The reconstruction of the extension function of wrist and fingers in 35 patients with radial nerveinjury was reported, The indications of oporation and the main management during and after operationwere discussed.It was thought that the tendon transfer was an effective method to reconstructextension functions of wrist and fingers after the injury of radial nerves and could be served as asupplementary means after radial nerve repair.
ObjectiveTo systematically review the efficacy and safety of endoscopic radial artery harvesting for coronary artery bypass grafting (CABG).
MethodsDatabases including The Cochrane Library (Issue2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to August 2015 to collect randomized controlled trials (RCTs) and cohort studies about endoscopic radial artery harvesting technique versus traditional incision technique for CABG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software.
ResultsA total of 12 studies involving 1359 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in perioperative mortality (OR=0.66, 95%CI 0.17 to 2.57, P=0.55), the incidence of postoperative myocardial infarction (OR=0.78, 95%CI 0.30 to 2.06, P=0.62), vascular graft patency rate (OR=1.40, 95%CI 0.80 to 2.45, P=0.24) and the incidence of wound infection (OR=0.59, 95%CI 0.33 to 1.07, P=0.08). The endoscopic group showed significantly lower incidence of hematoma formation (OR=0.39, 95%CI 0.20 to 0.74, P=0.004) and paresthesia (OR=0.44, 95%CI 0.22 to 0.88, P=0.02) than that of the incision group.
ConclusionCurrent evidence shows that, compared with the incision technique, the endoscopic radial artery harvesting could significantly reduce the incidence of hematoma formation and paresthesia in patients underwent CABG. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more high-quality studies.
Objective To investigate the curative effects of open reduction and internal fixation with Kirschner wire for Mason type-II radial head or neck fracture in children. Methods From September 2007 to June 2009, 17 cases of Mason type-II radial head or neck fracture were treated, including 11 males and 6 femals with an average age of 8.5 years (4-11 years).The locations were left side in 5 cases and right side in 12 cases. All fractures were caused by fall ing and classified as Mason type- II fracture. Two cases compl icated by radial nerve deep branch injury. The time from injury to operation was 4 hours to 5 days. All cases received open reduction and internal fixation with Kirschner wire. They were evaluated by anteroposterior and lateral radiographs and functionally by Broberg criteria. Results Wound healed primarily in all patients. According to Métaizeau criteria, the results were excellent in 15 patients and good in 2 patients, who achieved anatomical reduction. Seventeen patients were followed up for a mean time of 14 months (6-25 months). Function returned to normal in 2 cases compl icated by radial nerve deep branch injury after 6 months of operation. No compl ications of infection and nerve injury occurred. The X-ray films showed that bony heal ing was achieved in all cases; the heall ing time was 2.0-3.5 months (mean 3 months). According to Broberg criteria, the outcome was excellent in 11 cases, good in 4 cases, and fair in 2 cases, the excellent and good rate was 88.2%. Conclusion Open reduction and internal fixation with Kirschner wire has good effect, satisfactory functional recovery and less compl ication in the treatment of Mason type-II fracture of radial head or neck in children.
Since October 1984, we have designed a method of conversed transplant of radial styloid bone flap with fascial pedicle in the treatment of 22 patients with non-united waist fractures of carpal scaphoid. The results from follow-up of 2-7 years were satisfactory.This article introduced the design of the bone flap, the operative procedure and the advantages of the bone flap.
Objective To report the clinical outcome of the transposition of the radial styloid bone flap pedicled on the recurrent branch of the radial artery in the treatment of scaphoid nonunion. Methods From March 2000 to June 2005,the procedure was done in 18 patients with scaphoid nonunion, a small bone flap(1.5 cm×3.5 cm×0.5 cm) pedicled on the recurrent branch of radial artery to the styloid process was raised from the radial styloid process and grafted into the corresponding slot chiseled along the vertical axis of scaphoid crossing the fracture line. Of 18 patients, 15 were males and 3 were females, aging 18-39 years. The locations were lumbar scaphoid in 11 patients and proximal scaphoid in 7 patients,among whom 5 had presented avascular necrosis in the proximal fragments of the scaphoid. Pain occurred in the act of wrist motion, and became obvious in the case of dorsiextension and radial deviation. Compression pain was observed in the stuff nest. The wrist joint activity is subjected to limit. The X-ray showed hardening and cystic degereration at fracture end and obviously widening fracture line. Results The scaphoid fracture healed in all 18 cases, the 5 proximal scaphoid fracture fragments which had previously been necrosed survived, a mean healing time of scaphoid was4 months. A follow-up of 1 to 5 years revealed normal wrist motion without pain in all cases. The life and job was good every day. Conclusion Transposition of the bone flap pedicled on the recurrent branch of the radial artery to the scaphoid is relatively simple and can effectively treat scaphoid nonunion and avascular necrosis with a great value in clinical application.
Objective To summarize the experiences of off-pump coronary artery bypass grafting (off-pump CABG) and on-pump coronary artery bypass grafting (onpump CABG) for patients with coronary artery diseases and to improve the surgical techniques and clinical results. Methods Coronary artery bypass grafting(CABG) were performed from January 2000 to March 2009 on 698 consecutive cases, including 551 male and 147 female with a mean age of 67.2 years(range, 28.0-79.0). There were 552 cases with angina pectoris and 131 with old myocardial infarction. Preoperative cardiac function showed 301 cases in New York Heart Association classⅡ, 339 in class Ⅲ,and 58 in class Ⅳ. Coronary angiography revealed single vessel disease in 21 cases, 2vessel disease in 87, 3vessel disease in 590, and 201 cases had concomitant left main lesions.There were 687 elective CABG and 11 emergency / urgent ones. Offpump CABG were performed on 346 cases and the others received onpump CABG . Results A total number of 2 025 grafts ( range,1-6 grafts, mean, 2.9 grafts /case ) were constructed with 693 left internal mammary arteries,115 free right mammary arteries,229 left radial arteries, and 81 right radial arteries. Total arterial bypass grafting was feasible on 126 cases. Postoperative ventilation duration varied from 0-127 hours (mean, 11.5 hours). Fasttrack procedure was offered to 38 cases with good results.Introaortic balloon pump support were provided to 1 patient preoperatively and 27 postoperatively. There were 25 deaths with a mortality of 3.64% for the elective cases with the cause of acute myocardial infarction ( 5 cases ), low cardiac output syndrome (3 cases),protamine reaction (2 cases),respiratory failure (3 cases), renal failure (2 cases),and multiorgan failure (10 cases).Four deaths occurred to urgent cases with a mortality of 36.36% from low cardiac output syndrome ( 3 cases) and acute myocardial infarction (1 case). One hundred and fiftyone cases（21.63%）developed atrial fibrilation among which 147（97.35%）returned to sinus rhythem with administration of electrolytes and Amiodarone. Resternotomy were performed for bleeding in 12 cases. Upon discharge from the hospital, 511 patients were free from angina while 20 other patients still had coexisting relieved angina. Postoperative followup was carried out on 415 cases（62.03%）for a period of 1month to 8.2 years with 3 deaths for lung cancer (1 case), car accident(1case), and unknown reasons (1 case). Number of patients who were free from angina was 317 and 21 for those who had recurrent angina. The cardiac function improved with 269 cases（65.29%）in New York Heart Association class Ⅱ, 142（34.46%）class Ⅲ, and 1（0.24%） class Ⅳ. Conclusion Good surgical results could be achieved with careful analysis of native Chinese patients’ coronary vessels, individualized operative plan, control of operative risk factors, and proper selection of bypass conduits. Aggressive use of IABP can provide essential support for patients with poor left ventricular function and other high risk factors.
Objective To analyze and compare the effectiveness of the closed reduction with elastic intramedullary nail ing and open reduction with Kirschner wire fixations in the treatment of O’Brien type III radial neck fractures in children. Methods Between November 2007 and November 2010, 31 children with O’Brien type III radial neck fractures were treated by the closed reduction with elastic intramedullary nailing fixation (closed reduction group, n=18) and by the open reduction with Kirschner wire fixation (open reduction group, n=13). There was no significant difference in age, gender, disease duration, and fracture classification between 2 groups (P gt; 0.05). Results The incisions of 2 groups healed primarily. Allthe patients were followed up 1-2 years (mean, 1.5 years). Limitation of the elbow extension occurred in 2 cases of the closed reduction group, l imitations of the elbow extension, flexion, and forearm pronation in 6 cases of the open reduction group. There was no significant difference in elbow flexion, extension, pronation, and supination between affected side and normal side in the closed reduction group (P gt; 0.05). Except in supination (P gt; 0.05), there were significant differences in flexion, extension, and pronation between affected side and normal side in the open reduction group (P lt; 0.05). According to Metaizeau’s grading criterion, excellent results were achieved in 16 cases and good in 2 cases in the closed reduction group; excellent results were achieved in 4 cases, good in 4 cases, fair in 3 cases, and poor in 2 case in the open reduction group; and there was significant difference between 2 groups (Z=3.435, P=0.001). The X-ray films showed anatomical reduction in 2 groups before removal of internal fixation; redisplacement occurred in 4 cases after removal of internal fixation in the open reduction group, no redisplacement occurred in the closed reduction group. There was no avascular necrosis of radial head and epi physes during follow-up. Conclusion Comparison with the open reduction with Kirschner wire fixation, the closed reduction with elastic intramedullary nailing fixation is a rel iable and good treatment for O’Brien type III radial neck fractures in children, because it has the advantages of minimal invasion, easy operation, stable fixation, early mobilization, and less complication.
Objective
To study digitize design of custom-made radial head prosthesis and to verify its matching precision by the surgery of preoperative three-dimensional (3-D) virtual replacement.
Methods
Six healthy adult volunteers (3 males and 3 females, aged 25-55 years with an average of 33 years) received slice scan of bilateral elbow by Speed Light 16-slice spiral CT. The CT Dicom data were imported into Mimics 10.0 software individually for 3-D reconstruction image, and the left proximal radial 3-D image was extracted, the mirror of the image was generated and it was split into 2 pieces: the head and the neck. The internal diameter and the length of the radial neck were obtained by Mimics 10.0 software measurement tools. In Geomagic Studio 12 software, the radial head was simulated to cover the cartilage surface (1 mm thickness) and generated to an entity. In UG NX 8.0 software, the stem of prosthesis was designed according to the parameters above and assembled head entity. Each custom-made prosthesis was performed and verified its matching precision by the surgery of preoperative 3-D virtual replacement.
Results
Comparing the morphology of 6 digitize custom-made prostheses with ipsilateral radial heads by the 3-D virtual surgery, the error was less than 1 mm. The radial head prosthesis design on basis of the contralateral anatomy was verified excellent matching.
Conclusion
The 3-D virtual surgery test and the digitized custom-made radial head prosthesis will be available for clinical accurate replacement.
Objective?To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness.?Methods?Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm × 5.5 cm to 10.0 cm × 7.5 cm. According to Brown’s classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance.?Results?All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of seech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions.?Conclusion?According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for repairing defects.
Objective To summarize operative procedure and the effectiveness of open reduction with internal fixation or radial head replacement for the treatment of Essex-Lopresti injury. Methods Between November 2002 and October 2010, 10 patients with Essex-Lopresti injury were treated. There were 8 males and 2 females with a mean age of 36 years (range, 20-56 years). Eight cases were fresh closed fracture within 2 days. According to Mason classification, 5 fracture were typeII, 3 were type III. The other 2 cases were old fracture within 3 months. Wrist joint X-ray revealed that all the patients had distal radioulnar joint dislocation. Open reduction with internal mini-plate or absorbable screw fixation was performed in 5 cases, and radial head replacement in 5 cases; meanwhile, the distal radioulnar joint was reducted and fixed. Results All incisions healed by first intention without infection or bone nonunion. The patients were followed up 7 to 24 months with an average of 14.7 months. The X-ray films showed fracture heal ing at 9-20 weeks (mean, 16.3 weeks); distal radioulnar joint was stable without shortening or shift of proximal radius. According to elbow cl inical evaluation system, the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases. According to wrist cl inical evaluation, the results were excellent in 7 cases, good in 2 cases, and fair in 1 case. All patients had good elbow stabil ity, and recovered quickly. Conclusion Early diagnosis, operation, and functional exercises are important to obtain an excellent result in treating Essex-Lopresti injury.
