The results of nerve transposition for root avulsion of brachial plexas in 21 cases were reported. The methods of the nerve transposition were divided into four groups as followings: By transfer of phrenic nerve, accesory nerve, the motor branches of cervical plexus and intercostal nerves in cease; By transfer of phrenic nerve, accessory nerve and the motor branches of cervical plexus in 6 cases; By transfer of phrenic nerve and accessory nerve in 9 cases, and by transfer of phrenic nerve or the motor branches of cervical plexus or intercostal nerve in 5 cases. During operation, in 1 cases variation of the brachial plexus was found. Injury to the subclavian artery occurred in 4 cases and they were repaired, which is good for the blood circulation of the upper arm and nerve regeneration. Nineteen cases were followed up with good results. The overall excellent and good rate was 73.7%. It was considered that transposition of nerve should be a routine operation for the treatment of root avulsion of brachial plexus and the accompanied arterial injury should be repaired at the same time during operation, and the latter would be advantageous to enhance functional recovery of nerve.
BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
To investigate the feasibility of using the pedicled patella for repaire of the superior articular surface of the medial tibial condyle, 37 lower limbs were studied by perfusion. In this series, there were 34 obsolete specimens and 3 fresh specimens of lower legs. Firstly, the vessels which supply to patella were observed by the methods of anatomy, section and casting mould. Then, the form and area of the patellar and tibial medial conylar articular surface were measured in 30 cases. The results showed: (1) the arteries supplied to patella formed a prepatellar arterial ring around patella, and the ring gave branches to patella; (2) medial inferior genicular artery and inferior patellar branches of the descending genicular arterial articular branch merge and acceed++ to prepatellar ring at inferior medial part of patella; (3) the articular surface of patella is similar to the superior articular surface of the tibial medial condyle on shape and area. It was concluded that the pedicled patella can be transposed to medial tibial condyle for repaire of the defect of the superior articular surface. The function of the knee can be reserved by this method.
OBJECTIVE: To investigate the clinical results of transposition of muscular skeletal flap pedicled with straight head of rectus femoris for treatment of avascular necrosis of adult femoral head. METHODS: Eight patients with avascular necrosis of femoral head were adopted in this study. There were 6 males and 2 females, the ages were ranged from 24 to 56 years. According to the criteria of Ficat, there were 5 cases in stage II and 3 cases in stage III. The Smith-Peterson incision was used to expose the capsule of the hip. After complete curettage of the necrotic bone from the femoral head, the muscular skeletal flap pedicled with straight head of rectus femoris was resected and transposited into femoral head. Finally, conventional decompression of head was performed. RESULTS: All the cases were followed up for 1 to 3 years. There were excellent results in 5 cases, good in 2 cases and moderate in 1 case. The rate of excellent and good results were 87.5%. CONCLUSION: Comparing with other pedicled bony flaps, the muscular skeletal flap pedicled with straight head of rectus femoris is characterized by its convenience and efficacy. It is suitable for the treatment of avascular necrosis of femoral head in stage II or III, but the contour of the femoral head should be nearly normal.
OBJECTIVE: To provide a series of surgical approaches for treatment of talus neck fracture, ischemic necrosis of talus body, and other bone lesions in ankle and foot. METHODS: The major blood supply to cuboid bone, medial cuneiform bone and navicular bone was observed in 30 adult cadavers, by infiltration of red emulsion via major arteries of the lower limbs. Based on these anatomical investigations, 3 types of vascularized tarsal bone grafting were designed for repair of bone lesions in the area of ankle and foot, and applied in 49 clinical cases, ranging from 10 to 58 years in age, and 43 cases of which were followed up for 4 years and 3 months in average. RESULTS: Primary healing was achieved in 40 cases, and secondary healing achieved after further surgical intervention in other 3 cases. The function of all ankle joints recovered satisfactorily. CONCLUSION: The designed three types of vascularized tarsal bone flaps are easy and reliable for dissection because of their superficial pedicles, and they are available for different clinical cases with various bone lesions in ankle and foot.
OBJECTIVE To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. METHODS Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. RESULTS Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. CONCLUSION The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.
Objective To introduce a modified REV procedure of complicated transposition of the great arteries （TGA） or double outlet right ventricle （DORV） which was combined with ventrieular septal defect （VSD） and pulmonary valve stenosis（PS）. Methods From Sep. 2005 to Feb. 2006, 3 children with complicated transposition of the great arteries underwent a modified REV operation. This modified REV operation was designed on the basis of classical REV procedure to preserve the native pulmonary artery valve and its function. Results Two patients recovered uneventfully but one died after extraeorporeal membrane oxygenator （ECMO） treatment. After 4 and 1 months follow-up respectively, the discharged 2 patients were asymptomatie and the eehoeardiography revealed that the pressure gradient between left ventrieular-main pulmonary were estimated to be 15 and 5mmHg. Conclusion This modified REV operation for preservation of pulmonary artery valve is an ideal procedure to complicated transposition of the great arteries. Advantages and disadvantages of this modified REV procedure were discussed.
Objective To explore the effectiveness of pedicled il iac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Methods Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with il iac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 ± 5.95. Results All incisions healed by first intention and the patients had no compl ication of lung embol ism, sciatic nerve injury, lower l imb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture heal ing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 ± 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t= —18.447, P=0.000). The hi p function were excellent in 11 hi ps, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Conclusion Pedicled il iac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.
【Abstract】 Objective To investigate the feasibility of transpositional anastomosis of C4 anterior trunk and accessory nerve for functional reconstruction of the trapezius muscle so as to provide theoretical basis of repairing accessory nerve defects. Methods Thirty-six adult male Sprague-Dawley rats (weighing 200-250 g) were randomly divided into the experimental group (n=18) and control group (n=18). The transpositional anastomosis of C4 anterior trunk and accessory nerve was performed in the left sides of experimental group; the accessory nerve was transected in the left sides of control group; and the right sides of both groups were not treated as within-subject controls. The electrophysiological and histological changes of the trapezius muscle were measured. The values of the latencies and amplitudes of compound muscle action potential (CMAP) were recorded in the experimental group at 1, 2, and 3 months; the latency delaying rate, amplitude recovery rate, and restoration rate of muscular tension were caculated. The counts of myelinated nerve fibers from distal to the anastomotic site were analyzed. The transverse area of the trapezius muscle was also measured and analyzed in 2 groups. Meanwhile, the muscles and nerves were harvested for transmission electron microscope observation in the experimental group at 1 and 3 months. Results As time passed by, the experimental group showed increased amplitudes of CMAP, shortened latencies of CMAP, and improved muscular tension. At 3 months, the amplitude recovery rates were 63.61% ± 9.29% in upper trapezius muscle and 73.13% ± 11.85% in lower trapezius muscle; the latency delaying rates were 130.45% ± 37.27% and 112.62% ± 19.57%, respectively; and the restoration rate of muscular tension were 77.27% ± 13.64% and 82.47% ± 22.94%, respectively. The passing rate of myelinated nerve fibers was 82.55% ± 5.00%. With the recovery of innervation, the transverse area of the trapezius muscle increased, showing significant differences between experimental group and control group at different time points (P lt; 0.05). The transmission electron microscope showed that the myotome arranged in disorder at 1 month and tended to order at 3 months. Conclusion Transpositional anastomosis of C4 anterior trunk and the accessory nerve can effectively reconstruct the function of the trapezius muscle of rats.
ObjectiveTo summarize clinical experience of staged left ventricular retraining for infants with transposition of the great arteries (TGA). MethodsFrom January 2001 to December 2011, 38 TGA infants with intact ventricular septum or a small ventricular septal defect underwent left ventricular retraining in Fu Wai Hospital. There were 26 male and 12 female patients with their age of 19.1±7.7 months and body weight of 7.6±4.7 kg. Preoperative arterial oxygen saturation (SaO2)was 72.6%±9.1%. Left ventricular retraining included aortopulmonary shunt and pulmonary artery banding. Three patients received concomitant excision of the atrial septum. All survival patients were followed up after discharge. ResultsPostoperatively, SaO2 increased to 83.9%±8.1% from preoperative 72.6%±9.1%, and left ventricle-to-right ventricle pressure ratio increased to 0.75±0.09 from preoperative 0.36±0.04. Three patients (7.89%)died postoperatively. Thirty-five patients were followed up for 2 to 11 years. During follow-up, 23 patients successfully received second stage arterial switch operation (ASO). ConclusionFor TGA infants with decreased left ventricular mass who have missed the neonate period, left ventricular retraining is a safe and efficacious procedure to provide necessary preparation for second stage ASO.