术中电生理检测在肘管综合征的应用

目的 :探讨术中电生理监测在肘管综合征手术中的临床应用价值。方法 :对25例肘管综合征手术患者进行尺神经松解前后的电生理术中监测。结果 :术中尺神经肘管松解前后 ,传导速度提高50% ,潜伏期缩短30%,其中传导速度的改善有显著意义(P<0.05)。结论 :传导速度是较敏感的术中监测参数。肘管综合征术中应用电生理检测有一定临床意义。     

Ultrasound‐Assisted Precise In Situ Decompression for Cubital Tunnel Syndrome

ObjectiveTo explore the effect of locating the ulnar nerve compression sites and guiding the small incision so as to decompress the ulnar nerve in situ on the elbow by high‐frequency ultrasound before operation.MethodsA retrospective analysis was conducted on 56 patients who underwent ultrasound‐assisted in situ decompression for cubital tunnel syndrome from May 2018 to August 2019. The patients'' average age was 51.13 ± 7.35 years, mean duration of symptoms was 6.51 ± 1.96 months, and mean postoperative follow‐up was 6.07 ± 0.82 months. Nine patients had Dellon''s stage mild, 39 had stage moderate, and eight had stage severe. Ultrasound and electromyography were completed in all patients before operation. The presence of ulnar nerve compressive lesion, the specific location, and the reason and extent of compression were determined by ultrasound. A small incision in situ surgery was given to decompress the ulnar nerve according to the pre‐defined compressive sites.ResultsAll patients underwent in situ decompression. The compression sites around the elbow were as follows: two in the arcade of Struthers, one in the medial intermuscular septum, four in the anconeus epitrochlearis muscle, five beside the cyst of the proximal flexor carpi ulnaris (FCU), and the remaining 44 cases were all from the compression between Osborne''s ligament to the two heads of the FCU. The compression localizations diagnosed by ultrasound were confirmed by operations. Preoperative ultrasound confirmed no ulnar nerve subluxation in all cases. The postoperative outcomes were satisfactory. There was no recurrence or aggravation of symptoms in this group of patients according to the modified Bishop scoring system; results showed that 43 cases were excellent, 10 were good, and three were fair.ConclusionsHigh‐frequency ultrasound can accurately and comprehensively evaluate the ulnar nerve compression and the surrounding tissues, thus providing significant guidance for the precise minimally invasive treatment of ulnar nerve compression.     

A SIX-CENTRE INTERNATIONAL STUDY OF THE OUTCOME OF TREATMENT IN PATIENTS WITH CLEFTS OF THE LIP AND PALATE: THE RESULTS OF A CROSS-LINGUISTIC INVESTIGATION OF CLEFT PALATE SPEECH

During the period 1964–73, 286 patients were treated for mandibular fractures. 229 patients (80%) attended the follow-up examination. The length of observation was from 1 to 9 years. The treatment and the follow-up evaluations in the 229 patients are described. Early fracture treatment has been the objective, also in patients who have undergone severe cerebral traumas. Antibiotic prophylaxis was implemented in cases of compound fractures. Preservation of teeth and tooth buds in the line of fracture was attempted. Clinical infection occurred in 0.4% of the patients. At the follow-up examination 1 patient presented with a fracture displacement outside the condylar process. Neither malocclusion nor pseudarthrosis following fracture or after treatment were seen. Permanent sensory disturbances in the innervation area of the mental nerve following fracture occurred in 8%. Radiological examination of the teeth in the line of fracture revealed unnoticed apical bone lesions in 17% of 118 patients. In a further 23% there was a negative response to the vitality test. Follow-up control of mandibular fractures is advised at 12 to 18 months after treatment.     

中重度肘管综合征患者应用传统皮下前置术及带血运前置术的对比分析

目的比较两种治疗中重度肘管综合征手术方法的疗效。方法回顾性分析80例中重度肘管综合征患者的临床资料,其中40例接受传统皮下前置术（对照组）,40例接受带血运前置术（观察组）。根据手外科尺神经功能评定标准评价两组患者的尺神经功能,并比较两组的评分,中、重度患者的优良率及总优良率。结果对照组与观察组入院时尺神经功能评分分别为（3．6±0．4）,（3．7±0．5）分;术后分别为（7．5±0．9）,（7．4±0．6）分,均较入院时提高（P〈0．05）,但术后两组间差异无统计学意义（P〉0．05）。观察组总优良率为87．5％（35／40）,略高于对照组85．0％（34／40）,但差异无统计学意义（P〉0．05）,两组间中度患者的术后优良率分别为90．0％（27／30）、96．4％（27／28）（P〉0．05）,但重度患者的优良率分别为8／10和7／12,差异有统计学意义（P〈0．05）。结论带血运前置术治疗重度肘管综合征疗效优于传统皮下前置术。     

Outcomes following the conservative management of patients with non-radicular peripheral neuropathic pain

Study designProspective cohort.IntroductionThere is limited evidence for conservative management of patients with non-radicular peripheral neuropathic pain (PNP).PurposeTo investigate the effectiveness of a comprehensive treatment approach on pain and disability in patients with non–radicular PNP and to determine if improvements are maintained following the discontinuation of therapy.MethodsPatients received a multi-modal therapeutic intervention. Outcome measures were the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QDASH), Numeric Pain Rating Scale (NPRS), and grip strength. Follow-up data were collected 5 ± 2 months post-discharge.ResultsThere was a significant improvement in the QDASH and mean pain (p < .001). There was no significant change in grip strength (p > .13). Follow-up data suggest that pain and disability scores are maintained (p < .001).ConclusionA comprehensive, conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular PNP.Level of evidenceIIIa     

肘窝穿支蒂V-Y推进皮瓣的解剖学基础

目的　探讨肘窝穿支的形态学特征,为肘窝穿支蒂V-Y推进皮瓣修复肘前皮肤软组织缺损提供解剖学基础。 方法　选用30侧体积分数10%甲醛常规防腐固定的成人上肢标本,通过乳胶灌注、巨微解剖、摹拟手术等方法,手术放大镜下重点观测：①肘窝的形态;②肘窝动脉穿支的起源、分支与分布特点;③肘窝动脉穿支与邻近血管网的吻合。 结果　①肘窝为肘部前面的三角形凹陷,系前臂血管神经通行的门户。②肘窝前面皮肤血供多源性由肱动脉及其分支发出的穿支供养,穿支变异较大,据其数目和大小分为3型：A. 粗大集中型（肘下动脉）：穿支1支者,外径0.6~1.2 mm,占43.33%（13侧）;B. 细小分散型：穿支3~4支者,外径0.3~0.6 mm,占36.67%（11侧）;C. 适中均衡型：穿支2支者,外径0.4~0.7 mm,占20.00%（6侧）;③穿支沿前臂外侧皮神经/头静脉两侧浅出深筋膜至肘前皮肤,分支在浅筋膜内彼此相互间、邻近血管间均吻合沟通形成肘窝筋膜血管网。 结论　以肘窝动脉穿支为蒂,可形成V-Y推进皮瓣修复肘关节邻近软组织缺损。     

High-resolution ultrasound in etiological evaluation of ulnar neuropathy at the elbow

ObjectiveUlnar neuropathy at the elbow (UNE) involves mechanical compression and irritation of the ulnar nerve (UN) caused by environmental and dynamic abnormalities that can however also be found in asymptomatic patients. Using high-resolution ultrasound, we aimed to assess and compare the relevance of morphological and dynamic variants of the UN and its surrounding structures (UN abnormalities) in symptomatic and asymptomatic patients.MethodUN abnormalities in patients with UNE were assessed using high-resolution ultrasound and compared against unaffected arms (patients or healthy volunteers).ResultsWe studied 234 arms of 117 individuals (89 with UNE and 145 control). Eighty-one percent of the arms with UNE compared to 40% of control (p = 0.00001) showed UN abnormalities. While it was dislocated in 49% of arms with UNE compared to in 23% of control (p = 0.004).ConclusionThe two-fold higher frequency of occurrence of UN abnormalities in arms with UNE indicates their causative or at least contributory role in such neuropathies. High-resolution ultrasound should be part of the initial evaluation of UNE in order to assess the etiology of the conflict.