[Clinical effectiveness of less invasive intramedullary nail fixation combined with titanium cable cerclage for subtrochanteric fractures].

OBJECTIVE: To evaluate the surgical technique and clinical effect of less invasive intrame-dullary nail fixation combined with titanium cable cerclage in the treatment of subtrochanteric fractures. METHODS: A retrospective study was performed in 46 cases of subtrochanteric fractures in Peking University People's Hospital from January 2015 to December 2017. Among them, there were 14 males and 32 females, with an average age of (77.83±10.66) years (44-92 years); 17 cases on the left side and 29 cases on the right side. The causes of injury included crash from a height, traffic accident and accidental fall. According to Seinsheimer classification, there were 26 cases of type Ⅱ, 11 cases of type Ⅲ, 9 cases of type Ⅳ, and these cases were all closed injury. After admission, these patients underwent continuous tibial tuberosity bone traction to maintain the length and force line of the lower extremity, so as to reduce the difficulty of intraoperative fracture reduction. Anticoagulant therapy was given before operation to reduce perioperative thrombotic complications. All the patients were treated with less invasive intramedullary nail fixation combined with titanium cable cerclage. Operation time, blood loss during surgery, time of fracture healing were recorded, Harris and Sanders scoring system were used to assess hip function after operation at each follow-up time point. RESULTS: All the included patients underwent surgery successfully. Average operative time and intraoperative blood loss of these patients were (131.09 ± 20.06) min and (191.96±111.03) mL, respectively. All the patients were followed up satisfactorily, with an average follow-up time of 28 months. The fractures received bone healing within 3-6 months, average hospital stay was (10.61±2.85) days. The Sanders score was excellent in 3 cases, good in 37 cases and common in 6 cases, with an excellent and good rate of 86.96%. The Harris score was excellent in 6 cases, good in 36 cases, with an excellent and good rate of 91.30%. There were no cases of wound infection, loss of reduction, nonunion of fracture or internal fixation failure. Hip pain symptoms were effectively relieved in most patients. CONCLUSION: Less invasive intramedullary nail fixation combined with titanium cable cerclage can obtain good alignment and stability of fracture ends, which is an effective method for the treatment of subtrochanteric fractures.

[A mid-term clinical follow-up study on repair of the meniscus tears by a modified arthroscopic outside-in puncture suture technique].

OBJECTIVE: To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle. METHODS: From January 2015 to October 2017, 95 patients treated with this method were followed-up. Among these cases, there were 36 males and 59 females. The age of the patients ranged from 16 to 77 years, (46.79±18.07) years in average. Among them, there were 28 patieats aged 16-35, 53 patients aged 36-65, and 14 patients aged over 65 years old. 28 cases were diagnosed with medial meniscus tear, 43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear. Causes of the injury included sports, sprain, etc. According to Barrett standard, the clinical healing of meniscus tear was judged. Lysholm score, knee range of motion, visual simulation score (VAS) and magnetic resonance imaging (MRI) were used to evaluate the postoperative knee function and recovery of the patients. RESULTS: The 95 patients were followed up for 22 to 36 months, with an average of (28.32±3.98) months. According to Barrett standard, 90 patients (94.7%) obtained meniscus clinical healing. Meniscal healing rates were 96.43%, 96.23% and 85.71% in the three age groups, respectively. The meniscal healing rate was lower in the elderly group, but there was no significant difference in statistical results (P=0.262). Five patients had deep tenderness in the joint space of the injured side, and the overstretch test was positive. The preoperative and postoperative VAS scores, Lysholm scores and knee motion were compared in each group, and the differences were statistically significant (P < 0.01). At the end of the last follow-up, there were no cases of knee joint effusion, swelling and interlocking, and the joint function was effectively improved in most patients. No surgical site infection, periarticular vascular/nerve injury or knotting reaction was found during the follow-up. CONCLUSION: This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation, small trauma and rapid recovery, and the mid-term follow-up results were satisfactory. Therefore, we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.

[Correlation analysis between rotator cuff tear and the superior migration of humeral head].

OBJECTIVE: To evaluate the association between rotator cuff tear and the proximal migration of humeral head. METHODS: In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI. RESULTS: In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071). CONCLUSION: UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.

["Time-angle measurement" reduction evaluation technique and clinical evaluation of proximal humerus fracture].

OBJECTIVE: To evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with a "time-angle measurement" reduction evaluation technique, to assess the acceptance of the fracture reduction and to estimate the result of the sur-gery. METHODS: Forty-six patients [mean age: (66.2±14.9) years] with an acute proximal humeral fracture were managed with open reduction and internal fixation with this reduction evaluation technique from January 2012 to December 2013. According to the Neer classification, there were 6 two- part fractures, 25 three-part fractures and 15 four-part fractures. The functional outcome was evaluated for each patient using the Constant-Murley score; radiographic evaluation was also conducted and complications were recorded. The postoperative shoulder function recovery and imaging findings were followed up to evaluate the guiding significance of this reduction evaluation technique in the clinical treatment of this kind of fracture. RESULTS: In the study, 46 patients had been followed up for 13-36 months, and the average follow-up time was (23.5±7.3) months. All the patients achieved fracture healing 3 months after operation. The average head-shaft angle was (124±3.5) degrees. According to the Constant scoring system, 29 patients (63%) had excellent, 14 patients (30%) had good, and 3 patients (7%) had poor results. The most common complications were pain (7/65) and restricted movement of the shoulder (5/46). There were no cases of screw penetration, necrosis of humeral head, deep tissue infection, nonunion of fracture and axillary nerve injury after operation. CONCLUSION: For appropriate cases of displaced proximal humeral fractures, surgical treatment with application of "time-angle measurement" reduction evaluation technique that was introduced in the present study can lead to a good functional outcome, and the technique of reduction assessment should be regarded as a reasonable reference standard in the treatment of displaced proximal humerus fracture.

Effect of recombinant human endostatin on the expression of c-Myc and bFGF in mouse gastric cancer cells.

The aim of this study was to observe the effects of re-combinant human endostatin on the proliferation and apoptosis of mouse gastric cancer cells, and explore some possible mechanisms of recom-binant human endostatin inhibition of cancer. A murine gastric cancer xenograft model was established. A total of 20 mice were divided into two groups (control and experimental groups). The expression of c-Myc and basic fibroblast growth factor (bFGF) was determined by reverse transcription-polymerase chain reaction, Western blotting, and immu-nohistochemical staining methods. Tumor volume was measured and a growth curve was calculated. The tumor diameter in the experimental group was significantly smaller than that in the control group after treat-ment with endostatin for 21 days. The expression levels of c-Myc and bFGF in the experimental group were significantly lower than those of the control group (P < 0.05). There was a positive correlation between the expression of c-Myc and bFGF in the experimental group. Microvessel density was significantly inhibited in the experimental group (P < 0.05). These results demonstrated that recombinant human endostatin could in-hibit tumor metastasis by inhibition of the expression of c-Myc and bFGF in gastric cancer tissue as well as by inhibition of angiogenesis.

[Clinical characteristics and risk factors of newly developed vertebral fractures after vertebral augmentation].

OBJECTIVE: To identify the characteristics and risk factors of the refractures after percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). METHODS: A retrospective analysis of 148 patients who had undergone PKP or PVP between March 2006 and October 2013 in Peking University People's Hospital was conducted. In the study, 29 patients with 42 refractured vertebra and 119 patients without refracture were included. All the patients were observed for a time of (34.4±26.8) months. Clinical, imaging and procedure related factors (gender, age, height, weight, body mass index, the level of the injured vertebra, the time interval between the procedure and the refracture, the level of the refractured vertebra, the bone cement volume injected, performed PKP or PVP,performed unilateral or bilateral, the percentage of anterior vertebral height restoration, the correction of the Cobb angle, cement diffusion, bone mineral density, presence or absence of diabetes mellitus, history of fractures of the whole body, anti-osteoporosis treatment, cement leakage) for each group were analyzed by Cox proportional hazards regression analysis. RESULTS: Of all the patients,16 (55.17%, 16/29) had refractures in the adjacent vertebra, and 13 (44.83%, 13/29) had refractures in the nonadjacent vertebra. Refractures within 3 months accounted for 31.03% (9/29) of all the refractures, and within 1 year accounted for 55.17% (16/29). Both older age (P=0.027, HR=1.051, 95% CI=1.006-1.098) and a history of fractures of the whole body (P=0.012, HR=0.386, 95% CI=0.184-0.812) were statistically significant as the independent risk factors for predicting refractures. Others were not associated with refractures (P>0.05). CONCLUSION: Older age and a history of fractures of the whole body are the independent risk factors of the refractures after PKP and PVP. The mechanism of the refractures after PKP and PVP is mainly the natural development of osteoporosis.

[Applying percutaneous placement of guide wire combined with true lateral view fluoroscopy proximal femoral nail anti-rotation fixation].

OBJECTIVE: To apply modified proximal femoral nail anti-rotation (PFNA) fixation techniques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler. METHODS: A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014. In the study, 60 cases were followed for average 13 months. The operation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements (tip apex distance, TAD) and hip function scores were analyzed. RESULTS: In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were (34.9±6.1) mL, (70.5±12.5) min, (63.6±9.7) s respectively. In conventional PFNA group,they were (47.8±6.7) mL, (80.6±17.1) min, (68.5±8.7) s respectively. There were significant differences in the above respects between the two groups (P were 0.006, 0.013, and 0.022 respectively). There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups (P>0.05). CONCLUSION: Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture. Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluoroscopy time significantly, make the procedures simpler and acquire satisfactory results .

[Characteristics and perioperative management of hemophilia patients with fractures].

OBJECTIVE: To investigate the characteristics and perioperative management of hemophilia patients with fracture. METHODS: Retrospectively, we analyzed 8 patients with hemophilia combined with fracture, who were admittted to our department from 2005 to 2013. Six patients were with hemophilia A and two with hemophilia B; Based on the severity of hemophilia, 2 cases were light, 3 moderate and 3 severe; Based on the location of fracture, 4 cases were femoral neck fractures, 1 femoral intertrochanteric fracture, 1 bilateral distal femur fractures, 1 tibiofibula fracture, and 1 humerus intercondylar fracture. Blood coagulation factor replacement therapy was conducted preoperatively, intraoperatively and postoperatively, All the patients underwent closed or open reduction and internal fixation or joint replacement. Also, we analyzed the perioperative complications and observed whether the fracture healed. RESULTS: The average age was 33.5 years (14 to 47 years); In 6 cases, fractures occurred at femur, accounting for 75% of all the fractures; Femoral neck fracture was treated by closed reduction and hollow screws fixation; Femoral intertrochanteric fracture, distal femur fracture, and tibiofibula fracture were treated by open reduction and internal fixation with plate; Humerus intercondylar fracture was treated by elbow joint replacement. Intraoperative bleeding was from 50 to 600 mL, an average of 262 mL; Perioperatively, the average use of FVIII/activated prothrombin complex concentrates (APCC) was 358 U/kg (125 to 554 U/kg). Postoperatively, poor wound healing was observed in 2 patients, and the condition improved after symptomatic treatment; In patients with internal fixation, all the fractures united, and the average healing time was 14 weeks. No complications such as fixation loosening or rupture occurred after internal fixation. CONCLUSION: Hemophilia combined with fracture mainly occurred in the young, and the site of fracture was given priority to femur. With perfect preoperative preparation, on the basis of the replacement therapy, hemophilia combined with fractures was safe for surgical treatment, and postoperative fractures healing wasgood. But the risk of poor wound healing was high.

Radiological evaluation of reduction loss in unstable proximal humeral fractures treated with locking plates.

PURPOSE: The aim of this study was to radiologically evaluate the risk of reduction loss after locking plate fixation of proximal humerus fractures. METHODS: From September 2007 to April 2009, 71 patients (28 males, 43 females) with unstable proximal humeral fracture were treated with open reduction and internal fixation by locking plate. The mean follow-up time was 31.2 months (range: 26-47). The head-shaft angulation (HSA) and the humeral head height (HHH) in true anteroposterior (AP) were recorded and compared over time. All complications were noted. Shoulder function was measured by the Constant score. RESULTS: Patients with ΔHSA >10° (t=2.740, P=0.008) and ΔHHH >5mm (t=2.55, P=0.019) were more likely to have impaired shoulder function. Varus collapse occurred most frequently in patients with initial reduction of HSA <125° (χ(2)=19.17, P<0.001, Fisher's exact test F<0.001). Patients with >5mm HHH decrease were strongly associated with loss of reduction (χ(2)=24.23, P<0.001, F<0.001). CONCLUSIONS: Dynamic change of HSA >10° and HHH >5mm were radiological factors that indicated poor shoulder function. Intra-operative HSA >125° should be achieved to avoid reduction loss following locking plate fixation of proximal humerus fracture. LEVEL OF EVIDENCE: level IV.

Randomized prospective study of olecranon fracture fixation: cable pin system versus tension band wiring.

OBJECTIVE: This prospective, randomized study compared the effectiveness of the cable pin system (CPS) versus tension band wiring (TBW) for olecranon fracture fixation. METHODS: Patients with acute transverse or slight oblique olecranon fractures were randomly divided into two groups: one fixed by CPS and the other by TBW. Clinical outcome data were collected and analysed following a mean duration of 21 months. RESULTS: The mean ± SD fracture healing time was significantly shorter in the CPS group (n = 30; 9.73 ± 2.02 weeks) compared with the TBW group (n = 32; 11.13 ± 2.21 weeks). One patient in the CPS group and seven patients in the TBW group experienced postoperative complications; this difference was statistically significant. The mean ± SD Mayo Elbow Performance Score in the CPS group was significantly higher (88.67 ± 6.42) than that in the TBW group (80.78 ± 11.99). Logistic regression analysis showed an association between fixation method and fracture healing time, complications and elbow function. CONCLUSIONS: Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW.

Effect of aerobic exercise and ginsenosides on lipid metabolism in diet-induced hyperlipidemia mice.

AIM: To study the effect of aerobic exercise and its combination with Gin (ginsenosides from stems and leaves of ginseng) on lipid metabolism in diet-induced hyperlipidemia mice. METHODS: The mouse hyperlipidemia model was set up by feeding high cholesterol diet. Unloaded swimming was designed to be a manner of aerobic exercise. The effects of aerobic exercise and its combination with Gin on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-c) in serum, malondialdehyde (MDA), and superoxide dismutase (SOD) in liver tissue were measured; the thymus and liver were weighed. RESULTS: (1) The mouse hyperlipidemia model was set up successfully: TC and MDA increased (P < 0.05) but HDL-c and SOD decreased (P < 0.05); the liver weight increased and the thymus weight reduced; fatty liver was found; (2) aerobic exercise reduced TC but increased MDA and HDL-c in cholesterol-rich diet mice; the liver weight did not reduce, and fatty liver did not clear up; and (3) when aerobic exercise combined with Gin, TC and TG decreased markedly (P < 0.01), and MDA also decreased (P < 0.05); SOD and HDL-c increased markedly (P < 0.01); the thymus weight increased and the liver weight decreased to normal level; fatty liver cleared up. CONCLUSION: Aerobic exercise could lower serum lipid to some extent but could not satisfactorily regulate lipid metabolism. When combined with Gin, aerobic exercise could better lower serum lipid, regulate lipid metabolism, promote antioxidation, and enhance immune activity.

Effects of ginsenosides on myocardial reperfusion arrhythmia and lipid superoxidation in high cholesterol diet rats.

To explore the effects of GSL on myocardial reperfusion arrhythmia and lipid superoxidation in high cholesterol diet rats. Hyperlipidemia model was set up with administered high cholesterol emulsion 15 ml/kg to rats orally for 14 days. In GSL group, rats were given GSL i.p. 75 mg/kg simultaneously when administered high cholesterol emulsion. The experiment of myocardial ischemia reperfusion was performed on all rats. The results showed: (1) After administration of high cholesterol emulsion to rats orally for 14 days, hyperlipidemia model was set up successfully, simultaneously treatment with GSL. It lowered serum lipid; (2) In hyperlipidemia state, serum MDA increased (p < 0.01, SOD and NO decreased markedly (p < 0.01 and p < 0.05 respectively) after 2 h of myocardial reperfusion; the rate of reperfusion arrhythmia (RPAr) increased within 10 min of reperfusion, four out of nine rats died of ventricular fibrillation (VF); and (3) GSL decreased MDA, increased SOD and NO after 2 h of myocardial reperfusion. All changes were significant (p < 0.01); the rate of RPAr decreased, no VF occurred and all rats survived. Hyperlipidemia aggravated myocardial ischemia reperfusion injury and increased the incidence of RPAr. The results suggested that GSL reduced myocardial ischemia reperfusion injury and RPAr in high cholesterol diet state through antiperoxidating and inducing the production of NO.

[Effect of basic fibroblast growth factor on repairing transected sciatic nerve in rats].

OBJECTIVE: To investigate the effects of basic fibroblast growth factor(bFGF) on repairing transected sciatic nerves in rats. METHODS: The animal models of the transected sciatic nerve of 40 SD rats were established, which divided into 4 groups: normal saline (NS) group, nerve growth factor (NGF) group, bFGF group and normal control group. The epineurium of the transected sciatic nerve was sutured under microscope, then bFGF or NGF was dropped into local sites and injected intramuscularly once a day for 30 days after operation. Functional repair for the transected sciatic nerves was studied by nerve conductive velocity (NCV) and sciatic nerve function index (SFI). RESULTS: As a criterion, the level of the normal control group was regarded as zero, SFI of NS group, NGF group and bFGF group were -114.30 +/- 10.34, -70.50 +/- 11.01, -50.45 +/- 7.82 respectively at 1 month after operation, and they were -54.96 +/- 16.46, -35.21 +/- 10.80, -27.53 +/- 11.23 respectively in 3 months after operation. NCV of bFGF group was significantly faster than NS group and NGF group. CONCLUSION: bFGF can significantly promote the functional repair of injured peripheral nerve, and its effects are better than NGF.

Effect of chinonin on acute hypoxic pulmonary vasoconstriction in Sprague-Dawley rats.

The objective of this study was to determine the influence of chinonin on acute hypoxic pulmonary vasoconstriction (HPV) in Sprague-Dawley (SD) rats and investigate its mechanism. Sixty-five SD rats were divided into five groups at random: six in the control group; six in the hypoxia group; 13 in the group of hypoxia with chinonin; 20 in the group of endothelin-1 (ET-1) with chinonin and 20 in the group of platelet activating factor (PAF) with chinonin. Their mean pulmonary arterial pressures (mPAP) were measured and the concentration of molondialdehyde (MDA) in plasma and the activity of phospholipase A2 (PLA2) of the lung tissues were detected. The PAF and ET-1 levels of plasma and lung homogenates were detected in the control and hypoxia groups. There was evidence of an increase in mPAP, MDA, PAF and ET-1 in the plasma, and activity of PLA2, PAF and ET-1 of the lung tissues when the rats inhaled a 10% mixture of oxygen in nitrogen. It appeared that chinonin may have been inhibiting the action of ET-1 and PAF. Chinonin could have prevented an increase in MPAP caused by hypoxia and inhibited the action of ET-1 and PAF. But chinonin had no influence on the increase in MDA in the plasma and the PLA2 activity of the lungs when hypoxia occurred. Chinonin can reduce HPV, but does not influence normal mPAP. It may do this by blocking the action of ET-1 and/or PAF or others. The definite mechanism needs to be studied further.

Morphological analysis of lymph vessels and capillaries in gastric carcinoma.

AIM: To investigate the morphology of lymph vessel capillaries in both human gastric carcinomas and their peritumoral tissues, as well as the relation of this morphology to lymphatic metastasis. METHODS: The morphology and fine distribution of both lymph vessels and capillaries in and around the primary foci of gastric carcinoma were studied using the 5'Nase Alpase double staining method. The total amount of opened vessels and the opening rate of lymph vessels and capillaries were counted using a light microscope (100 × magnification), and the maximal luminal area, perimeter and diameter were measured using an image analysis technique. RESULTS: Lymph vessels and capillaries displayed strong 5'Nase-positive staining (brown and dark brown), while blood vessels and capillaries revealed significant Alpase activity (blue). There were many lymph vessels, capillaries and solid strip-like tissues found in the gastric carcinoma samples analyzed. The total amount of lymphatics in the metastatic group (gastric carcinoma vs peritumoral tissue) and non-metastatic group was 26.9 ± 14.2 vs 10.4 ± 4.0, 11.4 ± 3.4 and 9.7 ± 3.2, P < 0.01, respectively. Their opening rates were 21.2 vs 47.5 and 40.4 vs 46.0, P < 0.01, respectively. Their maximal luminal areas were 1502.98 ± 1236.91 vs 5526.80 ± 4853.42; 1918.14 ± 2299.24 vs 3836.16 ± 3549.16; 5526.80 ± 4853.42 vs 3836.16 ± 3549.16, P < 0.05, their perimeters were 220.33 ± 130.25 vs 441.43 ± 276.51; 241.79 ± 171.13 vs 333.80 ± 199.66; 441.43 ± 276.51 vs 333.80 ± 199.60, P < 0.05, and their diameters were 28.80 ± 14.98 vs 59.39 ± 28.53; 25.37 ± 15.79 vs 46.22 ± 20.85; 59.39 ± 28.53 vs 46.22 ± 20.85, P < 0.05, respectively. In summary, the lymphatics found in gastric carcinoma samples from the metastatic group were significantly lower than those of the other groups. CONCLUSION: There are newly formed lymph capillaries found in gastric carcinoma. Dilation of lymph capillaries may be related to edema found in peritumoral connective tissues. The observed lymph node metastases from gastric carcinoma occur through mature lymph capillaries that invade in and around primary gastric carcinoma foci.

Intrafascicular decompression in the treatment of causalgia with special reference to the mechanism.

A new concept of the pathogenesis of causalgia is suggested in accordance with experimental and clinical work. Endoneural hypertension secondary to nerve trunk disruption is incriminated and intrafascicular decompression is used as the key therapeutic measure. In 14 patients with causalgia thus treated, all except 1 were cured. No symptomatic recurrence was noted in a 4- to 6-year follow-up study.

Free musculocutaneous flap transfer of extensor digitorum brevis muscle by microvascular anastomosis for restoration of function of thenar and adductor pollicis muscles.

This article reports 3 cases of surgical restoration of function of the thenar muscle and the adductor pollicis muscle of the thumb with free musculocutaneous flaps of the extensor digitorum brevis muscle of the toe by microsurgical technique. Two years' follow-up revealed good functional recovery of the hand with normal electromyographic findings and grade 3-4 muscular power.