ObjectiveTo explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. MethodsEight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. ResultsThe reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. ConclusionOne-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.
ObjectiveTo investigate the diagnosis and treatment of thumb polydactyly with symphalangism in children.MethodsSeven cases of thumb polydactyly with symphalangism were treated between January 2013 and May 2017. There were 5 males and 2 females, aged from 10 months to 11 years, with an average age of 3.1 years. The thumb-polydactyly was diagnosed with MRI and it was seen that the base of radial multi-finger and the proximal phalangeal joint were connected by cartilage. All patients were treated with resection, lateral collateral ligament reconstruction, bone osteotomy and internal fixation.ResultsThe operation was successfully completed, and there was no early complications such as infection and flap necrosis. All patients were followed up 6-23 months (mean, 14.1 months). At last follow-up, there was no deformity finger, scar contracture, and other complications. The extension of the interphalangeal joint was no limited, and the flexion range of the interphalangeal joint was 20-75° (mean, 56.7°). The appearance and function of the thumb was rated as excellent in 3 cases and good in 4 cases by Japanese Society for Surgery of the Hand (JSSH) scoring, with the excellent and good rate of 100%.ConclusionThe thumb polydactyly with symphalangism in children can be combined with clinical manifestations, X-ray film, and MRI examination to diagnose, and can obtain satisfactory results through the reconstruction of lateral collateral ligament, bone osteotomy, and internal fixation.
ObjectiveTo explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication.MethodsTwelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring.ResultsAll the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry improved in all cases. The ratio of circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases.ConclusionThe anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
ObjectiveTo compare the effective of short-segment pedicle instrumentation with bone grafting and pedicle screw implanting in injured vertebra and cross segment pedicle instrumentation with bone grafting in injured vertebra for treating thoracolumbar fractures. MethodsA prospective randomized controlled study was performed in 40 patients with thoracolumbar fracture who were in accordance with the inclusive criteria between June 2010 and June 2012. Of 40 patients, 20 received treatment with short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra in group A, and 20 received treatment with cross segment pedicle instrumentation with bone grafting in injured vertebra in group B. There was no significant difference in gender, age, affected segment, disease duration, Frankel grade, Cobb angle, compression rate of anterior verterbral height, visual analogue scale (VAS) score, and Japanese Orthopaedic Association (JOA) score between 2 groups before operation (P>0.05). The operation time, blood loss, Cobb angle, compression rate of anterior vertebral height, loss of disc space height, Frankel grade, VAS and JOA scores were compared between 2 groups. ResultsThere was no significant difference in the operation time and blood loss between 2 groups (P>0.05). Primary healing of incision was obtained in all patients, and no early complication of infection or lower limb vein thrombus occurred. Forty patients were followed up 12-16 months (mean, 14.8 months). No breaking or displacement of internal fixation was observed. The improvement of Frankel grading score was 0.52±0.72 in group A and 0.47±0.63 in group B, showing no significant difference (t=0.188, P=0.853) at 12 months after operation. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and 12 months, and JOA score at 12 months were significantly improved when compared with preoperative ones in 2 groups (P<0.05). No significant difference was found in Cobb angle, disc space height, VAS score, and JOA score between 2 groups at each time point (P>0.05), but the compression rate of anterior verterbral height in group A was significantly lower than that in group B (P<0.05). The loss of disc space height next to the internal fixation or the injured vertebra was observed in 2 groups at 12 months, but showing no significant difference (P>0.05). ConclusionCompared with cross segment pedicle instrumentation, short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra can recover and maintain the affected vertebra height in treating thoracolumbar fractures, but it could not effectively prevent degeneration of adjacent segments and the loss of kyphosis correction degree.
ObjectiveTo compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. MethodsThirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. ResultsThe operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05). ConclusionCoracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.
ObjectiveTo compare the effectiveness of proximal femoral nail anti-rotation (PFNA) between in the supine "scissors" position and in the lithotomy position for treating femoral intertrochanteric fractures of old patients. MethodsA retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. Fracture was treated with PFNA in the lithotomy position in 28 cases (group A) and in the supine "scissors" position in 30 cases (group B). There was no significant difference in gender, age, side, cause of injury, fracture type, and interval from injury to operation between 2 groups (P>0.05). The incision length, operation time, perspective times, intraoperative blood loss, complications, and fracture healing time were recorded; Harris hip score was used to access the effectiveness. ResultsThe wound healed by first intention without infection, pressure sores, deep vein thrombosis of lower extremity, and other complications. There was no significant difference in incision length between 2 groups (t=1.313, P=0.212). Group B was significantly better than group A in operation time, perspective times, and intraoperative blood loss (P<0.05). All patients were followed up 10-31 months (mean, 15.3 months). Stretch injury at normal side and perineal discomfort occurred in 1 case and 5 cases of group A respectively, and no nonunion and other complications was observed in the other patients. There was no significant difference in fracture healing time and Harris hip score at last follow-up between 2 groups (P>0.05). ConclusionPFNA in the supine "scissors" position has exact effectiveness and advantages of shorter operation time, less intraoperative blood loss, less perspective times, and fewer complications.
ObjectiveTo compare the effectiveness of percutaneous kyphoplasty (PKP) between by unilateral approach and by bilateral approaches for treating mid-thoracic osteoporotic vertebral compression fracture (OVCF). MethodA prospective randomized controlled study was performed on 22 patients with mid-thoracic OVCF between September 2012 and June 2014. PKP was performed by unilateral approach in 11 cases (group A) and by bilateral approaches in 11 cases (group B). There was no significant difference in gender, age, causes of injury, disease duration, affected segment, preoperative bone mineral density, Cobb angle, compression rate of the anterior verterbral height, and Visual analogue scale (VAS) score between 2 groups (P>0.05) . The operation time, perspective times, hospitalization expenses, the leakage of cement, the sagittal Cobb angle, compression rate of the anterior vertebral height, and VAS scores were compared between 2 groups. ResultsThe operation time, perspective times, and hospitalization expenses of group A were significantly less than those of group B (P<0.05) . Twenty-two patients were followed up 13-34 months (mean, 15.3 months). Primary healing of incision was obtained in all patients, and no early complication of cement leakage, hypostatic pneumonia, or deep vein thrombosis occurred. At last follow-up, no new fracture occurred at the adjacent segments. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05) , but no significant difference was found between at 1 week and at last follow-up (P>0.05) . There was no significant difference in Cobb angle, compression rate of the anterior vertebral height, and VAS score between 2 groups at each time point (P>0.05) . ConclusionsPKP by both unilateral approach and bilateral approaches has the same effectiveness, but unilateral approach has shorter operation time, less perspective times, and less hospitalization expenses than bilateral approaches.