Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To revaluate the systematic reviews/meta-analysis of the literature on acupuncture in the treatment of stroke spastic hemiplegia.Methods:CNKI, Wangfang, VIP, CBM, Cochrane Library, PubMed and Embase were searched for systematic reviews/meta-analyses of acupuncture in the treatment of stroke spastic hemiplegia from the establishment of the databases to July 27, 2022. AMSTAR 2 Scale, Prisma statement (2020) and GRADE system were used to evaluate the quality of the collected literature.Results:A total of 5 systematic reviews/meta-analyses were included, all of which were rated as very low by AMSTAR 2. The 5 studies involved a total of 22 outcome measures, and the GRADE rating results were intermediate evidence in 5, low evidence in 8, and very low evidence in 9.Conclusions:Acupuncture therapy has certain therapeutic effects on reducing the degree of limb spasms and improving limb motor function in patients. However, the methodological quality of the included literature is poor, and there is limited high-level evidence to support conclusions. More high-quality experimental research is still needed to provide strong evidence-based medicine evidence.

Objective To explore the surgical effects and follow-up results in treating adult aortic coarctation patients using ascending aorta-abdominal aorta vascular prosthesis bypass and summarize the clinical experiences. Methods From May 2008 to July 2009, ascending aorta-abdominal aorta vascular prosthesis bypass surgery was performed in nine patients with adult aortic coarctation, among which, four were male, and five were female, with the average age of 42.6 years old. All patients had upper extremity hypertension, the systolic blood pressure difference between their upper extremities and lower extremities was 55 - 100 mm Hg, mean (70.2 ± 15. 6) mm Hg. Among which, seven cases showed descending aorta aneurysmal dilatation at coarctation segment distal end, with the wall thinning; two cases showed long segment stenosis; three cases showed aortic wall near coarctation segment was calcified. All cases belonged to complex aortic coarctation. All patients underwent radial artery and dorsalis pedis artery puncture manometry, the surgical effects were evaluated according to mean pressure difference changes between radial artery and dorsalis pedis artery before and after operations. Results All patients were cured and dispertension has been significantly improved, before operation, the mean pressure difference between radial artery and dorsalis pedis artery was 36 - 63 mm Hg, mean [(48.2 ± 5.6 ) mm Hg]; 24 hours after operation, the mean pressure difference between radial artery and dorsalis pedis artery was 0 - 13 mm Hg, mean [(6.2 ± 1.6) mm Hg], significantly reduced ( P ＜per extremity hypertension disappeared, no need for oral antihypertensive drugs, the mean pressure differences between upper extremities and lower extremities after operations were all less than 20 mm Hg, thoracoabodominal aorta main vessels multi-slice CT examination three months after operation showed that bypass vascular prosthesis was unobetructed, two cases showed that autologous artery at aortic coarctation distal end were partly occluded. Conclusion Ascending aorta-abdominal aorta vascular prosthesis bypass would be an effective means for the treatment of adult aortic coarctation patients.