Objective To assess the long-time results of reconstruction of the extensor pollicis longus (EPL) function by transfer of the extensorindicis(EI). Methods From August 1978 to March 2003, 46 cases of loss of the EPL function were treatedby transfer of the extensor indicis. Of 46 cases, there were 32 males and 14 females, aged 16-51 years with an average of 36 years; there were 24 cases of oldtraumatic rupture and 22 cases of secondary rupture. The disease course was 2 days to 5 months, averaged 74 days. A specific EIEPL evaluation method (SEEM) wasused to measure the EPL function after transfer.Results Fortyone cases were followed up 9 years and 3 months on average (7 months to 23 years). Based on the SEEM, the results were excellent and good in 39 of 41 patients. The elevation deficit and combined flexion deficit were 0-2.2 cm (1.8 cm on average) and 0-3 cm (1.6 cm on average); the independent extension deficit was 0°-8° (5° on average). Conclusion Restoration of the extensor pollicis function by transfer of the extensor indicis is an effective and safe treatment option and the SEEM is a valid method for assessing EPL function.
In transcranial magnetic stimulation (TMS), the conductivity of brain tissue is obtained by using diffusion tensor imaging (DTI) data processing. However, the specific impact of different processing methods on the induced electric field in the tissue has not been thoroughly studied. In this paper, we first used magnetic resonance image (MRI) data to create a three-dimensional head model, and then estimated the conductivity of gray matter (GM) and white matter (WM) using four conductivity models, namely scalar (SC), direct mapping (DM), volume normalization (VN) and average conductivity (MC), respectively. Isotropic empirical conductivity values were used for the conductivity of other tissues such as the scalp, skull, and cerebrospinal fluid (CSF), and then the TMS simulations were performed when the coil was parallel and perpendicular to the gyrus of the target. When the coil was perpendicular to the gyrus where the target was located, it was easy to get the maximum electric field in the head model. The maximum electric field in the DM model was 45.66% higher than that in the SC model. The results showed that the conductivity component along the electric field direction of which conductivity model was smaller in TMS, the induced electric field in the corresponding domain corresponding to the conductivity model was larger. This study has guiding significance for TMS precise stimulation.
Objective To investigate a synthetical technique combining static and dynamic states for treating facial paralysis. Methods From October 1993 to November 2005, 93 patients (26 males, 67 females; aged 9-69 years; illness course, 6 months to 24 years) with facial paralysis were admitted for treatment, of whom 48 were unknown in their pathological origins, 32 had a history of intracranial or ear operation, 13 had their facial paralysis related to trauma. We applied synthetical techniques for treating facial paralysis, including denerved muscle (extensor hallucis brevis and extensor digitorum brevis) free graft using an operating or chemical technique, temporal muscular flap suspending, treatment of eye closure by uplifting zygomomalar tissues and temporal muscular flap suspending, brow lifting by the Buried Guiding Suture Appliance, Botox injection, and the nerve amputation of normal side for mandibular marginal ramus paralysis. Results After the treatment for 82 patients with the method of the denerved muscle free graft combining femporal muscular flap suspending, 3 patients with the method of uplifting zygomo-malar tissues combining temporalmuscular flap suspending for eye closure, 15 patients with the method of the Buried Giding Suture for eyebrow lifting, 4 patients with the Botox injection and nerve amputation of normal side for the mandibular marginal ramus paralysis,93 patientshad a good therapeutic result. The follow-up for 3 months to 10 years in all the patients revealed that 75 patients were satisfied with their treatment results and 13 patients were almost satisfied according to the criteria for the facialsymmetrical checking and the House-Brackmann grading system. The technique hadadvantages of a complete survival of the related small muscles, a hidden incision, less trauma for the Botox injection, and the denerved muscles for surrounding nerve inserting. Conclusion The synthetical technique combining static and dynamic states for treating facial paralysis is a good therapeutic method and the therapies for facial paralysis should vary with the different conditions of the paralysis. We advocate an individuation treatment for facial paralysis.
Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. Methods Between March 2006 and August 2009, 35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. There were 25 males and 10 females with an average age of 33.5 years (range, 20-53 years); 20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury. The causes were sharp instrument injury in 24 cases, blunt injury in 9 cases, and hot crush injury in 2 cases. Six cases complicated by shaft fractures of radius and ulna. All the patients underwent an operation of nerve repair at 1 to 3 hours after injury (mean, 2 hours). The time from injury to reconstructing operation was 6-14 months (mean, 7.5 months). Two cases was able to abduct thumb sl ightly, the others had no functions of thumb abduct and thumb opposition. Results All the wounds gained the primary healing. The patients were followed up 12-18 months (mean, 14 months). The wrist joint angle and thumb dorsal extension were satisfactory. Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury; in 15 patients with median nerve injury and ulnar nerve injury, thumb abduct and thumb opposition function returned to normal in 15 and 13, respectively. According to ZHAO Shuqiang’s standard, the results of thumb opposition function were normal in all patients at 12 months after operation. Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons.
ObjectiveTo explore the effectivenesss of simple lateral extensor digitorum communis (EDC) split approach combined with loop-plate fixation in the treatment of ulnar coronoid fracture in terrible triad of elbow (TTE).MethodsThe clinical data of 60 patients with TTE who met the selection criteria between January 2015 and May 2018 were retrospectively analyzed. There were 48 males and 12 females, aged from 18 to 60 years (mean, 37.4 years). All the patients were closed fractures. Injury causes included fall injury in 28 cases, falling from height in 20 cases, and traffic accident injury in 12 cases. All patients had no vascular and nerve injury, and the time from injury to operation was 1-14 days, with an average of 4.8 days. The height and size of the fracture of the coronal process were measured by CT and accurate classifications were made. All the 60 patients were treated with simple lateral EDC split approach combined with loop-plate to fix the ulnar coronoid fracture; 20 patients of radial head fracture were fixed with hollow screw, 32 patients with mini-plate fixation, 8 patients with radial head prosthesis replacement; 16 patients with suture and 44 patients with suture anchor to reconstruct lateral collateral ligament complex; 10 patients with residual instability of elbow joint were fixed with hinge external fixator, and others were fixed with adjustable tension brace after operation. Postoperative imaging examination was performed to evaluate fracture healing and complications, such as loosening or breakage of internal fixator, osteoarthritis, and heterotopic ossification, etc. During follow-up, the range of motion (ROM) of the elbow joint was recorded, including elbow flexion, extension, and forearm pronation, supination. Mayo elbow function score system (MEPS) was used to evaluate elbow joint function at last follow-up.ResultsAll patients were followed up 16-24 months (mean, 20.2 months). All incisions healed by first intention after operation, and no complications such as vascular nerve injury, elbow joint instability, internal fixation failure, and infection occurred; the fracture healing time was 9-17 weeks (mean, 11.7 weeks). Four cases developed elbow stiffness after operation, and all underwent elbow joint lysis with internal fixator removal within 12-15 months after operation; 10 cases developed heterotopic ossification without special treatment. At last follow-up, the ROM of elbow flexion ranged from 85° to 135° (mean, 116°), the ROM of elbow extension ranged from 0° to 20° (mean, 11°), the ROM of forearm pronation ranged from 55° to 75° (mean, 70°), and the ROM of forearm supination ranged from 60° to 90° (mean, 83°). The MEPS score ranged from 55 to 100 (mean, 86.1); the effectiveness were excellent in 40 patients, good in 10 patients, fair in 6 patients, and poor in 4 patients, with an excellent and good rate of 83.3%.ConclusionThe simple lateral EDC split approach is fully exposed, and the loop-plate can fix the ulnar coronoid fractures firmly and stably, which can restore the stability of the elbow joint, and the effectiveness is satisfactory.
Objective To introduce a new operative technique of the expansive laminoplasty with reattachment of the spinous process and theextensor musculature for treatment of a tumor in the cervical vertebral channeland evaluate the clinical outcome of the technique. Methods From July 2003 to June 2006, this technique was applied to 26 patients (14 males,12 females; age, 25-57 years; illness course, 3 months-2 years) in our hospital. The four limbs had a muscle force of ⅢⅣ degrees, and with a high musculartension. The tendon reflex was sthenic and 2 patients had patellar clonus and ankle clonus. MRI was used to measure the tumor size (from 1.5 cm ×0.8 cm to 2.8 cm×2.0 cm, at the C3-6 levels) before and after operation.There were 8 cases at the C3,4levels, 9 cases at the C4,5 levels, 9 casesat the C5,6 levles. Results The result of the follow-up (average,8months; range, 6-12 months) showed that all the patients achieved a recovery at different degrees,with no death or complication. Although 10 of the patients felt a pain in the neck, but the pain was relieved after the functional exercise; the cervical active scope was changed a little with no cervical intervertrbal instability. The postoperative MRI and CT showed that the posterior column was maintained, and the “close-door” phenomenon did not happen. The degree of latitule of the cervical vertebra after operation was measured. The antecollis was 28.43°(37.9° onaverage). The hyposokinesis was 3244°(41° on average), the left antecollis was 25.45°(23° on average), and the right antecollis was 35.45°(36.2° on overage).Conclusion The expansive laminoplasty with reattachment of the spinous process and the extensor musculature can provide enough operative space and reserve the normal posterior column of the cervical vertebra. The intervertebral stability can beobtained after conglutination between the spinous process and the vertebral lamina.
Objective To investigate the pathological mechanism of epileptic comorbid sleep disorder by analyzing the changes of cerebral white matter diffusion tensor in patients with sleep disorder with negative magnetic resonance imaging (MRI) epilepsy based on the method of tract-based spatial statistics (TBSS). Methods MRI negative epilepsy patients comorbid sleep disorder who were epileptic patients treated l in China-Japan Union Hospital of Jilin University from January 2020 to December 2022 completed the Epworth sleepiness scale (ESS) and Pittsburgh sleep quality index (PSQI) tests, and those who complained of sleep disorder and PSQI index ≥11 were monitored by nighttime polysomnography (PSG) and those with objective sleep disorder confirmed by PSG were included in the epilepsy comorbid sleep disorder group. Healthy volunteers with matching gender, age, education were included in the health control group. Diffusion tensor image ( DTI) was collected for all subjects by using a 3.0T magnetic resonance scanner. Diffusion parameters were compared between the two groups using TBSS. Results This study included 36 epilepsy patients comorbid sleep disorder and 35 healthy volunteers. epilepsy patients comorbid sleep disorder showed significantly lower fraction anisotropy (FA) (P<0.05) and significantly higher mean diffusivity (MD) (P<0.05) than the health control group . Brain regions with statistical differences in FA reduction included middle peduncle of cerebellum, genu of corpus callosum, body of corpus callosum, splenium of corpus callosum, anterior corona radiata, external capsule and right posterior thalamic radiation.Brain regions with statistical differences in MD degradation included genu of corpus callosum, body of corpus callosum, anterior limb of internal capsule, anterior corona radiata, superior corona radiata, external capsule and right posterior limb of internal capsul. Conclusion Patients with epilepsy comorbidities with sleep disorders have widespread and symmetric white matter damage.The white matter damage is concentrated in the front of the brain.
Non-rigid medical image registration is a popular subject in the research areas of the medical image and has an important clinical value. In this paper we put forward an improved algorithm of Demons, together with the conservation of gray model and local structure tensor conservation model, to construct a new energy function processing multi-modal registration problem. We then applied the L-BFGS algorithm to optimize the energy function and solve complex three-dimensional data optimization problem. And finally we used the multi-scale hierarchical refinement ideas to solve large deformation registration. The experimental results showed that the proposed algorithm for large deformation and multi-modal three-dimensional medical image registration had good effects.
Objective To analyze the short-term effectiveness of repairing musculus extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) tendon using suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis. Methods Between March 2009 and May 2011, 10 patients (10 elbows) with recalcitrant lateral epicondylitis received repair of the ECRB and EDC tendon to the lateral epicondyle using a single suture anchor after debridement of extensor tendon insertion. There were 6 males and 4 females with an average age of 45.4 years (range, 36-57 years). The dominant elbow was involved in 8 patients and nondominant elbow in 2 patients; there were 4 manual workers and 6 ordinary workers. The disease duration ranged from 8 to 24 months (mean, 12.3 months). All patients had epicondylus lateralis humeri pain, local swelling and tenderness, and positive Mill sign. The average elbow range of motion (ROM) was 11.3°(range, 0-30°) in extension and was 132.5°(range, 120-145°) in flexion. Preoperative MRI showed external humeral epicondylitis in all patients. ResultsPrimary wound healing was obtained in all patients without complications of infection, leakage of joint fluid, and stiffness of elbow. Ten patients were followed up 4 to 23 months with an average of 12 months (more than 12 months in 7 cases). The time to return to work was (3.75 ± 0.95) months for manual workers and was (2.91 ± 0.20) months for ordinary workers, showing no significant difference (t=1.715, P=0.180). Compared with preoperation, the mean visual analogue scale (VAS) score significantly decreased (P lt; 0.05), and Mayo score and the grip strength of dominant and nondominant significantly increased (P lt; 0.05), but no significant difference was found when compared with non-surgical side at last follow-up (P gt; 0.05). At last follow-up, the average ROM was —1.5° (range, 0-—10°) in extension and was 150.5°(range, 140-160°) in flexion. ConclusionTo suture anchor for repairing the ECRB and EDC after debridement is a satisfactory procedure to treat recalcitrant lateral epicondylitis. It can effectively prevent loss of the forearm extensor strength, relieve the pain, recover the grip strength, and obtain good results.
This paper is aimed to analyze the topological properties of structural brain networks in depressive patients with and without anxiety and to explore the neuropath logical mechanisms of depression comorbid with anxiety. Diffusion tensor imaging and deterministic tractography were applied to map the white matter structural networks. We collected 20 depressive patients with anxiety (DPA), 18 depressive patients without anxiety (DP), and 28 normal controls (NC) as comparative groups. The global and nodal properties of the structural brain networks in the three groups were analyzed with graph theoretical methods.The result showed that ① the structural brain networks in three groups showed small-world properties and highly connected global hubs predominately from association cortices; ② DP group showed lower local efficiency and global efficiency compared to NC group, whereas DPA group showed higher local efficiency and global efficiency compared to NC group; ③ significant differences of network properties (clustering coefficient, characteristic path lengths, local efficiency, global efficiency) were found between DPA and DP groups; ④ DP group showed significant changes of nodal efficiency in the brain areas primarily in the temporal lobe and bilateral frontal gyrus, compared to DPA and NC groups. The analysis indicated that the DP and DPA groups showed nodal properties of the structural brain networks, compared to NC group. Moreover, the two diseased groups indicated an opposite trend in the network properties. The results of this study may provide a new imaging index for clinical diagnosis for depression comorbid with anxiety.