OBJECTIVE: To investigate the repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.
Objective To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method. Methods The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups: normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models (injury group); after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton-Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus. Results During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were (11.61±0.20), (5.39±0.12), (6.33±0.10), (7.12±0.08), and (8.30±0.10) MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups (P<0.05). Conclusion Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint. And the effect of volar-dorsal ligament reconstruction is the best, but the stability can not restore to normal.
Objective To study the functional change of nerve trunk after removing the partial bundles of ulnar nerve, to propose the concept of functional reserve of peripheral nerves and to investigate the functional reserve quantity of peripheral nerves. Methods Two hundred and twenty SD rats (male or female), aging 3 months and weighing 300-350 g, were randomized into the experimental group and the control group (n=110 per group). And the experimental group wassubdivided into group 1/8, group 1/4, group 1/3, group 1/2 and group 2/3 according to the resection portion (n=22 per group). In the experimental group, the section of the lowest level on ulnar nerve trunks was exposed, and a certain portion of its bundles was separated and cut, while in the control group the bundles were only separated without resection. The general condition of all rats was observed, and the motoneurons in cornu anterius medullae spinal is were detected at 1 week, 2 weeks and 2 months after operation. The neuro-electrophysiology and the function of dominated muscles were detected at 2 weeks, 2 months, 3 months, and 4 months after operation. Results All the rats survived without infection and obvious ulcer in the l imbs. The number of motoneurons in cornu anterius medullae spinal is in various experimental subgroups witnessed no obvious changes (P gt; 0.05). The superstructure changed obviously at the early postoperative stage in group 1/2 and group 2/3, but restored well at 2 months after operation. For the latent period of evoked potential, there was no significant difference between the various experimental subgroups and the control group at each time point (P gt; 0.05), but there was a significant difference among the various experimental subgroups when compared the time points of 2, 3 and 4 months to that of 2 weeks (P lt; 0.05) and no statistically significant difference at other time points (P gt; 0.05). For the wave ampl itude of evoked potential of motor nerves, the maximum wave ampl itude and the persistence time of the dominate muscle, there were significant differences between the various experimental subgroups and the control group at each time point (P lt; 0.05), and there were significant differences among the various experimental subgroups when comparing the time points of 2, 3 and 4 months to that of 2 weeks (P lt; 0.05) and no statistical significance at other time points (Pgt; 0.05). Conclusion The functional reserve of the ulnar nerve withoutcompromise accounts the 1/3 of the whole trunk diameter.
Objective To observe the recovery of the sensory and motor function of the repaired l imb and the impact on the healthy l imb function after contralateral C7 nerve root transposition for treating brachial plexus root avulsion injury. Methods Between August 2008 and November 2010, 22 patients with brachial plexus root avulsion injuries were treated with contralateral C7 nerve root transposition. All patients were male, aged 14 to 47 years (mean, 33.3 years). Total brachialplexus root avulsion was confirmed by preoperative cl inical examination and electrophysiological tests. In 22 cases, median nerve was repaired in 16 cases, radial nerve in 3 cases, and musculocutaneous nerve in 3 cases; primary operation was performed in 2 patients, and two-stage operation was performed in 20 patients. The sensory and motor functional recovery of the repaired limb was observed after operation. Results Twenty-one patients were followed up 7-25 months (mean, 18.4 months). In 16 cases of contralateral C7 nerve root transposition to the median nerve, wrist flexors reached more than M3 in 10 cases, while finger flexors reached more than M3 in 7 cases; sensation reached more than S3 in 11 cases. In 3 cases of contralateral C7 nerve root transposition to the musculocutaneous nerve, elbow flexors reached more than M3 in 2 cases; sensation reached more than S3 in 2 cases. In 3 cases of contralateral C7 nerve root transposition to the radial nerve, wrist extensor reached more than M3 in 1 case; sensation reached more than S3 in 1 case. Conclusion Contralateral C7 nerve root transposition is a good procedure for the treatment of brachial plexus root avulsion injury. Staged operation is one of important factors influencing treatment outcome.
ObjectiveTo evaluate the methods and effectiveness of contralateral C7 nerve root and multiple nerves transfer for the treatment of brachial plexus root avulsion. MethodsBetween June 2006 and June 2010, 23 patients with brachial plexus root avulsion were treated. There were 20 males and 3 females, aged 17 to 42 years (mean, 27.4 years). The time from injury to operation was 4 to 12 months (mean, 5.9 months). In 16 patients having no associated injury, the first stage procedure of contralateral C7 nerve root transfer and accessory nerve transfer to suprascapular nerve or phrenic nerve transfer to anterior upper trunk was performed, and the second stage procedure of the contralateral C7 nerve root transfer to median nerve and intercostal nerve transfer to axillary nerve was performed. In 4 patients having phrenic nerve and accessory nerve injuries, the first stage procedure of the contralateral C7 nerve root transfer and second stage procedure of the contralateral C7 nerve root transfer to median nerve and musculocutaneous nerve were performed. In 3 patients having hemothorax, pneumothorax, and rib fractures, the first stage procedure of the contralateral C7 nerve root transfer and accessory nerve transfer to suprascapular nerve, and the second stage procedure of the contralateral C7 nerve root transfer to median nerve and musculocutaneous nerve were performed. The British Medical Research Council (MRC) sensory grading (S0-S4) and modified muscle strength grading standard (M0-M5) were used for comprehensive assessment of limb and shoulder abduction, elbow/biceps muscle strength, flexor wrist and finger muscle strength and median nerve sensory recovery. ResultsTwenty-three patients were followed up 3-4.5 years (mean, 3.4 years). At 3 years after operation, the shoulder abduction reached 0-82°(mean, 44°). In 16 patients having no associated injuries, the shoulder abduction was more than 30°in 13 cases, and was more than 60°in 3 cases; in 3 patients having hemothorax, pneumothorax, and rib fractures, the shoulder abduction was more than 30°; and in 4 patients having phrenic nerve and accessory nerve injuries, the shoulder abduction was 0°. The muscle strength of elbow/biceps was M3 or more than M3 in 9 cases, was M1-M2 in 8 cases, and was M0 in 6 cases; the muscle strength of flexor wrist or finger was M3 or more than M3 in 7 cases, was M1-M2 in 11 cases, and was M0 in 5 cases. Median nerve sensory recovery was S3 or more than S3 in 11 cases, was S1-S2 in 7 cases, and was S0 in 5 cases. After 3 years, affected limb had locomotor activity in 11 patients, affected limb had activities driven by the contralateral latissimus dorsi muscle contraction in 12 patients. ConclusionContralateral C7 nerve root and multiple nerves transfer is a good method to treat brachial plexus root avulsion.
Objective To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Methods Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. Results All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant (P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. Conclusion For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.
ObjectiveTo evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA).Method We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14–62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report.ResultsThe average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the long-term right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032).ConclusionTVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.
Objective To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and RVOTO during follow up is very low.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
Abstract: The complete transposition of the great arteries (TGA) is one of the commonest congenital cardiac anomalies in cyanosis. In untreated patients, death occurs early in infancy. Nowadays arterial switch operation (ASO) has been widely proposed to treat TGA without pulmonary valve stenosis. Meanwhile, surgical risks and mortality will be increased if TGA is accompanied by coronary arterial anomalies. So proper surgical management of abnormal coronary artery has a significant influence on the outcome of ASO. The classification, operation methods and surgical results were reviewed in this article.