Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent l iterature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist spl inting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more cl inical researches, and surgical treatment is one method recommended by some scholars.
Objective To investigate the cl inical results of cross-finger flap combined with laterodigital pedicled skin flap for repair of severe flexion contracture of the proximal interphalangeal joint. Methods Between October 2008 and February 2011, 11 patients (11 fingers) with severe flexion contracture of the proximal interphalangeal joint were treated with cross-finger flap combined with laterodigital pedicled skin flap. There were 7 males and 4 females, aged 20-63 years (mean, 32.6years). The causes of injury were crush or electric-saw injury in 7 cases, burn or explosive injury in 3 cases, and electrical injury in 1 case. The locations were the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 2 cases, and the l ittle finger in 3 cases. The mean disease duration was 12.4 months (range, 6-24 months). All cases were rated as type III according to Stern classification standard. The volar tissue defect ranged from 3.0 cm × 1.5 cm to 5.0 cm × 2.5 cm, with exposed tendons, nerves, vessels, or bone after scar relaxation. The defects were repaired with cross-finger flaps (2.2 cm × 1.8 cm to 3.8 cm × 2.5 cm) combined with laterodigital pedicled skin flaps (1.5 cm × 1.2 cm to 2.5 cm × 2.0 cm). Double laterodigital pedicled skin flaps were used in 3 cases. The flap donor site was sutured directly or repaired with the skin graft. Results All flaps survived completely and wound healed by first intention. The donor skin graft survived. All the patients were followed up 6-18 months (mean, 11.3 months). The finger appearance was satisfactory. The flaps had soft texture and good color in all cases. No obvious pigmentation or contraction was observed. The contracted fingers could extend completely with good active flexion and extension motion. At last follow-up, the extension of the proximal interphalangeal joint was 10-15°. Based on proximal interphalangeal joint motion standard of Chinese Medical Association for hand surgery, the results were excellent in 6 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 90.9%. Conclusion It is an easy and simple therapy to cover wound area of severe flexioncontracture of the proximal interphalangeal joint after scar relaxation using cross-finger flap combined with laterodigital pedicled skin flap, which can repair large defect and achieve good results in finger appearance and function.
ObjectiveTo summarize the research progress of tissue engineered bile duct in recent years.MethodsThis paper summarized recently-published papers related to tissue-engineered bile duct on in vitro test platform, scaffold materials, acquisition methods of seed cells, and in vivo repair effectiveness after the fusion of seed cells and materials, in an attempt to review the basic and clinical application studies of tissue-engineered bile duct.ResultsTissue-engineered bile duct had been developing rapidly. At present, great progress had been made in the fields of in vitro test platform, scaffold materials, seed cells, and repair effectiveness in animal models. However, further study was still needed in terms of its clinical application. The external bile duct platform included 3D printing and biological simulation; in the aspect of scaffold material, apart from the progress of various artificial materials, acellular matrix was introduced; the selection of seed cells included the induction and differentiation of bile duct-derived stem cells, human bone marrow mesenchymal stem cells (hMSCs), hepatic oval cell (HOC), pluripotent stem cells (PSCs), and other stem cells; animal models of tissue-engineered bile ducts had also achieved good results in animals such as pigs and dogs.ConclusionThe development of tissue-engineered bile duct will promote the progress of fundamental in vitro studies on extrahepatic biliary tract diseases, thus introducing new options to the clinical treatment of extrahepatic biliary tract injuries.
Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles’ fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles’ fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, fall ing in 8 cases, fall ing from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland ＆ Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles’ fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no rel ief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% l idocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were rel ief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The results of Tinel test, Phalen test, and Reverse Phalen test were all negative. The X-ray film showed good fracture reduction and heal ing with an average heal ing time of 6 weeks (range, 3-14 weeks). According to GU Yudong’s criteria for functionalassessment, the results were excellent in 18 cases and good in 4 cases; the excellent and good rate was 100%. Conclusion Malposition, displacement of fracture fragments, and ulnar deviation of the wrist after plaster immobil ization are the mostimportant risk factors for ACTS. Expectant treatments are recommended in patients with Colles’ fracture of types I, II, and IV,but surgical treatment is the first choice for Colles’ fracture of type III.
ObjectiveTo improve the calculation method of the sum of residual hepatic lobe volume and total liver volume after partial hepatectomy in rats.MethodsOne hundred and thirty-five SD rats of different body sizes were divided into five groups by completely random design. The body length, tail length, chest circumference, body weight and length of hepatic triangle lobe of the rats were measured before surgery. Then, according to the classic Higgins and Anderson methods, different lobectomies of liver were performed for each group: middle lobe + left inner lobe, left outer lobe, bilateral papillary lobe, triangular lobe, and right lateral lobe were removed; the proportion of theoretical liver resection in each group was 38.1%, 30.1%, 7.9%, 7.8% and 15.3%, respectively. The actual liver resection volume and residual liver volume were measured after surgery. we finally analyzed statistical differences of liver volume calculated by different indirect methods. In addition, the correlation analysis and regression analysis were conducted between the preoperative measured rat body surface parameters and the measured whole liver volume, so as to explore a more simple and accurate volume measurement method.ResultsThe actual proportion of liver resection in each group was 35.0%, 29.2%, 7.1%, 4.9% and 12.0%, respectively. Compared with the residual liver lobe volume actually measured, that calculated by using the indirect method of substitution of the theoretical liver resection proportion was statistically different in all the other four groups except the left outer lobe group. However, there was no statistical difference between the residual liver lobe volume actually measured and that calculated by the actual liver resection proportion in the 5 groups. In addition, in the preoperative measurement of 5 kinds of basic parameters of rats, the body length has the best correlation with whole liver volume, and the regression equation is \begin{document}$\hat Y = - 27.667 + 0.899X$\end{document}.ConclusionsThe liver volume calculated by indirect method using the actual liver resection proportion, compared with the theoretical liver resection proportion, is more accurate. Compared with the body weight, the body length has the better correlation with whole liver volume.