Objective To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. Methods From April 2004 to December 2006,25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifing. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years).HV angle was 21.45° (mean 31.30°), intermetatarsal(IM) angle was 7-21° (mean 12.52°). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. Results The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30°±2.62° and 6.50°±2.46° respectively, showing significantdifferences when compared with before operation (Plt;0.05). According to the American Orthopaedic Foot amp; Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet,and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2feet after 3 months of operation, no HV recurred. ConclusionThe HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.
ObjectiveTo evaluate the effect of reconstruction of forearm interosseous membrane (IOM) using extensor carpi radialis longus combined with radial head replacement for restoring the forearm longitudinal stability. MethodsTen fresh-frozen adult cadaveric forearms were selected, including 8 males and 2 females with a mean age of 38.2 years (range, 29-74 years). Each forearm was treated as following steps: radial head excision (group A), radial head excision+the distal ulnar radial joints separation (group B), radial head excision+the distal ulnar radial joints separation+IOM central band excision (group C), reconstructed IOM with extensor carpi radialis longus tendon (group D), radial head prothesis replacement (group E), and reconstructed IOM with extensor carpi radialis longus tendon+radial head prothesis replacement (group F). The distance between ulna and radius and radioulnar joint displacement were observed under load and non load. The force loading on both ends of specimen was recorded when the radius shifted 5 mm proximally. ResultsRestoring the radial length could maintain normal distance between radius and ulna. The interosseous membrance reconstruction could restore the load transmission between radius and ulna. The force loading specimen was (74.507±4.967), (49.227±1.940), (17.827±1.496), (24.561±1.390), (140.247±8.029), and (158.423±9.142)N in groups A, B, C, D, E, and F respectively when the radius shifted 5 mm proximally, showing significant difference among groups (P < 0.01). ConclusionReconstruction of the IOM with the extensor carpi radialis longus tendon is insufficient to restore the forearm longitudinal stability. Reconstruction using extensor carpi radialis longus tendon combined with radial head replacement may be a new choice for treatment of forearm longitudinal instability.
Objective To assess the long-time results of reconstruction of the extensor pollicis longus (EPL) function by transfer of the extensorindicis(EI). Methods From August 1978 to March 2003, 46 cases of loss of the EPL function were treatedby transfer of the extensor indicis. Of 46 cases, there were 32 males and 14 females, aged 16-51 years with an average of 36 years; there were 24 cases of oldtraumatic rupture and 22 cases of secondary rupture. The disease course was 2 days to 5 months, averaged 74 days. A specific EIEPL evaluation method (SEEM) wasused to measure the EPL function after transfer.Results Fortyone cases were followed up 9 years and 3 months on average (7 months to 23 years). Based on the SEEM, the results were excellent and good in 39 of 41 patients. The elevation deficit and combined flexion deficit were 0-2.2 cm (1.8 cm on average) and 0-3 cm (1.6 cm on average); the independent extension deficit was 0°-8° (5° on average). Conclusion Restoration of the extensor pollicis function by transfer of the extensor indicis is an effective and safe treatment option and the SEEM is a valid method for assessing EPL function.
Objective To explore the difference of white matter changes between bipolar affective disorder and schizophrenia using diffusion tensor imaging (DTI). Methods Patients with bipolar affective disorder and schizophrenia were selected from the Mental Health Center of West China Hospital of Sichuan University between October 2014 and January 2017. Volunteers were recruited from October 2014 to January 2017. The included patients were divided into bipolar affective disorder group and schizophrenia group according to their diagnosis. Volunteers were divided into normal control group. The bipolar affective disorder group was divided into two subgroups: manic episode and depressive episode. DTI was performed on the included patients and volunteers. Tract based spatial statistics (TBSS) was used to study the differences in fractional anisotropy (FA) of white matter between patients and normal controls, and FA values of two subgroups of bipolar affective disorder and schizophrenia were compared. Results A total of 99 patients and 40 normal controls were included in this study. Among them, there were 40 cases in schizophrenia group and 59 cases in bipolar affective disorder group (31 cases of manic episode and 28 cases of depressive episode). Compared with the normal control group, FA values decreased in corpus callosum, fornix, occipital forceps and left inferior longitudinal fasciculus with bipolar affective disorder group and schizophrenia group (P<0.05). There was no significant difference in FA values between bipolar affective disorder group and schizophrenia group (P>0.05), but the FA value in left posterior thalamic radiation decreased in depressive episode of bipolar affective disorder group compared with schizophrenia group (P=0.001). Conclusions There are similarities between white matter changes in bipolar affective disorder and schizophrenia. However, the white matter change in posterior thalamic radiation may be the characteristic change in depressive episode of bipolar affective disorder.
ObjectiveTo explore the correlation between cognitive function and diffusion tensor imaging (DTI) in children with self-limited epilepsy with centrotemporal spikes (SelECTS). Methods A total of 28 children with SelECTS who visited our hospital from June 2020 to December 2022 were selected as the SelECTS group. An additional 28 healthy children of similar age and gender were selected as the control group. Cognitive function was assessed using the Wechsler Intelligence Scale for Children (WISC). The SelECTS group also underwent cranial DTI. The results of the WISC were then combined with DTI values for correlation analysis. Results Children in the SelECTS group exhibited varying degrees of cognitive deficits. Their full-scale IQ and verbal IQ were significantly lower than those of the control group (P<0.05). Specific cognitive domains, including classification, verbal comprehension, block design, knowledge, and comprehension, also showed significantly lower scores compared to the control group (P<0.05). DTI revealed significant microstructural changes in multiple regions of interest in the SelECTS group (P<0.05), and these changes were correlated with the results of several cognitive function tests. Conclusion Children with SelECTS have certain cognitive deficits. There is evidence of occult damage in brain white matter, and cognitive function is correlated with damage in specific brain regions.
ObjectiveChildhood absence epilepsy (CAE) is a common syndrome of idiopathic generalized epilepsy.However, little is known about the brain structural changes in this type of epilepsy, especially in the default mode network (DMN) regions.Diffusion tensor imaging (DTI) is a noninvasive techniques that can be used to quantitatively explore structural characteristics of brain.This study aims at using the DTI technique to quantify structural abnormalities of DMN nodes in CAE patients.MethodDTI data were obtained in 14 CAE patients and 13 age-and gender-matched healthy controls.The data were analyzed using voxel-based analysis (VBA) and statistically compared between patients and controls.For the regions with significant difference in group comparison, their DTI metrics were further analyzed with clinical symptoms using Pearson's correlation.ResultsPatients showed significant increase of apparent diffusion coefficient (ADC) in left medial prefrontal cortex (MPFC) (P=0.042), while fractional anisotropy (FA) value was significantly decreased in left precuneus (P=0.010).In correlation analysis, ADC value from left MPFC was positively associated with duration of epilepsy.Neither the disease duration nor the seizure frequency showed significant correlation with FA values.ConclusionThe findings indicate that structural impairments exist in DMN regions in children suffering from absence epilepsy.This may contribute to understanding the pathological mechanisms and chronic neurological deficits of this disorder.
Objective To investigate the result of free vascular transplantation of denervated extensor digitorum brevis and extensor hallusis brevisfor the treatment of late facial paralysis. Methods From April 2003 to April 2005, 26 cases of facial paralyces were treated by transplantation of denervated extensor digitorum brevis and extensor hallusis brevis. During operation, the ends of the tendons were fixed at ala nasi, middle point of nasal labial fold,oral commisure and chin; the muscle belly were put around the masseter nerveto correct the nasal and oral deformity, microsurgery was applied to anastomosethe tarsus lateral vessels to the superficial temporalis vessels or the facial vessels. The result of the operation was evaluated by the Standard of Douglas Harrison and the Paresis Assessment scoring system of Stennert. Results The static appearance was satisfactory in 26 cases after operation, the bilateral oral commisure was symmetry and the dynamic appearance was greatly improved 6 months after operation. Among the 23 cases whose disease history was above 2 years，all could smile naturally and show their teeth symmetrically except 1 case whocould only move the oral commissure. Among the 3 cases whose disease history was less than 2 years, one could smile naturally and show his teeth symmetrically, one could smile but could not show his teeth symmetrically, another could move oral commissure but have no motion appearance. The result was evaluated as“” according to Standard of Douglas Harrison, accounting for 88% (23/26). Evaluated according to the Paresis Assessment scoring system of Stenert, the difference before operation and after operation was more than 5, accounting for 86% (22/26). Conclusion The free vascular transplantation of denervated extensor digitorum brevis and extensor halluces brevis can reconstruct the oral appearance for the treatment of late facial paralysis.
Present study used diffusion tensor image and tractography to construct brain white matter networks of 15 cerebral palsy infants and 30 healthy infants that matched for age and gender. After white matter network analysis, we found that both cerebral palsy and healthy infants had a small-world topology in white matter network, but cerebral palsy infants exhibited abnormal topological organization: increased shortest path length but decreased normalize clustering coefficient, global efficiency and local efficiency. Furthermore, we also found that white matter network hub regions were located in the left cuneus, precuneus, and left posterior cingulate gyrus. However, some abnormal nodes existed in the frontal, temporal, occipital and parietal lobes of cerebral palsy infants. These results indicated that the white matter networks for cerebral palsy infants were disrupted, which was consistent with previous studies about the abnormal brain white matter areas. This work could help us further study the pathogenesis of cerebral palsy infants.
In order to investigate the effect of repair of paratendon in tendon healing, two different ways were performed to repair the transected extensor tendons of chick’s toe. End to end suture of the extensor tenon was performed in group 1 while the paratendon was also repaired simultaneously in addition to suture of the tendon in group 2. Gross observation and histological examination were undertaken in the 3rd and 6th week after operation. The result showed, in group 1, extensive adhesion and irregular proliferation of fibroblasts was found in the 3rd week, severe adhesion and irregular arrangement of fibroblasts with less collagen fiber was found in the 6th week; while in group 2, smooth and regular "fusiform structure" was formed, slight adhesion and regular proliferation of fibroblasts were found in the 3rd week, adhesion disappeared and the structure of paratendon and tondon recovered in the 6th week. It was concluded that repair of extensor tendon and paratendon simultaneously could promote the intrinsic tendon healing and prevent tendon adhesion.
Objective To investigate the feasibility of magnetic resonance diffusion tensor imaging (MRDTI) technique in displaying myocardial fiber architecture. Methods In five ex vivo swine heart, diffusion tensor imaging (DTI) was acquired in 25 directions within 2 hours after excision. The myocardial fiber was reconstructed by using brain white matter tractography algorithm to display its course, distribution and arrangement. Results In the swine heart 1 hour after excision, MRDTI revealed that the arrangement of the myocardial fiber had certain continuity. It spiraled and twisted to form the left and right ventricle. The divection of general myocardial fiber in the left ventricle was vertical below endocardium, horizontal below epicardium and oblique in stratum medium, which is consistent with the theory of ventricular myocardial band. Conclusion MRDTI can reveal the myocardial fiber architecture, showing its integrity and arrangement, and at some level confirming the theory of ventricular myocardial band.