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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1341-1345, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063502

RESUMO

Objective: To review the research progress of wrist arthroscopy assisted treatment of distal radius fractures. Methods: To summarize and describe the anatomical characteristics and fracture classification of the distal radius, indications and contraindications of wrist arthroscopy-assisted treatment, surgical methods, and associated soft tissue injuries, and summarize the advantages and disadvantages of the operation through a large number of literature at home and abroad on the treatment of distal radius fractures assisted by wrist arthroscopy. Results: Wrist arthroscopy as a minimally invasive technique for the treatment of distal radius fractures, compared with traditional surgery, can accurately observe intra-articular damage and perform operations under the microscope to avoid secondary damage to blood vessels, nerve, and tendon, etc., and can achieve one-stage repair and reconstruction by repairing the ligament, trigonal fibrocartilage complex, and carpal dislocation. It has the advantages of less trauma, fast postoperative recovery, extensive indications, fewer complications, and satisfactory effectiveness. Conclusion: Wrist arthroscopy has advantages that traditional X-ray film, CT, MRI, and arthrography examinations do not have. Moreover, wrist arthroscopy has achieved satisfactory effectiveness in the adjuvant treatment of intra-articular distal radius fractures.


Assuntos
Fraturas do Rádio , Artroscopia , Fixação Interna de Fraturas , Humanos , Fraturas do Rádio/cirurgia , Resultado do Tratamento , Punho
2.
Zhongguo Gu Shang ; 33(8): 770-5, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875771

RESUMO

The distal radioulnar joint is not only the main load-bearing joint in the wrist, but also the pivot of the rotation of the forearm. It is one of the most important and unique joints in the body. Maintaining the stability of the distal radioulnar joint is very important for our daily life. The tissue to stabilize the distal radioulnar joint includes bone structures and soft tissue structures. Although the contribution of soft tissue structures to its stability is far exceeding that of bone structures, the influence of abnormal bone structure on the distal radioulnar joint cannot be ignored. By reviewing the relevant literatures, this article divides the bone structural abnormalities into congenital and acquired bone structural abnormalities. The effects of congenital and acquiredbone structural abnormalities on the distal radioulnar joint stability are analysized and collated in this article, and its clinical symptoms, clinical grading, clinical treatments are also summerized. The problems of distal radioulnar joint instability in clinical practicing and its future researching directions are briefly described in order to provide some suggestions for future clinical applications.


Assuntos
Instabilidade Articular , Articulação do Punho , Antebraço , Humanos , Rotação , Ulna , Punho
3.
Handchir Mikrochir Plast Chir ; 52(5): 435-440, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32992399

RESUMO

The odd shape of the scaphoid is a challenge to our spatial sense. Computer assistance is of an unmatched value when reconstructing a non-united scaphoid: From CT data a true 3-D-model can be generated, fully interactive; thus it can be moved, manipulated and of course also printed for hands-on experience. Comparing the virtual 3-D-models of the nonunion with the healthy contralateral scaphoid, the exact amount of the deformity is calculated which allows for the planning of an anatomically precise reconstruction of the scaphoid shape. Finally, computer generated patient specific instruments will facilitate the implementation of this planning intraoperatively. This proceeding enables us to reconstruct the non-united scaphoid markedly more accurately and with this reliably normalize wrist kinematics. Meanwhile we have applied this technique successfully in more than 50 cases of scaphoid-nonunions presenting with significant deformity.


Assuntos
Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Humanos , Tomografia Computadorizada por Raios X , Punho , Articulação do Punho
4.
Arthroscopy ; 36(9): 2423-2424, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891244

RESUMO

When choosing the best treatment option for patients with tears of the triangular fibrocartilage complex, there are multiple patient factors that should be carefully considered. The role of ulnar variance is often overemphasized when attempting to predict the success of arthroscopic repair. In practice, variables such as the age of the patient and location and nature of the tear as traumatic or degenerative should primarily drive the decision between arthroscopic repair and primary ulnar-shortening osteotomy. Arthroscopic repair should generally be avoided in favor of ulnar-shortening osteotomy in patients with degenerative tears and evidence of ulnar impaction syndrome. However, for acute, traumatic, ulnar-sided tears in young patients, arthroscopic repair remains an effective treatment option regardless of ulnar variance.


Assuntos
Fibrocartilagem Triangular , Artroscopia , Florestas , Humanos , Resultado do Tratamento , Árvores , Ulna , Punho
5.
Med Probl Perform Art ; 35(3): 138-144, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32870965

RESUMO

AIMS: Musicians spend numerous hours perfecting their skills and art, often leading to overuse injuries of the hand; of specific concern to musicians is carpal tunnel syndrome (CTS). This study evaluated the median nerve cross-sectional area and hand function of musicians and made comparisons to non-musicians. METHODS: Seventy-six participants took part in the study, 38 music students and professors in the musician group and 38 participants in the control group. Participants completed patient-reported questionnaires to assess the level of pain and hand function. Ultrasound images were collected at the carpal tunnel inlet and outlet. The median nerve cross-sectional area and the depth of the carpal tunnel were measured on ultrasound images using software imbedded in the ultrasound unit. RESULTS: Musicians showed higher levels of hand dysfunction and CTS symptoms than the non-musicians. The median nerve cross-sectional area was greater in musicians than in the non-musician group on both the right (mean difference 1.5 mm2, p=0.002) and left sides (mean difference 0.9 mm2, p=0.036). The depth of the carpal tunnel at the carpal tunnel inlet and outlet did not differ between the groups (p>0.05). CONCLUSION: The current research identified between-group differences in median nerve cross-sectional area and the level of hand dysfunction. Understanding the interaction between the anatomy of the wrist and wrist and hand dysfunction will benefit clinicians when evaluating and treating musicians.


Assuntos
Síndrome do Túnel Carpal , Nervo Mediano , Música , Síndrome do Túnel Carpal/etiologia , Humanos , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Ultrassonografia , Punho
6.
No Shinkei Geka ; 48(9): 849-854, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32938814

RESUMO

A 51-year-old man had a 1-year history of numbness on the ulnar side of the 4th finger, the 5th finger, and the ulnar side of the forearm, and weakness of the right hand. The Spurling sign was negative, and cervical radiography and magnetic resonance imaging revealed no abnormality. The Tinel-like signs at the Guyon's canal and cubital tunnel were positive. The diagnosis upon electrophysiological examination was cubital tunnel syndrome and Guyon's canal syndrome, but the possibility of Guyon's canal syndrome was high. Based on the presence of numbness in the forearm, the Tinel-like sign at the cubital tunnel, and the high incidence rate of cubital tunnel syndrome, an operation for cubital tunnel syndrome was performed. After the first operation, the numbness in the forearm was improved, but numbness in the 4th and 5th fingers, and weakness of the right hand remained, and the Tinel-like sign at the Guyon's canal also remained positive. The second operation for Guyon's canal syndrome was performed a month after the first operation for cubital tunnel syndrome. After the second operation, the residual symptoms improved gradually. Guyon's canal syndrome is a rare condition, but it may be considered a causative factor in patients with ulnar neuropathy.


Assuntos
Síndrome do Túnel Ulnar , Síndromes de Compressão do Nervo Ulnar , Humanos , Hipestesia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Punho
7.
J Sports Sci ; 38(20): 2314-2320, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32965184

RESUMO

This study was designated to investigate the kinematical differences between successful and faulty spikes, in order to identify the best strategies leading to better spike performance. Simulating a real-game condition, 13 elite youth attackers performed 6 spikes in the presence of 2 blocks. The kinematic variables of the spike performances were recorded using 6 optoelectronic cameras (Vicon Motion systems, Oxford, UK). The paired sample t-test was used to compare the kinematic variables recorded during the delivery of successful and faulty spikes. Among the successful trials, both the angular velocities of the knees (≈12.4%) and hips (≈13.3%), and the vertical velocity of the centre of mass at take-off (≈6.5%) and arm swing (≈8.2%) were considerably higher during the plant phase. Consequently, the jump (≈4.3%) and spike (≈1.5%) heights, as well as the wrist velocity (≈5.5%), were significantly higher during the jump phase of successful spikes. In successful spike performances, the attackers adopted higher hip and knee angular velocities, combined with efficient arm swings, to produce higher take-off velocities and reach higher jump heights. This approach provides them with the better position regarding the ball and the blockers to find the best path and hit the ball with higher arm velocities.


Assuntos
Destreza Motora/fisiologia , Voleibol/fisiologia , Adolescente , Braço/fisiologia , Desempenho Atlético/fisiologia , Fenômenos Biomecânicos , Cotovelo/fisiologia , Quadril/fisiologia , Humanos , Joelho/fisiologia , Ombro/fisiologia , Estudos de Tempo e Movimento , Punho/fisiologia
8.
BMC Infect Dis ; 20(1): 672, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938418

RESUMO

BACKGROUND: Mycobacterium jacuzzii (M. jacuzzii) was first isolated in 2003 by insertion of breast implants in Tel Aviv, Israel. In this case report, we describe our experience in detection of M. jacuzzii using phenotypic and genotypic test of wrist synovial sample. CASE PRESENTATION: A 73-year-old woman complained of pain and swelling in the right wrist for 4 months. Her body temperature was 37-38 °C, and symptoms, such as pain, swelling, and some movement limitation, were reported. Clinical laboratory parameters showed an elevated C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and white blood cells (WBC) count. The sequences of hsp65, rpoB, 16S rDNA, and sodA genes indicated very high homology to M. jacuzzii. CONCLUSION: We report a case of synovial infection caused by M. jacuzzii in a patient with severe wrist pain in Iran, who was treated with amikacin, levofloxacin, and ethambutol. The outcomes of treatment after 8 months were positive, and no recurrence of infection was reported in the patient.


Assuntos
Implantes de Mama/efeitos adversos , Infecções por Mycobacterium/diagnóstico , Mycobacterium/genética , Membrana Sinovial/microbiologia , Idoso , Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Sedimentação Sanguínea , Feminino , Humanos , Irã (Geográfico) , Contagem de Leucócitos , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/microbiologia , Filogenia , RNA Ribossômico 16S/classificação , RNA Ribossômico 16S/metabolismo , Punho/microbiologia
9.
Medicine (Baltimore) ; 99(30): e21292, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791711

RESUMO

BACKGROUND: Insomnia is a common, recurrent, and tenacious sleep problem, especially the chronic insomnia. Repetitive transcranial magnetic stimulation (rTMS) at right dorsolateral prefrontal cortex (r-DLPFC) is used in chronic insomnia, and repetitive magnetic stimulation (rMS) at Shenmen (HT7) acupoint may be an alternative approach. However, the efficacy and mechanism of rMS at HT7 acupoint for chronic insomnia has not been confirmed. METHODS/DESIGN: This is a 3-armed randomized positive-controlled noninferiority clinical trial. We will allocate 45 subjects aged between 18 and 65 years old, diagnosed with initial chronic insomnia over 3 months to 3 groups randomly in a ratio of 1:1:1. Patients in the experimental group will be treated with rMS at HT7 acupoint while the others in the control group will be treated with rTMS at r-DLPFC or waiting treatment. All will be given rMS at HT7 or rTMS at r-DLPFC or no treatment for 10 days, and then received 20-day follow-up. Patients will be evaluated with the insomnia severity index and Pittsburgh sleep quality index for sleep state, Beck Depression Inventory-2nd edition scores for the depression state, Beck anxiety inventory scores for the anxiety state, and Montreal Cognitive Assessment scores for the cognition state before and the 10th day of treatment, 30th day of follow-up; study on mechanisms of rMS will be revealed through the resting motor threshold diversity of the motor cortex before and the 10th day of treatment, 30th day of follow-up. Baseline characteristics of patients will be summarized by groups and compared with Chi-squared for categorical variables, and analysis of variance or Kruskal-Wallis test for the continuous variables. Primary and secondary outcomes according to the measurement times are applicable to univariate repetitive measurement deviation analysis or analysis of variance, or Kruskal-Wallis test. CONCLUSION: The present study is designed to preliminarily investigate short-term efficacy and mechanism of rMS at HT7 acupoint therapy on chronic insomnia, also to explore the correlation between motor cortex excitability and chronic insomnia. With this research, we are looking forward to find out an appropriate alternative and easy therapy for chronic insomnia individuals compared with rTMS at r-DLPFC. TRIAL REGISTRATION: The trial was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) with the ID ChiCTR1900026844 on October 24, 2019.


Assuntos
Distúrbios do Início e da Manutenção do Sono/terapia , Estimulação Magnética Transcraniana/métodos , Pontos de Acupuntura , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Punho
10.
Plast Reconstr Surg ; 146(2): 343-354, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740587

RESUMO

Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.


Assuntos
Implementação de Plano de Saúde , Doenças Musculoesqueléticas/terapia , Sistemas On-Line , Ortopedia/organização & administração , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Estudos de Coortes , Coleta de Dados/métodos , Mãos/fisiopatologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Países Baixos , Ortopedia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Medição da Dor , Melhoria de Qualidade , Punho/fisiopatologia
11.
Orthopade ; 49(9): 797-807, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32776275

RESUMO

BACKGROUND: Wrist arthroplasty is still an exceptional indication in the field of hand surgery. In recent years, it has become increasingly accepted as an alternative to wrist arthrodesis as the ultima ratio for panarthrosis or similar destruction of the wrist. In particular, the patient's desire for functional integrity also plays an important role. COMPLICATIONS: While there were often complications with earlier prosthesis designs of the older generations and only a short survival rate could be achieved, this has improved, if the indication of the so-called fourth generation prostheses is done properly. Survival rates of over 10 years are no longer uncommon, even without revision operations. Currently, the indication for hemiarthroplasty has been increasing, particularly in the case of post-traumatic destruction. Those who are seriously interested in endoprosthesis should also be able to treat the associated complications. The present article is intended to provide an overview of common or potential complications in the context of wrist arthroplasty and to demonstrate possible solutions by presenting case studies. The basics of primary implantation are, therefore, not discussed. Reference is made to further literature.


Assuntos
Artroplastia de Substituição , Hemiartroplastia , Prótese Articular , Reoperação , Punho , Humanos , Desenho de Prótese , Punho/cirurgia , Articulação do Punho
12.
Orthopade ; 49(9): 784-796, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32809041

RESUMO

(Partial) arthrodeses of the wrist have been proven cornerstones to treat many lesions for decades, especially in the case of revision surgery. Four-corner, scapho-trapezo-trapezoidal (STT), radio-scapho-lunate (RSL) and total wrist fusions are very common techniques in hand surgery. However, even these proven surgical procedures have significant non-fusion rates. Prior to revising a failed arthrodesis, it is essential to analyse the latter failure precisely. A technically adequate revision is only feasible when based on a correct and meticulous analysis. The understanding of the biological processes and technical aspects of the implants are the basis for solving this issue.


Assuntos
Artrodese , Reoperação , Punho , Humanos , Osso Semilunar , Punho/cirurgia , Articulação do Punho
13.
Rev Med Suisse ; 16(700): 1380-1387, 2020 Jul 15.
Artigo em Francês | MEDLINE | ID: mdl-32672018

RESUMO

The management of many traumatic conditions of the hand and wrist can be done or at least initiated by the primary care physician, often the first actor of the scenario. To do so, he must first have performed a correct reading of X-rays made with specific incidences to the suspected pathology. This article reviews the radiological diagnosis of the most common pathologies in hand and wrist traumatology to facilitate interpretation by general practitioners.


Assuntos
Articulação do Punho , Punho , Medicina Geral , Mãos , Humanos , Masculino , Radiografia , Radiologia , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
15.
Arthroscopy ; 36(7): 1853-1855, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624121

RESUMO

A triangular fibrocartilage complex foveal lesion is one of the key structures for stabilizing the distal radioulnar joint. Its anatomy is unique and healing potential is still controversial. If surgical repair is necessary, ulnar abutment is contraindicated, evaluation of the ligament condition using distal radioulnar joint arthroscopy is crucial to achieve satisfactory results.


Assuntos
Cirurgiões , Fibrocartilagem Triangular , Traumatismos do Punho , Artroscopia , Humanos , Punho , Articulação do Punho
16.
Stud Health Technol Inform ; 272: 171-174, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604628

RESUMO

Invasive blood pressure (IBP) is the gold standard method for BP monitoring in critically ill patients. However, due to practical difficulties and complications, noninvasive methods may offer an alternative. We aim to evaluate an automatic oscillometry-based wrist BP monitor in critically ill patients compared to IBP. Forty five adult patients were included, and systolic, diastolic and mean BP (SBP, DBP, MBP) were simultaneously measured by IBP in the radial artery and by non-invasive blood pressure (NIBP) monitoring using the OMRON RS7 automatic wrist monitor. NIBP and IBP (mean ± SD) were: SBP 114 ± 18 vs 130 ± 18; DBP 63 ± 13 vs 63 ± 13; MBP 80 ± 13 vs 86 ± 15 mmHg. Bland-Altman analysis of the differences (NIBP-IBP) mean bias was: SBP -16; DPB 0.5 and MBP -6. The OMRON wrist monitor may not be sufficiently accurate compared to IBP in critically ill patients.


Assuntos
Monitores de Pressão Arterial , Punho , Pressão Sanguínea , Determinação da Pressão Arterial , Cuidados Críticos , Humanos , Oscilometria
17.
Fa Yi Xue Za Zhi ; 36(2): 249-255, 2020 Apr.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32530176

RESUMO

Abstract: Bone age is an important indicator of human growth and development, which can objectively reflect the growth level and maturity of individuals. Traditional manual bone age assessment usually compares the X-ray of the left wrist with the reference standard to obtain the corresponding bone age. This method is time-consuming and its results vary with different observers. In recent years, with the continuous development of computer science, bone age assessment has began to change from traditional manual assessment to automatic assessment. Although there has already been numerous researches on automatic bone age assessment, most of them are still in the experimental stage. This paper reviews related research and progress on automatic bone age assessment at home and abroad in recent years, in order to provide reference and research ideas for relevant researchers.


Assuntos
Determinação da Idade pelo Esqueleto , Humanos , Punho , Raios X
18.
Zhongguo Gu Shang ; 33(6): 540-5, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32573159

RESUMO

OBJECTIVE: To observe the clinical effects of zheng's massage combined with electroacupuncture in the treatment ofreflex sensory dystrophy syndrome of the wrist. METHODS: From October 2016 to September 2018, 48 cases of reflex sensory dystrophy syndrome of the wrist were divided into the observation group and the control group. In the observation group, there were 24 cases, including 10 males and 14 females, ranging in age from 54 to 76 years old, with an average age of (61.41 ±7.90) years old. The patients in the observation group were treated with Zheng's massage combined with electroacupuncture. The control group consisted of 24 patients, including 9 males and 15 females, ranging in age from 52 to 75 years old, with an averageage of (58.71±8.11 ) years old. The patients in the control group were treated with electroacupuncture alone. All the patients in both groups were treated for 6 weeks. The clinical symptoms and signs, visual anglogue scale (VAS), Cooney wrist score and clinical efficacy evaluation were compared between the two groups before and after treatment, and statistical analysis was conducted. RESULTS: After 6 weeks of treatment, VAS in the control group was 4.9±1.8, and Cooney wrist score was 74.63±1.72; VAS in the observation group was 2.2±1.4, and Cooney wrist score was 86.31±2.53. The comprehensive scores of VAS and Cooney wrist joint between two groups were improved after treatment, and the observation group was better than control group(P<0.05). The curative effect of the observation group was better than that of the control group. CONCLUSION: Zheng's massage combined with electroacupuncture has the following advantages in the treatment of reflex sympathetic dystrophy syndrome of the wrist, such as small trauma, patients' willingness promoting functional rehabilitation, which is worthy of clinical promotion.


Assuntos
Eletroacupuntura , Distrofia Simpática Reflexa , Idoso , Feminino , Humanos , Masculino , Massagem , Pessoa de Meia-Idade , Distrofia Simpática Reflexa/terapia , Resultado do Tratamento , Punho , Articulação do Punho
19.
Zhonghua Shao Shang Za Zhi ; 36(6): 419-425, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32594699

RESUMO

Objective: To explore the clinical effect of free anterolateral thigh flap combined with arterial vascular reconstruction on repairing high-voltage electrical burn wound of type Ⅱ and Ⅲ on the wrist. Methods: From May 2016 to February 2019, 25 patients with deep high-voltage electrical burn wounds on the wrist were admitted to Zhengzhou First People's Hospital, including 23 males and 2 females, aged 11-63 years. Among them, 4 cases had bilateral electrical burns on the wrist, and 21 cases had unilateral electrical burns on the wrist. There were 29 wounds in 29 affected limbs with depth of full-thickness to full-thickness with tendon and bone exposure, and 17 wounds were type Ⅱ and 12 wounds were type Ⅲ. Twenty-four patients underwent CT angiography of the upper extremities before surgery, while the other one patient did not undergo the examination due to seafood allergy. There were no obvious injury to the ulnar and radial arteries in 7 affected limbs, simple ulnar artery injury in 6 affected limbs, simple radial artery injury in 7 affected limbs, and both ulnar and radial arteries injury in 9 affected limbs. The wound areas after debridement were 10 cm×7 cm-36 cm×17 cm, and the free anterolateral thigh flaps were obtained with area of 11 cm×8 cm-37 cm×18 cm for repairing the wounds. For patients with no damage of ulnar artery and radial artery, the trunk of descending branch of lateral circumflex femoral artery of the flap or combined with the thick muscle perforating branch or lateral branch was anastomosed with the ulnar or radial artery of the wound. For patients with simple ulnar artery or radial artery injury, the trunk, lateral branch, or medial branch was anastomosed with the ulnar artery or radial artery of the wound. For patients with long injury of ulnar artery and radial artery, the ulnar artery or radial artery of the wound was reconstructed with one of the above-mentioned methods, the injured artery that was not anastomosed was reconstructed with great saphenous vein, and the transplanted blood vessel was embedded in the lateral femoral muscle. The accompanying vein of the descending branch of the lateral circumflex femoral artery of the flap was anastomosed with the accompanying vein of the ulnar artery or radial artery of the wound and/or the cephalic vein. The donor sites of flaps were sutured directly or repaired with split-thickness skin graft from the thigh. The survival condition of flap and affected limb after operation and during follow-up was observed, and hand function of the affected limb during follow-up was evaluated according to the evaluation standard after repair of peripheral nerve injury in upper limbs. Results: Fifteen affected limb wounds had tissue liquefaction but healed after second debridement on 14-28 days after flap repair operation. All 29 flaps survived in the end. One patient had long ulnar artery and radial artery injuries in affected limbs and the hand was necrotic due to second embolism of the blood vessel in 1 week post operation, and the remaining affected limbs survived. During the follow-up of 6 to 30 months after operation, the flaps were slightly bloated, the affected limbs were warm with normal blood flow, and finger flexion, wrist flexion, and sensory function of hand recovered to varying degrees. The functions of the survived affected limbs were evaluated as excellent in 8 affected limbs, good in 9 affected limbs, medium in 5 affected limbs, and poor in 6 affected limbs, with an excellent and good rate of 60.71%. Conclusions: The clinical effect of free anterolateral thigh flap combined with arterial vascular reconstruction is good for repairing high-voltage electrical burn wound on the wrist, and the patency restoration of the ulnar artery and/or radial artery of the upper limb in stage Ⅰ is helpful for improving the success rate of limb salvage.


Assuntos
Queimaduras por Corrente Elétrica , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Queimaduras por Corrente Elétrica/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Coxa da Perna , Resultado do Tratamento , Cicatrização , Punho , Adulto Jovem
20.
Zhonghua Shao Shang Za Zhi ; 36(6): 433-439, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32594701

RESUMO

Objective: To analyze the epidemiological characteristics of inpatients with high-voltage electrical burns on the wrist in Beijing Jishuitan Hospital (hereinafter referred to as the author's unit), so as to provide reference for the prevention and treatment of high-voltage electrical burns on the wrist. Methods: The medical records of inpatients suffered from high-voltage electrical burns on the wrist in the author's unit from January 2008 to December 2019 were collected. The patients' gender, age, population category, injury situation, injury season, total burn area, electrical burn type on the wrist of the affected limbs, the time from injury to first flap/myocutaneous flap transplantation, vascular reconstruction and flap/myocutaneous flap transplantation of the affected limbs, the total amputation rate of the affected limbs and the amputation rate of the affected limbs with type Ⅲelectrical burns on the wrist, the number of operation, postoperative infection rate of flap/myocutaneous flap, length of hospital stay, hospitalization expense, and treatment outcome were retrospectively analyzed. Comparison of the aforementioned statistical items between patients admitted from January 2008 to December 2013 (hereinafter referred to as the pre-stage) and January 2014 to December 2019 (hereinafter referred to as the post-stage) except gender, the total amputation rate of the affected limbs, treatment outcome were performed. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Wilcoxon rank-sum test. Results: During the 12 years, a total of 169 patients with high-voltage electrical burns on the wrist were admitted to the author's unit, including 162 males and 7 females, aged (35±13) years, and 75.15% (127/169) of patients were 21-50 years old. The top three groups in population category from high to low were workers, migrant workers, and primary and secondary school students, accounting for 48.52% (82/169), 28.99% (49/169), and 9.47% (16/169), respectively. At work of non-electric power accounted for 47.93% (81/169) and ranked the first in the proportion of injury situation. The injury occurred mostly in summer and autumn, accounting for 39.05% (66/169) and 28.99% (49/169), respectively. About 65.09% (110/169) of the patients were with total burn area less than 10% total body surface area. There were totally 216 affected limbs with high-voltage electrical burns on the wrist, of which the numbers of wrist with type Ⅲ and type Ⅳ injury were 25 (11.57%) and 21 (9.72%), respectively. The time from injury to first flap/myocutaneous flap transplantation was 6.00 (3.75, 8.00) d. There were 45 affected limbs operated with vascular reconstruction, 75 affected limbs transplanted with pedicled axial flap, and 86 affected limbs transplanted with free flap/myocutaneous flap. The total amputation rate of affected limbs was 12.96% (28/216), and the amputation rate of the affected limbs with type Ⅲ electrical burns on the wrist was 28% (7/25). The number of operation was 4 (3, 5) times, the postoperative infection rate of flap/myocutaneous flap was 7.18% (13/181), the hospitalization time was 39.00 (25.00, 50.00) d, and the hospitalization cost was 123 553.00 (50 656.50, 216 003.00) yuan. Compared with those of the pre-stage, the time from injury to first flap/myocutaneous flap transplantation was significantly shortened (Z=-4.038, P<0.01), the ratio of free flap/myocutaneous flap transplantation on affected limbs was significantly increased (χ(2)=13.478, P<0.01), the ratio of pedicled axial flap transplantation on affected limbs was significantly decreased (χ(2)=10.242, P<0.01), the number of operation was significantly reduced (Z=-5.903, P<0.01), the postoperative infection rate of flap/myocutaneous flap was significantly decreased (χ(2)=4.492, P<0.05), the length of hospital stay was significantly shortened (Z=-2.723, P<0.01), and the hospitalization expense was significantly decreased among patients hospitalized in the post-stage (Z=-2.121, P<0.05). The other items were close between patients hospitalized in the pre-stage and those in the post-stage. Conclusions: Men were more likely than women to suffer from high-voltage electrical burns on the wrist in the author's unit. Young workers and migrant workers may be the key groups for the prevention of high-voltage electrical burns on the wrist. It is very important to strengthen the management of high voltage safety education for non-electric power staff, warn and protect the surrounding area of high voltage environment, and prohibit non staff for entering the high voltage environment, especially in summer and autumn. In the last 6 years, the patients with high-voltage electrical burns on the wrist may benefit from the active vascular reconstruction at early stage and free flap/myocutaneous flap repair in the author's unit.


Assuntos
Queimaduras por Corrente Elétrica , Adulto , Queimaduras por Corrente Elétrica/epidemiologia , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Punho , Adulto Jovem
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