OBJECTIVE To study the compression factor and clinical manifestation of the compression of the palmar cutaneous branch of the median nerve. METHODS Anatomic study was done on both sides of 2 cadavers and 6 cases of hand injury in the debridement, the origin, course, branch of the palmar cutaneous branch of the median nerve were observed. From 1995 to 1998, 12 patients of compression of the palmar cutaneous branch were treated by local blockade injection. Among them, there were 8 males and 4 females, aged from 23 to 65 years and the course of disease ranged 3 to 12 months. RESULTS The palmar cutaneous branch of the median nerve was (1.3 +/- 0.1) mm in diameter, it could be pulled when the wrist dorsi-extension. All cases showed good recovery of hand function and no recurrence after 4 to 12 months follow-up. CONCLUSION The palmar cutaneous branch compression syndrome is closely related to the local anatomy. The diagnosis is definite according to the clinical symptoms and signs, and local blocking is effective on the most patients.
ObjectiveTo summarize the experience and lessons of right ventricular decompression in children with pulmonary atresia and intact ventricular septum (PA/IVS) and to reflect on the strategies of right ventricular decompression.MethodsThe clinical data of 12 children with PA/IVS who underwent right ventricular decompression in our hospital from March 2015 to December 2019 were reviewed retrospectively. There were 10 males and 2 females with a median age at the time of surgery was 5 d (range, 1-627 d). Correlation analysis between the pulmonary valve transvalvular pressure gradient and changes in Z score of tricuspid valves after decompression was performed.ResultsOne patient died of refractory hypoxemia due to circulatory shunt postoperatively and family members gave up treatment. There were 2 (16.67%) patients received postoperative intervention. The pulmonary transvalvular gradient after decompression was 31.95±21.75 mm Hg. Mild pulmonary regurgitation was found in 7 patients, moderate in 2 patients, and massive in 1 patient. The median time of mechanical ventilation was 30.50 h (range, 6.00-270.50 h), and the average duration of ICU stay was 164.06±87.74 h. The average postoperative follow-up time was 354.82±331.37 d. At the last follow-up, the average Z score of tricuspid valves was 1.32±0.71, the median pressure gradient between right ventricle and main pulmonary artery was 41.75 mm Hg (range, 21-146 mm Hg) and the average percutaneous oxygen saturation was 92.78%±3.73%. Two children underwent percutaneous balloon pulmonary valvoplasty at 6 and 10 months after surgery, respectively, with the rate of reintervention-free of 81.8%. There was no significant correlation between pulmonary transvalvular gradients after decompression and changes in Z score of tricuspid valves (r=–0.506, P=0.201).ConclusionFor children with PA/IVS, the simple pursuit of adequate decompression during right ventricular decompression may lead to severe pulmonary dysfunction, increase the risk of ineffective circular shunt, and induce refractory hypoxemia. The staged decompression can ensure the safety and effectiveness for initial surgery and reduce the risk of postoperative death.
OBJECTIVE To summarize the clinical results of hollow compression screw in treatment of fracture of neck of femur in the aged. METHODS: From November 1993 to October, 1998, 52 aged patients with several types of fracture of neck of femur were treated; among them, there were 25 males and 27 females aged from 60 to 83 years (70 years on average). There were 48 cases of fresh fracture and 4 cases of old fracture. Forty-two cases were performed closed reduction internal fixation, 10 cases with open reduction internal fixation. RESULTS: All the patients could sit by themselves 4 to 6 days after operation, and could walk with a crutch 10 to 15 days after operation. The mobility of hip joint was nearly normal 4 weeks after operation. All the patients were followed 26 to 84 months, 48.5 months on average. Bone union was achieved in 50 cases, nonunion in 2 cases. The average healing time was 4.7 months. There were no other complications, such as ankylosis and muscular atrophy, but ischemic necrosis in 3 cases. CONCLUSION: This method has following advantages, convenient manipulation, less injury, stable fixation, and the short-term recovery, which avoid some common complications. It is a reliable method worthy of popularizing.
OBJECTIVE: To investigate the mechanism, diagnosis, and treatment of common fibular nerve compression syndrome secondary to sciatic nerve injury. METHODS: Based on the clinical manifestation and Tinel’s sign at fibular tunnel, 5 cases of common fibular nerve secondary compression following sciatic nerve injury were identified and treated by decompression and release of fibular tunnel. All 5 cases were followed up for 13-37 months, 25 months in average, and were evaluated in dorsal flexion strength of ankle. RESULTS: The dorsal flexion strength of ankle in 4 cases increased from 0-I degrees to III-V degrees, and did not recover in 1 case. CONCLUSION: Fibular tunnel is commonly liable to fibular nerve compression after sciatic nerve injury. Once the diagnosis is established, either immediate decompression and release of the entrapped nerve should be done or simultaneous release of fibular tunnel is recommended when the sciatic nerve is repaired.
ObjectiveTo evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.MethodsA retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.ResultsThe operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).ConclusionBilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.
Objective To compare the effectiveness of titanium elastic nail (TEN) and locking compression plate fixation in treating femoral subtrochanteric fracture in older children. Methods Between April 2015 and September 2016, 35 older children (aged 7-13 years) with femoral subtrochanteric fractures were treated, the clinical data were retrospectively reviewed. TEN fixation was used in 19 cases (group A) and locking compression plate fixation in 16 cases (group B). There was no significant difference in age, gender, sides, fracture causes, type of fracture, and time from injury to operation between 2 groups (P>0.05). The fluoroscopy times, operation time, intraoperative blood loss, fracture healing time were recorded and compared between 2 groups. The limb function was evaluated according to the Sanders scores and Flynnet al. outcome score. Results All the patients were followed up 6-24 months (mean, 11.46 months). The operation time, intraoperative blood loss, and fracture healing time of group A were significantly less than those of group B, but the fluoroscopy times of group A was significantly more than that of group B (P<0.05). All the fractures were healed, no breakage of screw, infection of deep tissue, nerve injury, osteonecrosis of the femoral head, or other complication occurred. At last follow-up, according to the Sanders scores, the results were excellent in 14 cases, good in 4 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 12 cases, good in 3 cases, and fair in 1 case in group B with an excellent and good rate of 93.75%; showing no significant difference between 2 groups (χ2=0.400, P=0.980). According to the Flynn et al. outcome score, the results were excellent in 13 cases, good in 5 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 11 cases, good in 3 cases, and fair in 2 cases in group B with an excellent and good rate of 87.50%; showing no significant difference between 2 groups (χ2=0.748, P=0.688). Conclusion Both TEN and locking compression plate have satisfactory outcomes for treating pediatric femoral subtrochanteric fractures. TEN method has minimally trauma, security, and faster fracture healing when compared with locking compression plate.
ObjectiveTo investigate the effects of intraoperative intermittent pneumatic compression (IPC) treatment on coagulation and fibrinolysis, lower extremity venous blood flow velocity, and deep venous thrombosis (DVT) in patients with gastric cancer (GC) after radical gastrectomy. MethodsThe patients with GC who underwent radical gastrectomy at Hebei Provincial People’s Hospital from July 2021 to July 2024 were retrospectively enrolled, then the patients were assigned into control group (the patients who did not receive intraoperative IPC) and study group (the patients who received intraoperative IPC), and the propensity score matching (PSM) method was used to conduct 1∶1 matching based on the basic characteristics such as age, gender, body mass index, comorbidities to ensure baseline comparability between the two groups. The incidences of postoperative DVT and lower extremity swelling, and coagulations [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT)] and fibrinolysis [D-dimer (D-D), fibrinogen (FIB), and fibrin degradation products (FDP)], as well as lower extremity venous blood flow velocity were analyzed after PSM. The locally weighted regression was used to analyze the correlation between the coagulation and fibrinolytic functions indexes and the lower extremity venous blood flow velocity. ResultsA total of 120 patients were matched (60 cases per group). The baseline characteristics of both groups were comparable (P>0.05). The incidences of DVT on day 7 and lower extremity swelling on day 1, 3, and 7 after surgery in the study group were significantly lower than those in the control group (P<0.05). The results of repeated-measures analysis of variance showed that there were statistically significant differences in the inter-group, time-related, and group-by-time interaction effects of coagulation and fibrinolysis indexes as well as lower extrimety venous blood flow velocities (P<0.05). The impact of the time factor on coagulation and fibrinolysis indexes and lower extrimety venous blood flow velocities varied with intraoperative IPC intervention measures. After surgery, the PT, TT, APTT, and lower extrimety venous blood flow velocities in the study group first decreased and then increased as compared with those before surgery, and the decrease degree was smaller and the increase degree was larger than those in the control group. After surgery, the D-D, FIB, and FDP in the study group first increased and then decreased as compared with those before surgery, and the increase degree was smaller and the decrease degree was larger than those in the control group. Both PT and TT were significantly positively correlated with femoral vein blood flow velocity (r=0.21, P=0.042; r=0.22, P=0.040), and both also showed significant positive correlations with popliteal vein blood flow velocity (r=0.25, P＜0.001; r=0.20, P=0.032). APTT was only significantly positively correlated with popliteal vein blood flow velocity (r=0.33, P＜0.001). D-D was negatively correlated with the flow velocities of the femoral vein, external iliac vein, and popliteal vein (r=–0.23, P=0.012; r=–0.22, P=0.047; r=–0.37, P<0.001). Both FIB and FDP were negatively correlated with the flow velocity of the femoral vein (r=–0.23, P=0.036; r=–0.27, P=0.002). FIB was also negatively correlated with the flow velocity of the popliteal vein (r=–0.26, P=0.038), and FDP was negatively correlated with the flow velocity of the external iliac vein (r=–0.31, P<0.001). ConclusionBased on the results of this study, intraoperative IPC treatment could improve coagulation and fibrinolytic functions of patients with GC after surgery, and has a certain preventive effect on occurrence DVT of lower extremity.
ObjectiveTo evaluate the safety and mid-to-long term outcomes of catheter-directed thrombolysis (CDT) in combination with percutaneous mechanical thrombectomy (PMT) followed by stent placement treatment for acute proximal deep vein thrombosis (DVT) complicated by iliac vein compression syndrome (IVCS), and to identify risk factors relevent to primary stent restenosis. MethodsA retrospective study was conducted. The patients diagnosed with acute proximal DVT and concurrent IVCS who underwent CDT in combination with PMT followed by stent placement at the First Affiliated Hospital of Chongqing Medical University from January 2018 to December 2021 were included. The demographics, clinical history, and procedural data were collected. The postoperative follow-up using color Doppler ultrasound were scheduled at 3, 6, and 12 months, and annually thereafter. The primary and secondary stent patency rates were evaluated. The univariate and multivariate Cox proportional hazards regression models were employed to assess risk factors for primary stent restenosis. ResultsA total of 188 patients who met the inclusion and exclusion criteria were enrolled, underwent CDT combined with PMT and stent implantation, and completed follow-up. During the follow-up, the restenosis occurred in 26 patients. The cumulative primary patency rates at 3, 6, 12, 24, 36, and 48 months after surgery were 100%, 98.9%, 92.5%, 88.3%, 86.7%, and 86.2%, respectively. The multivariate Cox proportional hazards regression analysis confirmed that a history of previous DVT [HR (95%CI)=4.21 (1.73, 10.28), P=0.002], implantation of two or more stents [HR (95%CI)=11.85 (1.66, 84.63), P=0.014], stent crossing the inguinal ligament [HR (95%CI)=9.92 (1.87, 52.78), P=0.007], and stent length [HR (95%CI)=0.98 (0.97, 0.99), P=0.003] were the affecting factors for primary restenosis. ConclusionsThe findings of this study suggest that CDT combined with PMT and stent implantation is a safe and effective strategy for treating acute proximal DVT complicated by IVCS. Close attention should be paid to the occurrence of restenosis in patients with two or more stents, stent crossing the inguinal ligament, and a history of previous DVT.
Objective To investigate the cl inical appl ication and efficacy of lumbar vertebral canal expansion withpreservation of posterior l igaments complex, and to study its biomechanical properties. Methods Eight fresh lumbosacralcadaveric samples were divided into 3 groups. In group A, 8 intact lumbosacral cadaveric samples were used for biomechanical test. In group B, L3-5 laminectomy were, after the test in group A, performed and the posterior l igaments complex was preserved. In group C, the posterior l iagments complex was excised after the test in group B. In all 3 groups, the axial compression test, three-point bending test and torsional test were conducted. From June 2000 to June 2006, 309 patients (152 males and 157 females, aged 20-80 years with the average of 57.2 ) with lumbar canal stenosis received operation of the lumbar vertebral canal expansion with preservation of posterior l igaments complex. The course of disease was 3 months to 41 years. There were 55 patients suffering from pure lumbar canal stenosis, and 254 from lumbar canal stenosis combined with lumbar disc herniation, among which 105 were at L4, 5 level, 56 at L4-S1 level, 86 at L5, S1 level, and 7 at L2, 3 level. The therapeutic effect was assessed based on the JOA low back pain scoring system, the satisfaction degree of patient and radiographical observation. Results The axial compression test was performed. In the position of forward bending, stress, strain and axial displacement were smaller in groups A, B than those in group C, and axial stiffness in groups A, B was higher than those in group C, and the difference was significant(P lt; 0.01). In the position of backward extension, there was no significant difference among 3 groups (P gt; 0.05). Concerning the three-point bending test, under the same bending moment, there was a significant difference in deflection, dip and bending rigidity between group A and group C, and also between group B and group C (P lt; 0.01), but no significant difference between group A and group B (P gt; 0.05). In the torsional test, under the same torsional angle, the torque in group B was bigger than that in group C (P lt; 0.01). Under the same torque, the torsional angle in group B was smaller than that in group C (P lt; 0.01), and the torsional stiffness in group B was higher than that in group C (P lt; 0.01). The compl ications included 7 cases of distraction of nerve root, 5 leakage of cerebrospinal fluid and 4 wound infection. All compl ications were treated and restored completely. All patients were followed up for 1-7 years. According to the JOA low back pain scoring system, the improvement rate averaged 86.0%. Of all the 309 cases, 163 were excellent, 112 good, 34 fair, and the choiceness rate was 89%. The satisfaction rate of patient was 87%. There was no radiographic vertebral instabil ity postoperatively. Conclusion The lumbar vertebral canal expansion with preservation of posterior l igaments complex is conducive to maintaining the stabil ity of lumbar spine and have good cl inical outcomes.
ObjectiveTo investigate the effect of non-heated silver needle decompression under the guidance of pathogenic principle of muscle shortening on patients with cervical vertebra disease of the nerve root type. MethodsSixty patients diagnosed with cervical vertebra disease of the nerve root type between April 2007 and June 2009 were divided randomly into therapy group (n=30), treated with non-heated silver needle decompression, and control group (n=30), treated with physical therapy. Then, we observed the total effective rate, positive physical signs and electrophysiological indexes of the patients 3, 6, 12, and 24 months after treatment. ResultsThe total effective rate was 96.7%, 93.3%, 93.3% and 86.7% in the therapy group 3, 6, 12, and 24 months after treatment, while it was 80.0%, 63.3%, 60.0%, and 50.0% in the control group, and the diTherence between the two groups in each time point was significant (P<0.05). The rate of positive sign in the top pressure test and Brachial plexus traction test lowered significantly 3, 6, and 12 months after treatment in both the two groups (P<0.05), while the rate lowered significantly only in the therapy group 2 years after treatment (P<0.05). Paraspinal tenderness lowered significantly at each time point in the therapy group after treatment (P<0.05), while the decrease in the control group had no significance (P<0.05). The interpeak latency of somatosensory evoked potential N9-N13 got significantly shorter at each time point after treatment in the therapy group (P<0.05), while this only happened at the time points of 3 and 6 months after treatment in the control group (P<0.05). The latency of wave F got significantly shorter at each time point after treatment in the therapy group (P<0.05), while the shortening only occurred 6 months after treatment in the control group (P<0.05). ConclusionNon-heated silver needle decompression under the guidance of pathogenic principle of muscle shortening is an effective treatment for patients with cervical vertebra disease of the nerve root type.