肌电图辅助定位小切口尺神经松解术治疗肘管综合征

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

肌电图辅助定位小切口尺神经松解术治疗肘管综合征

目的 评价肌电图辅助定位小切口尺神经松解术治疗肘管综合征的疗效及手术适应证.方法 选取无明显手内在肌萎缩及肘关节畸形,具有典型临床症状和体征的肘管综合征患者12例,术前通过神经短节段传导(short-segment nerve conduction test,SSCT)检测的方法,以相邻两次动作电位波幅下降＞50%或潜伏期差＞0.5ms为定位标准,对上述患者进行卡压点定位,采用小切口局部尺神经松解术式,并观察卡压点术中与术前定位比较.结果 术中观测结果证明尺神经损害部位位于肱骨内上髁上方3 cm到肱骨内上髁下方1cm之间,与术前SSCT法检测卡压部位相符.12例术后均主诉手部有明显轻松感;术后3个月感觉异常全部恢复,刺痛觉及爪形指恢复,捏力和抓握力恢复;术后6个月时小指展肌肌力已完全恢复至正常,两点分辨觉平均为5.0 mm,神经传导速度(NCV)均＞45.0 m/s,波幅开始增加,SSCT无阳性发现;术后1年肌肉萎缩基本恢复,屈肘试验、肘部Tinel征、夹纸试验阴性,7例肌电图无阳性发现,1例NCV仍低于正常标准,但无临床症状及体征.术中观察神经卡压位置与术前肌电图定位相符.结论 肌电图辅助定位小切口尺神经松解术治疗肘管综合征是一种有效的方法.

Abstract：

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

止血带对全膝关节置换术中股骨远端旋转定位时髌骨轨迹的影响

Objective To explore, the influence of tourniquet application on patellar tracking with using the surgical transepieondylar axis as distal femur alignment in total knee arthroplasty (TKA). Methods From December 2002 to August 2008, 349 cases (526 knees) of primary TKA were performed. There were 124 males and 225 females with an average age of 68 years from 33 to 84 years. A total of 387 knees had varus deformity and 94 had valgus deformity. All of prosthesis were rotating platform with posterior cruciate ligament retaining provided by Gemini MK Ⅱ. All patients underwent anterior medial parapatellar approach. The surgical transepieondylar axis had been principally used as the distal femur alignment. Patellar tracking was checked with no thumb test. For maltracking ones, we prefered to use a single retinacular closing stitch at the superior medial arthrotomy and deflate tourniquets. Patellar tracking was checked again. Finally, later-al retinaeular releases (LRR) had been performed to obtain optimizing patellar tracking. Results Intraoper-atively, no thumb test were positive in 138 knees, including patellar subluxation (vaigus deformity) in 12 knees and patellar inclining (74 of valgns deformity and 52 of varus deformity) in 126 knees. After using a single retinacular closing stitch at the superior medial arthrotomy and deflating tourniquets, no thumb test were positive in 40 knees, including patellar subluxation (valgus deformity) in 8 knees and patellar inclining (29 of valgns deformity) in 32 knees. The total rate of LRR was 7.6% (40/526), the rate of LRR in valgus deformity was 39.4% (37/94) and that in yarns deformity and no deformity was 0.7% (3/432). Conclusion There was significant influence of tourniquet application on patellar tracking during the TKA. We were not falsely correcting patellar tracking problems with using a single retinaeular closing stitch at the superior me-dial arthrotomy anti deflating tourniquets intraoperatively and reducing the rate of LRR.     

Nerve transfer for treatment of brachial plexus injury：comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves

Objective:To compare the effect of using partial median and ulnar nerves for treatment of C5-6 orC5-7 avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.Methods:The patients were divided into 2groups randomly according to different surgical procedures.Twelve cases were involved in the first group.The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft,and the spinal accessary nerve was to the suprascapular nerve.Eleven cases were classified into the second group.A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve.The cases were followed up from 1to 3years and the clinical outcome was compared between the two groups.     

游离足底内侧皮瓣修复腕掌尺侧皮肤神经缺损

目的 探讨修复腕掌尺侧皮肤神经同时缺损的新方法.方法 2000年4月至2009年8月,应用游离足底内侧皮瓣修复腕掌尺侧皮肤并神经缺损5例.足拇趾胫侧趾底固有神经修复小指尺掌侧固有神经缺损1例;桡神经浅支修复尺神经及其深浅支缺损2例,修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例;尺神经手背支修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例.足底内侧血管与尺血管吻合.供区取同侧大腿皮片移植修复.结果 术后皮瓣及移植皮片全部成活.5例获得6个月至4年的随访,皮瓣质地好、外观满意,无手内肌萎缩和爪形手畸形,皮瓣和手指感觉恢复达S3～S3+,皮瓣两点辨距觉为7～10 mm.尺神经深浅支缺损病例术后综合评价均为优.结论 游离足底内侧皮瓣是修复腕掌尺侧皮肤神经缺损的有效方法.

Abstract：

Objective To explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side. Methods From April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps.Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomozised with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg. Results All the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.Conclusions Free medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.     

尺神经神经束膜瘤二例

Objective To summariariae the diagnosis and treatmentof 2 cases of intraneuml perineurioma involving the ulnar nerve and review the relevant fiterature. Methods Case one was a female patient who had a mass of her right.upper arm for 3 years.Preoperatively the sensadon was normal.however the hand movement was impaired.Intraoperatively a 4 cm×2 cm fusiform enlargement of the ulnar nerve above elbow was seen.The mass was reseeted and sural nerve graft was done one week later to repair the nerve.Case two was B male patient who had a mass around his right ellbow for 3 months.Preoperatively there was diminished sensatiln of the right little finger and decreased strength of the hand intrinsic muscles.Intraoperadvely a 9 cm×4 cm fusiform enlargement of the ulnar nerve at the elbow was seen.A neve biopsy was carried out for pathology.Results Pathology for both cases was intraneural perineurioma of the ulnar nerve.Case one was followed for 3 months with no sign of tumor recurrence Hand functions innervated by the ulnar nerve were unchanged .Case two was followed for 9 months and the mass didn't become bigger.Hard function was the same comparing to the preoperative level.Conclusion Intraneural perineurioma is a rare benign tumor.Surgical resection and nerve repair is the treatment option for those with pathologically confirmed cases.Nerve biopsy and regular follow up is 5nother option.     

Endoscopic decompression combined with interspinous process implant fusion for lumbar spinal stenosis

Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome.
Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group.
Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.     

The anterior cubital approach for irreducible Gartland type Ⅲ supracondylar fractures of the humerus in children

Objective To assess the anterior cubital fossa approach in the treatment of irreducible Gartland type Ⅲ supracondylar fractures of the humerus in children. Methods Forty-four children (26 boys) with Gartland Ⅲ supracondylar fractures of the humerus were divided into 2 groups. Group A(19 cases) was treated with a minimal incision in the anterior cubital fossa, and Group B (25 cases) through anterolateral cubital fossa or combined median-lateral approach. The fractures were stabilized with 1.5 mm Kirschner wires and plaster slab after anatomical reduction, followed by functional exercise for 3 to 6 weeks. The clinical outcomes of the 2 groups were evaluated by the Flynn score system for the elbow joint. Results All patients were followed up for 1 to 4 years, with an average of 1.8 years. Group A needed significantly shorter operation time (37 vs. 59 minutes). The good to excellent rates were 89% for Group A and 83% for Group B. There was no significant difference in functional recovery between the 2 groups (P > 0.05). Conclusion Open reduction through the anterior cubital approach is a quick and safe alternative for pediatric Gartland Ⅲ supracondylar fractures of the humerus, because it allows good visualization of the median and ulnar nerves, the brachial artery and the fracture.     

Autogenous standard versus inside-out vein graft to repair facial nerve in rabbits

Objective： To evaluate autogenous vein grafts and inside-out vein grafts as conduits for the defects repair in the rabbit facial nerves. Methods： The 10 nun segments of buccal division of facial nerve were transected for 48 rabbits in this study. Then the gaps were immediately repaired by autogenous vein grafts or inside-out vein grafts in different groups. All the animals underwent the whisker movement test and electrophysiologic test during the following 16 weeks at different time points postoperatively. Subsequently, the histological examination was performed to observe the facial nerve regeneration morphologically. Results： At 8 weeks after operation, the facial nerve regeneration has significant difference between the experimental group and the control group in electrophysiologic test and histological observation. However, at the end of this study, 16 weeks after operation, there was no signifi- cant difference between inside-out vein grafts and standard vein grafts in enhancing peripheral nerve regeneration. Conclusion： This study suggest that both kinds of vein grafts play positive roles in facial nerve regeneration after being repaired immediately, but the autogenous inside-out vein grafts might accelerate and facilitate axonal regeneration as compared with control.     

Surgical treatment of acute convergent dislocation of elbow北大核心CSCD

Objective To evaluate the surgical treatment of acute convergent dislocation of elbow after failed closed reduction. Methods A retrospective study was conducted of the 8 patients with acute convergent dislocation of elbow who had been admitted from January 2017 to December 2020 for surgical treatment after failed closed reduction and completely followed up at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. There were 3 males and 5 females, with an average age of 30.9 years (from 15 to 51 years). Five left and 3 right elbows were injured. Combined injuries included radial head fracture in 6 cases, distal radius fracture in 2 cases, coronoid fracture in one, medial epicondyle fracture of the humerus in one, scaphoid fracture in one, and distal radioulnar dislocation in one. All patients underwent surgery after failure of closed reduction. Intraoperative exploration found in every case a longitudinal tear on the brachialis tendon. The radial head protruded from the front into the tear and twisted the tendon so that the reduction of the radial head was frustrated. At the last follow-up, the elbow flexion and extension and forearm rotation were recorded, and the Mayo elbow performance score (MEPS) was used for function assessment. Results All the 8 patients were followed up for a mean of 6.1 months (from 2 to 12 months). At the last follow-up, the elbow flexion and extension averaged 101.9° (from 65° to 150°), the forearm rotation 132.5° (from 75° to 170°), and the MEPS 96.3 (from 90 to 100). None of the patients had significant pain or joint instability. Various degrees of joint mobility limitation existed in 7 patients, one of whom underwent elbow arthrolysis and another of whom underwent ulnar neurolysis and anterior transposition due to ulnar nerve injury. Conclusions For treatment of acute convergent dislocation of elbow, if closed reduction fails, surgical treatment should be performed on time, because the surgical efficacy is more reliable. As the severity and combined injuries of the convergent dislocation vary from person to person, the therapy algorithm should be individualized. © 2023 Chinese Journal of Orthopaedic Trauma. All rights reserved.