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.
