BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
From March 1991 to October 1993, 6 the latissimus dorsi M. was transferred to reconstruct the flexor of the elbow following the injury of brachial plexus in 12 cases (8 males and 4 females). The average age was 31-year-old (6to 45-year-old). The patients were followed up for six months to two years. All of musculocutaneous flaps were survived. The contour of the upper arm was satisfactory. In 8 cases, the muscle strength was more than grade 4 and the active motion of the elbow was 135 degrees in flexion and 10 degrees in extension. The elbow could lift the load of l0kg. In 2 cases, the muscle strength was grade 4 and the active movement was 25 degrees in flexion and 25 degrees in extension. On 90 degrees flexion, the elbow could lift the load of 3kg. In 2 cases, the muscle strength was grade 3 and the active movement of elbow was 100 degrees in flexion 25 degrees in extension. Following the irreversible injury of the brachial plexus, the atrophy of the muscles was obvious. After the transfer of musculocutaneous flap, the circumference of the arm was increased while the tenseness of the skin was decreased. This faciliated the movement of the transferred muscle, improved the appearance of the upper limb and was convenient to observe the blood supply of the flap. When the brachial plexus was injuried at the root level, the latissimus dorsi M. was atrophied, after transfer of the nerve to the muscle, the function of the muscle recovered, then the tranferred muscle could be transferred to reconstruct the flexor of the elbow.
The results of nerve transposition for root avulsion of brachial plexas in 21 cases were reported. The methods of the nerve transposition were divided into four groups as followings: By transfer of phrenic nerve, accesory nerve, the motor branches of cervical plexus and intercostal nerves in cease; By transfer of phrenic nerve, accessory nerve and the motor branches of cervical plexus in 6 cases; By transfer of phrenic nerve and accessory nerve in 9 cases, and by transfer of phrenic nerve or the motor branches of cervical plexus or intercostal nerve in 5 cases. During operation, in 1 cases variation of the brachial plexus was found. Injury to the subclavian artery occurred in 4 cases and they were repaired, which is good for the blood circulation of the upper arm and nerve regeneration. Nineteen cases were followed up with good results. The overall excellent and good rate was 73.7%. It was considered that transposition of nerve should be a routine operation for the treatment of root avulsion of brachial plexus and the accompanied arterial injury should be repaired at the same time during operation, and the latter would be advantageous to enhance functional recovery of nerve.
In order to preserve the major vessels of the extremities in the repair and reconstruction of wounds of the extremities, the distally based fascial pedicled island flap was applied clinically. Its axis and rotatary point were designed along orientation of the major arteries, and the blood supply was from the abundant vascular networks in the deep fascia. Twenty-two cases with exposure of tendon and bone including 10 upper limbs and 12 lower limbs were treated. The flap area of forearm ranged from 7 cm x 8 cm to 12 cm x 9 cm and the ratio of the length to width of the pedicle was 1: 1-2. The flap area of the calf ranged from 10 cm x 6 cm to 16.5 cm x 12 cm and the ratio of the length to width of the pedicle was 2:1. The rotatary angle was 130 degrees-170 degrees. After operation, 18 flaps were survived completely, 2 cases had partial necrosis on the margin, 2 failures received cross-leg flap in the second operation. The patients were followed up with an average of 13.5 months (ranged from 3 months to 2 years). The conclusions were as follows: 1. the blood supply of this type of flap was reliable and the major arteries of the extremities needed not to be sacrificed; 2. the preparation of the flap was easy and the survival rate was satisfactory; 3. the shortcomings of this flap were unsightly incision scar and the limited size of flap and; 4. during the operation, the compression of the pedicle must be avoided.
Objective To investigate the results of two stage multiple nerves transfer for treatment of complete brachial plexus root avulsion. Methods Eight patients with complete brachial plexus avulsion, aging 18-38 years andwith a mean 6 months interval of injury and repair, were surgically treated with the following procedures. One stage surgical procedure was that the contralateral C7 never root was transferred to the ulnar nerve, the phrenic nerve to theanterior division of upper trunci plexus brachialis and the accessory nerve to the suprascapular nerve. Two stage surgical procedure was that the ulnar nerve was transferredto the median nerve , the intercostal nerves to the radial nerve and the thoracodorsal nerve. Results All patients were followed upfrom 13 months to 25 months(21 months on average), muscle reinnervation was observed in all patients. Return of muscle power of M3 or better are regarded as effective. The effective recovery results were 75% in musculocutaneous nerve, 37.5% in suprascapular nerve, 37.5% in radial nerve, 75% in thoracodorsal nerve and 62.5% in median nerve. In sensory recovery of the median nerve, 4 patients obtained S3, 3 patients S2 and 1 patient S1. Conclusion Two stage multiple nerves transfer for treatment of root avulsion of brachial plexus can achieve better motor function results and is safe and effective. The procedure should be recommended for treatmentof root avulsion of brachial plexus in selected patients with complete brachial plexus root avulsion, especially in young patients with a short interval between injury and repair. It isone of the alternative options.
Objective To simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
Objetive To investigate the effect of elastic pivot stable biteplate on treating irredueible temporal bone displacement of the temporomandibular joint. Methods Twenty-eight cases of irredueible temporal bone displacement of the temporomandibular joint treated with the elasticpivot stable biteplate from 2000 to 2004 were summarized. The ages of the patients ranged from 15 to 58 yeras includding 11 men and 17 women.Results All the patients were treated for 1 month and followed up for 3 to 6 months. The effective rate was 87.51%. The patients who had shorter course of diseases obtained better effect than the patients who had longer courses of diseases. Conclusion Elastic pivot stable biteplate is an effective alternative for treating irredueible temporal bone displacement of the temporomandibular joint and it exerts better effect on the patients that have short courses of diseases.
Based on the anatomical studies, the authors had designed an operation for treating old dorsal subluxation of the inferior radio-ulnar joint.The periosteum was longitudinally incised at the dorsal side of the lower ulna. forming musculo-periosteal flap, and a periosteal flap, and a periosteal valves of pronator quadratus. They were subluxation, passing the flap from palmar to the dorsal side through thc subperiosteal tunnel at the lateral margin of the radius corresponding to the ulna. Then it was circled round the lower end on the ulna and sutured to the muscular flap and the tough interosseous membranes at the palmar side, being used to stabilize the recuperated dorsal subluxation of the inferior radio-ulnar joint. The result of its clinical use was satifying.
【摘要】 目的 了解青年早期宫颈癌患者在卵巢移位术后的卵巢功能。 方法 2001年1月-2009年12月收治53例年龄26~40岁宫颈癌Ⅰb~Ⅱa期患者，其中27例在宫颈癌根治术中行卵巢移位术为观察组，26例行宫颈癌根治术切除双侧卵巢的为对照组。术后应用血清卵泡刺激素（FSH）、黄体生成激素（LH）、雌二醇（E2），B超及Kuppermann评分进行卵巢功能测定，随访1~4年。 结果 观察组术后4年内卵巢功能基本正常，对照组术后1个月卵巢功能丧失。观察组术后4年内血FSH、LH、E2及Kuppermann评分与对照组比较有显著性意义（Plt;0.05）；两组复发率比较无显著性意义（P gt;0.05）。 结论 青年早期宫颈癌患者在宫颈癌根治术中行卵巢移位术对其卵巢功能无明显影响。【Abstract】 Objective To investigate the function of ovary after ovarian transposition among young patients with early-stage cervical cancer. Methods A total of 53 young females (26-40 years old) with early stage cervical cancer (FIGO ⅠB or ⅡA) from January 2001 to December 2009. Ovarian transposition was performed at the same time of radical hysterectomy and pelvic lymphadenectomy on 27 patients who were the experimental group. Radical hysterectomy and pelvic lymphadenectomy was done without ovarian transposition on other 26 patients who were the control group. The function of ovarian was evaluated by serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), the ultrasound examination and Kuppermann score system in all patients during 1- 4 years’ follow-up. Results The patients in the control group became climacteric in one month after the operation. However, among the patients in the experimental group, their normal ovarian function was preserved within 1- 4 years’ follow-up. There was statistically significant difference between the experimental group and the control group regarding to serum E2, FSH, LH level and Kuppermann score of the patients (Plt;0.05). However, there was no statistically significant difference between the two groups regarding to the recurrence rate (Pgt;0.05). Conclusion Ovarian transposition has statistical significant effect on protection of ovarian function in young patients with early stage cervical cancer, who undergoes radical hysterectomy and pelvic lymphadenectomy.