例,11例为背侧脱位,2例为掌侧脱位,脱位时间最短2周,最长2个月,拇指掌指关节均出现被动活动度增大,主动活动不同程度受限,X线片可明确关节脱位情况.所有患者均采用拇短伸肌腱转位修复重建手术稳定掌指关节,术后积极康复锻炼,随访内容包括观察手指外形及并发症、测量掌指关节活动度,观察掌指关节屈伸、对掌、对指功能情况,行手功能评定.结果 术后随访时间为3～36个月,平均12个月,所有患者拇指掌指关节屈伸功能恢复良好,按中华医学会手外科学会上肢功能评定试用标准评价手功能:优9例,良4例.结论 掌指关节脱位对手功能影响较大,陈旧性脱位治疗复杂,预后不良,采用拇短伸肌腱转位修复重建治疗,术后经康复锻炼,能很大程度上恢复关节功能.
目的 介绍动脉内膜剥脱的游离皮瓣采用的改良血管缝合技术,并总结其临床疗效.方法 自2016年12月至2022年9月,我们应用股前外侧游离皮瓣修复足踝部皮肤软组织缺损的患者中,共16例存在动脉内膜剥脱,均行"管腔重塑"后血管吻合.创面横行长度6～15 cm、纵行长度7～25 cm.结果 术后所有患者均无动脉危象发生,2例出现短暂的静脉危象.15例皮瓣完全存活,其中13例创面Ⅰ期愈合,2例发生感染接受扩创治疗后愈合;1例出现皮瓣远端边缘坏死,换药治疗后瘢痕愈合.所有患者均获得随访,时间为3～18个月,平均10个月,均保肢成功并恢复了日常行走功能.随访期间,皮瓣无溃疡、质地良好、外观满意.结论 应用"管腔重塑"技术处理动脉内膜剥脱的游离皮瓣安全可靠,解决了病变动脉吻合的难题,值得临床推广.
患者 男,62岁,因右手中环指疼痛畸形就诊.家族自祖辈至儿女四肢或其他系统器官均无先天畸形病史,患者未合并其他系统器官的先天畸形,既往患指未经治疗.临床检查:右中环指肥大畸形,大小为健侧对应手指的2～3倍,两指呈蟹足样分别向尺侧、桡侧侧弯,皮色皮温未见明显异常,皮肤粗糙,伴有增生小结节,痛觉过敏,指间关节及掌指关节均僵直无活动度.
