OBJECTIVE: To study the morphological character of long head of triceps muscle for clinical application in reconstruction of shoulder abduction. METHODS: Forty-four upper extremities of fixed human adult cadavers were carefully dissected. The origins and the pedicles of blood vessels and nerves of long head of triceps muscle, as well as the maximum available size of the muscles, were measured. Six cases of clinical application of long head of triceps muscle for reconstruction of shoulder abduction were followed up for 3 to 11 months. RESULTS: The origins in the dorsal side of long head of triceps muscle were muscular and the ventral side were tendinous, which was 7.6 to 13.3 cm in length and 1.6 to 3.4 cm in width. The distance from the origin to the neurovascular pedicle was 5.7 to 11.4 cm. The radial nerve, which innervated the muscles, could be dissected for 2.9 to 11.8 cm in length. The blood supplies to the triceps muscle were from humeral artery (43.2%), 1.0 to 6.0 cm in length and 1.6 to 2.4 mm in diameter, and from humeral profundus artery (45.5%), 1.5 to 4.4 cm in length and 0.9 to 2.4 mm in diameter, if the vessel was separated to the humeral artery, the length was 1.5 to 6.3 cm. The neurovascular pedicles were multiple branched. In the 6 cases of clinical application of the triceps muscles, the operated shoulder could abduct from 5 degrees preoperatively (0 degree to 10 degrees) to 77.3 degrees (50 degrees to 90 degrees) postoperatively. CONCLUSION: In accordance to the anatomical character of the triceps muscles, the long head of triceps muscle is a suitable choice for reconstruction of shoulder abduction with optimistic outcomes.
The stress distribution and different abduction angles have a close relation to the hip joint. The purpose of this study is to provide biomechanical evidence for the treatment or precaution of hip joint injuries. A three-dimensional model of the hip was established through a series of processing based on the normal human hip joint computed tomograph (CT) image data which were applied to reverse engineering software Mimics14.0 in this study. Firstly, a three-dimensional finite element model was generated with meshing and assigned material and then it was imported into the finite element analysis software Ansys13.0. At last the stress at the femoral neck was solved, computed and analyzed in the positive orthostatic position with 7 hip abduction angles of the hip joint: 0°, 5°, 10°, 15°, 20°, 25°, and 30°, respectively. The results showed that the stresses of femoral neck and outer region were obviously higher than those of front and rear area of the neck of femur in the upright position or abduction of a different angle. With the increase of abduction angle, femoral neck in front of the regional stress value basically unchanged and rear area decreased, but the more obvious changes occurred in the outer region although the stress of inner and outer area also increased gradually. The hip abduction may cause changes in stress distribution because of the femoral neck stress mostly concentrated in the inner and outer cortex, and therefore it has an important role in guiding for hip surgery injury patients to choose the most reasonable solutions and prevention initiatives.
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 investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS). Methods The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The symptom duration of CTS was 12-120 months (mean, 48.7 months) and the thenar muscle atrophy duration was 6-48 months (mean, 13.4 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before operation and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up. Results All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There was no complications such as wound infection, scar pain of wrist, or tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation (P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation (P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied. Conclusion The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.