旋前方肌对前臂旋前功能的影响

目的 研究旋前方肌对前臂旋转功能的影响.方法 选取2017年至2020年我们手术治疗的重度肘管综合征患者,随机分为两组,A组常规做肘部尺神经松解前置术;B组做肘部尺神经松解前置术的同时加做腕部旋前方肌支配神经切断转位尺神经手术.随访比较两组患者术前术后前臂旋前、旋后角度,中立位时旋前、旋后最大静止肌力及上肢功能(dis...     

带旋前方肌蒂肌骨瓣的临床应用

尸体解剖２０只上肢，发现旋前方肌平均长４．４２ｃｍ，宽４．１７ｃｍ，附着于挠骨与尺骨远端，主要为骨间掌侧动脉供应，有３～５个穿支经骨间膜穿向背侧，肌肉远端血管呈丛状，极为丰富。从１９８７年４月到１９９２年１２月我院应用带旋前方肌蒂的肌骨瓣转移治疗月骨无菌坏死６例，舟骨骨不连５例，舟骨无菌坏死１例，桡骨下端骨不连１例，术后３个月骨性愈合。本文详细介绍了手术方法及临床应用适应证。     

旋前方肌支转位修复前臂正中神经和尺神经损伤

正中神经和尺神经在前臂远端及腕部较为表浅，易受损伤，其损伤率占该神经损伤之７０％～８０％。由于传统修复手术常常遗留手内肌萎缩及运动障碍，Ｓｃｈｕｌｔｚ于１９７２年首先采用尺神经第三蚓状肌支转位修复鱼际肌支〔１〕。该方法虽然有效，但牺牲部分蚓状肌功能较...     

经旋前方肌下肌骨通道保留旋前方肌内固定治疗桡骨远端骨折

目的 探讨经旋前方肌下肌骨通道保留旋前方肌内固定治疗桡骨远端骨折的疗效。方法 将100例桡骨远端骨折患者根据是否保留旋前方肌分为对照组(采用倒L形切口切开旋前方肌内固定治疗,54例)和观察组(采用经旋前方肌下肌骨通道保留旋前方肌内固定治疗,46例)。记录骨折复位及愈合情况、疼痛VAS评分、腕关节影像学指标、前臂及腕关节活动度、Gartland-Werley评分。结果 患者均获得随访,时间12～20个月。术后X线片显示：骨折均对位对线良好,关节面恢复平整,达到解剖复位。两组骨折均愈合良好,时间2.7～5.5个月。术后6周疼痛VAS评分、前臂旋前及旋后活动度、Gartland-Werley评分观察组均优于对照组(P<0.05);末次随访时前臂旋前活动度观察组大于对照组(P<0.05),前臂旋后活动度、Gartland-Werley评分两组比较差异均无统计学意义(P>0.05)。末次随访时腕关节掌屈、背伸活动度及掌倾角、尺偏角两组比较差异均无统计学意义(P>0.05)。结论 经旋前方肌下肌骨通道保留旋前方肌内固定治疗桡骨远端骨折,可缩短患者康复时间,最大程度保留前臂旋...     

旋前方肌缝合与否对桡骨远端骨折固定的影响

目的比较旋前方肌的缝合与否对桡骨远端骨折内固定疗效的中期影响。方法两组独立手术医师组,A组对桡骨远端骨折采用切开复位钢板内固定后,不予以缝合旋前方肌;B组对桡骨远端骨折钢板内固定后,仔细修补缝合旋前方肌;共随机回顾性选取30例患者,15例为一组,均为AOB型骨折。分别在术后4周、6个月比较健侧与患侧的腕关节旋前、旋后功能以及上肢功能评分（disabilityofarm—shoulder—hand,DASH）。结果术后4周,患侧的旋前旋后功能较健侧有极显著性差异（P〈0．01）;AB两组患侧组内旋前有显著性差异（P〈0．05）,旋后无显著性差异（P〉0．05）;术后6个月,患侧的旋前旋后功能较健侧无显著性差异（P〉0．05）;AB两组患侧组内旋前以及旋后均无显著性差异（P〉0．05）;术后4周,AB两组组间DASH评分具有显著性差异（P〈0．05）;术后6个月,AB两组组间DASH评分无明显差异（P〉0．05）。结论旋前方肌对桡骨远端骨折切开复位内固定的中期疗效无明显影响,手术内固定对桡骨远端B型骨折可取得良好的中期疗效。     

保留旋前方肌手术治疗桡骨远端骨折的体会

目的探讨桡骨远端骨折保留旋前方肌内固定术的方法和疗效。方法分析82例桡骨远端骨折采取掌侧入路保留旋前方肌行复位内固定的情况。结果本组获随访4~12个月,腕关节功能评分结果:优56例,良17例,可7例,差2例,优良率89.02%。术后出现创伤性关节炎,严重的腕痛症及内固定失效11例。结论采用切开复位内固定治疗桡骨远端骨折,可恢复腕关节的解剖关系,保留旋前方肌符合微创的治疗理念。     

旋前方肌紧缩术治疗陈旧性下尺桡关节背侧脱位

陈旧性下尺桡关节由于关节盘和下尺桡背侧韧带损伤,造成尺骨小头向尺侧、背侧移位。旋前方肌紧缩术把该肌起点从尺骨前缘移到背侧,这样无论旋前方肌收缩或者松弛,张力均增大。将尺骨小头向桡侧、掌侧牵拉,恢复了下尺桡关节正常的解剖位置和应力分布,近4年来,治疗患者11例,经过4个月～4年半随访,疗效优9例、良2例。     

旋前方肌血管瘤1例

血管瘤属良性肿瘤,从性质上往往难以区分是真正的肿瘤还是血管变形[1]。一般可分为全身和局部二类。全身可侵犯皮肤、皮下、神经、肌肉,亦可侵犯骨和腱鞘。局部较全身常见。但源于旋前方肌血管瘤罕见。病例报告:患者,男性,12岁。4岁时发现左腕掌侧有一米粒大小肿块,无痛。8岁时肿块为黄豆大小。近2年来肿块生长速度,并出现手指麻木和活动受限等症状。检查:神清,全身表浅淋巴结未触及肿大。心肺(-),血常规、肝、肾功能等实验室检查均无异常发现。左腕掌侧触及12ｃｍ×7ｃｍ大小的肿块,质软、无活动、无压通,与周围组织界线不清。左大鱼际见萎…     

肺海绵状血管瘤1例

病人　女 ,72岁。咳嗽、咳痰反复发作 2 0个月。初为干咳 ,后咳少许白粘痰。偶有发热 ,伴夜间盗汗 ,无胸痛、胸闷。查体无明显异常。Ｘ线胸片示右上肺尖前段肺不张 ,密度不匀 ,右上肺纹理稍聚拢 ,水平裂上移明显。ＣＴ片示右上肺及前段致密影 ,肺门淋巴结不大。支气管镜检查发现右上肺尖、前段开口狭窄 ,后段开口下可见一新生物。组织学检查见支气管粘膜呈慢性炎症改变 ,刷片未找到抗酸杆菌。多次痰检未发现结核杆菌。术前诊断为右上肺良性肿瘤。2 0 0 2年 2月在全麻下剖胸手术。术中见该肿块位于右肺上叶尖前段 3ｃｍ× 2ｃｍ× 2ｃｍ大小 …     

保留旋前方肌钢板固定长段粉碎性盖氏骨折

[目的]介绍保留旋前方肌钢板内固定治疗长段粉碎性Ⅱ型盖氏骨折的的手术技术和初步临床结果。[方法] 2018年12月—2022年2月采用保留旋前方肌钢板固定治疗长段粉碎性Ⅱ型盖氏骨折患者14例,采用桡侧腕屈肌与桡动脉间微创切口入路,自腕横纹水平向近端纵向切开约3.0cm,先在远端桡侧切口腕屈肌桡侧分离,将桡侧腕屈肌牵向尺侧,桡动脉牵向桡侧,显露旋前方肌,用骨膜剥离器在旋前方肌下方贴骨膜剥离,建立“肌-骨隧道”后经皮插入合适规格的锁定钢板,复位骨折,三点定位钢板位置,分别拧入螺钉,固定骨折。[结果]所有患者均顺利完成手术,手术时间平均（75.1±15.0）min,术中出血量平均（38.2±30.3）ml,。患者均获随访,随访时间平均（24.6±10.9）个月。术后6个月Mayo评分：疼痛评分（23.6±2.3）分,满意度评分（23.9±2.1）分,活动范围评分（17.1±4.1）分,握力评分（23.6±3.5）分,所有患者均骨性愈合。[结论]保留旋前方肌钢板内固定治疗长段粉碎性Ⅱ型盖氏骨折具有创伤小、内固定确切、患肢功能恢复迅速等优点。     

旋前方肌骨膜瓣移位治疗陈旧性下尺桡关节脱位

目的：探讨旋前方肌骨膜瓣移位治疗陈旧性下尺桡关节脱位的疗效。方法：从1992年以来，收治23例陈旧性下尺桡关节脱位患者，应用旋前方肌骨膜瓣移位手术治疗，将旋前方肌尺骨附着点部骨膜切开，骨膜下剥离形成旋前方肌骨膜瓣，将其向尺骨背侧移位与骨膜重叠缝合，石膏外固定4～6周。结果：经6个月～12年随访，下尺桡关节功能恢复满意，X线片显示下尺桡关节对位关系正常。结论：该术式和其他术式相比有其明显优点，不破坏关节邻近或它处结构，创伤小，操作简单，能长期维持复位状态。     

Influence of the pronator quadratus and supinator muscle load on DRUJ stability

PURPOSE: To determine the effects of altering the load contributions of the pronator quadratus and supinator muscles on in vitro distal radioulnar joint (DRUJ) stability during pronation and supination and before and after ulnar head excision. METHODS: Multiple pronation trials were conducted with incremental loading of the pronator quadratus relative to the pronator teres muscle; supination trials were similarly conducted with incremental loading of the supinator relative to the biceps muscle. All trials were conducted using an upper-limb apparatus capable of simulating muscle/tendon loading and displacement. Stability measurements included dorsal-volar translations of the radius relative to the ulna and DRUJ diastasis and convergence. RESULTS: Increased pronator quadratus loading did not affect intact DRUJ stability but effects were noted after ulnar head excision when the forearm was positioned between neutral and full pronation. Incremental loading of the supinator muscle did not modify DRUJ stability in the intact or ulnar head excised state. CONCLUSIONS: Pronator quadratus muscle activity aggravates forearm instability after ulnar head excision. Immobilization of the forearm in mid- to full supination should minimize pronator quadratus activity and optimize soft-tissue healing. This information may be useful to develop in vitro muscle-loading scenarios and analytical forearm models.     

Isolated compartment syndrome of the pronator quadratus compartment: a case report

We present a case of compartment syndrome that involves the pronator quadratus space but does not affect any of the other forearm compartments. Symptoms consisted of pain out of proportion to examination findings, splinting of the forearm in a 30 degrees pronated position, and severe pain with passive supination. Diagnosis was confirmed with pressure measurements of all forearm compartments at the time of surgery. Symptoms resolved promptly with isolated release of the pronator quadratus compartment with concomitant reduction in compartment pressure in that one compartment.     

带旋前方肌桡骨膜瓣移植治疗腕舟骨骨不连

目的 报告采用带旋前方肌挠骨膜瓣移植治疗腕舟骨骨不连的方法和疗效.方法于腕挠掌侧切取带旋前方肌的近端挠骨膜 5cm x 2cm,将桡骨膜翻转包裹适宜的挽骨块植入舟骨骨槽内.术后管型石膏固定3个月.结果1991～1998年共治疗20例,术后随访8个月～6年,平均1.8年,骨性愈合达到100%.愈合时间2～4个月,腕关节功能完全恢复正常.结论 该手术方法疗效甚好,操作方便,特别适合于基层医院推广.     

Calcific tendinopathy of the pronator quadratus muscle: A rare site and cause of ulnar sided wrist pain

Ulnar -sided wrist pain is a common complaint and can present a diagnostic challenge for a musculoskeletal clinician. Calcific tendinopathy is a well-recognised disorder related to the deposition of calcium hydroxyapatite crystals within tendons. Classically, tendons around the shoulder and the hip joints are the most commonly affected sites. We report a rare site of calcific tendinopathy of the Pronator Quadratus muscle presenting with ulnar-sided wrist pain in a 36-year-old male posing a diagnostic dilemma. This case-report highlights the importance of a thorough clinical evaluation and crucial role of cross-sectional imaging in reaching a diagnosis of calcific tendinopathy of the Pronator Quadratus muscle as unusual cause of ulnar-sided wrist pain. This is the first reported case of calcific tendinopathy in pronator quadratus in the literature we could review.     

An anatomical study of the anterior interosseous nerve and its innervation of the pronator quadratus muscle

This anatomical study of 40 upper limbs from cadavers investigated the branching pattern of the anterior interosseous nerve in its distal part using the operating microscope. An articular branch to the wrist joint and/or the distal radioulnar joint was only found in seven of the 40 specimens and was always a small terminal continuation of the anterior interosseous nerve after the nerve had passed through the pronator quadratus and innervated it. Therefore, we do not recommend division of the anterior interosseous nerve from the dorsal approach through the interosseous membrane before it gives off its muscular branches to the pronator quadratus. This risks damage of the innervation of this muscle of importance for initiation of hand pronation.     

Management of neuromas in continuity of the median nerve with the pronator quadratus muscle flap.

Treatment of painful neuromas in continuity of the median nerve at the wrist level is a challenging problem. Nine median nerve neuromas were covered with the pronator quadratus muscle preelevated as an island flap. Patients were followed for 10 to 60 months after surgery. Results showed a marked improvement in terms of symptoms in all patients. In particular, 6 patients had complete pain relief and 3 patients complained of mild intermittent pain.     

带旋前方肌桡骨膜瓣移植治疗腕舟骨骨不连

目的总结采用带旋前方肌桡骨膜瓣移植治疗腕舟骨骨不连的方法和疗效.方法于腕桡掌侧切取带旋前方肌的近端桡骨膜5cm×2cm,将桡骨膜翻转包裹适宜的桡骨块植入舟骨骨槽内.术后管型石膏固定3个月.结果治疗腕舟骨骨不连20例,术后随访8个月～6年,平均1.8年,根据刘树清等的功能评定标准,结果优18例,良2例.愈合时间2～4个月,腕关节功能完全恢复正常.结论旋前方肌桡骨膜瓣有为受骨提供丰富血运和成骨的双重功能,有效地促进了骨折愈合,且该手术操作简便,特别适合于基层医院推广.     

Anatomy and intracompartmental pressure measurement technique of the pronator quadratus compartment

The compartment of the pronator quadratus muscle in 25 cadaver specimens is described. Defined by the radius, ulna, and distal interosseous membrane dorsally and the pronator quadratus fascia on the palmar side, the osteofibrous walls of the compartment confine the pronator quadratus muscle within a noncompliant space. A safe and reliable location for compartment pressure measurement was defined at a site 4 cm proximal to the scaphoid tubercule, on the radial side of the flexor carpi radialis tendon and on the ulnar side of the radial artery. These clear anatomic definitions might be useful in diagnosis of compartment syndrome of the pronator quadratus; a clinical investigation may be justified on the basis of pressure measurements made using this technique.