ObjectiveTo compare the effectiveness between micro-anchor repair and modified pull-out suture in the treatment of mallet fingers. MethodsBetween June 2010 and March 2011, 33 patients with mallet fingers were treated by micro-anchor repair method (n=18, group A) and by modified pull-out suture method in which the broken tendons were sutured with double metal needle Bunnell’s suture and a knot was tied palmarly (n=15, group B). There was no significant difference in age, gender, and disease duration between 2 groups (P gt; 0.05). ResultsThe operation time was (62.5 ± 3.1) minutes in group A and (65.0 ± 4.6) minutes in group B, showing no significant difference (t=1.85, P=0.07). The treatment expense in group A [(8 566.2 ± 135.0) yuan] was significantly higher than that in group B [(5 297.0 ± 183.5) yuan] (t=58.92, P=0.00). Incision infection occurred in 2 cases of group A and 1 case of group B; the other patients obtained healing of incision by first intention. Relapsed mallet finger was observed in 1 case of group B. All patients in 2 groups were followed up 12-21 months. According to the Crawford functional assessment system, the results were excellent in 5 cases, good in 10 cases, fair in 2 cases, and poor in 1 case at the last follow-up with an excellent and good rate of 83.3% in group A; the results were excellent in 4 cases, good in 9 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 86.7% in group B. There was no significant difference in the excellent and good rate between 2 groups (χ2=0.23, P=0.97). ConclusionBoth micro-anchor repair and modified pull-out suture are simple and effective methods in the treatment of mallet finger. But compared with micro-anchor repair, pull-out suture has lower expense.
ObjectiveTo investigate the effectiveness of modified extensor indicis proprius (EIP) tendon transfer for reconstruction of spontaneously ruptured extensor pollicis longus (EPL) tendon by comparing with the traditional EIP tendon transfer. MethodsBetween January 2009 and December 2011, 11 cases of spontaneously ruptured EPL tendon were treated by modified EIP tendon transfer to reconstruct extension function (modified group). On the base of traditional procedure, the proximal end of EPL tendon was sutured with EIP tendon and the distal end of EIP tendon was crossed round extensor pollicis brevis (EPB) tendon and sutured back with EPL tendon. A specific EI-EPL evaluation method (SEEM) was used to measure the EPL tendon function after transfer. The result was compared with that of the other 18 cases undergoing traditional operation (traditional group). There was no significant difference in gender, age, disease duration, and injury causes between 2 groups (P gt; 0.05). ResultsAll incisions healed by first intention. In traditional group, 5 cases were out of follow-up, and the other 24 cases were followed up 1 year and 6 months on average (range, 8 months-2 years and 6 months). At the last follow-up, according to the evaluation of SEEM, the thumb elevation and flexion deficits of modified group were significantly less than those of traditional group (P lt; 0.05). The independent elevation deficit of the index finger of modified group was similar to that of traditional group (P gt; 0.05). The effectiveness was excellent in 9 cases and good in 2 cases with an excellent and good rate of 100% in modified group, and was excellent in 5 cases, good in 6 cases, and fair in 2 cases with an excellent and good rate of 84.6%. The effectiveness of modified group was significantly better than that of traditional group (χ2=0.03, P=0.03). ConclusionReconstruction of EPL tendon function by modified EIP tendon transfer is effective and easy. It can increase strength of the transferred tendon and obtain satisfactory results, but the long-term effectiveness needs further follow-up.
ObjectiveTo evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction. MethodsBetween March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25° (mean, 20°), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm × 4 cm to 8 cm × 6 cm; the upper limb free flap from 7 cm × 5 cm to 9 cm × 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting. ResultsAll the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90° (mean, 88°). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered. Conclusion A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.
Objective To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Methods Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size oftumor was 6.5 cm 3.5 cm-8.0 cm 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15° (mean, 10.7°), flexion 9-21° (mean, 14.2 ), radial incl ination 0-10 (mean, 8.6 ), and ulnar incl ination 0-15° (mean, 7.9°). The ROM of forearm was as follows: pronation 15-50 (mean, 28.7 ) and supination 10-25° (mean, 16.5°). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. Results All patients achieved primary heal ing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone heal ing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 (mean, 29.0 ), flexion 30-50° (mean, 35.0°), radial incl ination 10-20° (mean, 16.5°), and ulnar incl ination 20-25 (mean, 23.5 ). The ROM of forearm was as follows: pronation 40-90° (mean, 68.3°) and supination 30-80 (mean, 59.6 ). There were significant differences in the ROM between before operation and after operation (P lt; 0.05). According to the Krimmer et al wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Conclusion Wrist joint reconstruction with vascularized fibular head graft can restore function of wrist joint. The operation is proved to be safe and effective in treating distal radius giant cell tumor.
Objective To estimate the clinical curative effect of replacement of inverttype artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of malignant tumor in shoulder. Methods From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasmsthoroughly, replacement of inverttype artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. Results The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1 250 ml to1 900 ml(1 540 ml on average). The follow-up ranged from 7 to52 onths,with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA(Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. Conclusion The replacement of inverttype artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and goodstability. It can not only reserve arm but also rehabilitate function.
Objective To evaluate the effect of tendon transfer on reconstructing the extension of wrist, thumb and digit after irreversible radial nerve injury. Methods From January 1987 to February 2005, 25 cases of irreversible radial nerve injury were treated with Riordan tendon transfer. Among them there were 19 cases of central radial nerve injury with wrist ,thumb and digit extension dysfunction and 6 cases of deep branch of radial nerve injury with digit and thumbextension dysfunction. The muscle strength of wrist and digit extension ranged from grade 0 to grade Ⅰ. Tendon transfer was done 4 months to 8 years after their injuries. Results Twenty-three cases were followed up for3 to 60 months. According to the standard established by Chen Desong, 19 cases (82.6%) showed excellent and good results. Fair result was showed in 2 cases and poor result was showed in 2 cases. Conclusion Riordan tendon transfer should be the first choice of treating irreversible radial nerve injury.
Objective〓〖WTBZ〗To assess treating results of functional reconstruction of irrecoverable partial injury of brachial plexus and to improve the function ofinjured upper extremity. Methods Seventiy-nine cases with irrecoverable partial injury of brachial plexus were treated in transfer of muscle (tendon) or by fuctional anthrodesis (fixation of tendon) from January 1984 to June 2003. According to the evaluation criterion by American Shoulder and Elbow, Hand Association,all patients were followed up in motion of reconstructive joint and daily activities after operation for 1 year to 19 years. The effect of the operation was comprehensively scored and evaluated. Results Final results in 54 caseswere as follows: 30 patients with good results, 19 patients with fair results, and 5 with poor results. The results demonstrated some points as follow: ①if the shoulder was instable, athroedesis of shoulder would be a better choice;②the flexion of the elbow joint should be only reconstructed with the dynamic reconstructive methods. The reconstruction of flexion of elbow by transfer of pectoral major muscle was more effective than that by transfer of flexor carpi ulnaris muscle; ③the dynamic reconstruction of extension of digital and carpi was better than that of flexion of digital and opposition function of the thumb; ④the supination of the forearm was effectively reconstructed by transfer of flexorcarpi ulnaris muscle. Pronation teres muscle should be studied more in reconstruction of supination function of the forearm.
OBJECTIVE: To evaluate the results of limb function and the methods of bone and soft tissue reconstruction of patients treated with allografting. METHODS: From May 1992 to January 1999, 90 patients suffered from bone malignant tumor were treated with allografting in different methods of internal fixations. The average follow-up was 37.5 months. The limb postoperative function, complications related to different surgical methods were compared according to Enneking evaluation system. RESULTS: Skin necrosis, infection, non-union, fracture of allograft were the main complications which affect patients’ limb postoperative functions. Of the 90 fresh-frozen allografting procedures, the final results of operation showed that hip joints and knee joints were better than the shoulder joints. More than 80% of the patients treated with interlocked intramedullary nail and allograft-prosthesis combination led to an over-all result that was excellent and good. Interlocked intermedullary nail was of recommended method of internal fixation. Early exercises of operative limbs could promote function recovery. CONCLUSION: Using of interlocked intramedullary nail and allograft-prosthesis combination are of recommended operation method and can be applied with better results, and early exercises of operative limbs will lead to better functions.
OBJECTIVE: To report repair and reconstruction of massively damaged wound under unusual condition. METHODS: One hundred and forty-seven patients with deep tissue defects were admitted from January 1993 to December 2000, among them, 96 cases suffered from electrical injury, 18 cases with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, 6 cases caused by chemical producing necrosis and wound infection, 3 cases with radiation injuries, 2 cases with chemical burn, 2 cases with explosive injury, 2 cases with frostbite. One hundred and seventy five wounds in 147 patients were repaired by transfer of local flap, forearm conversal island skin flap, pectoralis major myocutaneous flap, delto-pectoral skin flap, latissimus dorsi skin flap, gastroecnemius myocutaneous flap, anterior and posterior tibial artery island skin flap, and so on. The wound defect ranged from 1 cm x 1 cm to 20 cm x 28 cm, and the flaps were 1.5 cm x 2.0 cm to 22 cm x 30 cm. The necrotic tendon was replaced with acellular allogenic tendon simultaneously in 7 cases. RESULTS: One hundred and sixty-nine flaps were survival with first intention, while necrosis of the tip of flap occurred in 6 cases. The transplantation of acellular allogenic tendon in all cases were survival. The function and configuration in 28 cases were satisfactory after 4 months to 8 years follow-up. CONCLUSION: Various types of flaps are choosen according to the position, defect range and degree of wound, which is an ideal method to restore the function and to improve patients’ living condition.
Abstract From August 1983 to June 1995, 15 cases of middle and upper 1/3 femoral malignant tumors were treated by removal of compete femur and functional reconstruction of both hip and knee. The key procedure was: arrested the artery and vein by rubber band with a nail put in the iliacbone, or exposed the atery and vein directly in the inguinal region. After the disarticulation of the hip and knee, the whole femur with the tumor was removed.Rotated the lower leg 180° and put an artificial femoral head on the upper endof tibia, kept the nerve, artery and vein intact or anastomosed the vessels. Three weeks after surgery, an artificial leg was put on and began to do functionalexercises. From 1～12 years follow-up, no mortality and no local recurrence or metastasis were noted. The function of the reconstructed hip and knee was satisfactory. This procedure could both provide a radical excision of the tumor and obtain a relatively good functioning hip and knee joints.