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1.
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
2.
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
3.
J Plast Reconstr Aesthet Surg ; 73(8): 1413-1423, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32499185

RESUMO

INTRODUCTION: Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the safety of interrupting anticoagulation and antiplatelets for non-emergency surgery, although such reviews excluded upper limb procedures and represents the rationale for this review. METHODS: The literature was systematically searched for studies concerning the outcomes of adult hand or wrist surgery on patients receiving anticoagulation or antiplatelet agents in direct comparison to controls (no anticoagulation or antiplatelet agents, or interruption of either). The primary outcome was reoperation for any complication related to postoperative bleeding, within 30 postoperative days. RESULTS: Nine cohort studies (3628 individuals; 3863 operations) were included. Based on very low-quality evidence, anticoagulation did not affect the risk of reoperation for bleeding (RR 2.4 [95% CI 0.1, 57]; 3 studies, n=443) or bruising (RR 2.5 [95% CI 1.0, 6.3]; n=124; I2=0%). Based on low quality evidence, antiplatelet agents did not affect the risk of reoperation for bleeding (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=1885; I2=0%) or bruising (RR 3.2 [95% CI 0.2, 44]; n=571; I2=66%). A sensitivity analysis showed that carpal tunnel decompression on patients receiving anticoagulants or antiplatelets appeared to be safe (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=2077; I2=0%). CONCLUSIONS: Given the sparsity of events (bleeding and bruising) and low-quality of the literature, no firm conclusions can be drawn. The decision to interrupt antiplatelets or anticoagulants should be made jointly with expert physicians and the patient. Registration: PROSPERO ID CRD42018087755.


Assuntos
Anticoagulantes/administração & dosagem , Mãos/cirurgia , Inibidores da Agregação de Plaquetas/administração & dosagem , Punho/cirurgia , Hemorragia/prevenção & controle , Hemorragia/cirurgia , Humanos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Reoperação
4.
Pain Physician ; 23(2): E175-E183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214296

RESUMO

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. OBJECTIVES: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. STUDY DESIGN: A randomized, double-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Patients: 60 patients with CTS (> 6 months' duration). INTERVENTION: patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). MEASUREMENTS: assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well. RESULTS: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up. LIMITATION: We suggest a longer period could be reasonable. CONCLUSIONS: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration. KEY WORDS: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Dissecação/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Manejo da Dor/métodos , Resultado do Tratamento , Punho/diagnóstico por imagem , Punho/inervação , Punho/cirurgia
5.
Jt Dis Relat Surg ; 31(1): 50-5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160494

RESUMO

OBJECTIVES: This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). PATIENTS AND METHODS: The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1: mini-open and group 2: extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure pre- and postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. RESULTS: Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. CONCLUSION: Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.


Assuntos
Síndrome do Túnel Carpal , Descompressão Cirúrgica/métodos , Dor , Parestesia , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor/diagnóstico , Dor/etiologia , Medição da Dor/métodos , Parestesia/diagnóstico , Parestesia/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Punho/fisiopatologia , Punho/cirurgia
8.
J Craniofac Surg ; 31(1): e30-e32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31609951

RESUMO

A vein graft in head and neck reconstruction is essential in some circumstances. The cephalic vein in the wrist has a suitable caliber for both a concomitant vein and the internal jugular vein (IJV). A vein graft involving the cephalic vein and its branches was used in 2 cases of head and neck reconstruction. The ramified distal vein was anatomized with a concomitant vein, and the proximal larger vein was anastomosed with the IJV using an end-to-side technique. After placement of vein grafts using the cephalic vein, the flaps were stable with no venous complications. To overcome the size difference between concomitant veins and the IJV, the authors recommend the cephalic vein including its distal branches in the wrist area.


Assuntos
Cabeça/cirurgia , Pescoço/cirurgia , Veias/transplante , Punho/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Punho/irrigação sanguínea
9.
J Orthop Surg Res ; 14(1): 365, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727130

RESUMO

BACKGROUND: Flap transplantation is often needed for soft tissue defects of the fingers that cannot be closed directly. Sensory reconstruction of the fingers is important for patients to recover feelings. In this study, we report clinical outcomes of using free neurovascular transverse wrist crease flap for repairing finger defects from multiple centers. METHODS: This case series includes 72 consecutive patients with finger defects between June 2013 and June 2016 from multiple centers. A neurovascular transverse free radial artery superficial palmar branch flap, named transverse wrist crease flap, was designed to reconstruct soft tissue defects of the fingers with microvascular anastomosis. When there were soft tissue defects of the fingers with digital nerve defect, end-to-end neurorrhaphy between the median palmar cutaneous branch and the digital nerves was also performed. The donor incision was sutured directly. All the patients were followed-up for more than 24 months. RESULTS: The soft tissue defects of the fingers were all completely covered with this free neurovascular transverse wrist crease flap, and the flaps in 71 patients survived completely without ischemia. Vascular crisis appeared in one case, and the wound healed gradually after changing wound dressing for nearly 1 month. Slight infections of wounds appeared in eight cases. There were no complications in the donor site, like infection and poor wound healing. At the last follow-up, the mean static two-point discrimination was 9.6 ± 2.4 mm on the injured finger and 4.5 ± 0.8 on the contralateral corresponding finger. The motion range of the distal interphalangeal joint and proximal interphalangeal joint on the injured finger were 72.5 ± 23.3% and 78.7 ± 32.5% of the contralateral corresponding finger, respectively. Patient self-evaluations were good in 53 cases and fair in 19 cases. CONCLUSIONS: The results indicate that the free neurovascular transverse wrist crease flap is a good choice for repairing soft tissue defects of the fingers. LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Traumatismos dos Dedos/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Punho/cirurgia
10.
J Surg Orthop Adv ; 28(3): 196-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675296

RESUMO

Pisiform pathology may be a source of ulnar-sided wrist pain. This study reviews the long-term outcomes of patients treated with pisiformectomy. A retrospective study approved by the institutional review board was performed over a 27-year period of patients undergoing pisiformectomy. Range of motion, grip strength, complications, and need for revision surgery were recorded. The series includes 61 wrists (60 patients) with an average age at surgery of 46 years. Two complications were noted (3%): a postoperative ulnar nerve palsy and symptomatic retained suture. At final follow-up, average flexion-extension arc was 81% (expressed as percent of contralateral), radioulnar deviation arc was 88%, and average grip strength was 89%. Pisiformectomy is a reliable, motion-preserving procedure with low complication rates for patients with chronic ulnar-sided wrist pain. In this series, 93% of patients did not require further procedures at an average of 8.2 years follow-up. (Journal of Surgical Orthopaedic Advances 28(3):196-200, 2019).


Assuntos
Osteoartrite , Punho , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/cirurgia , Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Punho/cirurgia , Articulação do Punho
11.
Curr Pain Headache Rep ; 23(10): 70, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31372847

RESUMO

PURPOSE OF REVIEW: Carpal tunnel syndrome (CTS) is an entrapment neuropathy that involves the compression of the median nerve at the wrist and is considered the most common of all focal entrapment mononeuropathies. CTS makes up 90% of all entrapment neuropathies diagnosed in the USA and affects millions of Americans. RECENT FINDINGS: Age and gender likely play a role in the development of CTS, but additional studies may further elucidate these associations. Of known associated risk factors, diabetes mellitus seems to have the greatest association with CTS. One of the most commonly reported symptoms in CTS is a "pins-and-needles" sensation in the first three fingers and nocturnal burning pain that is relieved with activity upon waking. Treatment for CTS is variable depending on the severity of symptoms. Conservative management of CTS is usually considered first-line therapy. In cases of severe sensory or motor deficit, injection therapy or ultimately surgery may then be considered. Still CTS is often difficult to treat and may be reoccurring. Novel treatment modalities such as laser and shockwave therapy have demonstrated variable efficacy though further studies are needed to assess for safety and effect. Given the unknown and potentially complex etiology of CTS, further studies are needed to explore combinations of diagnostic and therapeutic modalities.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Dor/cirurgia , Punho/cirurgia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Nervo Mediano/fisiopatologia , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/cirurgia , Dor/complicações , Fatores de Risco , Punho/inervação
12.
Clin Rheumatol ; 38(11): 2995-3003, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31290023

RESUMO

INTRODUCTION: Inflammatory arthritis frequently affects the wrist, resulting in pain and disability. This study aims to investigate the long-term outcome of patients who underwent posterior interosseous nerve (PIN) denervation for inflammatory arthritis of the wrist. METHOD: xForty consecutive wrists (36 patients) treated with PIN denervation were identified (mean follow-up 47 months; mean age 62.6 years, 77.5% female). Pain and function scores were objectively measured using the patient-rated wrist-evaluation (PRWE) questionnaires. Data was compared for pre-operation and post-operation (early and long term). The Student's t test was used to compare differences between groups for continuous data, whilst the sign test was utilised for pairwise comparisons. The p value was set at 0.05 for all comparisons. RESULTS: Three patients died during the course of this study from causes unrelated to wrist surgery, resulting in 93% follow-up. PRWE questionnaires demonstrated a significant improvement following PIN denervation (median pain pre-op 42 vs post-op 16 (p < 0.001); median function pre-op 82 vs post-op 41 (p < 0.001), respectively). There were no differences identified between early and long-term post-operative scores. Four cases (10%) had persistent, ulnar-based pain and required secondary salvage wrist arthrodesis. However, 95% of patients remained "very satisfied" or "satisfied" after surgery. CONCLUSIONS: This study highlights the effectiveness of PIN denervation as a simple alternative to wrist arthrodesis due to long-term improvement in pain and preservation of function. We recommend this procedure in the presence of a positive diagnostic PIN infiltration test to avoid wrist arthrodesis for as long as possible. In patients with predominantly ulnar-based wrist pain, the outcome is less predictable and this subgroup of patients should be counselled about the possibility of subsequent salvage wrist fusion. Key Points • One of the largest study cohorts which report on the outcome of the wrist PIN denervation procedure with over 2-year follow-up • Clinical outcomes of success are enhanced with the use of validated, objective patient-reported outcome measures relating to overall satisfaction, pain relief and function. • Long-term outcomes are compared to pre-operative and immediate post-operative outcome scores, demonstrating the benefits of PIN denervation and the longevity it provides.


Assuntos
Artrite Reumatoide/cirurgia , Denervação/estatística & dados numéricos , Punho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Denervação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Punho/inervação
13.
J Am Acad Orthop Surg ; 27(21): 785-793, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305353

RESUMO

Since the advent of disease-modifying antirheumatic drugs for rheumatoid arthritis, orthopedic surgeons see fewer patients in the office who require hand surgery. However, a significant number of patients still seek surgical intervention to improve pain and function. These patients often present with isolated soft tissue pathologies, but even bone and joint pathology require meticulous soft tissue handling in this cohort. This review highlights the principles and techniques relevant to the management of soft tissue deformity in rheumatoid hand and wrist surgery, as exposure in training and practice continues to decrease.


Assuntos
Artrite Reumatoide/complicações , Deformidades Adquiridas da Mão/cirurgia , Procedimentos Ortopédicos , Punho/patologia , Punho/cirurgia , Artrite Reumatoide/cirurgia , Deformidades Adquiridas da Mão/etiologia , Humanos
14.
Med Sci Monit ; 25: 4122-4129, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155608

RESUMO

BACKGROUND This study aimed to compare the efficacy and safety of wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery for the treatment of carpal tunnel syndrome. MATERIAL AND METHODS Patients with carpal tunnel syndrome (n=111) were treated with wrist arthroscopy (n=33), small incision surgery (n=40), and conventional open carpal tunnel release surgery (n=38). Incision length, duration of surgery, degree of intraoperative bleeding, recovery time, and findings at postoperative follow-up at one month, three months, and six months after surgery were recorded. Assessment included the two-point discrimination test, the grip and pinch strength test, the visual analog scale (VAS) score for pain, the Levine questionnaire, and Kelly's therapeutic evaluation. RESULTS Incision length, duration of surgery, intraoperative bleeding, and recovery time were significantly reduced in the wrist arthroscopy group and the small incision surgery group compared with the conventional surgery group (p<0.05). There were no significant differences in the two-point discrimination or grip and pinch strength test (p>0.05). Postoperatively, at one month, the VAS score, Levine score, and Kelly's therapeutic evaluation in the wrist arthroscopy group and the small incision surgery group were significantly lower compared with the conventional surgery group (p<0.05). Scar length and scar tenderness in the conventional surgery group were significantly increased compared with the wrist arthroscopy group and the small incision surgery group (p<0.05). CONCLUSIONS Wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery were effective for the treatment of carpal tunnel syndrome, but conventional surgery resulted in more postoperative complications.


Assuntos
Artroscopia/métodos , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Adulto , China , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Punho/cirurgia , Articulação do Punho/cirurgia
15.
J Ayub Med Coll Abbottabad ; 31(2): 141-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094104

RESUMO

Background: The incidence of brachial plexus injuries have shown to increase over the years. It is 1- 2% worldwide according to the WHO. In global brachial plexus injuries and lower root injures when the wrist and hand functions are lost, wrist arthrodesis is a viable option. In other cases, when there are some residual hand functions, wrist arthrodesis stabilizes the wrist as well as provides donor muscles tendons to enhance finger functions. Apart from these, wrist arthrodesis increase grip strength and power, and also wrist in extension assume a better shape cosmetically. Purpose: Outcome of dynamic compression plate with dorsal radial sliding graft for wrist arthrodesis in terms of time to union and complications in brachial plexus injury patients. Methods: This is a retrospective chart review of patients treated in National Orthopaedic Hospital Bahawalpur, from January 2011 to Sep 2017. All the patients with brachial plexopathies of both genders from age 14 to 60 were included in the study. Data was analysed using MS Excel 2010. Results: A total of 34 patients were included in the study. Road traffic accidents was the major cause of the injury having 30 (88%) patients whereas birth palsy and gunshots had 2 patients each (6%). Twenty-three patients had no associated fracture while remaining 11 patients had a fracture. There was union in all patients (100 %) and mean time to union was 6.5 weeks (range 6-8) radiologically. Mean follow up was 20.2 months (range 1.5-72).


Assuntos
Artrodese , Placas Ósseas , Neuropatias do Plexo Braquial , Punho , Adolescente , Adulto , Artrodese/instrumentação , Artrodese/métodos , Neuropatias do Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Punho/diagnóstico por imagem , Punho/cirurgia , Adulto Jovem
16.
Clin Plast Surg ; 46(3): 317-327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103076

RESUMO

Tendinopathy and tendinitis are some of the most frequently encountered disorders in hand and upper extremity surgery. Patients often present with progressively increasing pain over a subacute or chronic period. In most cases it is a clinical diagnosis, with confirmation via advanced imaging. First-line treatment consists of conservative measures such as activity modification, splints, and injections. After a 3- to 6-month trial of nonoperative treatment, surgery usually involves decompression of the involved tendons and debridement of any inflammatory tissue. Patient and anatomic factors can affect the outcomes of both nonoperative and operative treatments.


Assuntos
Procedimentos Ortopédicos/métodos , Tendinopatia/terapia , Antebraço/cirurgia , Mãos/cirurgia , Humanos , Contenções , Tendinopatia/cirurgia , Punho/cirurgia
18.
BMC Musculoskelet Disord ; 20(1): 157, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967143

RESUMO

BACKGROUND: Endoscopic carpal tunnel release (ECTR) has been gradually adopted for the treatment of severe carpal tunnel syndrome (CTS). However, perioperative assessment of neuroanatomical parameters of median nerve, which are important determinant of median nerve recovery, has rarely been reported. This one-year prospective study aimed to investigate the natural history of the neuroanatomical morphology of the median nerve after ECTR in severe CTS patients by high-frequency ultrasonography and assess the ability of neuroanatomical measures to quantify morphological recovery of the median nerve after ECTR. METHODS: This study recruited 31 patients (44 wrists) with a definitive diagnosis of severe CTS and underwent ECTR operation. The edema length (EL) of median nerve from the inlet of the carpal tunnel to the proximal wrist was detected on long axis imaging plane and the anteroposterior diameter (D) and cross-sectional area (CSA) at the inlet of the carpal tunnel on short axis imaging plane were detected by high frequency ultrasound. All these metrics were detected at 3 days before surgery and at the 2nd week, 4th week, 3rd month, 6th month and 12th month after surgery separately. RESULTS: There was no significant difference of each parameter between the 2-week postoperative (1.914 ± 0.598 cm in EL, 0.258 ± 0.039 cm in D and 0.138 ± 0.015 cm2 in CSA) and 3-days preoperative time points (P-EL =0.250; P-D = 0.125; P-CSA =0.712). From the fourth week to the third month after surgery, the parameters quickly improved. The EL (0.715 ± 0.209 cm), D (0.225 ± 0.017 cm) and CSA (0.117 ± 0.012 cm2) at the 3- month postoperative time points were more reduced than at the fourth week after surgery (P-EL < 0.001; P-D = 0.038; P-CSA =0.014). Thereafter, the neurological anatomy parameters recovered slowly. By the 12-month postoperative time points, the three parameters were neuroanatomically close to normal. Compared to the control group in D (0.213 ± 0.005 cm), there was no difference at the 12-month time point (0.214 ± 0.009 cm, P = 0.939). However, the difference in EL (0.098 ± 0.030 cm vs. 0.016 ± 0.011 cm) and CSA (0.103 ± 0.008 cm2 vs. 0.073 ± 0.005 cm2) between patients and healthy volunteers at the 12-month time point still existed (P-EL < 0.001; P-CSA < 0.001). CONCLUSIONS: Neuroanatomical parameters were gradually improved after ECTR surgery. The best time for US follow up is at 3-month postoperative time point for patients who do not show clinical improvement, since at this time the change is the greatest for most CTS patients. This study has been registered in Chinese Clinical Trial Registry: ChiCTR-ROC-17014068 (retrospectively registered 20-12-2017).


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Neuroendoscopia/métodos , Índice de Gravidade de Doença , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Eletrodiagnóstico/métodos , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Punho/anatomia & histologia , Punho/diagnóstico por imagem , Punho/cirurgia
19.
Medicine (Baltimore) ; 98(4): e14202, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681593

RESUMO

The distal forearm is the preferred site for hemodialysis access. However, forearm vessels have small diameter, which may lead to complications of arteriovenous fistulas constructed at this site. Indeed, the mean patency rate of such fistulas has been reported at 65.2% (range, 56-79%) at 1 year postoperatively. In this study, we aimed to evaluate the patency rate of Brescia-Cimino arteriovenous fistulas constructed under microscopic guidance. We retrospectively evaluated the records of patients with chronic renal failure who received a Brescia-Cimino arteriovenous fistula between 2014 and 2015 for hemodialysis access. Preoperative venography and Doppler mapping were used to evaluate vein diameter at the wrist. Veins with a diameter of >2 mm were chosen. End-to-side microanastomosis was performed using Nylon #9-0 suture under microscopic guidance. Postoperatively, monthly follow-up (first with venography; with Doppler ultrasound thereafter) was conducted to detect vessel obstruction and evaluate blood flow. Six of the seven patients included in this study received hemodialysis without signs of obstruction or complications. On Kaplan-Meier survival analysis, the mean patency rate at 2 years postoperatively was 85.7%. One patient (female, 60 years) had vessel obstruction and underwent percutaneous transluminal angioplasty 3 times after receiving the arteriovenous fistula. The median follow-up duration was 41 months (range, 25-47 months). Our experience indicates that, for relatively healthy vessels with a diameter of >2 mm, Brescia-Cimino arteriovenous fistulas at the wrist can be safely constructed using microsurgical suturing under microscopic guidance, without complications such as ischemic hand syndrome or infection.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Falência Renal Crônica/terapia , Microcirurgia/métodos , Diálise Renal , Técnicas de Sutura , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento , Punho/irrigação sanguínea , Punho/cirurgia
20.
Arch Orthop Trauma Surg ; 139(3): 361-367, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30225565

RESUMO

INTRODUCTION: The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions. MATERIALS AND METHODS: Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up. RESULTS: No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group. CONCLUSIONS: For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.


Assuntos
Artroscopia , Cistos Glanglionares/cirurgia , Punho/cirurgia , Artroscopia/efeitos adversos , Artroscopia/métodos , Artroscopia/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
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