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 treatment method and effect of abduction and lateral rotation l imitation of the shoulder in obstetric brachial plexus palsy (OBPP). Methods From February 2005 to August 2008, 11 patients with abduction and lateral rotation l imitation of the shoulder in OBPP were treated with dissection of the origin of subscapular muscle,transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. Among them, there were 6 males and 5 females with a mean age of 6 years (1-15 years). The main cl inical manifestations showed adduction, internal rotation contracture deformity of shoulder, l imited active and passive external rotation and severely restricted active abduction of shoulder. The passive abduction was more than 90°. According to Gilbert grading, there were 7 cases of grade 1 and 4 cases of grade 2. Based on Mallet score systems, the scores were 5 points in 3 cases, 6 points in 3 cases, and 7 points in 5 cases. The muscle strength of deltoid, supraspinatus, infraspinatus, teres major muscle and latissimus dorsi all reached 3-4 grades. Results One patient developed postoperative hematoma, wound healed after symptomatic management. Other patients achieved incision heal ing by first intention. All patients were followed up for 12 to 37 months (17 months on average). The active abduction and external rotation of the shoulder joints recovered obviously. The Gilbert grading were grade 2 in 1 case, grade 3 in 1 case, and grade 4 in 9 cases; the Mallet scores were 10 points in 1 case, 11 points in 2 cases, 12 points in 4 cases, 13 points in 3 cases, and 14 points in 1 case; showing significant differences when compared with those before operation(P lt; 0.01). The muscle strength of deltoid, supraspinatus, infraspinatus, teres major muscle and latissimus dorsi increased to 4-5 grades. Conclusion The dissection of the origin of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles can resolve shoulder adduction, internal rotation contracture, and can enhance abduction, external rotation strength. It is an effective operation for abduction and lateral rotation l imitation of the shoulder in OBPP.
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 value of computer-aided design (CAD) in defining the resection boundary, reconstructing the pelvis and hip in patients with pelvis tumors. Methods Between November 2006 and April 2009, 5 cases of pelvis tumors were treated surgically using CAD technology. There were 3 males and 2 females with an average age of 36.4 years (range, 24-62 years). The cause was osteosarcoma, giant cell tumor of bone, and angiosarcoma in 1 case, respectively,and chondrosarcoma in 2 cases. According to the Enneking system for staging benign and mal ignant musculoskeletal tumors, regions I, I + II, III, IV, and I + IV is in 1 case, respectively. According to the principle of reverse engineering, 5 patients with pelvis tumors were checked with lamellar CT/MRI scanning, whose two-dimensional data were obtained in disease area. The three-dimensional reconstruction of pelvic anatomical model, precise resection boundary of tumor, individual surgical template, individual prosthesis, and surgical simulation were precisely made by computer with CAD software. Based on the proposal of CAD, the bone tumor was resected accurately, and allograft il ium with internal fixation instrument or allogeneic il ium with personal ized prosthetic replacement were used to reconstruct the bone defect after tumor was resected. Results The operation was successfully performed in 5 cases. The average operation time was 7.9 hours, and the average blood loss was 3 125 mL. Hemorrhage and cerebrospinal fluid leakage occurred in 1 case, respectively, and were cured after debridement. Five patients were followed up from 24 to 50 months (mean, 34.5 months). All patients began non-weight bearing walk with double crutches at 4-6 weeks after operation, and began walk at 3-6 months after operation. Local recurrence developed in 2 patients at 18 months after operation, and resection and radiotherapy were performed. According to International Society of Limb Salvage criteria for curative effectiveness of bone tumor l imb salvage, the results were excellent in 2 and good in 3. Conclusion The individual surgical template, individual prosthesis, and surgical simulation by CAD ensure the precision and rel iabil ity of pelvis tumors resection. The CAD technology promotes pelvis tumor resection and the reconstruction of pelvis to individual treatment stage, and good curative effectiveness can be obtained.
To introduce the experience and comprehend of appl ication of many kinds of skin flaps in repair of heel skin and soft tissue defect. Methods From August 1993 to April 2007, 242 cases of skin and soft tissue defect on heel were treated. There were 157 males and 85 females aged 27-76 years. There were 35 cases of unstable scar, 46 cases ofchronic ulcer, 57 cases of squamous cell carcinoma, 72 cases of mal ignant melanoma and 32 cases of injury. The defect area ranged from 2 cm × 2 cm to 8 cm × 14 cm, wound was with low-grade infection in 51 cases. The course of disease was 1 hour to 5 years. The lateral calcaneal flaps (34 cases), the dorsum pedis flaps (15 cases), the medial plantar artery island flaps (108 cases), the sural neurovascular flaps (36 cases), the saphenous neurocutaneous vascular flaps (26 cases) and free (myocutaneous) skin flaps (23 cases) were used to repair heel wounded surface according to specific location of heel wounded surface, range of skin and soft tissue defect. The size of the (myocutaneous) skin flap was 3.0 cm × 2.5 cm to 15.0 cm × 9.0 cm. The donor area was directly sutured or covered with skin grafts. Results In 242 cases, 235 cases achieved heal ing by first intention, 5 cases had partial necrosis of flaps, 2 cases had mild infection. The donor area healed by first intention. A total of 217 patients were followed up for 1 month to 60 months. The color of flaps were normal and the texture of flaps were softer than that of normal heel tissue; the flaps were wearable, the shape of flaps were satisfactory. The patients can walk after 6 months of operation, andthe gait was normal. In 118 cancer patients, no local tumor recurrence occurred, and distant metastatic lesions were observe in 22 mal ignant melanoma patients. In 32 cases of mal ignant melanoma followed up 60 months, no distant metastatic lesions were found. Conclusion In base of following the primary disease treatment, heel function reconstruction and contour structural feature remodel ing, we adopted some kind of island or free (myocutaneous) skin flap can be used to repair heel wound. The ideal effect in heel function reconstruction and contour structural feature remodel ing were obtained.
Objective To study the repair and function reconstruction of complex soft tissue defect of posterior of hand and forearm. Methods From May 2001 to November 2003, 8 cases of soft tissue defect of posterior of hand and forearm were repaired with thoracico abdominal flaps with hilum for primary stage. The tendon transplantation and allogeneic tendon function reconstruction of hand were performed for secondary stage. The range of the flap was 9 cm×15 cm to 12cm×38 cm. Allogeneic tendon amounted to 6.Results All the flaps survived. The flap countour was good. The results of allogeneic tendon transplantation were satisfactory and the function of hand was good. Conclusion Repairing complex soft tissue defect of posterior of hand and forearm and reconstructing hand function by use of thoracico abdominal flaps with hilum and transplantation of allogeneic tendon have the satisfactory clinical results.
Objective To evaluate the results of open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. Methods From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 caseswere extremely serious (less than 30° extension-flexion arc) and 18 cases were serious (30-60° extension-flexion arc). The range of motion of the elbow stiffness was (32.5 ± 28.9)° and the Mayo score was 51.9±13.1 before operation. All initial fractures were healed according to cl inical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Results Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instabil ity and debil itating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 ± 14.4 and the range of motion of elbow stiffness was (108.8 ± 36.0)°; showing significant differences when compared with preoperation (P lt; 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrol ysis. Conclusion Open elbow arthrolysis and postoperative rehabil itation for patients with elbow stiffness can improve joint function and ensure the stabil ity of elbows.
Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
OBJECTIVE: To investigate a clinical method in repairing destructive hand injury and reconstructing hand function in early stage. METHODS: From January 1990 to June 1999, composite tissue transplantation was used to repair destructive hand damage and reconstruct hand function with vascular anastomosis in emergency (33 cases) or subemergency (126 cases). For the radial damage, combined flaps with toes was used to treat cicatricial contracture of thumb-web space. Opposing function of thumb was reconstructed by combined transplantation of short extensor muscle of great toe, short extensor muscle of toes or short abductor muscle of great toe in the same time of freeing the second toe. For no or deficient anastomosing vessels in donor site, "Y"--shaped reversal vein, anterograde bridging, or branches bridging of host vessels were applied. RESULTS: All of tissue transplantation were survived, including combined tissue transplantation in 51 cases, composite tissue transplantation in 4 cases, tissue transplantation after replantation of severed wrist and finger in 4 cases, there were no infection or necrosis in all cases, and hand function recovered well. CONCLUSION: It is an ideal procedure to repair destructive hand injury and reconstruct hand function by combined or composite tissue transplantation with vascular anastomosis in emergency or subemergency.
ObjectiveTo investigate the effects of fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery. MethodsBetween July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection (group A) and 38 underwent fibular head preservation (group B). There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups (P>0.05). The complications and the position of the components were observed, and American society for bone tumors scoring system (MSTS93) was used to evaluate the joint function. ResultsAll patients were followed up 12-150 months (mean, 87 months). Incision infection occurred in 1 patient (2.63%) of group A and 6 patients (15.79%) of group B, showing significant difference (χ2=3.934, P=0.047). Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups (χ2=0.106, P=0.744). ConclusionFibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage, and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.