Palmar dislocation of the proximal interphalangeal joint--an injury not to be missed

Palmar dislocations of the proximal interphalangeal (PIP) joint are associated with long term complications if suboptimally treated. Six cases of palmar dislocation of the PIP joint are presented and a systematic approach in the diagnosis and management of such injuries in the accident and emergency department is described.     

Palmar dislocation of the proximal interphalangeal joint--an injury not to be missed.

Palmar dislocations of the proximal interphalangeal (PIP) joint are associated with long term complications if suboptimally treated. Six cases of palmar dislocation of the PIP joint are presented and a systematic approach in the diagnosis and management of such injuries in the accident and emergency department is described.     

骨质疏松与远侧指间关节变性性关节炎

目的了解骨质疏松与远侧指间关节增生变形的关系 , 为临床治疗老年人常见的变性性关节炎提供依据.方法 1995/1997门诊就诊的 50岁以上的女患者 205例,不包括手指有创伤史及类风湿病的病例.根据手指远侧指间关节( DIP关节)的变形程度,参考 Swanson分类方法,将 DIP关节分为 6级.选腰椎、髋关节及手指骨为测定部位进行骨密度评价.腰椎与髋关节用 dual energy X-ray absorptiometry(DEXA)法,手指骨用 digital image processing(DIP)法测定.以 Spearmem顺位相关系数计算, P< 0.05时判定有意义.结果 ( 1) DIP关节的级别随着年龄的增加而增加( r=0.381, P< 0.001).( 2)腰椎、髋关节及手指骨的钙盐含量与年龄存在有意义的负相关(相关系数 r=0.371, P< 0.001).( 3) DIP关节的级别与手指骨钙盐含量之间不存在有意义的相关性( r= - 0.612, P >0.05).( 4) DIP关节的级别与腰椎、髋关节的钙盐含量不存在有意义的相关性(与腰椎 r=- 0.071, P >0.05,与髋关节 r=- 0.180, P >0.05).结论 DIP关节的变形程度与骨质疏松不存在有意义的相关性,但随年龄的增加而加重.     

应用桡骨远端掌侧锁定钢板治疗胸锁关节脱位和锁骨近端骨折

目的探讨应用桡骨远端锁定钢板内固定治疗胸锁关节脱位和锁骨近端骨折的疗效。方法对3例胸锁关节脱位及7例锁骨近端骨折采用切开复位桡骨远端掌侧锁定钢板内固定治疗。结果 10例患者术后均得到随访,术后X线片检查均无再脱位、内固定失效、骨延迟愈合或骨不连,无血管、神经损伤等并发症。根据Rockwood评分法对术后患者进行评定,优9例,良1例。结论桡骨远端掌侧锁定钢板治疗胸锁关节脱位和锁骨近端骨折,利用锁定钢板的优势,具有固定可靠、风险小、疗效满意的优点。     

Irreducible dislocation of the interphalangeal joint of the thumb: a case report.

A case of open irreducible dislocation of the interphalangeal joint of the thumb with interposed flexor pollicis longus tendon and palmar plate with sesamoid bone is described.     

Isometric torque of the finger extensors at the metacarpophalangeal joints

A pilot study was undertaken to evaluate the isometric torque produced at the metacarpophalangeal joint during finger extension. Fifteen women with normal right hands, aged 21 to 29 years, participated. Each subject was tested for maximal force of isometric extension at the metacarpophalangeal joint angles of 0, 30, and 60 degrees on each of the four fingers. Torque was computed by multiplying the recorded tension and measured length of the proximal phalanx (lever arm). The mean torque for the long finger was significantly greater than the average torque for each of the other three fingers. The mean torque at the joint angle of 60 degrees was significantly greater than at 0 degrees but not at 30 degrees. Reasons for the findings are discussed.     

手指末节撕脱离断再植17例分析

目的 探讨手指末节撕脱离断再植的手术方法.方法 再植手术根据撕脱指条件,11例行指动脉交叉吻合.6例行静脉移植桥接修复动脉,静脉回流采用直接吻合,静脉移植及放血等.结果 再植指成活15列,坏死1例,部分坏死1例.再植指成活的15例得到随访,随访4个月至2年,平均随访14个月,再植指功能评定13指优,2指良好.结论 末节指撕脱离断再植后,外形和功能恢复良好.     

指背逆行皮瓣修复手指远端软组织缺损的应用研究

目的研究手指远端软组织缺损使用指背逆行皮瓣修复的应用价值。方法尸体手4只，死婴手6只，经乳胶血管灌注，观察手指的动脉、静脉分布。在尸体手指背侧设计10个逆行皮瓣，蒂部在手指远端的一侧，皮瓣范围3cm×1．5cm，将泛影葡胺加墨汁加压注入桡动脉，肉眼观察皮瓣的颜色变化，X线造像观察皮瓣内血管显影情况。在手指解剖学研究的基础上，对22例手指烧伤、外伤患者，应用了27个指背逆行皮瓣修复手指远端皮肤缺损伴有肌腱、指骨、指关节外露创面，皮瓣范围（1—5．5）cm×（1—3）cm，长宽比例（1—2．5）：1。结果解剖学研究见手指动脉间有多方位、层次交错的吻合，静脉间相互吻合成网，保证了手指的血液供应和静脉回流。指背逆行皮瓣的蒂部可见有指掌侧固有动脉的分支，灌注后可见皮瓣内静脉即刻充盈黑染，说明实验皮瓣已完成“血液”从动脉-毛细血管-静脉的循环过程，皮瓣X线造像显示整体透光度减低，皮瓣内有血管显影。本组临床移植的27个皮瓣全部成活，随诊6—12个月，远期效果满意。结论指背逆行皮瓣的血液供应来源于指掌侧固有动脉的分支，皮瓣内有丰富的静脉并与指腹僻静脉形成网状交通，保证了皮瓣的血液回流。指背逆行皮瓣可以较好地满足手指远端皮肤软组织缺损修复的需要，特别是对手指远端、小指末节尺侧、拇指末节桡侧等使用局部皮瓣修复困难的部位。     

妊娠合并子宫肌瘤诊治进展

子宫肌瘤合并妊娠占全妊娠的1．5％，近年来晚婚晚育的高龄孕妇增多，子宫肌瘤合并妊娠发病率有增加趋势。最近的观点认为，大多数肌瘤妊娠期间没有明显的增大，而且多数对妊娠不会造成影响，但是，大的黏膜下和胎盘后肌瘤可能对妊娠造成不良后果，包括阴道流血、疼痛、胎盘早剥、胎儿生长受限、早产、产后大出血等。妊娠期间肌瘤剔除术只限于带蒂的，或浆膜下肌瘤，而且疼痛等症状经保守治疗无效的，在中期妊娠实施。     

Differential permeability of the proximal and distal rabbit small bowel

The permeability of the proximal and distal rabbit intestine for two to six carbon polyhydric alcohols was compared. Intestinal segments were mounted in chambers that permitted the measurement of the unidirectional flux across the brush border membrane. For both proximal and distal intestine, the permeability for a series of polyhydric alcohols decreased with increasing size. The proximal intestine was more permeable for four, five, and six carbon polyhydric alcohols than distal intestine. This regional permeability difference can be attributed to variations in the permeability characteristics of the brush border specifically. The uptake of alcohols was nonsaturable and was not inhibited by phlorizine or n-ethylmaleimide. The results are compatible with the concept that the brush border membrane has properties similar to artificial porous membranes and that the equivalent radius of the pores of the proximal intestine exceeds that of the distal gut.     

Biomechanical evaluation of pyrocarbon proximal interphalangeal joint arthroplasty: An in-vitro analysis

BackgroundPyrocarbon proximal interphalangeal joint arthroplasty provided patients with excellent pain relief and joint motion, however, overall implant complications have been very variable, with some good outcomes at short-medium-term follow-up and some bad outcomes at longer-term follow-up. Implant loosening with migration, dislocation and implant fracture were the main reported clinical complications. The aim of the present work was to test the hypothesis that the magnitude proximal interphalangeal joint cyclic loads in daily hand functions generates stress-strain behaviour which may be associated with a risk of pyrocarbon component loosening in the long-term.MethodsThis study was performed using synthetic proximal and middle phalanges to experimentally predict the cortex strain behaviour and implant stability considering different load conditions for both intact and implanted states. Finite element models were developed to assess the structural behaviour of cancellous-bone and pyrocarbon components, these models were validated against experimentally measured cortex strains.FindingsCortex strains showed a significant increase at dorsal side and reduction at palmar side between intact and implanted states. Cancellous-bone adjacent to the condylar implant base components suffers a two to threefold strain increase, comparing with the intact condition.InterpretationThe use of pyrocarbon implant changes the biomechanical behaviour of the joint phalanges and is associated with a potential risk of support cancellous-bone suffer fatigue failure in mid to long term due to the strain increase for cyclic loads in the range of daily hand activities, this risk is more prominent than the risk of bone resorption due to strain-shielding effect.     

Movement of finger joints induced by synergistic wrist motion

BACKGROUND: An experiment has recently been conducted to evaluate and compare the differences in tendon excursions between the flexor digitorum profundus and superficialis using three mobilization techniques. No previous studies deal with the total joint excursions with constant tendon length. The purpose of this study was to investigate the coordinated motion between the finger and wrist joints resulting from passive tension of the muscles while performing synergistic wrist motion. METHODS: The relative joint positions of the hand and wrist were measured using a three-dimensional motion analysis system with external retroreflective markers 2 mm in diameter placed on the dorsal surface of the hand. Fifty normal subjects, with a 1:1 gender ration, ranging in age from 20 to 40 years, and with no previous history of upper extremity injury, were recruited for the experiment. FINDINGS: The relationships of synergistic motion between the wrist and finger joints due to passive tension in the muscles were approximately linear. The ranges of wrist motion averaged 60 degrees extension and 60 degrees flexion. Moving the wrist from flexion into extension induced synergistic finger joint motion as follows: the distal interphalangeal joint angles changed from an average of 12 degrees of flexion to 31 degrees; proximal-interphalangeal joint angles changed from 19 degrees to 70 degrees; and metacarpal phalangeal joints changed from 27 degrees to 63 degrees of flexion. INTERPRETATION: The relationships of synergistic motion between the wrist and finger joints were systematically documented. Such a relationship could be considered in optimizing the design of dynamic splints used for rehabilitation in post-surgical tendon repair, as well as providing useful information about potential diagnoses of problems with the integrity of the flexor and extensor mechanisms.