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.
OBJECTIVE: To study the reconstructional method and effect of shoulder joint function in the older obstetrical palsy with medial rotation contracture deformity. METHODS: From April 1996 to July 1999, 7 patients of older obstetrical palsy were adopted in this study. Among them, there were 5 males and 2 females, aged from 13 to 21 years old. No previous operation history and the main deformity was medial rotation contracture of shoulder. During operation, these patients were treated with "Z"-shape elongation of the tendon of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. RESULTS: Followed up for 6 to 44 months(averaged 19 months), the Gilbert grading and Mallet scoring were 1.57, 7.57 preoperatively versus 3.45, 10.86 postoperatively, the abduction and external rotation of the shoulder joints recovered obviously. CONCLUSION: It is an effective operation for the older obstetrical palsy with medial rotation contracture of shoulder.
Objective To study the surgical procedures and results for treating the nonunion of lateral humeral condyle fracture combined with cubitus valgus in adolescents. Methods From June 2004 to October 2006, 5 patients with nonunion of lateral humeral condyle fracture and cubitus valgus were treated, including 3 males and 2 females aged 8-17 yearsold. Three cases received external fixation for 2-3 weeks in other hospital, while 2 cases were misdiagnosed as soft tissue injury. The patients were hospital ized after they were diagnosed with nonunion of lateral humeral condyle fracture and cubitus valgus 4-12 years after injury. Preoperatively, the angle of cubitus valgus deformity was 25-55° (average 44.8°), and the elbow motion range of flexion and extension was 135-140° (average 139°) and 0-20° (average 7°), respectively. One case with the symptoms of ulnar neuritis was diagnosed as incomplete injury of ulnar nerve. The time between admission to hospital and operation was 3-7 days. All the patients were treated with wedge shaped supracondylar osteotomy of the distal aspect of humerus and humerus lateral column reconstruction. Regular follow-up was conducted after operation and the elbow function was evaluated according to the scale system of Jupiter et al. Results All incisions healed by first intention and all the cases were followed up for 14-28 months (average 20 months). X-ray films revealed that bone union was attained in all the 5 cases, among which the bone union at the supracondylar osteotomy site was reached 5-8 weeks after operation (average 6 weeeks) and the bone union at the lateral column reconstruction site was reached 3-6 months after operation. The deformity of cubitus valgus was corrected in all thecases. At latest follow-up, the flexion motion of the elbow was 100-135° (average 121°), and the extension range was 0-30° (average 13°), the angle of postoperative cubitus valgus deformity was — 5-10° (average 2°). According to the system of Jupiter et al, 2 cases were excellent, 2 cases were good and 1 case was fair. One patient and symptoms of radial nerve traction injury after operation and achieved complete recovery 3 months later; and 1 case suffering from ulnar neuritis before operation recovered 6 months after operation. No other compl ications occurred. Conclusion It is effective to use wedge-shaped supracondylar osteotomy of the distal aspect of the humerus and lateral colum reconstruction through internal fixation to treat the nonunion of the lateral humeral condyle fracture combined with cubitus valgus.
From 1972 to 1990,121 cases of bone tumor were treated by segmental resection of tumor and followed by artifical joint re- placement. All of the prostheses were designed and manufactured by our hospital. One hundred and two cases were followed up for an average of 7.4 years and the curative rate with the affected limbs preserved was 85.28%. The indication, the advantages and disadvantages, the material and the type of artifical joints, and the assessment of functional reconstruction following operation were discussed.
This article reviews the development and progress in the field of limb salvage treatment, surgical techniques, and function reconstruction of pelvic malignant tumors in China in the past 30 years. Based on the surgical classification of pelvic tumor resection in different parts, the development of surgical techniques and bone defect repair and reconstruction methods were described in detail. In recent years, in view of the worldwide problem of biological reconstruction after pelvic tumor resection, Chinese researchers have systematically proposed the repair and reconstruction methods and prosthesis design for bone defects after resection of different parts for the first time in the world. In addition, a systematic surgical classification (Beijing classification) was first proposed for the difficult situation of pelvic tumors involving the sacrum, as well as the corresponding surgical plan and repair and reconstruction methods. Through unremitting efforts, the limb salvage rate of pelvic malignant tumors in China has reached more than 80%, which has preserved limbs and restored walking function for the majority of patients, greatly reduced surgical complications, and achieved internationally remarkable results.
From 1979 to 1994, reparative and recons tructive surgery were used to repair the war injuries of skins, bones, blood vessels and nerves of the limbs in 800 cases. A systematic clinical study was carried out. Many new operative methods were used and the results of treatment were good. Innovations and modifications were made in technique. In 120 cases of warin juries having soft tissues defects including skin and muscles, various tissue transplantations were used with the hope to accomplish onestaged repair of the defect and reconstruction of motor function of muscle. To those infections of bone and joint in war injuries, following early eradication of infected focus, transplantation of musculocutaneous flap or omental graft was immediately carried out with the aim to obtain primary healing of the wound. In the treatment of bone defects from war wounds with loss of skin and muscles, the vascularized skeletocutaneous graft was used. In the treatment of 150 cases of injury of peripheral nerve from forearms, the result of good to fair rated 68.8 percent for upper extremity and that for lower extremity, it was 62.2 percent. Following the early repair of 500 cases of injury of peripheral blood vessels, the patency rate of the blood vessel was 90 percent. The result following by pass vascular graft in the treatment of forearms injury of blood vessels even with very poor local condition was still very successful.
Objective To investigate the method and the cl inical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula. Methods The cl inical data were retrospectively analyzed, from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009 (test group). Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group. There was no significant difference in gender, ages, disease duration, and tumor site between 2 groups (P gt; 0.05). Lateral stress test was performed after operation; X-ray films were taken to measure the joint space. Musculoskeletal Tumor Society (MSTS) functional score system was used to evaluate the joint function. Results All incisions healed by first intention in 2 groups. Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection. The patients in both groups were followed up 12 to 36 months, with an average of 30 months. One patient with osteosarcoma of the test group developed local recurrence, and died of lung and systemic metastases after 12 months; the other patients had no recurrence. At last follow-up, the results of knee lateral stress test were negative in the test group, and the joint space increased and was classified as grade A; the results of knee lateral stress test were positive in the control group, and the joint space was classified as grade D. The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group, showing significant difference (t=2.85, P=0.01). Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe, rel iable, and simple technique to reconstruct knee stabil ity after resection of tumors of the proximal fibula.
OBJECTIVE: To investigate the reparative method and effect of radial nerve injury. METHODS: From 1990 to 2000, 50 cases with radial nerve injuries were adopted in this study. Among them, there were 38 males and 12 females, aged from 5 to 65 years. For the 50 cases, there were 28 cases with complete nerve rupture, 3 cases with incomplete nerve rupture, 10 cases with compressive injury, 5 cases with contusion injury and 4 cases with defect and irreversible injury. All the patients were treated with radial nerve exploration in 1 hour to 6 months after injury. 31 cases were treated with nerve anastomosis, 10 cases with nerve lytic operation, 4 cases with tendon transfer and 5 cases with palliative treatment. RESULTS: All the cases were followed up 3 months to 10 years. The curative effect was assessed according to Highest grade method. There were excellent and good results in 46 cases, moderate results in 4 cases. CONCLUSION: It is necessary to explore and repair the radial nerve injury immediately after the diagnosis being confirmed. If the function of radial nerve could not recover in 6 months, tendon transfer should be carried out to reconstruct the extension of elbow, thumb and fingers.
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.
ObjectiveTo study the feasibility and advantages of preparing an animal model of defecation reconstruction after spinal cord injury in rats by mechanical polishing method. MethodsForty adult female Sprague Dawley rats (weighing, 250-300 g) were randomly divided into 2 groups (n=20). The lamina was opened by mechanical polishing method to expose the cauda equina in experimental group, then bilateral L5 and S1 nerve roots end-to-end anastomosis was done under 10 times microscope, and finally cauda equina between the L5 and L6 (except S1) was cut. The lamina was opened by traditional bites method in control group, and the other treatment methods were in agreement with the experimental group. The operative time, intra-operative blood loss, and situation of rats at postoperative 3 days were recorded. ResultsThe operative time of experimental group[(93.05±7.60) minutes] was significantly shorter than that in control group[(131.30±11.68) minutes] (t=12.279, P=0.000); intra-operative blood loss in experimental group[(4.33±0.46) mL] was significantly lower than that in control group[(7.36±0.58) mL] (t=18.293, P=0.000). At 3 days after operation, 18 rats (90%) survived in experimental group, and 12 rats (60%) survived in control group; difference was significant in the survival rate between 2 groups (χ2=4.800, P=0.028). ConclusionTo establish an animal model of defecation reconstruction after spinal cord injury in rats by mechanical polishing method is feasible, and it has shorter operative time, less blood loss, and lower postoperative mortality than the traditional bites method. But there is a certain learning curve and requirement to master microsurgical techniques.