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find Keyword "腕关节" 38 results
  • PROGRESS OF TREATMENT OF WRIST DISORDER BY LIMITED INTERCARPAL ARTHRODESIS

    OBJECTIVE: To review the recent progress in the treatment of wrist disorder by limited intercarpal arthrodesis and the related experimental study. METHODS: Recent original articles related to limited intercarpal arthrodesis, including clinical practice and experimental study, were extensively retrieved and carefully analyzed. RESULTS: Limited intercarpal arthrodesis could relieve pain and stabilize the wrist joint with partial motion. CONCLUSION: With suitable indication and well selected operation approach, the limited intercarpal arthrodesis should be the optimal surgical intervention than total carpal athrodesis in the treatment of wrist disorder.

    Release date:2016-09-01 10:21 Export PDF Favorites Scan
  • 腕部痛风性关节炎一例

    (正文)1  病例介绍患者  男,30 岁。2009 年 3 月无明显诱因出现右腕关节红肿、疼痛并腕关节活动受限。检查:右腕轻度肿胀,皮温较高,无红斑。腕关节掌屈、背伸、桡偏、尺偏活动度分别为 20、30、10 和 20°。血尿酸 579 μmol/L。X 线片检查示右腕关节骨质密度减低,呈骨质疏松改变,右腕舟状骨骨质欠规整。CT 检查示右腕关节骨质密度减低,骨小梁纤细,关节面模糊,周围软组织肿胀(图 1)。入院诊断为腕部痛风性关节炎。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • LIMB SALVAGE SURGERY FOR WRIST IN BONE TUMOR BY USING FREE VASCULARISED FIBULAR GRAFT WITH FIBULAR HEAD OR SIMPLE FIBULAR GRAFT

    Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.

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  • DORSAL INTERCARPAL LIGAMENT CAPSULODESIS FOR CHRONIC STATIC SCAPHOLUNATE DISSOCIATION

    Objective To investigate the radiographic and clinical outcomes of dorsal intercarpal ligament capsulodesis (DILC) procedure for chronic static scapholunate dissociation. Methods Between January 2008 and January 2011, 12 patients with chronic static scapholunate dissociation were treated with DILC. Of 12 cases, 10 were male and 2 were female with an average age of 42 years (range, 20-66 years). All injuries were caused by falling. The interval from injury to surgery was 3-19 months (mean, 8 months). Physical examination at admission showed wrist tenderness and limited range of motion (ROM). Radiological examination showed that scapholunate gap was greater than 3 mm on posteroanterior view, and scapholunate angle more than 60° on the lateral view. Before operation, the grip strength was (25.4±8.2) kg; the wrist ROM was (56.7±11.5)° in flexion and (52.0±15.2)° in extension; visual analogue scale (VAS) score was 6.3±1.4; and disabilities of arm, shoulder & hand (DASH) score was 39.5±7.4. According to Garcia-Elias staging criteria, all cases were rated as stage 4, indicating that the scapholunate interosseous ligament was completely injured and reduction could easily be obtained. Eight patients had wrist instability. Results Primary healing of incision was achieved, no complication was found. All patients were followed up 13-34 months (mean, 15.9 months). During surgery, all deformities were corrected completely, but 7 patients (58%) recurred at 1 month after Kirschner wire removal. Compared with preoperative ones, the scapholunate gap, scapholunate angle, radiolunate angle, lunocapitate angle, and wrist height ratio at 1 month after Kirschner wire removal and last follow-up showed no significant difference (P > 0.05); the wrist flexion and extension ROM were significantly decreaed to (46.8±7.2)° and (42.0±9.0)° at last follow-up (P < 0.05); the grip strength was significantly increased to (32.7±9.6) kg at last follow-up (P < 0.05); VAS score and DASH score were improved to 1.7±1.0 and 8.1±8.7 (P < 0.05). Conclusion Carpal collapse will recur in short time after DILC. DILC is not the best way to treat chronic static scapholunate dissociation.

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  • 高原腕关节结核的诊断与治疗

    目的 总结高原地区腕关节结核的诊断及治疗方法。 方法 回顾分析2007 年10 月- 2009 年10月25 例腕关节结核患者临床资料。男12 例,女13 例;年龄25 ~ 65 岁,平均34.6 岁。左腕15 例,右腕 10 例。其中15例有肺结核或既往有肺结核病史。腕关节结核发病至入院时间为2 ~ 8 个月,平均6 个月。单纯腕关节滑膜结核10 例行保守治疗;全腕关节结核12 例、腕部屈肌腱腱鞘结核3 例采用化疗联合手术病灶清除治疗。 结果 治疗后除2 例全腕关节结核及1 例腕部屈肌腱腱鞘结核患者切口Ⅱ期愈合外,其余患者切口均Ⅰ期愈合。患者均获1 年6 个月随访。随访期间无结核复发,切口周围均无再次窦道形成。10 例单纯腕关节滑膜结核者及3 例腕部屈肌腱腱鞘结核者腕关节、掌指关节及指间关节活动自如,均于治疗后2 个月完全恢复劳动。12 例全腕关节结核者前臂旋前平均70°、旋后70°,较术前明显改善,术后4 个月完全恢复劳动。 结论 早期诊断、手术前后联合化疗、及时手术清除病灶、术后腕关节石膏固定、同时加强各掌指及指间关节活动,是治疗腕关节结核的有效方法。

    Release date:2016-08-31 05:43 Export PDF Favorites Scan
  • WRIST JOINT RECONSTRUCTION WITH VASCULARIZED FIBULAR HEAD GRAFT AFTER RESECTION OF DISTAL RADIUS GIANT CELL TUMOR

    Objective To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Methods Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size oftumor was 6.5 cm 3.5 cm-8.0 cm 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15° (mean, 10.7°), flexion 9-21° (mean, 14.2 ), radial incl ination 0-10 (mean, 8.6 ), and ulnar incl ination 0-15° (mean, 7.9°). The ROM of forearm was as follows: pronation 15-50 (mean, 28.7 ) and supination 10-25° (mean, 16.5°). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. Results All patients achieved primary heal ing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone heal ing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 (mean, 29.0 ), flexion 30-50° (mean, 35.0°), radial incl ination 10-20° (mean, 16.5°), and ulnar incl ination 20-25 (mean, 23.5 ). The ROM of forearm was as follows: pronation 40-90° (mean, 68.3°) and supination 30-80 (mean, 59.6 ). There were significant differences in the ROM between before operation and after operation (P lt; 0.05). According to the Krimmer et al wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Conclusion Wrist joint reconstruction with vascularized fibular head graft can restore function of wrist joint. The operation is proved to be safe and effective in treating distal radius giant cell tumor.

    Release date:2016-09-01 09:04 Export PDF Favorites Scan
  • ANATOMICAL AND BIOMECHANICAL RESEARCH OF DORSAL WRIST INTEROSSEOUS LIGAMENTS

    Objective To explore the anatomical features of some major dorsal wrist interosseous l igaments, and to measure their biomechanical properties to screen a suitable donor site for the repair of scapholunate dorsal l igament. Methods Sixteen wrist joints from 8 frozen fresh male adult cadavers were selected, whose age was 20-38 years and whose height was 165-178 cm. There were no injuries to their wrists. The follow l igaments were observed and measured for the interosseous l igaments: volar and dorsal scapholunate l igaments (SL-v, SL-d), lunotriquetral dorsal l igament (LT), trapezoidcapitate dorsal l igament (TC), capitohamate l igament (CH) and the 2nd-4th carpometacarpal l igaments (CMC-2-4). The bone-l igament-bone samples of the above l igaments were prepared for further biomechanical measurements. Ligament extension testing was performed for each bone-l igament-bone sample on a material testing system. The broken load and length were measured and statistically analyzed. Results The SL and the LT were both “C” shape, attaching to the volar, proximal and dorsal joint surface. The TC and CH l igaments were mainly transverse fibers, which connected with each other at the dorsal side of capitate. The CMC-2-4 l igaments were obl iquitous fibers. Within these wrist interosseous l igaments, the SL-v and CMC-4 were relatively long. The l igament length differences were significant between SL-v and TC and between CMC-4 and TC (P lt; 0.05). TC and CMC-2 were fairly thick. But there was no significant difference among the l igaments (P gt; 0.05). SL-d had the highest broken load of (73.6 ± 9.6) N. The broken load differences were all significant between SL-d and other l igaments (P lt; 0.05). SL-v had largest broken length of (5.24 ± 1.65) mm. The broken length differences were all significant between SL-v and other l igaments (P lt; 0.05). Conclusion The anatomical structures and biomechanical features of the wrist interosseous l igaments were closely related with their physiological functions. CMC-2 and CH are both suitable to be used for the repair of scapholunate dorsal l igament.

    Release date:2016-09-01 09:05 Export PDF Favorites Scan
  • EFFECT OF ASSOCIATED ULNAR STYLOID FRACTURE ON WRIST FUNCTION AFTER DISTAL RADIUS FRACTURE

    Objective To evaluate the effect of associated ulnar styloid fracture on wrist function after distal radius fracture by comparing the cl inical data between the cases of distal radius fracture with or without ulnar styloid fractures. Methods The cl inical data of 182 patients with distal radius fracture between February 2005 and May 2010 were retrospectively analyzed, including 75 with ulnar styloid fracture (group A), and 107 without ulnar styloid fracture (group B). There was no significant difference in sex, age, disease duration, and fracture classification between 2 groups (P gt; 0.05). In groups A and B, closed reduction and spl intlet or cast fixation were performed in 42 and 63 cases respectively, and openreduction and internal fixation in 33 and 44 cases respectively. All ulnar styloid fractures were not treated. Results Thepatients were followed up 21 months on average in group A and 20 months on average in group B. All incisions healed by first intention after operation. Ulnar wrist pain occurred in 4 patients (5.3%) of group A and 6 patients (5.6%) of group B, showing no significant difference (χ2=0.063, P=0.802). The fracture heal ing time was (10.9 ± 2.7) weeks in group A and (11.6 ± 2.3) weeks in group B, showing no significant difference (t=1.880, P=0.062). There was no significant difference in the palmar tilt angle, the ulnar incl ination angle, and the radial length between groups A and B when fracture healing (P gt; 0.05). At last follow-up, there was no significant difference in wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip and pinch strength between 2 groups (P gt; 0.05). According to the Gartland-Werley score in groups A and B, the results were excellent in 24 and 35 cases, good in 43 and 57 cases, fair in 5 and 10 cases, and poor in 3 and 5 cases with execllent and good rate of 89.3% and 86.0%, respectively, showing no significant difference between 2 groups (Z= —0.203, P=0.839). There were significant differences in the above indexes between patients undergoing closed reduction and open reduction in group A (P lt; 0.05). Conclusion Associated ulnar styloid fracture has no obvious effect on the wrist function after distal radius fracture. The anatomical reduction of distal radial fracture is the crucial importance in the treatment of distal radial fracture accompanying ulnar styloid fracture.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 舟骨月骨间韧带损伤修复早期效果

    目的 评价采用骨锚治疗舟骨月骨间韧带损伤的早期临床效果。 方法 2005 年9 月- 2008 年12 月, 采用Mitek 骨锚修复9 例舟骨月骨间韧带损伤,其中男8 例,女1 例;年龄24 ~ 40 岁,平均31 岁。受伤距韧带修复时间为7 ~ 40 d,平均22 d。9 例经X 线片检查均符合舟骨月骨间韧带损伤诊断标准。术后定期随访,包括疼痛程度、腕关节活动度、双手握力及X 线片检查。腕关节总体功能评价采用Krimmer 腕关节评分表。患者自我功能评价采用患者源性功能调查表上肢功能(DASH)评定表。 结果 患者术后切口均Ⅰ期愈合。9 例均获随访,随访时间7 ~ 18 个月,平均10 个月。术后6 个月X线片检查示舟骨月骨间隙及舟月角分别为(2.8 ± 0.7)mm、(53 ± 9)°,较术前的(5.1 ± 0.8) mm、(80 ±13)° 明显减小,差异有统计学意义(P lt; 0.05)。术后12 个月腕关节屈伸活动度为(97 ± 16)°,术前为(60 ± 10)°;尺桡偏活动度为(55 ± 12)°,术前为(32 ± 9)°;双手握力为(36 ± 7)kg,术前为(28 ± 6)kg;腕关节疼痛视觉模拟评分(VAS)为(21.0 ± 5.2)分,术前为(43.0 ± 11.0)分;以上各指标手术前后比较差异均有统计学意义(P lt; 0.05)。术后18 个月腕关节总功能Krimmer 评分为(82 ± 12)分,其中优4 例,良4 例,中1 例,与术前(56 ± 10)分比较差异有统计学意义(P lt; 0.05)。术后12 个月DASH 评分为(23 ± 12)分,术前为(42 ± 14)分,手术前后比较差异有统计学意义(P lt; 0.05)。 结论 骨锚修复舟骨月骨间韧带能恢复舟月骨稳定性,术后腕关节功能明显改善。

    Release date:2016-09-01 09:04 Export PDF Favorites Scan
  • BIOMECHANICAL EVALUATION OF STABILITY OF THE VOLAR CAPSULAR LIGAMENT COMPLEX

    【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
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