Abstract Peripheral nerve injury remains a major clinical challenge due to unsatisfactory functional recovery after severe nerve damage. Although nerve wraps have emerged as a promising strategy for clinical peripheral nerve repair, conventional nerve wraps still exhibit insufficient topographical guidance during regeneration. In this study, we developed a bilayer collagen nanofiber nerve wrap via blow-spinning technology, consisting of an outer random fibrous layer for structural support and an inner aligned nanofibrous layer for longitudinal neural guidance. To further evaluate its regenerative efficacy and translational potential, a canine neurorrhaphy-assisted peripheral nerve repair model was established. The bilayer nanofiber wraps accelerated organized neural tissue remodeling, aligned axonal regeneration, Schwann-cell-associated remodeling, and progressive remyelination throughout the regenerative process. Electrophysiological assessment further demonstrated favorable motor nerve conduction recovery, accompanied by improved locomotor restoration and muscle reinnervation. Importantly, the regenerative performance of the bilayer nanofiber wraps was comparable to, and partially superior to, that of a commercially available sponge-like nerve wrap, particularly in promoting oriented neural regeneration and accelerating myelination. These findings highlight the advantages of aligned topographical guidance in promoting organized peripheral nerve regeneration and support the translational potential of the bilayer collagen nerve wrap as a clinically applicable platform for peripheral nerve repair.

This study presents a wedge osteotomy technique for correcting metacarpal adduction in the treatment of Wassel types V and VI thumb polydactyly, evaluating its clinical efficacy and reporting intraoperative anatomical abnormalities. A retrospective analysis of 37 thumbs treated between January 2016 and June 2023 was performed. Preoperatively, the median inter-metacarpal angle (IMA) was 0°, and the median radial deviation angle of the metacarpophalangeal (MCP) joint of the ulnar thumb was 30°. All cases underwent excision of the hypoplastic radial thumb, thenar muscle relocation, and a radial closing wedge osteotomy at the base of the ulnar thumb metacarpal to achieve a corrected IMA exceeding 40°. The ulnar capsule and collateral ligament were reinforced, and one or two Z-plasties were performed to enlarge the first web space in most cases. Mean follow-up was 51.4 months (range, 12–120). Postoperative IMA and MCP joint angle improved significantly to a median of 40° (IQR: 35–42°) and 0° (IQR: 0–10°),respectively. Mean range of motion at the MCP and interphalangeal joints was 40° (IQR: 30–45°) and 60° (IQR: 45–75°). According to the modified Tada score, 31 thumbs were rated good, 5 fair, and 1 poor. In conclusion, wedge osteotomy to correct metacarpal adduction deformity in type V/VI thumb duplication yields encouraging results, with good functional outcomes and a low reoperation rate.

Abstract Background The kinematics of the wrist have been widely studied in terms of flexion/extension, radial/ulnar deviation, and the dart-throwing motion (DTM); however, the opposite dart-throwing motion (oDTM)—despite its functional importance in daily activities—remains poorly characterized. This study aimed to quantify in vivo kinematics of the radiocarpal and midcarpal joints and to characterize their motion patterns during oDTM. Methods In vivo kinematics of eleven wrists from healthy subjects were assessed using four-dimensional computed tomography (4D CT). A custom-designed device guided wrist motion along a plane oriented 45° in supination from the sagittal plane. Three-dimensional bone models were reconstructed to calculate the Euler angles and translational displacements of the third metacarpal, proximal carpal row, and distal carpal row. Throughout the arc of motion, the contributions of the radiocarpal and midcarpal joints were compared. Results The actual oDTM of the subjects was performed within a plane supinated 50.3 ± 7.0° [95% confidence interval (CI): 45.6° to 55.0°] from the sagittal plane, with a motion arc of 59.9 ± 10.3° [95% CI 53.0° to 66.8°]. During ulnar extension, the proximal carpal row underwent extension, supination, and ulnar deviation relative to the radius, while the distal carpal row flexed, pronated, and deviated ulnarly relative to the proximal row. During radial flexion, the proximal carpal row flexed, pronated, and deviated radially, except for the lunate which deviated ulnarly. Relative to the scaphoid, the trapezium, trapezoid, and capitate extended, supinated, and deviated radially. The capitate and hamate flexed, supinated, and deviated radially relative to the lunate and triquetrum, respectively. Translational displacements were generally less than 5 mm. Throughout the oDTM, the radiocarpal joint contributed predominantly to extension/flexion, whereas the midcarpal joint contributed substantially to radial/ulnar deviation. Conclusion During the oDTM, the radiocarpal joint exhibited motion consistent with the oDTM plane, while the midcarpal joint—particularly on the radial side—demonstrated motion more characteristic of the classical dart-throwing motion (DTM). Both the radiocarpal and midcarpal joints play integral and complementary roles in facilitating wrist oDTM. However, due to the relatively small sample size (n = 11) and the homogeneous cohort, the generalizability of these findings to broader or more diverse populations may be limited.

ABSTRACT Background Previous studies on Activities of Daily Living (ADL) suggest that the wrist demonstrates different ranges of motion and frequencies in various directions. However, the specific directional characteristics of wrist activities remain unexplored. This study aims to investigate the directional characteristics of wrist motions during ADL with optical motion capture technology. Method This is a basic science study. Twenty‐six right‐handed subjects executed 22 ADLs, with angular wrist positions tracked via retroreflective markers on the dominant limb. The Cartesian coordinate system formed by wrist flexion–extension and radial–ulnar deviation angles was transformed into a polar coordinate system, enabling the directional analysis and the calculation of the directional range of motion (ROM). The directional distribution of trajectory points was analyzed using the Rayleigh test and visualized. The values and trends of directional RoM in 72 directions for both aggregated and individual ADLs were examined. The peaks of ROMs across ADLs were clustered using K‐means to identify key directions. Differences in gender and age were analyzed with a two‐way ANOVA. Result The trajectories exhibited a strong directional preference across all ADLs (p < 0.01). In the majority of ADLs, the trajectories favored the ulnar extension direction (19/22) and were distributed along the radial flexion–ulnar extension plane (12/22). ROM was calculated for each of the 72 directions in each ADL. The aggregated ADL analysis provided the directional functional ROM (fROM). Three types of ADLs were identified, each with 1, 2, and 3 peaks in their directional ROM, respectively. Three key directions were identified as clusters of peak ROMs in the ADLs. Comparisons across gender and age groups revealed varying preferences for directional ROM in each group. Conclusion This study identified three key wrist motion directions essential for daily functions, highlighting the critical role of ulnar extension. Additionally, it demonstrated variations in directional wrist motion preferences across different genders and age groups.

The human wrist comprises a complex network of fine structural components such as the Triangular Fibrocartilage Complex (TFCC). Comprehensive observation of this fine structure using magnetic resonance imaging (MRI) typically requires multiple orthogonal volumes of anisotropic resolutions. However, existing methods of implicit neural representation (INR)-based isotropic super-resolution often produce blurry results when handling multiple volume inputs due to their averaging effects. In this study, we propose a Fourier-guided implicit fusion method to enable INR-based methods to achieve high-quality reconstruction. By leveraging a 2D Fourier loss function, our approach enables the INR framework to integrate high-resolution signals from the lateral slices of low-resolution volumes, mitigating the blurring effects in the perpendicular direction while avoiding the averaging effect between multiple views. Our method achieves isotropic reconstruction for real wrist MRI volumes and facilitates downstream assessment of TFCC. Our method also outperforms competing methods on the HCP-1200 brain MRI dataset, demonstrating its generalization capability.

The feasibility and accuracy of robot-assisted bone tunnel construction in the transosseous repair of the triangular fibrocartilaginous complex (TFCC) were compared with those of freehand arthroscopic repair. A total of 20 cadaveric specimens were randomized into robotic-assisted and arthroscopy-guided groups. Three bone tunnels were constructed in the ulnar foveal region in each specimen. The discrepancy between the planned and actual tunnel exits was determined in the robot-assisted group by merging images. The success rate of tunnel construction, time consumption and number of drilling attempts were compared between groups. The median planned/actual exit discrepancy was 0.8 mm in the robot-assisted group, with 90% of tunnel exits successfully placed in the footprint region, compared to 63.3% in the arthroscopy-guided group. The robot-assisted group spent less time and required fewer drilling attempts to construct bone tunnels. These results indicated that the robot-assisted technique can accurately construct multiple bone tunnels in the foveal region and reduce the difficulty of TFCC transosseous repair.Level of evidence: III.

BackgroundThe purpose of this study is to explore the feasibility and accuracy of a robot-assisted technique in four-corner fusion compared with traditional freehand operation.MethodsTwenty cadaver specimens were randomly assigned to the robot-assisted group and freehand groups. Three screws were placed percutaneously to fix the capitate-lunate joint, lunate-triquetrum joint, and triquetrum-hamate-capitate joint in each specimen by robot-assisted or freehand technique. The offset between the actual and planned screw positions was determined by merging the images of intraoperative and postoperative CT scans in the robot-assisted group. The centrality of the screw, time-consuming, drilling attempts, and radiation exposure were compared between the two groups.ResultsThe mean offset between the actual and planned screw position was 1.09 (SD: 0.56) mm. The offset at the start point of the screw was significantly lower than that at the endpoint. There was no significant difference in the centrality of the screws, surgical time between the two groups. The number of drilling attempts and the radiation dose received by surgeons were significantly lower in the robot-assisted group.ConclusionsAlthough there was no significant difference in screw centrality between the two groups, the slight offset between the actual and planned screw positions confirmed the feasibility of the robot-assisted technique in four-corner fusion. The robot-assisted technique has advantages in reducing the difficulty of surgery and protecting the surgeon from exposure to large doses of radiation.

PurposesTo compare the robotic-assisted and the traditional freehand percutaneous scaphoid fixation in number of guidewire attempts, duration of fluoroscopy time, amount of radiation dose, and screw centrality.MethodsTwenty cadaveric specimens were randomized into either the robotic or freehand group. The scaphoids in both groups were fixed by either the same attending or resident from our hand surgery department. The operation duration, amount of radiation from intraoperative fluoroscopy, total fluoroscopy time, and the number of guidewire attempts were documented and compared. Postoperatively, all the specimens had a computed tomography (CT) scan performed, and the difference in the final position of the screw and the central axis of the scaphoid was examined.ResultsIn the robotic group, all the guide wires were satisfactorily positioned within a single attempt, while the median number of attempts in the traditional freehand group was 18 (quaternion 14-65). This also meant that the surgeon in the robotic group experienced significantly lower radiation exposure dose and time as compared to the freehand group. There were no significant differences in the final screw position as compared to the central axis of the scaphoid in both groups. Although there was no difference in surgeon performance in the robotic group, the operative time for the attending was significantly lower as compared to the resident in the freehand group.ConclusionRobotic-assisted surgery for scaphoid fracture fixation is superior to the traditional freehand method as it facilitates accurate screw placement with lower radiation exposure and fewer guide wire attempts.

目的 开发研制一种便携式组织血氧检测仪,用于临床上实时、动态检测断指/断肢再植、皮瓣移植术后组织血氧值,帮助医护人员早期评估再植组织的血运情况.方法 基于近红外光谱法,利用人体血液中含氧血红蛋白和脱氧血红蛋白对近红外光吸收度不同的原理来进行组织血氧检测,采用无线蓝牙技术实现终端数据传输,并通过长时程的大数据管理和人工智能算法对再植组织的血氧水平进行智能评价.结果 设备的再植组织血氧参数测量范围为20％～100％,误差值为±2％,有效无线传输距离>3 m,基于人工智能算法的大数据管理,可以实现组织血氧水平的标定和评价.结论 无线便携式组织血氧检测仪体积小、重量轻、测量数据准确,能够帮助医护人员实时了解再植组织的恢复情况,有利于把握治疗的最佳时机.

Objective:To investigate the value of high-resolution ultrasound in the diagnosis of triangular fibrocartilage complex (TFCC) injuries.Methods:Forty-eight patients who underwent wrist arthroscopic surgery for wrist diseases in our hospital were studied and analyzed, including 34 cases of TFCC injury and 14 cases of other wrist diseases with normal TFCC. The TFCC high-resolution ultrasound was performed. Taking the results of arthroscopic exploration as the gold standard, the statistical research was carried out by comparing TFCC ultrasound imaging and arthroscopic manifestations. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of high-resolution ultrasound in the diagnosis of TFCC injury and injury site were obtained.Results:The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of high-resolution ultrasound in the diagnosis of TFCC injury were 0.9375, 0.875, 0.9375, 0.875, 7.5, and 0.071 respectively. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for the diagnosis of central degenerative perforation of TFCC were 0.9629, 0.9048, 0.9285, 0.95, 10.11 and 0.041 respectively. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of high-resolution ultrasound in the diagnosis of TFCC ulnar insertion injuries were 0.95, 1, 1, 0.9655, + ∞ and 0.05 respectively.Conclusion:High resolution ultrasound has certain value in the diagnosis of TFCC injury, especially the common clinical TFCC central degenerative perforation and ulnar insertion injuries, which is worthy of further study on its method and diagnostic criteria.

目的:探究基于微信群的延续性护理模式对断指再植患者自护能力及手功能恢复的影响.方法:选取2018年4月-2020年5月本院接受断指再植手术的患者88例作为研究对象,随机分为观察组及对照组,每组44例.对照组使用常规护理模式,观察组在对照组基础上给予基于微信群的延续性护理模式,两组均连续护理2月.比较两组护理效果,利用自我能力实施量表(ESCA)比较两组护自护能力,利用手功能量表(MHQ)对两组手功能进行评价,利用生活质量综合评定问卷(GQOLI-74)对患者生活中质量进行比较.结果:观察组护理后手功能总优良率为86.36％,相比对照组的68.18％明显升高,差异有统计学意义(P<0.05);观察组护理后较对照组自我概念、为我护理技能、自我责任感、健康知识水平评分明显升高(P<0.05);观察组护理后较对照组外观、手部满意情况、工作情况、日常活动、总体功能评分及总分明显升高(P<0.05);观察组护理后较对照组躯体健康、社会功能、物质生活、心理健康评分明显升高(P<0.05).结论:基于微信群的延续性护理模式可明显提高断指再植患者自护能力,提升患者手功能恢复效果,改善患者生活质量,有良好的应用价值.

Objective:To introduce a new design of double rotation flap in the treatment of congenital clasped thumb. The clinical effect of this new method to deepen the thumb-index webspace and release the palmar contracture of the first metacarpophalangeal joint (MCP) was assessed.Methods:Retrospective analysis was performed on the data of children with congenital clasped thumb treated by hand surgery in Beijing Jishuitan Hospital from January 2017 to December 2020. All patients presented with a narrow thumb-index webspace and palmar contracture at the first MCP joint. The double rotation flap contains two components, one of which was harvested from the radial-dorsal side of the index and transferred to widen the first webspace. The volar defect was mainly covered by the rotation flap transposed from the ulnar-dorsal side of the thumb. The extensor pollicis brevis was tightened or reconstructed based on the various developmental abnormality and the intrinsic muscle contracture was released to facilitate passive extension of the first MCP joint. Postoperative plaster immobilization was applied for one month and regular rehabilitation was conducted afterward. The survival of the flaps and the healing of the donor sites were followed up, the effect of the first webspace and palmar contracture release and thumb function were evaluated, and the parents’ satisfaction was investigated.Results:A total of 10 children with 11 affected thumbs (4 on the left side and 7 on the right side) were enrolled, with an average age of 26 months (11-36 months). All transposition flaps were survived without tip necrosis. Based on Gilbert’s method of assessment of thumb function, excellent or good improvement was achieved in the abduction of thumb (42°, 38°-43°) and extension of the MCP joint (1.6°, -5°-10°). All parents were satisfied with the appearance and function of the affected hand.Conclusions:The double dorsal-lateral rotation flap can provide sufficient width and depth of the first webspace and adequate coverage of the volar defect of the first MCP joint. This simple design is a reliable procedure for the treatment of congenital clasped thumb.

Objective:To compare the efficacy and safety of continuous subcutaneous insulin analogues infusion (CSII) and multiple daily insulin analogues injection (MDII) in fracture patients with type 2 diabetes mellitus (T2MD) during the perioperative period.Methods:The medical data of patients with lower limb fracture complicated with T2MD in Beijing Jishuitan Hospital from 2017 to 2021 were collected by hospital information system and analyzed retrospectively. The medical data of patients extracted included gender, age, body weight, body mass index (BMI), fracture site, pain score and grading, time from fracture to admission, duration of T2MD, laboratory test results at admission, blood glucose control regimen and monitoring result after admission, and the adverse events. Patients were divided into CSII group and MDII group according to blood glucose control regimen during the perioperative period. The clinical features, time to reach target blood glucose range, insulin application, and adverse events in patients of the 2 groups were compared.Results:A total of 207 patients were enrolled in this study, including 90 males and 117 females, aged (61±15) years with BMI of (25.5±3.5) kg/m 2. No significant differences were found in gender, age, BMI, fracture site, pain score and grading, time from fracture to admission, duration of T2MD, and laboratory test resurts at admission in patients between the 2 groups (all P>0.05). Patients in the CSII group had shorter time to reach target range of fasting blood glucose, 2-h postprandial blood glucose, and the both than those in the MDII group [(48.7±30.2) h vs. (78.7±44.5) h, P=0.003; (66.8±31.5) h vs. (93.3±47.6) h, P=0.001; (68.4±30.5) h vs. (96.3±48.1) h, P<0.001]. The total daily dose and total pre-prandial dose of insulin per unit weight in patients when the fasting and 2-h postprandial glucose both reach the target range were less in the CSII group than those in the MDII group [(0.67±0.20) U/kg vs. (0.73±0.17) U/kg, P=0.030; (0.34±0.10) U/kg vs. (0.38±0.09) U/kg, P=0.004]. In 207 patients, hypoglycemia occurred in 17 patients for 23 times with an overall incidence of 8.2%(17/207). The difference in the incidence of hypoglycemia was not significant between the 2 groups [4.9%(5/102) vs. 11.4%(12/105), P=0.319]. None of the 5 patients with hypoglycemia in the CSII group had hypoglycemia for 2 times or more, while 4 of the 12 patients in the MDII group had 2 times of hypoglycemia and 1 had 3 times of hypoglycemia. Other adverse drug events included allergy, systemic edema, nodular hyperplasia of subcutaneous fat, and persistent bleeding at the injection site. Eight patients in the CSII group had other adverse events, including device failure in 5 patients, and using insulin pump during anesthesia, in magnetic field environment, and in humid environment in 3 patients respectively. Conclusions:CSII regimen is helpful for fracture patients with T2DM to achieve target blood glucose range earlier, and provides more ways and opportunities to correct hypoglycemia in patients. However, the insulin pump needs more professional maintenance in practice, so it has limitations to some extent in clinical application.

We investigated abnormal MRI findings of the triangular fibrocartilage complex in 154 asymptomatic volunteers (21–79 years). Except prevalence, we focused on the morphological features of abnormal signals in relation to age. The majority of full-thickness tears were located in the articular disc (63 participants). The incidence of disc perforation with characteristics of ulnar impaction syndrome increased significantly with age. Asymptomatic full-thickness tears of the ulnar attachment were found in ten participants (seven over 60 years old). The proximal and distal laminae of the ulnar attachment could not be differentiated in 36 participants. In conclusion, MRI is of limited value for the elderly in diagnosing triangular fibrocartilage disorders. For young subjects, MRI is still valuable, especially in diagnosing ulnar detachment, although the ability to distinguish between proximal and distal laminae remains questionable. Disc perforations in volunteers mimicked ulnar impaction syndrome, therefore age, clinical signs and other factors should also be considered in clinical diagnosis. Level of evidence: III

Patterns in stress hormone (glucocorticoid: GC) levels and their relationship to reproductive condition in natural populations are rarely investigated. In this study, we (1) validate an enzyme-immunoassay to measure fecal cortisol metabolite (FCM) levels in North American red squirrels (Tamiasciurus hudsonicus), and (2) examine relationships between FCM levels and reproductive condition in a free-ranging red squirrel population. Injected radiolabeled cortisol was entirely metabolized and excreted in both the urine (mean+/-SE; 70.3+/-0.02%) and feces (29.7+/-0.02%), with a lag time to peak excretion in the feces of 10.9+/-2.3h. Our antibody reacted with several cortisol metabolites, and an adrenocorticotropic injection significantly increased FCM levels above baseline levels at 8h post-injection. Relative to baseline levels, manipulation by handling also tended to increase FCM levels at 8h post-manipulation, but this difference was not significant. FCM levels did not differ significantly between samples frozen immediately and 5h after collection. Reproductive condition significantly affected FCM levels in free-ranging females (pregnant>lactating>post-lactating>non-breeding) but not males (scrotal testes vs. abdominal testes). Among females with known parturition dates, FCM levels increased during gestation, peaked at parturition, and declined during lactation. The difference between pregnant and lactating females was therefore dependent upon when the fecal samples were obtained during these periods, suggesting caution in categorizing reproductive stages. This study demonstrates the utility of fecal hormone metabolite assays to document patterns of glucocorticoid levels in free-ranging animals.

目的 研究口服阿仑膦酸钠维D3或单次肌肉注射维生素D2预处理对首次静脉注射唑来膦酸治疗骨质疏松症发生急性时相反应的影响.方法 选取绝经后骨质疏松症患者97例,随机纳入口服阿仑膦酸钠维D3处理组(阿仑组,33例)、单次肌肉注射维生素D2组(VD2组,31例)、无预处理组(对照组,33例),比较分析3组的临床资料、基线指标及静脉注射唑来膦酸前后血常规、生化指标及72 h内急性时相反应发生率.采用多元Logistic回归分析探讨发热与血常规、 生化指标、 骨转换指标的相关性.结果 3组患者年龄、 体重及基线血常规、生化指标均无明显差异(均P>0.05).单因素方差分析(One-way ANOVA)对比三组患者静脉注射唑来膦酸前后血常规及生化指标,VD2组及阿仑组中性粒细胞/淋巴细胞比值(neutrohpil to lymphocyte ratio,NRL)均小于对照组,差异均有统计学意义(P<0.05).静脉输注唑来膦酸后72 h内对照组、VD2组、阿仑组急性时相反应发生率分别为:发热(81.8％,74.2％,41.9％)、乏力(45.5％,9.7％,12.9％)、头痛(60.6％,19.4％,6.5％)、头晕(21.2％,9.7％,0％)、骨痛(69.7％,45.2％,16.1％)、关节痛(54.5％,6.5％,12.9％)、肌肉痛(63.6％,38.7％,22.6％)及恶心(15.2％,3.2％,0％),差异均有统计学意义(均P<0.05),VD2组及阿仑组上述症状发生率均较对照组低.经Pearson相关性分析发现发热与用药前总I型前胶原氨基端延长肽(total procollagen type 1 amino-terminal propeptide,tP1NP)及I型胶原羧基端肽β特殊序列(β-isomerized C-terminal telopeptide of type I collagen,β-CTX)呈显著正相关(相关系数分别为0.28和0.29,P均<0.05),与25羟维生素D[25-OH vitamin D,25(OH)D]呈显著负相关(相关系数为-0.36,P<0.05).多元Logistic回归分析表明用药前血清25(OH)D低水平为用药后发生发热的危险因素[OR=0.86(95％CI:0.72～0.90),P=0.04].结论 阿仑膦酸钠维D3及维生素D2预处理均可有效缓解首次静脉注射唑来膦酸出现的急性时相反应,用药前血清25(OH)D低水平可作为静脉注射唑来膦酸后发热的危险因素.

目的 观察新型冠状病毒流行的不同时期手外科急诊就诊的特点.方法 统计2020年1月至12月和2019年1月至12月北京积水潭医院手外科就诊患者的资料,将2020年全年数据和2019年数据对比,并把2020年1月至12月中疫情发展不同阶段的数据进行对比,分析疫情对于手外科急诊患者情况的影响.结果 2020年全年的就诊量和手术量均比2019年略有增加;疫情严重时期就诊量显著下降;疫情缓解后就诊量显著反弹.男性和女性患者根据年龄分层后呈现不同的发病规律.结论 新型冠状病毒流行对手外科急诊的就诊量产生巨大影响.疫情控制对于急诊工作的正常开展意义重大.

亚急性舟骨骨折的治疗迄今仍有争议。延迟的石膏固定使骨折不愈合的发生率较高；亚急性舟骨骨折也并不都需要植骨手术，稳定无移位的骨折可通过微创经皮螺钉固定实现愈合。但由于舟骨特殊的解剖形态，徒手拧入螺钉可能出现位置及长度不满意，这使得术后关节磨损、骨折不稳定等并发症的发生率较高。机器人辅助技术能大大提高螺钉置入的精确度及安全性，且目前尚无应用于稳定亚急性舟骨骨折的报道。笔者回顾性分析2例稳定无移位的亚急性舟骨骨折患者在导航机器人与腕关节镜辅助下行微创固定治疗的临床资料，探讨其可行性及初步临床疗效。

Objective:This study aimed to investigate the functional and aesthetical outcomes after index pollicization for severe congenital thumb hypoplasia.Methods:From June 2010 to November 2018, 26 patients (29 hands) with Manske modified Blauth type ⅢB-V thumb hypoplasia who were admitted to Department of Hand Surgery, Beijing Ji Shui Tan Hospital were treated with index pollicization. Thumb abduction angles, Kapandji score, pinch forces, interphalangeal and metacarpophalangeal ranges of motion were measured. The stability of carpometacarpal joint was checked. Goldfarb function score and Likert scale score were used to evaluate overall function of thumb. Whether new first metacarpal’s physeal closure presence was observed on X-ray film. Postoperative complications were recorded. The patients’guardian’s and follow-up doctor’s subjective satisfactions on thumb appearance and function were surveyed. The correlation between guardian’s satisfaction and objective indicators, the differences between guardian’s and doctor’s satisfactions, the difference between operation satisfaction before and after 3 years old were analyzed.Results:Among 26 patients(4 type ⅢB, 16 type Ⅳ, and 9 type V), there were 19 males and 7 females with an average age of 37 months (range: 15-89 months) during surgery, including 8 left hands, 15 right hands and 3 bilateral hands. The average follow-up was 42 months. Average thumb radial abduction was 46.2°, average palmar abduction was 34.1°, and average Kapandji score was 7.1. Average angle of interphalangeal joint extension was 3.4°, flexion 40.7°, metacarpophalangeal joint extension 4.1°, flexion 38.6°. The average pinching forces (key pinch, tip pinch and tripod pinch) were 0.5 kg, 0.8 kg and 1.2 kg respectively. All carpometacarpal joints were stable. The average Goldfarb score was 4. The average Likert scale was 22. All epiphyses were open. First web contracture and superficial skin necrosis were respectively observed in 1 and 6 cases. There was no correlation between the guardian’s satisfaction and the objective indicators. The guardian’s satisfaction on thumb appearance and function was significantly lower than that of doctors’. There was no significant difference in guardian’s and physician’s satisfaction between patients before and after 3 years old.Conclusions:Satisfactory functional outcomes can be obtained after index pollicization for patients with Manske modified Blauth ⅢB-V thumb hypoplasia, with weak strength of thumb opposition and flexion. The subjective satisfaction of doctors was higher and that of guardians was lower.