Objective To compare milrinone （MIN）, Phenoxybenzamine （PHE），and mixture of nitroglycerin and verapamil(NVC) for the prevention and treatment of human radial artery spasm. Methods Residuary radial arteries from 30 patients undergoing coronary artery bypass grafting （CABG） using autologous radial artery from March to September of 2012 in General Hospital of Shenyang Military District were collected. All the artery specimens were cut into 60 vessel rings of 3 mm in width and hanged in the Organ-Bath. Using a random number table，all the vessel rings were divided into 4 groups：PHE group，NVC group，MIN group and blank group （control group）. Firstly，20 vessel rings were used for spasm relaxation experiment with 5 rings in each group. Phenylephrine was added into the Organ-Bath to reach final concentration of 10-3 mol/L in order to cause vessel rings spasm. PHE of 1 mmol/L，NVC of both 30 μmol/L，MIN of 30 μmol/L and Krebs-Ringer’s solution were added respectively into above groups to compare the relaxant effect of these vasodilators on radial artery spasm. Secondly，the other 40 vessel rings were used for spasm prevention experiment with 10 rings in each group. All the 40 vessel rings were dipped in above 4 groups. After 30 minutes，phenylephrine was added to the Organ-Bath to reach final concentration of 10-3 mol/L. Time-dependent constriction of the vessel rings were compared to examine the prevention effect of these vasodilators on radial artery spasm. Results In the spasm relaxation experiment, vessel ring spasm relaxed most quickly in NVC group （P＜ 0.01）. Vessel rings in MIN group relaxed more slowly but steadily （P＜ 0.05）. Vessel rings in PHE group relaxed most slowly （P＜0.01）. And there was no relaxation in the control group. In the spasm prevention experiment，vessel rings in the control group contracted （spasm） 100% immediately after phenylephrine administration. Vessel rings in MIN group contracted immediately after phenylephrine administration too，but slower than the control group（P＜0.01）. Vessel rings in NVC group did not contract right after phenylephrine administration，but the sedentary tension of these vessel rings gradually increased 120 minutes after phenylephrine administration，and vessel ring contraction reached 46.89% 240 minutes after phenylephrine administration. There was no vessel ring contraction in PHE group. Conclusions All the vasodilators in our experiment are effective for the prevention and treatment of radial artery spasm to different degree，but each medication has its own characteristics，vasodilatation result and time-dependent effect. NVC is most effective to dilate radial artery which has been in spasm state, while radial artery pretreated by PHE is least to become spasm after being stimulated.
Objective To explore perioperative outcomes of coronary artery bypass grafting （CABG） using the radialartery as the second arterial graft. Methods Clinical data of 175 consecutive patients undergoing off-pump coronary artery bypass grafting （OPCAB） in General Hospital of Shenyang Military Command from August 2011 to April 2012 were retrospectively analyzed. All the 175 patients were divided into two groups. There were 75 patients including 49 male and 26 female patients with their age of 56.8±8.2 years in group 1，who received radial artery as a graft vessel. There were 100patients including 66 male and 34 female patients with their age of 57.7±8.1 years in group 2，who received great saphenousvein but not radial artery as the graft vessel. The use of left internal mammary artery as a graft vessel was 100% in both groups. Perioperative cardiovascular events and other clinical results were compared between the two groups. Results All the patients survived OPCAB and there was no 30-day death. There was no statistical difference in operation time，thoracic drainage within the first 24 hours after surgery or postoperative hospital stay between the two groups（P＞0.05）. Length of postoperative ICU stay and mechanical ventilation time of group 1 were shorter than those of group 2，although the differencewas not statistically significant. The percentage of patients receiving prolonged postoperative inotropic therapy of group 2 was higher than that of group 1 ［16% （16/100） vs. 12% （9/75）］，although the difference was not statistically significant. Postoperatively，there was no patient in group 1 who had new-onset myocardial ischemia or received intra-aortic balloon pump （IABP） support for hemodynamic instability. In group 2，3 patients had new-onset myocardial ischemia and 2 patientsreceived IABP support after OPCAB. Conclusion Radial artery can partly replace great saphenous vein as a graft vesselfor OPCAB，which does not increase the risk of perioperative cardiovascular events but is beneficial for postoperativerecovery to some degree. Radial artery can be more extensively used in CABG.
Objective To summarize the experiences of off-pump coronary artery bypass grafting (off-pump CABG) and on-pump coronary artery bypass grafting (onpump CABG) for patients with coronary artery diseases and to improve the surgical techniques and clinical results. Methods Coronary artery bypass grafting(CABG) were performed from January 2000 to March 2009 on 698 consecutive cases, including 551 male and 147 female with a mean age of 67.2 years(range, 28.0-79.0). There were 552 cases with angina pectoris and 131 with old myocardial infarction. Preoperative cardiac function showed 301 cases in New York Heart Association classⅡ, 339 in class Ⅲ,and 58 in class Ⅳ. Coronary angiography revealed single vessel disease in 21 cases, 2vessel disease in 87, 3vessel disease in 590, and 201 cases had concomitant left main lesions.There were 687 elective CABG and 11 emergency / urgent ones. Offpump CABG were performed on 346 cases and the others received onpump CABG . Results A total number of 2 025 grafts ( range,1-6 grafts, mean, 2.9 grafts /case ) were constructed with 693 left internal mammary arteries,115 free right mammary arteries,229 left radial arteries, and 81 right radial arteries. Total arterial bypass grafting was feasible on 126 cases. Postoperative ventilation duration varied from 0-127 hours (mean, 11.5 hours). Fasttrack procedure was offered to 38 cases with good results.Introaortic balloon pump support were provided to 1 patient preoperatively and 27 postoperatively. There were 25 deaths with a mortality of 3.64% for the elective cases with the cause of acute myocardial infarction ( 5 cases ), low cardiac output syndrome (3 cases),protamine reaction (2 cases),respiratory failure (3 cases), renal failure (2 cases),and multiorgan failure (10 cases).Four deaths occurred to urgent cases with a mortality of 36.36% from low cardiac output syndrome ( 3 cases) and acute myocardial infarction (1 case). One hundred and fiftyone cases（21.63%）developed atrial fibrilation among which 147（97.35%）returned to sinus rhythem with administration of electrolytes and Amiodarone. Resternotomy were performed for bleeding in 12 cases. Upon discharge from the hospital, 511 patients were free from angina while 20 other patients still had coexisting relieved angina. Postoperative followup was carried out on 415 cases（62.03%）for a period of 1month to 8.2 years with 3 deaths for lung cancer (1 case), car accident(1case), and unknown reasons (1 case). Number of patients who were free from angina was 317 and 21 for those who had recurrent angina. The cardiac function improved with 269 cases（65.29%）in New York Heart Association class Ⅱ, 142（34.46%）class Ⅲ, and 1（0.24%） class Ⅳ. Conclusion Good surgical results could be achieved with careful analysis of native Chinese patients’ coronary vessels, individualized operative plan, control of operative risk factors, and proper selection of bypass conduits. Aggressive use of IABP can provide essential support for patients with poor left ventricular function and other high risk factors.
Abstract: Objective To compare the effects of nitroglycerine (NTG)， Verapamil(VP), papaverine(PA) and the mixed solution of Verapamil and nitroglycerine (VG) on relaxing function of human radial arteries. Methods The radial arteries of thirty patients were used during the operation of coronary artery bypass grafting (CABG). A short segment (1.0-1.5cm) of radial arteris were taken from the distal end of radial arteries of each patient and were cut into vascular rings, which were mounted in the organ bath chamber and then subject to a series of tests for vascular smooth muscle viability and endothelial integrity. The effects of five storage solutions on the relaxing function were evaluated by “OrganBath” technique. The five solutions included: (1) Ringer’ s solution (control group); (2) VP solution (VP group); (3) NTG solution (NTG group); (4) PA solution (PA group); (5) VG solution (VG group). First, challenged with phenylephrine (10-5mol/L), vasorelaxant effect of these drugs (effect onset and efficacy) was observed at different time point and resting tension was recorded. Second, after 30min preincubation with either verapamil, papaverine, phenoxybenzamine or VG mixture, potassium chloride (final concentration of 60mmol/L) was added in the organ bath chamber and then vasoconstriction was observed subsequently. Finally, after 30min pretreatment of different antispasmodic agent in the same way as described above, the vascular rings were mounted in organ bath chamber and challenged with phenylephrine(10-5mol/L). Vascular spasticity and vosospasm duration were observed at different time point which might provide guidance for optimal timing of clinical application. Results The radial arteries in VG, VP, NTG and PA solutions were relaxed in 11 min after vasospasm and there was no difference between them (Pgt;0.05). But during the initial three minutes，the relaxation effect of VG and NTG was significantly better than other two groups. Relaxation curve showed that the ability of vasodilatation of VG, NTG, VP and PA decreased in order. In the experiment about antivasospasm pretreatment of radial arteries, there was no difference between VG and VP group (Pgt;0.05 ), whose effects were better than NTG and PA group(Plt;0.05 ). After cold storage for 24h, VG and VP still could prevent vasospasm. But NTG and PA hardly had any function and there was no difference compared with the control group (Pgt;0.05 ). Conclusion Although in the final all these drugs could prevent and relieve vasospasm of radial arteries in the different level, it appeared that a combination of verapamil and nitroglycenn is more fit for treating radial artery during CABG operation than other drugs.
Abstract: Though the use of the radial artery (RA) as a coronary artery bypass graft has been accepted world widely in myocardial revascularization, there has been no uniformity regarding harvest techniques, assessment of the adequacy of hand collateral circulation, antispasm rotocols, selection of target vessels, and the site of proximal anastomosis. It is widely believed and practiced that the RA should be harvested as a pedicle graft and preferably be used to bypass critically stenosed (gt;70% stenosis) coronary arteries. It is used either as a free graft with proximal anastomosis to the ascending aorta or as a composite arterial graft along with the left or right internal thoracic artery. The patency of RA grafts depends on the severity of the target coronary artery stenosis and target artery location rather than its use as an aortocoronary conduit or composite graft. Though lacking of evidences, most surgeons use antispasm therapy for RA conduits. There are advantages in using RA as an alternative for right internal mammary artery in total artery coronary revascularization.
Objective\ To search for suitable and multiple arterial grafts for myocardial revascularization, in order to avoid the long term problems of vein graft atherosclerosis. Methods\ Between October 1994 and April 2000, 456 consecutive patients underwent myocardial revascularization using radial artery and internal mammary artery. In coronary artery bypass grafting, minimally traumatic harvesting radial artery techniques and new pharmacologic antispasmodic agents was used. Results\ 448 internal mammary artery ...
Objective To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects. Methods Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm × 0.6 cm to 2.3 cm × 2.1 cm. According to ZHOU Qingwen’s grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm × 0.6 cm to 2.5 cm × 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft. Results All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.
Objective To study digitize design of custom-made radial head prosthesis and to verify its matching precision by the surgery of preoperative three-dimensional (3-D) virtual replacement. Methods Six healthy adult volunteers (3 males and 3 females, aged 25-55 years with an average of 33 years) received slice scan of bilateral elbow by Speed Light 16-slice spiral CT. The CT Dicom data were imported into Mimics 10.0 software individually for 3-D reconstruction image, and the left proximal radial 3-D image was extracted, the mirror of the image was generated and it was split into 2 pieces: the head and the neck. The internal diameter and the length of the radial neck were obtained by Mimics 10.0 software measurement tools. In Geomagic Studio 12 software, the radial head was simulated to cover the cartilage surface (1 mm thickness) and generated to an entity. In UG NX 8.0 software, the stem of prosthesis was designed according to the parameters above and assembled head entity. Each custom-made prosthesis was performed and verified its matching precision by the surgery of preoperative 3-D virtual replacement. Results Comparing the morphology of 6 digitize custom-made prostheses with ipsilateral radial heads by the 3-D virtual surgery, the error was less than 1 mm. The radial head prosthesis design on basis of the contralateral anatomy was verified excellent matching. Conclusion The 3-D virtual surgery test and the digitized custom-made radial head prosthesis will be available for clinical accurate replacement.
【Abstract】 Objective To investigate the methods and effectiveness of arthroscopic poking reduction and percutaneousfixation of radial head fractures. Methods Between August 2002 and May 2010, 15 patients with radial head fractures weretreated using arthroscopic poking reduction and percutaneous fixation with a Kirschner wire. There were 11 males and 4 females with an average age of 29.6 years (range, 17-41 years). The locations were left side in 6 cases and right side in 9 cases. Injuries were caused by falling in 8 cases, by traffic accident in 4 cases, and by sports in 3 cases. The average time from injury to admission was 3.4 days (range, 1-8 days). Of them, 13 patients had Mason type II, and 2 patients had type III fractures. Accompanying injuries were lateral collateral ligament ruptures in 5 patients. Results The X-ray films confirmed good reduction and fracture heal ing. Incisions healed by first intention; no complication occurred, such as neurovascular injury, infection, or hardware failure. All patients were followed up 25 months on average (range, 12-32 months). The flexion-extension arc was (139.0 ± 7.9)° at last follow-up, showing no significant difference when compared with the contralateral (141.0 ± 5.1)° (t=1.146, P=0.271); the range of pronation and supination was (143.3 ± 7.0)° when compared with the contralateral (146.0 ± 4.7)° (t=1.948, P=0.072). The mean Mayo elbow performance score was 92 (range, 80-100); the mean Broberg-Morrey score was 95.2 (range, 85-100); the results were excellent in 12 cases and good in 3 cases. Conclusion Arthroscopic poking reduction and percutaneous fixation with a Kirschner wire offers accurate reduction, rel iable fixation, minimal trauma, rapid recovery, and lower morbidity for Mason type II and selective Mason type III radial head fractures.
Objective To investigate the effectiveness and surgical skills of microsurgical repair of radial nerve deep branch injury. Methods Between March 2001 and February 2011, 49 cases of radial nerve deep branch injury were treated by microsurgical technique. There were 40 males and 9 females with an average age of 32 years (range, 19-58 years), including 13 cases of knife-cut injury, 9 cases of electric-saw injury, 7 cases of dagger-stab injury, 6 cases of glass-cut injury, 5 cases of iatrogenic injury, 4 cases of Monteggia fracture, 3 cases of nailgun injury, and 2 cases of crush injury of the forearm complicated by fracture of the proximal radius. The disease duration ranged from 3 hours to 3 years and 8 months (mean, 4.9 months). The sites of injury were at front of supinator tube in 15 cases, in the supinator tube in 23 cases, and at back of supinator tube in 11 cases. One-stage repair was performed by end-to-end suture in 21 cases, including 9 cases of epineurial neurorrhaphy and 12 cases of perineurial neurorrhaphy; two-stage repair was performed in 28 cases, including 26 cases of sural nerve graft and 2 cases of neurolysis. Results Postoperative wounds primarily healed. All patients were followed up 21.5 months on average (range, 12-39 months). At last follow-up, in 21 cases of one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 13 cases, and level 4 in 8 cases; in 28 cases of two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 21 cases, level 3 in 4 cases, and level 2 in 1 case; and significant difference was found (Z= — 5.340, P=0.000). In 9 cases undergoing epineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 3 cases, and level 4 in 6 cases; in 12 cases undergoing perineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 10 cases, and level 4 in 2 cases; and significant difference was found (Z= — 2.279, P=0.023). In 26 cases undergoing nerve graft at two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 20 cases, level 3 in 3 cases, and level 2 in 1 case; in 2 cases undergoing neurolysis at two-stage repair, the muscle strength of the extensor pollicis longus was level 4 in 1 case and level 3 in 1 case; and no significant difference was found (Z= — 1.117, P=0.264). According to the upper arm function assessment criterion issued by Hand Surgery Association of Chinese Medicine Association, the results were excellent in 18 cases, good in 3 cases in one-stage repair patients; excellent in 2 cases, good in 21 cases, fair in 4 cases, and poor in 1 case in two-stage repair patients; and there was significant difference (Z= — 5.340, P=0.000). Conclusion Microsurgical one-stage repair of radial nerve deep branch injury can obtain better effectiveness than two-stage repair by nerve graft, and perineurial neurorrhaphy is significantly better than epineurial neurorrhaphy.