An Anatomical Study to Demonstrate the Proximity of Kirschner Wires to Structures at Risk in Percutaneous Pinning of Distal Radius Fractures

Distal radius fractures are often treated using percutaneous Kirschner wires (K-wires). The sensory nerves in this area, extensor tendons, radial artery and cephalic vein are at risk of injury in this procedure. We undertook a cadaveric investigation to identify probability of damage to these ‘at risk’ structures by measuring their distances in relation to standard K-wire sites. Nine upper limbs from six formalin-preserved cadavers were studied. Four K-wires were placed percutaneously simulating fixation of a distal radius fracture. Careful dissection was done preserving the original position of neurovascular and tendinous structures. Distances to relevant soft-tissue structures from each K-wire were measured using an electronic digital caliper. Distance of superficial nerves from radial styloid and Lister’s tubercle was measured to determine their ‘safe distance’ from these fixed landmarks. None of the superficial nerves were injured by a K-wire. Cephalic vein had been pierced on 4 occasions (4/18) and extensor tendons on 3 occasions (3/18). Wilcoxon signed-rank test was used to compare distance of the superficial nerves from radial styloid and Lister tubercle, and the latter was found to be the safer option. This study highlights the inherent danger in percutaneous K-wire fixation of wrist fractures. Limited size of the area, where K-wires can be positioned, and anatomic variations of neurovascular structures pose obstacles in developing guidelines for reducing risk of injury. We advocate use of mini-open approach and guiding devices to avert complications of inadvertent impalement and damage to these structures.     

Over the wire lead extraction and focused force venoplasty to regain venous access in a totally occluded subclavian vein

Introduction  Venoplasty allows the addition or replacement of leads despite subtotal or total subclavian occlusion. Methods  The threshold of the LV pacing lead implanted for biventricular pacing over a period of 18 months increased to greater than 5 V. A pre implant venogram revealed total subclavian occlusion. Venous access was maintained by extraction of the 4 F LV lead over a wire. Subsequently the sheath would not advance despite 6mm balloon inflation to 30 atm with no residual waist. A wire was placed beside the balloon and the balloon was reinflated. Results  The subclavian obstruction was eliminated without damage to the existing leads. Conclusion  The obstruction formed by the fibrous track around an extracted lead may persist despite what appears to be successful balloon dilation. Inflation with a wire beside the balloon increases the effect eliminating the resistant obstruction without damaging the leads. Acknowledgements of Sources of Financial Support:Dr. Worley receives compensation in various forms from Medtronic, Pressure Products, Guidant, and St Jude Medical. Dr. Gohn receives compensation in various forms from Medtronic. No financial support was provided for the creation of this case report     

经桡动脉行冠脉造影及介入中上肢径路异常时PTCA导丝的应用价值

目的 探讨经桡动脉途径行冠状动脉造影及介入术中,上肢血管异常时PTCA导丝的应用价值。方法 我院近3年行桡动脉造影及介入治疗2000例,如果 0.035"J型导丝和亲水超滑导丝在右上肢血管推送过程中遇到阻力,遂撤出导丝,进行上肢局部血管造影,如果疑似桡动脉痉挛的,局部推注维拉帕米100～200ug后再次复查血管造影。结果仍有40例未能成功,其中桡动脉环9例、严重桡动脉狭窄18例、桡动脉发育细小8例、桡动脉痉挛5例,随机分成PTCA导丝组和改股动脉组。PTCA导丝组改用PTCA导丝,最终完成冠状动脉造影检查;改股动脉组直接经股动脉途径行冠状动脉造影术。比较两组手术成功率、操作时间、造影剂用量及局部出血、血肿并发症等情况。结果 两组完成冠状动脉造影成功率比较未见统计学差异（95%比100%,P=0.746）,PTCA导丝组操作时间长于改股动脉组［（950.0±125.3）s比（710.0±98.3）s, P=0.032］,两组造影剂用量比较未见统计学差异［（50.0±6.3）ml比（47.0±5.9）ml,P=0.18］,改股动脉组出血、血肿并发症多于PTCA组（20%比0%,P=0.035 ）。结论 经桡动脉途径行冠状动脉造影及介入治疗术中,当上肢血管发生异常,常规导丝不能完成时,换用PTCA导丝,操作轻柔,并发症发生率低,是安全有效的,特别对于不适合经股动脉造影的患者尤为适合。     

不同手术方式治疗儿童肱骨近端骨折的临床观察

目的 比较切开复位克氏针内固定和切开复位外固定架治疗儿童肱骨近端骨折的效果.方法 2010年10月至2013年8月南阳市中心医院小儿外科行克氏针和外同定架治疗的肱骨近端骨折的患儿62例.其中克氏针内固定组患儿40例,外固定架组22例.比较两种手术方式的临床效果.结果 两组患儿手术时间[(40.3±7.2)min比62.3±6.7)min]、手术出血量[(28.9±14.5)ml比(71.7±17.5) ml]、切口长度[(32.4±11.3) cm比(63.3±13.2) cm]和术后肩关节Neer评分[(96.8±9.8)分比(92.3±8.5)分]等方面外固定架组要优于克氏针组,差异有统计学意义(P＜0.05).而在住院时间、骨折愈合时间和术后并发症方面差异无统计学意义(P＞0.05).结论 对儿童肱骨近端骨折,切开或闭合复位外固定架治疗,手术操作简单易行,对干骺端损伤小,固定可靠利于早期功能锻炼,对术后上肢功能的恢复具有良好的效果.     

Individually Addressable Suspended Conducting‐Polymer Wires in a Chemiresistive Gas Sensor

An effective method is described for producing poly(3,4‐ethylenedioxythiophene) poly(styrenesulfonate) (PEDOT:PSS) arched microwires, which are used as transducers in chemiresistive gas sensors. Three‐dimensional arched wires with diameters of 0.8, 1.2, 2.5, and 10 μm are individually fabricated by using a simple, inexpensive fountain‐pen lithography technique. The wires show superior stretchable behavior under omnidirectional strain of ca. 120%. A gas sensor assembled with the PEDOT:PSS arched wires exhibits linear responses to the concentrations of different vapor gases, such as ethanol, acetone, and methanol, at room temperature. The signal‐to‐noise ratio in the sensing response, which influences the detection limit, is enhanced by increasing the number of wires with a larger surface‐to‐volume ratio in parallel to increasing the signal level and diminishing the baseline noise in the wire transducers.

     

关节镜辅助下克氏针、钢丝张力带治疗髁间棘骨折的疗效分析

目的:分析克氏针、钢丝张力带治疗髁间棘骨折的临床疗效。方法:对我科2011年-2017年收治的58例Ⅱ型及以上的髁间棘骨折采用关节镜辅助下克氏针、钢丝张力带的方法进行固定,术后定期复查评估膝关节稳定性、活动度及骨折愈合情况,并采用Lysholm评分系统对膝关节功能进行评估。结果:58例患者均获得随访,术后6周复查膝关节屈伸0°-120。及以上,术后3个月复查X线提示骨折愈合良好,抽屉实验、Lachman实验阴性,末次随访Lysholm评分(94.6±1.1)分,较术前(73.6±2.6)分显著提高,差异有统计学意义(P<0.05)。结论:关节镜辅助下克氏针、钢丝张力带治疗髁间棘骨折固定牢靠,方法简单实用,经济低廉,膝关节功能恢复满意。     

One,two, three … breakdance and twist

Wire breakage during percutaneous coronary intervention is a rare event. It occurs especially when treating complex lesions, and it should be prevented with careful planning of each procedural step. We reported a case in which wire breakage occurred when treating the left anterior descending (LAD)/first diagonal bifurcation with the T‐stenting technique. After careful evaluation of all the available retrieval techniques and failure of the balloon–catheter trapping, the twin‐twisting wires technique (TTWT) was applied. This technique allows the retrieval of a foreign body thanks to its entrapment in the spiral made by two twisting wires. At the first attempt, the broken wire was only withdrawn and not retrieved, while the two twisting wires went broken. The second attempt was performed using stronger wires as twisting wires. The two recently broken fragments were successfully retrieved together with a long proximal remnant of the initially broken wire, which distal tip was further withdrawn. The broken wire was successfully retrieved with the third attempt, together with the previously implanted LAD stent that was accidentally entrapped in the twist. This is the first report of TTWT implementation for the retrieval of a broken wire from a two‐stent bifurcation, both proximal and distal wire remnants and a total of three broken wires. The improvements we made to the technique, tips and tricks, caveats, and suggestions for successful wire retrieval and avoidance of the complications that we experienced are described in detail.     

直丝弓矫治技术联合前方牵引矫治恒牙早期安氏Ⅲ类错的疗效观察

目的观察直丝弓矫治技术联合前方牵引矫治恒牙早期骨性Ⅲ类错患者治疗前、后软硬组织及牙的变化。方法选择符合纳入标准的17例恒牙早期骨性Ⅲ类错患者,采用直丝弓矫治技术联合前方牵引进行治疗,配合快速扩弓,并对治疗前、后头颅侧位片进行测量分析比较。结果矫治结束后覆盖及磨牙关系发生了显著变化,前牙反解除,患者凹面型改善;SNA角平均增加1.37°,A点前移,下颌骨向下向后旋转,ANB角趋于正常。结论恒牙早期骨性Ⅲ类错患者由于生长潜力有限,直丝弓矫治技术联合前方牵引是有效的矫治方法之一。