Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints.

10.3969/j.issn.2095-4344.2013.26.002

BACKGROUND:Kienb?ck disease lacks of suitable animal models, which are similar to the pathological process of avascular necrosis of human lunate bone.
OBJECTIVE:To establish a new animal model of Kienb?ck disease using medical TH adhesive embolism and to explore the rationality of model establishment.
METHODS:A total of 30 healthy adult New Zealand rabbits, male or female, were selected. Using self-control method, the rabbits were randomly assigned to experimental sides and control sides. By dril ing in the center of the lunate bone, 0.2 mL of medical TH glue was injected three times. An equal volume of physiological saline was injected into the center of the lunate bone on the control side. X-ray examination, general observation, Micro-CT measurement of bone, and tissue pathology detection were conducted at 4, 8 and 12 weeks.
RESULTS AND CONCLUSION:Gross specimen, X-ray and histological results showed that ischemic necrosis of the lunate bone on the experimental side was visible at 8 weeks after model induction. The ischemic necrosis of the lunate bone became more typical at 12 weeks. Among the Micro-CT microscopic parameters of trabecular bone, trabecular bone density parameters bone volume fraction and the number of trabecular bone were significantly lower on the experimental side than those on the control side (P<0.05). Spatial parameters of trabecular bone significantly increased. Trabecular separation and structure model index on the experimental side were significantly greater than those on the control side. Results suggested that ischemic necrosis of the lunate bone appeared on the experimental side at 8 weeks after injection of medical TH glue. Rabbit models of ischemic necrosis of the lunate bone can be established at 12 weeks. Thus, alterations, which were similar to ischemic necrosis of human lunate bone, appeared, such as blood transportation damage in the lunate bone, trabecular bone fracture, and empty lacuna, when surrounding tissues were not obviously injured.

BACKGROUND:Single-row and double-row suture method are commonly used in the rotator cuff repair. Previous studies have shown that, double-row suture is not better than single-row suture in clinics.
OBJECTIVE:To compare clinical outcomes of single-row suture and double-row suture for rotator cuff repair, and evaluate the difference of therapeutic efficacy between two methods.
METHODS:A computer-based search was performed in the Medline (from January 2003 to February 2014), EMBASE (from January 2003 to February 2014) and Cochrane library (February 2014). According to the inclusion and exclusion criteria, al the randomized control ed studies addressing the outcome of single-row repair and double-row repair techniques were included in this meta-analysis. The methodological quality of each study was judged and a meta-analysis was conducted using Revman5.0. The preoperative and postoperative differences between the Constant score, American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, the re-rupture rate and the muscle strength were compared. The forest chart was used to compare the data between two groups, and the funnel plot was finished to detect the publication bias.
RESULTS AND CONCLUSION:A total of 10 randomized control ed trials (Levels I, II) were included. Meta-analysis showed that, there was no statistical y significant difference in the Constant, ASES and UCLA scores in the double-row group and the single-row group before and after treatment. In the postoperative fol ow-up, double-row group had a lower re-rupture rate and a higher abductor muscle strength than single-row group. When the rotator cuff tear was less than 3 cm, double-row group had no significant difference with the single-row suture group. While in the over 3-cm tear group, double-row group showed better results than the single-row suture group on the Constant scpre, ASES score and UCLA score. Double-row suture has a low re-rupture rate than single-row suture in rotator cuff injury, and could achieve better abduction muscle strength. There is no significant difference in the functional score between double-row suture and single-row suture in the rotator cuff tear of less than 3 cm, while in the over 3-cm tear, double-row suture could achieve better functional score.

OBJECTIVESTo investigate the different effects of closed suction drainage and non-drainage for total knee arthroplasty(TKA) and to provide reference information for the choice of clinical treatment.

METHODSRandomized controlled trials (RCTs) of closed suction drainage versus non-drainage for TKA were collected from the Cochrane Library, PubMed, EMBase, Springer, CBM, CNKI, VIP and WANFANG database. Methodological quality of the RCTs was independently assessed using the Consolidated Standards of Reporting Trials (CONSORT) checklist. Data analysis was performed by RevMan Version 5.1.6 based on the methods recommended by the Cochrane Collaboration.

RESULTSTwenty-one RCTs without bias were finally enrolled, and 1920 enrolled knees were identified into drainage group (979 knees) and non-drainage group (941 knees). A lower incidence of soft tissue ecchymosis was demonstrated in the closed suction drainage group (OR = 0.30, 95%CI: 0.24 - 0.49); however, compared with the non-drainage group, more loss of blood (MD = 320.03, 95%CI: 235.31 - 404.76) and more need of homologous blood transfusion (OR = 1.83, 95%CI: 1.26 - 3.29) were found in the closed suction drainage group. In addition, there were no significant differences of postoperative infection (OR = 0.53, 95%CI: 0.22 - 1.32), deep venous thrombosis (OR = 1.00, 95%CI: 0.46 - 2.18), and the joint range of motion (MD = -0.04, 95%CI: -1.11 - 1.02) between the two groups.

CONCLUSIONBased on the current evidence, no obvious advantage is demonstrated for closed suction drainage, in comparison with non-drainage for TKA.

Arthroplasty, Replacement, Knee ; Drainage ; statistics & numerical data ; Humans ; Postoperative Complications ; epidemiology ; Randomized Controlled Trials as Topic ; Range of Motion, Articular ; Venous Thrombosis ; epidemiology

Objective Application of the second metatarpophalangeal joint by traction prolong trans- plant repair the defects in the metacarpophalangeal joint,reconstruct the function of it.Methods By means of the apparatus to prolong finger in advance,then transplant the second metatarpophalangeal joint to recon- struct metacarpophalangeal joint for seven cases of obsolete defects in the metacarpophalangeal joint.Results The average of finger prolong was 2.6 cm,consultation from 1 to 4 years.average 2.5 years,thai the trans- plant joints have all survived and osteal concrescence.Through the criterion Chinese Medical Association,good rate was 85.7%. Conclusion It' s a good method to repair obsolete defects in the metacarpophalangeal joint by transplant traction prolong of the second metatarpophalangeal joint.

Adult ; Biopsy ; DNA ; genetics ; Female ; Gene Expression Profiling ; Glomerulonephritis, IGA ; genetics ; pathology ; Humans ; Kidney ; pathology ; Male ; Middle Aged ; Young Adult

OBJECTIVETo study the reconstructive effect of the dissociate bone flap to repair the macrosis depressed skull fracture on the frontal and orbit part.

METHODSThe coronal scalp flap was elevated and dissociate bone flap was expanding to the 2cm width beside the edge of depressed skull fracture. The first step was to extract the dissociate bone flap and make there is an area for operating . Then extract free bone fragments, and elevate the depressed orbital lamina and use the biological glue to stick it to its position. The free fragments extracted were stacked into a whole one and it to its position in use of the biological glue on the dissociate bone flap. The uneven inner table should was smoother with bon-wax. The prosthetic dissociate bone flap was put back on its position and fixation.

RESULTSFrom January 2000 to December 2004, 17 cases of the macrosis depressed skull fracture on the frontal and orbit part undertaken plastic surgery by the dissociate bone flap to treat the macrosis depressed skull fracture and obtained excellent curative effect.

CONCLUSIONSUsing dissociate bone flap to treat the mocrosis depressed skull fracture on the frontal and orbit part can avoid the complication of the traditional operation, and make the method become a plastic surgical operation.

Adult ; Bone Transplantation ; methods ; Female ; Humans ; Male ; Orbit ; Orbital Fractures ; surgery ; Reconstructive Surgical Procedures ; methods ; Skull Fracture, Depressed ; surgery ; Surgical Flaps ; Young Adult

Adolescent ; Adult ; Dust ; analysis ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Occupational Exposure ; analysis ; Pneumoconiosis ; prevention & control ; Sentinel Surveillance ; Surveys and Questionnaires ; Welding ; Young Adult