Contralateral S1 nerve root transfer for motor function recovery in the lower extremity among patients with central nervous system injury: study protocol for a randomized controlled trial.

BACKGROUND: Central nervous system injury (CNSI) comprises a series of common diseases that severely affect patients' motor function and quality of life and is associated with high disability and mortality rates. Previous studies have shown that contralateral lumbosacral nerve root transfer significantly improved the function of the paralyzed limb in rat models of CNSI. These studies showed that severing the sacral 1 nerve root (S1) did not damage the function of the ipsilateral lower extremity. Thus, we speculate that contralateral S1 nerve root transfer can improve the recovery of a paralyzed limb. Because no associated rigorously designed randomized controlled trial has evaluated the effectiveness of contralateral S1 nerve transfer thus far, we designed this clinical trial to compare the effects of this new treatment approach with those of traditional treatments in paralyzed patients after chronic CNSI. METHODS: This is a single-center, prospective, randomized controlled trial. Forty patients, who meet the inclusion criteria and have hemiplegia caused by chronic CNSI, will be randomly divided into the surgical or non-surgical group. The treatment effect in the 2 groups will be assessed before and 3, 6, 9, 12, 18, and 24 months after intervention by using numerous scales and resting-state functional magnetic resonance imaging. The primary outcome will be the Fugl-Meyer score for the lower limbs 24 months after treatment. The secondary outcomes include the modified Ashworth spasm scale, the modified Barthel scale, 10-m walking speed measurement results, three-dimensional gait analysis, muscle strength testing, electromyography, and resting-state functional magnetic resonance imaging findings. Safety outcomes and adverse events will be observed simultaneously. DISCUSSION: We expect that the surgery will improve the sensorimotor functions of the paralyzed limb, and the results of this trial will provide high-quality clinical evidence for a new efficient treatment strategy for disability after CNSI. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1800014414, registration date: 12 January 2018.

[Analysis and prevention of the complications after treatment of metacarpal and phalangeal fractures with internal fixation].

OBJECTIVE: To retrospective analysis the complications after treatment of metacarpal and phalangeal fractures with internal fixation, and propose measures to prevent or reduce surgical complications. METHODS: From July 2007 to October 2009, 342 patients with metacarpal and phalangeal fractures were treated with internal fixation,including 203 males and 139 females with an average age of 30.4 years old ranging from 18 to 56 years. There were 217 right hands and 125 left hands, 38 cases of the first metacarpal fracture, 47 cases of the second metacarpal fracture, 52 cases of the third metacarpal fracture, 40 cases of the forth metacarpal fracture, 39 cases of the fifth metacarpal fracture, 43 cases of the proximal phalangeal fractures, 52 cases of the middle phalangeal fractures, and 48 case of the distal phalangeal fractures. The fractures were fixed with K-wires in 129 patients, mini plates in 153 cases, screws in 48 cases, wires in 12 cases. RESULTS: All 324 patients were followed up for 3 to 15 months (averaged 8.5 months) and complications occurred in 74 patients (22.84%). The main complication was unhealthy wound healing in 24 patients (7.4%), others was adhesion of tendon in 54 patients (16.67%), malunion in 34 patients (10.49%), nonunion in 13 patients (4.01%) and shortening of metacarpal and phalangeal in 21 patients (7.41%). CONCLUSION: The important reasons responsible for complications are iatrogenic factors such as unsuitable implant selection, unskillful surgical technique and improper post-operative functional rehabilitation.