微创交锁髓内钉内固定治疗胫骨中下段骨折的疗效分析

目的观察交锁髓内钉内固定治疗胫骨干中下段骨折的疗效。方法回顾性分析本院2007年1月～2010年12月采用闭合复位、微创交锁髓内钉内固定治疗胫骨干中下段骨折39例的临床资料。结果所有患者均获随访,随访时间12～48个月,平均31.2个月,骨折全部愈合,无感染和畸形愈合,膝、踝关节功能恢复正常,按马元璋评定标准,本组优33例,良6例,优良率为100%。结论交锁髓内钉内固定治疗胫骨干骨折有术式简单、损伤小、疗效好、符合生物力学要求等优点,值得推广应用。     

Paediatric forearm refractures with retained plates managed with flexible intramedullary nails

During the past 18 months we have managed four paediatric patients who have sustained forearm refractures associated with retained plates that were used to treat their original fracture. Although this complication is not new, most literature regarding paediatric forearm refracture relates to refractures that occur after closed treatment or after removal of metalwork. We treated the patients in this small series with plate removal and intramedullary stabilisation using elastic stable intramedullary nails (Nancy, Depuy, UK) as opposed to revision plating. Treatment of this complication by this method has not previously been described.     

The significance of forearm bone mineral density evaluation in determining surgical indications in primary hyperparathyroidism

PurposeForearm osteoporosis is a well-known complication of primary hyperparathyroidism (PHPT). However, measuring forearm bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) at the distal radius is often neglected in clinical practice despite the fact that osteoporosis at any site is a criterion indicating surgery. We aimed to evaluate the importance and priority of forearm BMD and to determine its association with biochemical parameters.Material and methodsThree hundred fourteen patients (272 females, 42 males) with PHPT who had BMD measurements at 3 sites were recruited for this retrospective study. The effect on surgical indications of osteoporosis only in the forearm was evaluated. Group 1 (n = 151) with forearm osteoporosis and group 2 (n = 163) without were compared in terms of biochemical and clinical parameters.ResultsIn the overall study population, 165 of the 314 patients had osteoporosis in at least 1 site. Twenty seven percent (n = 86/314) had osteoporosis only in the forearm, while the other 2 sites (lumbar spine and femoral neck) were normal or osteopenic. Surgery was indicated based on osteoporosis only in the forearm in 10% of patients (n = 30/314). Corrected calcium and parathyroid hormone levels were significantly higher in group 1 than group 2 (p = 0.001 and p < 0.001, respectively) and were also negatively correlated with distal radius BMD, T-score and Z-score in the whole study group.ConclusionIncluding the distal radius in BMD measurement increased the number of patients diagnosed with osteoporosis and for whom surgery was indicated. Calcium and PTH were also more frequently elevated in patients with forearm osteoporosis. These results show that distal radius BMD is relevant to the management of PHPT.     

脐胸皮瓣在前臂创面修复中的应用

用脐胸皮瓣修复前臂创面９例的临床经验。皮瓣面积最大为８．５×２８ｃｍ，最小为７×１６ｃｍ，全部成活，效果良好。认为应用脐胸皮瓣带蒂转移修复前臂创面有以下优点：①肢体贴胸固定时位置比较舒服。②皮瓣切取面积大。③供瓣区多能直接缝合，且位置比较隐蔽，对受区功能无影响。     

Reconstruction of iatrogenic dorsal skin defects of hands with reverse forearm flaps

Summary Distally based radial and ulnar forearm flaps were employed to reconstruct iatrogenic dorsal skin defects of hands in young children. The defects resulted from the extravasation of intravenous medication; flaps were required for reconstruction because the extensor tendons were exposed in the base of the ulcer in Case 1 and were involved in dense scar tissue in Case 2. The reverse forearm flap is an easy and reliable technique requiring short operating time, and it allows initiation of early physiotherapy compared with the other techniques, such as free flap or an abdominal flap.     

中重度前臂缺血性肌肉挛缩晚期功能重建的手术治疗

目的 探讨中、重度前臂缺血性肌肉挛缩晚期功能重建的手术方法及疗效。方法 对42例中、重度前臂缺血性肌肉挛缩的晚期患者，进行旋前畸形矫正和旋后对掌功能重建手术。其中6例行指浅、深屈肌腱交叉延长术，17例行肌腱转位术＋骨间膜、旋前方肌松解术，19例行肌腱转位术＋骨间膜、旋前方肌松解术＋腕屈肌旋后功能重建术。结果 术后42例患者均获得6～34个月的随访。旋后功能恢复：优9例，良18例，可12例，差3例，优良率为64．3％。手功能恢复：优11例，良15例，可14例，差2例，优良率为61．9％。结论 对中、重度晚期缺血性肌肉挛缩的患者，应针对其不同的挛缩程度采用不同的手术方法进行治疗。     

股前外侧皮瓣修复前臂大面积软组织缺损

目的　介绍应用股前外侧皮瓣移植修复前臂大面积皮肤软组织缺损。方法　切取自髂前上棘至髌骨外缘连线 1/2以上的超长股前外侧皮瓣 ,修复前臂大面积软组织缺损 2 4例 ,对其中 4例 ,采用双侧股前外侧皮瓣组合修复 ;皮瓣面积最大为 3 6cm× 12cm ,最小为 2 0cm× 8cm。结果　 2 4例 2 8块组织瓣全部成活 ,术后无血管危象发生。术后 14例获得 6～ 3 6个月的随访 ,前臂外形满意 ,皮肤质地柔软 ,弹性好 ,皮瓣恢复保护性感觉 ,有排汗功能。皮瓣供区游离植皮区瘢痕较大 ,但无功能影响。结论　超长股前外侧皮瓣能一次修复前臂大面积软组织缺损 ,方法可靠 ,解剖容易 ,是一种简单、理想的手术方法。     

Detection of pronator muscle overactivity in children with unilateral spastic cerebral palsy: Development of a semi-automatic method using EMG data

BackgroundThe pronator teres and pronator quadratus muscles are frequently injected with neuromuscular blocking agents to improve supination in children with spastic cerebral palsy and limited active elbow supination. However, determining by simple clinical examination whether these muscles are overactive during active movement is difficult.ObjectiveThis study aimed to develop a semi-automatic method to detect pronator muscle overactivity by using surface electromyography (EMG) during active supination movements in children with cerebral palsy.MethodsIn total, 25 children with unilateral spastic cerebral palsy (10 males; mean [SD] age 10.6 [3.0] years) and 12 typically developing children (7 males; mean age 11.0 [3.0] years) performed pronation–supination movements at 0.50 Hz. Kinematic parameters and surface EMG signals were recorded for both pronator muscles. Three experts visually assessed muscle overactivity in the EMG signals of the children with cerebral palsy, in comparison with the reference group. The reliability and discrimination ability of the visual assessments were analysed. Overactivity detection thresholds for the semi-automatic method were adjusted by using the visual assessment by the EMG experts. The positive and negative predictive values of the semi-automatic detection method were calculated.ResultsIntra-rater reliability of visual assessment by EMG experts was excellent and inter-rater reliability was moderate. For the 25 children with unilateral spastic cerebral palsy, EMG experts could discriminate different profiles of pronator overactivity during active supination: no pronator overactivity, one overactive pronator, or overactivity of both pronators. The positive and negative predictive values were 96% and 91%, respectively, for this semi-automatic detection method.ConclusionsDetection of pronator overactivity by using surface EMG provides an important complement to the clinical examination. This method can be used clinically, with the condition that clinicians be aware of surface EMG limitations. We believe use of this method can increase the accuracy of treatment for muscle overactivity, resulting in improved motor function and no worsening of paresis.     

The radial forearm flap without fascia and other refinements

The radial forearm flap is generally classified as a fasciocutaneous flap. The skin of the forearm is, however, supplied by branches from the radial artery which pierce the fascia of the forearm to course and branch subcutaneously. We have used the flap as a skin flap in 300 cases over 11 years. It is not necessary to take the fascia with the flap. Two other refinements of the forearm flap, also used over the past 11 years, are described. The venous drainage of the flap is simplified by utilising the usual anatomical confluence of deep and superficial veins at the elbow. Secondly, draping a large loop of pedicle in the neck during intraoral reconstruction enables a larger calibre vein to be used for the anastomosis, thus increasing its reliability.