OBJECTIVE To investigate the compression factor and clinical manifestation of the compression of deep branch of the ulnar nerve at the wrist. METHODS Anatomic study was done on both sides of 10 cadavers, the deep branch of ulnar nerve, the Guyon’s canal and the flexor digiti minimi brevis pedis were observed. Then from Jan. 1990 to Jan. 1997, 5 patients with compression of the deep branch of ulnar nerve at the wrist were treated clinically. Among them, there were 4 males and 1 female, aged from 37 to 48 years and the course of disease ranged from 1 to 5 months. RESULTS The motor branch of the ulnar nerve passed under the tendinous arcade of flexor digiti minimi brevis pedis. Occasionally, the branch of ulnar artery overpassed the motor branch. Clinically, the tendinous arcade compressed the motor branch was released, and after 2 to 4 years follow-up, the clinical results were satisfactory. CONCLUSION The main compression factor of the ulnar nerve at the wrist is the tendinous arcade of the flexor digiti minimi brevis pedis, the tendinous arcade should be released sufficiently during the operation.
Objective To evaluate the feasibil ity and effectiveness of percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease. Methods Between May 2003 and February 2009, 17 patients with Kümmell disease (6 at stage II, 11 at stage III) were treated with percutaneous kyphoplasty in hyperextension position. There were 5 males and 12 females with an average age of 71 years (range, 55-85 years). The involved vertebral bodies were T10 in 1 case, T11 in 3 cases, T12 in 7 cases, L1 in 4 cases, L2 in 1 case, and T12, L1 in 1 case by X-ray, CT, and MRI examinations. The effectiveness was determined by the visual analogue scale (VAS) and the Oswestry Disabil ity Index (ODI). The height and the kyphotic Cobb angle of the involved vertebral body were measured pre- and postoperatively. Results The operation was successfully completed in all the patients, and the incisions healed by first intention. Pain was alleviated or eliminated within 48 hours after operation; no spinal nerves injury or pulmonary embolism occurred. One patient had cement leakage to the adjacent disc, who did not manifest any cl inical symptoms. Thirteen patients were followed up 24 to 56 months (mean, 32 months). The VAS score, ODI, anterior and medial vertebral height, kyphotic Cobb angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P lt; 0.05), there was no significant difference between at 1 week after operation and at last follow-up (P gt; 0.05). Adjacent vertebral fracture occurred in 1 patient at 6 months after operation and was cured after percutaneous kyphoplasty. Conclusion Percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease can rel ieve back pain, improve viabil ity, decrease Cobb angle, and retain the vertebral body height and spinal alignment. The general condition of the patient is needed to be evaluated and the operation indication should be controlled strictly.
Objective To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021 and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with three-dimensional visible technique without fluoroscopy; 20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score (ISS), and the time between injury to operation between the two groups (P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale (SUS) score were recorded and compared. Results All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients (95%) in trial group, which was better than that in the control group (13 cases, 65%), with a significant difference (χ2=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups (P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group (P<0.05), and SUS score in trial group was significantly higher in trial group than in control group (P<0.05). ConclusionCompared to using unlocking closed reduction system under two-dimensional fluoroscopy, three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operative time, and is valuable to reduce iatrogenic radiation exposure for patients and medical workers.
Objective To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as “computer navigation system”) in the treatment of posterior pelvic ring injuries. MethodsA retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups (P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. ResultsThe operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group (P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant (P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group (P<0.05). ConclusionCompared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.