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find Author "高顺红" 14 results
  • RESEARCH PROGRESS OF TREATMENT OF CARPAL TUNNEL SYNDROME

    Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent l iterature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist spl inting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more cl inical researches, and surgical treatment is one method recommended by some scholars.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • MICROSURGERY FOR SEVERE FLEXION CONTRACTURE OF PROXIMAL INTERPHALANGEAL JOINT

    Objective To investigate the cl inical results of cross-finger flap combined with laterodigital pedicled skin flap for repair of severe flexion contracture of the proximal interphalangeal joint. Methods Between October 2008 and February 2011, 11 patients (11 fingers) with severe flexion contracture of the proximal interphalangeal joint were treated with cross-finger flap combined with laterodigital pedicled skin flap. There were 7 males and 4 females, aged 20-63 years (mean, 32.6years). The causes of injury were crush or electric-saw injury in 7 cases, burn or explosive injury in 3 cases, and electrical injury in 1 case. The locations were the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 2 cases, and the l ittle finger in 3 cases. The mean disease duration was 12.4 months (range, 6-24 months). All cases were rated as type III according to Stern classification standard. The volar tissue defect ranged from 3.0 cm × 1.5 cm to 5.0 cm × 2.5 cm, with exposed tendons, nerves, vessels, or bone after scar relaxation. The defects were repaired with cross-finger flaps (2.2 cm × 1.8 cm to 3.8 cm × 2.5 cm) combined with laterodigital pedicled skin flaps (1.5 cm × 1.2 cm to 2.5 cm × 2.0 cm). Double laterodigital pedicled skin flaps were used in 3 cases. The flap donor site was sutured directly or repaired with the skin graft. Results All flaps survived completely and wound healed by first intention. The donor skin graft survived. All the patients were followed up 6-18 months (mean, 11.3 months). The finger appearance was satisfactory. The flaps had soft texture and good color in all cases. No obvious pigmentation or contraction was observed. The contracted fingers could extend completely with good active flexion and extension motion. At last follow-up, the extension of the proximal interphalangeal joint was 10-15°. Based on proximal interphalangeal joint motion standard of Chinese Medical Association for hand surgery, the results were excellent in 6 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 90.9%. Conclusion It is an easy and simple therapy to cover wound area of severe flexioncontracture of the proximal interphalangeal joint after scar relaxation using cross-finger flap combined with laterodigital pedicled skin flap, which can repair large defect and achieve good results in finger appearance and function.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • REPAIR OF FINGER TISSUE DEFECT WITH MODIFIED ISLAND FLAP BASED ON REVERSED DORSAL METACARPAL ARTERY

    Objective To investigate the operative procedure and the cl inical results of the modified island flap based on the reversed dorsal metacarpal artery for repairing finger tissue defect. Methods From January 2004 to March 2009, 38 patients (43 fingers) with finger tissue defect were treated with the modified island flaps based on the reversed dorsal metacarpal artery. The deverting point was altered from the dorsal point to the palm. There were 27 males (31 fingers) and 11 females (12 fingers) with an average age of 43.6 years (range, 12-67 years). Defect was caused by crash injury in 18 cases, crush injury in 14 cases, and cutting injury in 6 cases. Of them, 11 index fingers, 23 middle fingers, 7 ring fingers, and 2 l ittle fingers were involved. The area of the defect ranged from 1.0 cm × 0.7 cm to 3.2 cm × 2.5 cm. The area of flaps ranged from 1.2 cm × 1.0 cm to 3.5 cm × 2.8 cm. The donor sites were sutured directly. Results Tension vesicular scabbing occurred in distal part of flap, and was cured after dressing change in 3 cases. The other flaps survived and incision healed primarily. All incision at donor sites healed primarily. Thirty-one patients (35 fingers) were followed up 6-29 months (15.3 months on average). All flaps survived with satisfactory appearance, sensation, and function. Two-point discrimination was 6-9 mm (7.9 mm on average). The results were excellent in 20 fingers, good in 13 fingers, and fair in 2 fingers according to the total active movement (TAM) standards; the excellent and good rate was 94.3%. Conclusion The treatment of finger tissue defect with the modified island flap based on the reversed dorsal metacarpal artery is recommendable. The deverting point was altered from the dorsal point to the palm. The vessel pedicle is extended. It can be easily and conveniently performed for more cases.

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
  • 指动脉顺行岛状皮瓣修复再植术后指间关节严重屈曲挛缩畸形并动脉缺损

    目的 总结应用指动脉顺行岛状皮瓣修复手指再植术后指间关节严重屈曲挛缩畸形并动脉缺损的临床疗效。 方法 2010年3月-2012年6月,收治9例9指手指再植术后指间关节严重屈曲挛缩患者,再植术均吻合一侧指固有动脉。男5例,女4例;年龄21~58岁,平均34.7岁。损伤指别:示指2例,中指3例,环指3例,小指1例。近侧指间关节屈曲挛缩6例,远侧3例。病程6~18个月,平均10.5个月。按照Stern等的指间关节屈曲挛缩分型标准,均为Ⅲ型。术中瘢痕切除、手指伸直后,均伴肌腱外露,掌侧皮肤软组织缺损范围2.5 cm × 1.0 cm~4.5 cm × 2.5 cm,动脉缺损1.5~4.0 cm。于相应供指切取大小为2.7 cm × 1.2 cm~4.7 cm × 2.6 cm的指固有动脉顺行岛状皮瓣移位修复;供区采用中厚皮片游离植皮修复。 结果术后患指皮瓣及植皮均成活,创面及切口均Ⅰ期愈合。患者均获随访,随访时间8~18个月,平均12.6个月。皮瓣质地柔软,无明显色素沉着和瘢痕形成,患指无冷不耐受,外形及主动屈伸活动恢复满意。末次随访时按照中华医学会手外科学会上肢部分功能评定试用标准评定:获优6例,良3例,优良率为100%。 结论指动脉顺行岛状皮瓣是修复再植术后指间关节严重屈曲挛缩畸形并动脉缺损有效方法之一。

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • CLINICAL ANALYSIS OF ACUTE CARPAL TUNNEL SYNDROME AFTER REDUCTION OF Colles’ FRACTURE IN TWENTY-TWO PATIENTS

    Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles’ fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles’ fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, fall ing in 8 cases, fall ing from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland & Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles’ fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no rel ief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% l idocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were rel ief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The results of Tinel test, Phalen test, and Reverse Phalen test were all negative. The X-ray film showed good fracture reduction and heal ing with an average heal ing time of 6 weeks (range, 3-14 weeks). According to GU Yudong’s criteria for functionalassessment, the results were excellent in 18 cases and good in 4 cases; the excellent and good rate was 100%. Conclusion Malposition, displacement of fracture fragments, and ulnar deviation of the wrist after plaster immobil ization are the mostimportant risk factors for ACTS. Expectant treatments are recommended in patients with Colles’ fracture of types I, II, and IV,but surgical treatment is the first choice for Colles’ fracture of type III.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤

    目的 总结逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤的手术方法和临床效 果。 方法 2004 年 8 月- 2008 年12 月,收治 22 例23 指末节毁损型离断伤患者。男 16 例17 指,女 6 例 6 指;年龄12 ~ 67 岁,平均36 岁。撕脱伤11 例11 指,压砸伤9 例10 指,爆炸伤2 例2 指。示指9 指,中指7 指,环指5 指,小指2 指。缺损平面均在中节指骨以远,缺损长度1.1 ~ 2.3 cm。受伤至手术时间为30 min ~ 8 h。术中采用范围为4.6 cm ×0.6 cm ~ 6.1 cm × 2.2 cm 的逆行指动脉背侧支三叶皮瓣修复。供区植皮修复。 结果 术后3 例皮瓣出现静脉危象,经换药愈合;其余皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。16 例16 指获随访,随访时间6 ~ 25 个月,平均16.5 个月。皮瓣质地柔软,外观饱满,无臃肿,指端无触痛。皮瓣两点辨别觉为6 ~ 10 mm。术后6 个月手功能按总主动活动度法评定,优9 指,良6 指,可1 指,优良率93.8%。 结 论 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤手术简便、安全,疗程短,是一种较为理想的方法。

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • 双套圈交叉加压缝合法治疗手指近侧指间关节侧副韧带损伤

    目的总结双套圈交叉加压缝合法治疗手指近侧指间关节侧副韧带损伤的疗效。 方法2008年12月-2013年2月,采用双套圈交叉加压缝合法治疗18例(20指)近侧指间关节侧副韧带起、止点断裂患者。男10例,女8例;年龄18~56岁,平均36.5岁。致伤原因:扭伤10例(10指),绞伤5例(7指),戳伤3例(3指)。损伤指别:示指8指,中指8指,环指4指。患指关节屈伸活动受限;侧方应力试验(+)。2例(2指)合并细小撕脱骨块。伤后至手术时间2~10 d,平均6.5 d。 结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间8~50个月,平均30个月。术后患指均无疼痛、关节稳定,侧方应力试验(-),关节分别遗留不同程度梭形肿胀。术后8个月,根据总主动活动度系统评定方法:获优12指,良7指,差1指,优良率95%。 结论双套圈交叉加压缝合法治疗手指近侧指间关节侧副韧带损伤疗效满意。

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  • TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT

    ObjectiveTo investigate the effectiveness of tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft in the treatment of tibial bone defects. MethodsBetween January 2007 and December 2013, 19 cases of traumatic tibia bone and soft tissue defects were treated. There were 14 males and 5 females, aged from 18 to 49 years (mean, 28 years). The tibial fracture site located at the middle tibia in 6 cases and at the distal tibia in 13 cases. According to Gustilo type, 4 cases were rated as type Ⅲ A, 14 cases as type Ⅲ B, and 1 case as type Ⅲ C (injury of anterior tibial artery). The length of bone defect ranged from 4.3 to 8.5 cm (mean, 6.3 cm). The soft tissue defects ranged from 8 cm×5 cm to 17 cm×9 cm. The time from injury to operation was 3 to 8 hours (mean, 4 hours). One-stage operation included debridement, external fixation, and vacuum sealing drainage. After formation of granulation tissue, the fresh wound was repaired with sural neurovascular flap or posterior tibial artery perforator flap. The flap size ranged from 10 cm×6 cm to 19 cm×11 cm. In two-stage operation, tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft was used to repair tibial defect. The periosteal flap ranged from 6.5 cm×4.0 cm to 9.0 cm×5.0 cm; bone graft ranged from 4.5 to 9.0 cm in length. External fixation was changed to internal fixation. ResultsAll flaps survived with soft texture, and no ulcer and infection occurred. All incisions healed by the first intention. All patients were followed up 18-40 months (mean, 22.5 months). All graft bone healed, with the healing time from 3 to 9 months (mean, 6.5 months). No complication of implant loosening or fracture was observed. No pain and abnormal activity in the affected leg occurred. All patients resumed weight-bearing and walking function. The length of the limb was recovered and difference value was 0.5-1.5 cm between normal and affected sides. The function of the knee and ankle joint was good without infection, malunion, and equinus. According to the Johner standard at last follow-up, the results were excellent in 15 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 94.7%. ConclusionTibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft is an effective method to treat bone defect of the tibia.

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  • 改良邻指双叶皮瓣修复指掌侧大面积皮肤缺损

    目的总结采用改良邻指双叶皮瓣修复指掌侧大面积皮肤软组织缺损的疗效。 方法2004年3月-2013年5月,采用改良邻指双叶皮瓣修复23例(23指)指掌侧大面积皮肤软组织缺损。男19例,女4例;年龄23~38岁,平均28.5岁。致伤原因:挤压伤12例,锐器伤6例,绞伤2例,高压灌注伤3例。损伤指别:示指13例,中指8例,环指2例。18例为外伤急诊入院,伤后至手术时间2~6 h,平均4.5 h;5例为外伤后指掌侧皮肤软组织坏死择期手术,伤后至手术时间12~26 d,平均18.6 d。 结果术后皮瓣及植皮均成活,创面Ⅰ期愈合。患者均获随访,随访时间6~30个月,平均20个月。手指皮瓣外形满意,色泽正常,质地柔软。末次随访时根据手指总主动活动度(TAM)系统评定,获优20例,良2例,可1例,优良率95.7%。 结论改良邻指双叶皮瓣修复指掌侧大面积皮肤软组织缺损手术操作简便,术后皮瓣外观好,伤指功能恢复满意。

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  • ANTEROLATERAL THIGH FLAP PEDICLED WITH MEDIAL SURAL VESSELS AS RECIPIENT VESSELS IN RECONSTRUCTION OF LEG SKIN AND SOFT TISSUE DEFECTS

    ObjectiveTo discuss the effectiveness of free anterolateral thigh flap pedicled with medial sural vessels for treatment of leg skin and soft tissue defects. MethodsBetween July 2008 and January 2014, 32 cases of serious skin and soft tissue defects in the leg were repaired by using free anterolateral thigh flap pedicled with medial sural artery and vein. Of them, there were 22 males and 10 females, aged 23 to 50 years (mean, 36.5 years). Defects were caused by traffic accidents injury in 9 cases, crash injury of heavy object in 15 cases, and machine twist injury in 8 cases. The left side was involved in 10 cases and the right side in 22 cases. The mean interval of injury and admission was 2.5 hours (range, 1-4 hours). The location was the upper, middle, and lower one third of the anterior tibia in 15 cases, 10 cases, and 7 cases respectively. The area of defect ranged from 10 cm×5 cm to 23 cm×9 cm. After debridement and vaccum sealing drainage treatment, the anterolateral thigh flap ranging from 12 cm×7 cm to 25 cm×11 cm pedicled with the medial sural vessels was used to repair the wound. The donor site was sutured directly or repaired with the skingrafts. ResultsAll flaps and skingrafts survived after operation, and primary healing of wound was obtained. After 6-23 months (mean, 14.5 months) follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. The sensation of the flaps were recovered to S2~S3+ according to the Britain's Medical Research Council criteria at 6 months after operation. No obvious scar contracture was observed at donor site. ConclusionThe medial sural artery has the advantages of constant anatomical position, large diameter, rich blood flow, and a long artery pedicle, so the medial sural vessels is an ideal choice as recipient vessels for the reconstruction of leg skin and soft tissue defect.

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