The Stiff Elbow

Elbow motion is essential for upper extremity function to position the hand in space. Unfortunately, the elbow joint is prone to stiffness following a multitude of traumatic and atraumatic etiologies. Elbow stiffness can be diagnosed with a complete history and physical exam, supplemented with appropriate imaging studies. The stiff elbow is challenging to treat, and thus, its prevention is of paramount importance. When this approach fails, non-operative followed by operative treatment modalities should be pursued. Upon initial presentation in those who have minimal contractures of 6-month duration or less, static and dynamic splinting, serial casting, continuous passive motion, occupational/physical therapy, and manipulation are non-operative treatment modalities that may be attempted. A stiff elbow that is refractory to non-operative management can be treated surgically, either arthroscopically or open, to eliminate soft tissue or bony blocks to motion. In the future, efforts to prevent and treat elbow stiffness may target the basic science mechanisms involved. Our purpose was to review the etiologies, classification, evaluation, prevention, operative, and non-operative treatment of the stiff elbow.     

断肢断腕断掌再植后手内在肌挛缩51例分析

探讨断肢断腕断掌再植术后手内在肌挛缩的发病机理,结合临床经验提出分类、预防和治疗方法。方法:对51例断肢(腕、掌)再植,分别采用术中切开骨间肌肌筋膜、掌腱膜及腕横韧带;术后严重肿胀时早期切开骨筋膜室;缺血时间超过10小时者,除上述措施外尚须切断或部分切除拇收肌和骨间肌肌腹。结果:采用上述预防措施后,手内在肌挛缩的发生率明显降低。结论:本症重在预防,如能及时、果断地采取措施,效果良好。一旦发生中、重度手内在肌挛缩应尽早手术。     

全厚皮片移植修复颈部瘢痕挛缩畸形

应用全厚皮片移植修复治疗183例颈部烧伤后瘢痕挛缩畸形患者,术后经3～5年随访观察效果确切.并对全厚皮片术后易发生收缩的问题,进行讨论.     

A theoretical consideration of extensions of the Z-plasty principle

For the release of congenital or posttraumatic webs a variety of local skin flap techniques have been described. Confusion exists on how much lengthening may be obtained by each of these techniques, as well as on how much lateral slack is needed for the flaps to be shifted. These techniques and the results they provide are reviewed, calculated, and visualized by diagrams. It is concluded that the Z-plasty and its modifications lead to superior lengthening-to-narrowing ratios. Combined YV-plasties have their advantage in that resection of scarred skin will be obtained. Position, extent and orientation of the scar or web will generally indicate which technique is to be used in each individual case.     

臀肌挛缩症的微创治疗

目的:寻找一种创伤小、恢复快、效果好的臀肌挛缩症(GMC)的治疗方法。方法:根据体征及病理变化,将GMC分为A、B、C三型后,采用特制叶氏剥离刀对20例40侧各型GMC患者进行微创治疗,然后按同一疗效评价标准与大转子后小切口治疗GMC的效果相比较。结果:GMC微创治疗疗效1周评分平均为9分,3周评分为10分,患者4天-6天即可恢复出院;GMC大转子后小切口治疗疗效1周评分平均为6.2分,3周评分为9.6分,患者12天-14天拆线出院。结论:GMC的微创治疗具有创伤小、痛苦少、恢复快、效果好、操作安全可靠、易掌握的特点。     

Energy deficiency,calcium overload or oxidative stress: Possible causes of irreversible ischemic myocardial injury

Summary After prolonged ischemia or hypoxia myocardial injury is not reversed but exacerbated by a resupply of the tissue with oxygen and substrates. The mechanism by which reversible ischemic or hypoxic myocardial injury becomes irreversible is not yet understood. It has been debated whether reperfusion injury merely uncovers pre-existing irreversible injury, or is indeed caused by the reperfusion/reoxygenation process. In recent years, three theories have been discussed that relate the onset of irreversibility either to: a critical energy loss; a critical accumulation of cellular calcium; or to the deleterious effects of free radical formation. In certain experimental models for each of these theories favourable results have been obtained. Current research suggests that absolute reversibility thresholds in energy depletion or calcium accumulation in the ischemic or hypoxic cell do not exist. A key role of free radical injury for reperfusion injury must also be questioned. There is, however, evidence that in tissue reversibility of ischemic cardiomyocyte injury is limited by conditions that make calcium-induced hypercontracture upon reoxygenation unavoidable. This occurs when, by hypercontracture, mutual mechanical disruption of the cells destroys the tissue. From isolated cardiomyocytes that are able to metabolically survive hypercontracture it has been observed that these metabolic conditions do not represent the last biological possibility to reverse injury.     

复杂指蹼挛缩和皮肤缺损的显微外科重建

目的：研究复杂指蹼挛缩和缺损的显微外科重建技术。方法：应用７种岛状皮瓣和１０种游离皮瓣重建指蹼４４例，其中应用联合移植方法同时重建虎口和拇指８例。结果：皮瓣全部成活，平均经１５个月随访，疗效优２５例，良１７例，可２例。结论：指背和手背岛状皮瓣适合修复小面积指蹼缺损，骨间背侧动脉皮瓣是修复中等指蹼创面的较佳选择，脐旁皮瓣和股前外侧皮瓣能重建大面积和不规则指蹼缺损。本组经验显示，缝合皮神经的皮瓣疗效稍优，趾蹼皮瓣重建的指蹼综合效果最佳，联合移植能有效地一期再造拇指和指蹼。     

Patients with Dupuytren’s Contracture,Ledderhose Disease,and Peyronie’s Disease are at higher risk of arthrofibrosis following total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is a successful treatment for patients with late stage osteoarthritis, yet arthrofibrosis remains a consistent cause of TKA failure. Dupuytren’s, Ledderhose and Peyronie’s Diseases are related conditions of increased fibroblast proliferation. The aim of this study was to identify whether an association exists between these conditions and arthrofibrosis following TKA.MethodsPatient records were queried from 2010 to 2016 using an administrative claims database to compare the rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with independent chart diagnoses of Dupuytren’s Contracture, Ledderhose, or Peyronie’s Diseases versus those without. Complications were queried and compared using multivariate logistic regression.ResultsPatients with Dupuytren’s (n = 5,232) and Ledderhose (n = 50,716) had a significantly higher rate of ankylosis following TKA: 30-days (OR, 1.54; OR, 1.23), 90-days (OR, 1.20; OR, 1.24), 6-months (OR, 1.23; OR, 1.23), and 1-year (OR, 1.28; OR, 1.23), while patients with Peyronie’s (n = 1,186) had a higher rate of diagnosis at 6-months (OR, 1.37) and 1-year (OR, 1.35). Patients with diagnoses of any of the fibroproliferative diseases had a statistically higher risk of MUA at 90-days, 6-month, and 1-year following primary TKA. These cohorts did not have a significantly higher rate of revision TKA.ConclusionThere is an increased odds risk of arthrofibrosis and MUA in patients who have undergone TKA and have a diagnosis of Dupuytren’s Contracture, Ledderhose, or Peyronie’s Diseases. Improvements to frequency and application of post-operative treatment should be considered in these cohorts to improve outcomes.     

地方性下蹲困难综合征的流行病学调查

目的　探讨地方性下蹲困难症的发病原因。方法　流行病学病例对照调查及分析。结果　该病症为臀肌挛缩症。结论　在儿童时期 ,尤其是婴幼儿 (1～ 3岁 )时期 ,多次频繁的臀肌注射是重要的危险因素 ,此外注射的部位、方法、剂量和病儿的年龄等方面也必须加以注意。必须对基层医务人员进行必要的培训 ,提高他们的医疗水平和护理水平 ,其中肌注技术应是重要内容