To find new technique for repair of peripheral nerve defect, the nerve elongation repair technique was adopted. Two cases with nerve defect were treated by this method. One was a 12 year old male, the defect length of right radial nerve was 7.2 cm at the elbow. The other one was a 28 year old male, the defect length of left ulnar nerve the was 5 cm at elbow. In this method, the nerve was elongated by slow stretch from distal and proximal end of the ruptured nerve. After a few days, the nerve was repaired by direct suture. After operation, the function of nerves were recovered in 119 days and 114 days respectively. Follow-up for 5 years, the function of the effected limbs were recovered to the normal side. It was concluded that: (1) the peripheral never can be elongated by slow stretch; (2) to stretch the nerve end in a rubber tube can prevent adhesion and connective tissue blocking; (3) strength and supporting point of stretching should be designed carefully.
ObjectiveTo explore the effectiveness of self-made adjustable tractor for correction of inverted ni pple. MethodsBetween March 2005 and March 2011, 37 female patients with inverted ni pples (69 ni pples) underwent continuous traction with self-made adjustable tractor for 2 to 4 months. The age ranged from 18 to 46 years (mean, 23 years). Of 37 cases, 5 had unilateral inverted ni pple, and 32 had bilateral inverted ni pples, including 8 cases (15 ni pples) of mild inversion, 16 cases (30 ni pples) of moderate inversion, and 13 cases (24 ni pples) of severe inversion. The 2 cases (4 ni pples) recurred after traditional surgical method, and 1 case (2 ni pples) had infection because of severe inversion before traction. ResultsNo infection or hemodynamic disorder occurred during traction. All cases were followed up 6-12 months (mean, 8.2 months). Wound healed after traction in 1 patient (2 ni pples) with infection because of severe inversion; 2 recurrent cases (2 ni pples) were cured after re-traction; wire dislocation occurred in 1 case (1 ni pple), and was cured after changing traction position. The shape, sensation, and erectile function were normal after treatment with no scar. ConclusionContinuous traction with selfmade adjustable tractor is a good method for all the types of inverted ni pple. It is a simple, safe, effective, and minimally invasive method without scar.
Objective To observe the effect of continuous elastic outside distraction on the change of collagen content in female mini pig’s ni pples and their supporting tissues, and to investigate the mechanism of continuous elastic outside distraction correcting inverted ni pples. Methods Three 3-month-old female mini pigs (weighing 18.5-22.0 kg), which had 12 nipples, were employed. Four nipples of each minipig were not treated as control group (n=12), and the other nipples were continuously distracted with inverted nipple correction instruments as experimental group (n=24). The nipple specimens were harvested at 2, 4, 8, and 12 weeks after distraction and HE staining was performed to observe the change oftheir tissue structure. And saturated picric acid sirius red staining was used to observe the distribution and content of collagen types I and III, image analysis software for quantitative analysis. Results The control group had normal structure of epidermis at all time points. In experimental group, the epidermis thickened; basal cells, fibroblasts, and capillary significantly prol iferated along with the times; and the content and the density of collagen types I and III increased gradually. There were significant differences in collagen type I at 4, 8, and 12 weeks, and in collagen type III at 2, 4, 8, and 12 weeks between 2 groups (P lt; 0.01). There were significant differences in the ratio of collagen type I to III at 2 and 4 weeks between 2 groups (P lt; 0.05). Conclusion Continuous elastic outside distraction can increase the quantity of collagen types I and III in the tissue, the thickness of the dermis, and the height of the nipple, which may be one of key mechanisms of correction the inverted nipple by continuous elastic outside distraction.
As a potent collagenase activator, ocriplasmin is a recombinant truncated form of serine protease that retains the protease activity of plasmin. Pre-clinical animal experiments, clinical trials and recent clinical studies all indicated a promising outcome of intravitreal injection of ocriplasmin to treat vitreomacular interface diseases, including vitreomacular adhesion (VMA), vitreomacular traction (VMT) and full-thickness macular hole. Ocriplasmin was approved by the Food and Drug Administration of USA in the management of symptomatic VMA, and by the European Medicines Agency in treating VMT-associated macular hole with less than or equal 400 μm. Further randomized controlled clinical trials are needed for further comprehensive observation and evaluation on its efficiency, safety and other noteworthy issues.
ObjectiveTo explore the clinical effect of the end-traction upper limb rehabilitation training system on patients with upper limb motor dysfunction after stroke.MethodsPatients with upper limb motor dysfunction who were admitted to the Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanchang University from September to November 2019 were selected. According to the software, the patients were randomly divided into the experimental group and the control group. Both groups received conventional medical treatment, basic rehabilitation, and activities of daily living training. In addition, the control group received traditional occupational therapy, while the experimental group received end-traction upper limb rehabilitation training. The training time of both groups was 30 min/ (times ·d) and 5 days per week. Rehabilitation evaluation and recording were performed before and after the four-week treatment in both groups using the simplified upper extremity Fugl-Meyer assessment (FMA) and the modified Barthel index (MBI).ResultsA total of 36 patients were enrolled, with 18 in each group. All patients completed the experiment, and no special discomfort was observed. Before the treatment, there was no statistically significant difference in FMA and MBI between the experimental group [(13.22±3.13) and (49.66±6.81) points] and the control group [(14.78±1.70) and (51.67±6.65) points] (t=1.858, 0.896; P=0.072, 0.377). After four-week treatment, FMA and MBI in both groups improved significantly (P<0.05); the difference between the experimental group [(27.56±15.68) and (73.55±8.72) points] and the control group [(17.67±6.73) and (65.33±9.20) points] was statistically significant (t=2.459, 2.751; P=0.019, 0.009).ConclusionsThe end-traction upper limb rehabilitation training system can significantly improve the upper limb motor function of patients with upper limb motor dysfunction after stroke and improve the patients’ daily life ability. It is worthy of clinical promotion and application.
ObjectiveTo observe the medium-term clinical and radiological outcomes of anterior release internal distraction in treatment of severe and rigid scoliosis. MethodsBetween March 2009 and March 2012, 26 patients with severe and rigid scoliosis were treated with anterior release, posterior internal distraction, and two stage posterior spinal fusion. There were 11 males and 15 females with an average age of 19.6 years (range, 14-25 years). The average disease duration was 13.6 years (range, 3-24 years). All cases were idiopathic scoliosis. Of 26 cases, 2 cases were rated as Lenke type I, 8 as type Ⅱ, 13 as type IV, 1 as type V, and 2 as type VI. The apical vertebrae located at T6 in 1 case, at T7 in 3 cases, at T8 in 7 cases, at T9 in 13 cases, and at T10 in 2 cases. The average 4 vertebral bodies were released by anterior approach, and average 14 vertebral bodies were fused after posterior surgery. Fourteen patients received 2 times distraction. Scoliosis Research Society-22 (SRS-22) questionnaire was used to access health-related quality of life. The radiological parameters were measured, including coronal plane Cobb angel of major curve, apical vertebral translation (AVT), C7 plumb line-center sacral vertical line (C7PL-CSVL), sagittal vertical axis (SVA), and thoracic kyphosis (TK) at pre-and post-operation. ResultsThe average total operation time was 592.7 minutes; the average total blood loss volume was 1 311.2 mL; and total hospitalization cost was (14.7±1.4)×104 yuan RMB. The coronal plane Cobb angle of major curve was (55.7±16.5)°, and the TK was (43.2±16.2)° after first distraction. The patients were followed up 2-5 years (mean, 3.8 years). Temporary dyspnea and pleural effusion occurred in 1 case respectively after distraction, and symptoms disappeared after symptomatic treatment. Screw loosening and pseudoarthrosis formation was observed in 1 case at 6 months after fusion, good recovery was achieved after revision. No infection or neurological complication was found. The coronal plane Cobb angel of major curve, TK, and AVT after fusion and at last follow-up were significantly lower than preoperative ones (P<0.05), but no significant difference was found between at post-fusion and last follow-up (P>0.05). There was no significant difference in C7PL-CSVL and SVA between at pre-and post-operation (P>0.05). At last follow-up, SRS-22 questionnaire scores were 4.32±0.42 for active degree, 4.54±0.58 for mental health, 3.97±0.76 for self-image, 4.09±0.64 for pain, and 4.03±0.83 for satisfaction degree. ConclusionAnterior release internal distraction can provide satisfactory correction results for severe and rigid scoliosis with higher safety and lower incidence of complication.