Damage to the palmar cutaneous branch of the median nerve (PCBMN) is a potential complication of surgery at the volar aspect of the wrist. The aim of this study was to determine the relationships of the PCBMN to both ...Damage to the palmar cutaneous branch of the median nerve (PCBMN) is a potential complication of surgery at the volar aspect of the wrist. The aim of this study was to determine the relationships of the PCBMN to both surface and bony landmarks using reliable methods. Ten pairs of forearms from cadavers aged 73 to 98 years were dissected. The PCBMN was identified and its course and relationships documented. The situation of the PCBMN was quantified relative to the distal wrist crease, bistyloid line, scaphoid tubercle, radial styloid process and flexor carpi radialis tendon. A PCBMN was identified on 90% of sides. The PCBMN arose from the radial aspect of the median nerve 52.4 (SD 31.0) mm from the bistyloid line and entered the transverse carpal ligament 10.9 (SD 9.5) mm proximal to the bistyloid line. At the level of the distal wrist crease the PCBMN was located 0.6 to 7.5 mm (mean 4.5;SD 1.9 mm) from the ulnar aspect of the flexor carpi radialis tendon. The inter- and intra-observer reliability of the measurement methods ranged from ICC 0.96 to 1.00. Detailed morphometric data of the PCBMN relative to bony landmarks contribute to knowledge of the spatial relationships of the PCBMN to inform the precision of surgical incisions.展开更多
AIM To investigate the structural and functional characte-ristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different agegroups.METHODS Eighty-seven Dupuytren's contrac...AIM To investigate the structural and functional characte-ristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different agegroups.METHODS Eighty-seven Dupuytren's contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old(Y-group, n = 22); the others were 55 and older(O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.RESULTS Frequency of cases with rapid development of contracture(less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels(more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.CONCLUSION Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.展开更多
AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency microultrasound, 7T and 3T magnetic resonance imaging(MRI).METHODS Four subjects(ages 22-50 years) were scanned...AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency microultrasound, 7T and 3T magnetic resonance imaging(MRI).METHODS Four subjects(ages 22-50 years) were scanned on a micro-ultrasound system with a 45-MHz transducer(Vevo 2100, Visual Sonics). Subjects' hands were then imaged on a 3T clinical MR scanner(Siemens Biograph MMR) using an 8-channel special purpose phased array carotid coil. Lastly, subjects' hands were imaged on a 7T clinical MR scanner(Siemens Magnetom 7T Whole Body Scanner) using a custom built 8-channel transmit receive carotid coil. All three imaging modalities were subjectively analyzed for image quality and visualization of the vessel wall. RESULTS Results of this very preliminary study indicated that vessel wall imaging of the superficial palmar arch was feasible with a whole body 7T and 3T MRI in comparison with micro-ultrasound. Subjective analysis of image quality(1-5 scale, 1: poorest, 5: best) from B mode, ultrasound, 3T SPACE MRI and 7T SPACE MRI indicated that the image quality obtained at 7T was superior to both 3T MRI and micro-ultrasound. The 3D SPACE sequence at both 7T and 3T MRI with isotropic voxels allowed for multi-planarreformatting of images and allowed for less operator dependent results as compared to high frequency microultrasound imaging. Although quantitative analysis revealed that there was no significant difference between the three methods, the 7T Tesla trended to have better visibility of the vessel and its wall. CONCLUSION Imaging of smaller arteries at the 7T is feasible for evaluating atherosclerosis burden and may be of clinical relevance in multiple diseases.展开更多
Objective:Open thoracic sympathectomy has been established as a routine treatment for patients with primary hyperhidrosis. Recently, thoracoscopic techniques have allowed surgeons to offer these patients a permanent s...Objective:Open thoracic sympathectomy has been established as a routine treatment for patients with primary hyperhidrosis. Recently, thoracoscopic techniques have allowed surgeons to offer these patients a permanent solution with minimal surgical trauma. Methods:From June 1996 to July 2002, 78 thoracoscopic sympathectomies(TS) were performed. There were 28 males and 50 females with a mean age of 22.4 years (range, 14 to 48 years). The procedures were performed with the patients under general anesthesia using a double-lumen endotracheal tube. In palmar hyperhidrosis the second thoracic sympathetic ganglia are destroyed by electrocautery. In axillary hyperhidrosis the second to fourth ganglion are cut off. Each lung was reinflated on completion of the sympathectomy, and residual pneumothorax aspirated before closure of the incisions. No placement of chest tubes was performed in the operating . Results:All sympathectomies were completed thoracoscopically. The symptoms disappeared completely in all patients immediately after the operation. Their hands were dry and warm when they waked up from anaesthesia. There was no surgical mortality. Median operation time for a bilateral procedure is 28 min. (range, 8-90 min). The average hospital stay was 5.5 days. The mean follow-up time was 43.8 months (range, 3-73months). Compensatory hyperhidrosis was found in 41.03% (32/78) of patients, but the symptoms were not serve enough to interfere with lifestyle, and were not required further treatment. In all 78 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis.Conclusions:Thoracoscopic sympathectomy is the most effective and minimally invasive treatment for palmar and axillary hyperhydrosis.展开更多
Background Compensatory sweating （CS） is one of the most common postoperative complications after thoracic sympathectomy, sympathicotomy or endoscopic sympathetic block （ESB） for palmar hyperhidrosis. This study w...Background Compensatory sweating （CS） is one of the most common postoperative complications after thoracic sympathectomy, sympathicotomy or endoscopic sympathetic block （ESB） for palmar hyperhidrosis. This study was conducted to examine the relevance between CS and the sympathetic segment being transected in the surgical treatment of palmar hyperhidrosis, and thus to detect the potential mechanism of the occurrence of CS. Methods Between October 2004 and June 2006, 163 patients with primary hyperhidrosis were randomly divided into two groups, T3 sympathicotomy （78 patients） and T4 sympathicotomy（85）, who were operated upon under general anesthesia via single lumen intubation and intercostal video-mediastinoscopy （VM）. Results No morbidity or mortality occurred. Palmar hyperhidrosis was cured in all patients. Follow-up（mean （13.8i-6.2） months） showed no recurrence of palmar hyperhidrosis. The difference of rates of mild CS in groups T3 and T4 was of no statistical significance. The rate of moderate CS was significantly lower in group T4 than in group T3. No severe CS occurred. Conclusion The rates of occurrence and severity of CS are lowered with the lower sympathetic chain being transected.展开更多
Background L-shaped incision of pronator quadratus （PQ） muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation.Repair of the PQ muscle was always reco...Background L-shaped incision of pronator quadratus （PQ） muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation.Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons.But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ.Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through miniincisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus.The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair.Methods Between September 2010 and April 2012,65 patients （42 males and 23 females; aged 20-68 years and a mean age of 42.5 years） with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates （Depuy or Smith companies）.The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association （OTA） classifications.All surgeries were completed by the same trained team.The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females.We compared the two groups for wrist pain,forearm range of motion,grip strength,pedoperative complications and wrist functional recovery score.Results The minimum follow-up for the whole cohort was one year.The differences between the two groups were significant with regard to wrist pain,forearm range of motion,grip strength and wrist function at 1,2,and 6 weeks postoperatively,but insignificant at 6 and 12 months postoperatively.No significant differences were found in the pedoperative complications and radiographs postoperatively.Conclusions Preservation of the pronator quadratus muscle is a satisfactory method for the treatment of majority of the fractures of the distal radius with volar locking palmar plates,as this technique can yield better early wrist function and shorten the rehabilitation.展开更多
Background Video-assisted thoracic sympathetic block is an effective, safe, and minimally invasive method for treatment of primary hyperhidrosis. The purpose of this study was to decide which one of using electrocaute...Background Video-assisted thoracic sympathetic block is an effective, safe, and minimally invasive method for treatment of primary hyperhidrosis. The purpose of this study was to decide which one of using electrocautery hook and titanium clip is the appropriate procedure for primary palmar hyperhidrosis by assessing the compensatory sweating （CS） and quality of life （QOL） of patients after sympathetic block. Methods Between October 2007 to August 2010, 120 patients with primary palmar hyperhidrosis were randomly divided into two groups, electrocautery hook group （60 patients） and titanium clip group （60 patients）. All patients were treated by sympathetic block at T4 level. The CS was graded based on severity and location; the QOL was classified to 5 different levels based upon the summed total scores （range from 20 to 100） before and after surgery. The variables were compared. Results The postoperative follow-up period was 2 months. All patients were cured. Three patients in electrocautery hook group and 1 patient in titanium clip group had a unilateral pneumothorax on chest X-ray, but none of them was necessary to have chest drainage. Neither perioperative mortality nor serious complications such as cardiac arrhythmia or arrest were observed during the operation. No bradycardia or Horner＇s syndrome occured. CS was not more common in patients in titanium clip group than in those in electrocautery hook group （P=0.001）. Moderate and severe CS was few in all patients, and there was no significant difference between two groups （P=0.193）. Most of the patients feel a notable improvement of the the QOL; nevertheless, there was no significant difference between the groups （P=0.588）. Conclusions Both electrocautery hook and titanium clip used for sympathetic block at the T4 level are effective, safe, and minimally invasive for palmar hyperhidrosis. Because of the lower severity of CS and the similar improvements in the QOL after operation, we prefer to use of titanium clip for treating palmar hyperhidrosis.展开更多
Primary palmar hyperhidrosis(PPH)is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’social activity,professional life,and psychological state.Endoscopic thoracic sympathicot...Primary palmar hyperhidrosis(PPH)is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’social activity,professional life,and psychological state.Endoscopic thoracic sympathicotomy(ETS)is by far the treatment choice for PPH with the most stable and durable curative effects,but special attention should be given to the side effects of the surgery,especially compensatory hyperhidrosis(CH).This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis(CECPH),which was published 10 years ago.This consensus emphasizes the need for special attention and careful assessment of the patients’feelings,as well as their emotional and mental state,and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis.It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect.New evidence of the epidemiology,pathogenesis of PPH,and indications for surgery were also assessed or recommended.展开更多
文摘Damage to the palmar cutaneous branch of the median nerve (PCBMN) is a potential complication of surgery at the volar aspect of the wrist. The aim of this study was to determine the relationships of the PCBMN to both surface and bony landmarks using reliable methods. Ten pairs of forearms from cadavers aged 73 to 98 years were dissected. The PCBMN was identified and its course and relationships documented. The situation of the PCBMN was quantified relative to the distal wrist crease, bistyloid line, scaphoid tubercle, radial styloid process and flexor carpi radialis tendon. A PCBMN was identified on 90% of sides. The PCBMN arose from the radial aspect of the median nerve 52.4 (SD 31.0) mm from the bistyloid line and entered the transverse carpal ligament 10.9 (SD 9.5) mm proximal to the bistyloid line. At the level of the distal wrist crease the PCBMN was located 0.6 to 7.5 mm (mean 4.5;SD 1.9 mm) from the ulnar aspect of the flexor carpi radialis tendon. The inter- and intra-observer reliability of the measurement methods ranged from ICC 0.96 to 1.00. Detailed morphometric data of the PCBMN relative to bony landmarks contribute to knowledge of the spatial relationships of the PCBMN to inform the precision of surgical incisions.
基金Supported by The RF Ministry of Health within Government Mandated Program for FSBI Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics"(RISC"RTO") for Scientific Research in 2018-2020 Yr./Yrs.No.АААА-А18-118011190119-5 from 11/01/2018
文摘AIM To investigate the structural and functional characte-ristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different agegroups.METHODS Eighty-seven Dupuytren's contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old(Y-group, n = 22); the others were 55 and older(O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.RESULTS Frequency of cases with rapid development of contracture(less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels(more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.CONCLUSION Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.
文摘AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency microultrasound, 7T and 3T magnetic resonance imaging(MRI).METHODS Four subjects(ages 22-50 years) were scanned on a micro-ultrasound system with a 45-MHz transducer(Vevo 2100, Visual Sonics). Subjects' hands were then imaged on a 3T clinical MR scanner(Siemens Biograph MMR) using an 8-channel special purpose phased array carotid coil. Lastly, subjects' hands were imaged on a 7T clinical MR scanner(Siemens Magnetom 7T Whole Body Scanner) using a custom built 8-channel transmit receive carotid coil. All three imaging modalities were subjectively analyzed for image quality and visualization of the vessel wall. RESULTS Results of this very preliminary study indicated that vessel wall imaging of the superficial palmar arch was feasible with a whole body 7T and 3T MRI in comparison with micro-ultrasound. Subjective analysis of image quality(1-5 scale, 1: poorest, 5: best) from B mode, ultrasound, 3T SPACE MRI and 7T SPACE MRI indicated that the image quality obtained at 7T was superior to both 3T MRI and micro-ultrasound. The 3D SPACE sequence at both 7T and 3T MRI with isotropic voxels allowed for multi-planarreformatting of images and allowed for less operator dependent results as compared to high frequency microultrasound imaging. Although quantitative analysis revealed that there was no significant difference between the three methods, the 7T Tesla trended to have better visibility of the vessel and its wall. CONCLUSION Imaging of smaller arteries at the 7T is feasible for evaluating atherosclerosis burden and may be of clinical relevance in multiple diseases.
文摘Objective:Open thoracic sympathectomy has been established as a routine treatment for patients with primary hyperhidrosis. Recently, thoracoscopic techniques have allowed surgeons to offer these patients a permanent solution with minimal surgical trauma. Methods:From June 1996 to July 2002, 78 thoracoscopic sympathectomies(TS) were performed. There were 28 males and 50 females with a mean age of 22.4 years (range, 14 to 48 years). The procedures were performed with the patients under general anesthesia using a double-lumen endotracheal tube. In palmar hyperhidrosis the second thoracic sympathetic ganglia are destroyed by electrocautery. In axillary hyperhidrosis the second to fourth ganglion are cut off. Each lung was reinflated on completion of the sympathectomy, and residual pneumothorax aspirated before closure of the incisions. No placement of chest tubes was performed in the operating . Results:All sympathectomies were completed thoracoscopically. The symptoms disappeared completely in all patients immediately after the operation. Their hands were dry and warm when they waked up from anaesthesia. There was no surgical mortality. Median operation time for a bilateral procedure is 28 min. (range, 8-90 min). The average hospital stay was 5.5 days. The mean follow-up time was 43.8 months (range, 3-73months). Compensatory hyperhidrosis was found in 41.03% (32/78) of patients, but the symptoms were not serve enough to interfere with lifestyle, and were not required further treatment. In all 78 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis.Conclusions:Thoracoscopic sympathectomy is the most effective and minimally invasive treatment for palmar and axillary hyperhydrosis.
文摘Background Compensatory sweating （CS） is one of the most common postoperative complications after thoracic sympathectomy, sympathicotomy or endoscopic sympathetic block （ESB） for palmar hyperhidrosis. This study was conducted to examine the relevance between CS and the sympathetic segment being transected in the surgical treatment of palmar hyperhidrosis, and thus to detect the potential mechanism of the occurrence of CS. Methods Between October 2004 and June 2006, 163 patients with primary hyperhidrosis were randomly divided into two groups, T3 sympathicotomy （78 patients） and T4 sympathicotomy（85）, who were operated upon under general anesthesia via single lumen intubation and intercostal video-mediastinoscopy （VM）. Results No morbidity or mortality occurred. Palmar hyperhidrosis was cured in all patients. Follow-up（mean （13.8i-6.2） months） showed no recurrence of palmar hyperhidrosis. The difference of rates of mild CS in groups T3 and T4 was of no statistical significance. The rate of moderate CS was significantly lower in group T4 than in group T3. No severe CS occurred. Conclusion The rates of occurrence and severity of CS are lowered with the lower sympathetic chain being transected.
文摘Background L-shaped incision of pronator quadratus （PQ） muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation.Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons.But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ.Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through miniincisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus.The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair.Methods Between September 2010 and April 2012,65 patients （42 males and 23 females; aged 20-68 years and a mean age of 42.5 years） with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates （Depuy or Smith companies）.The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association （OTA） classifications.All surgeries were completed by the same trained team.The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females.We compared the two groups for wrist pain,forearm range of motion,grip strength,pedoperative complications and wrist functional recovery score.Results The minimum follow-up for the whole cohort was one year.The differences between the two groups were significant with regard to wrist pain,forearm range of motion,grip strength and wrist function at 1,2,and 6 weeks postoperatively,but insignificant at 6 and 12 months postoperatively.No significant differences were found in the pedoperative complications and radiographs postoperatively.Conclusions Preservation of the pronator quadratus muscle is a satisfactory method for the treatment of majority of the fractures of the distal radius with volar locking palmar plates,as this technique can yield better early wrist function and shorten the rehabilitation.
文摘Background Video-assisted thoracic sympathetic block is an effective, safe, and minimally invasive method for treatment of primary hyperhidrosis. The purpose of this study was to decide which one of using electrocautery hook and titanium clip is the appropriate procedure for primary palmar hyperhidrosis by assessing the compensatory sweating （CS） and quality of life （QOL） of patients after sympathetic block. Methods Between October 2007 to August 2010, 120 patients with primary palmar hyperhidrosis were randomly divided into two groups, electrocautery hook group （60 patients） and titanium clip group （60 patients）. All patients were treated by sympathetic block at T4 level. The CS was graded based on severity and location; the QOL was classified to 5 different levels based upon the summed total scores （range from 20 to 100） before and after surgery. The variables were compared. Results The postoperative follow-up period was 2 months. All patients were cured. Three patients in electrocautery hook group and 1 patient in titanium clip group had a unilateral pneumothorax on chest X-ray, but none of them was necessary to have chest drainage. Neither perioperative mortality nor serious complications such as cardiac arrhythmia or arrest were observed during the operation. No bradycardia or Horner＇s syndrome occured. CS was not more common in patients in titanium clip group than in those in electrocautery hook group （P=0.001）. Moderate and severe CS was few in all patients, and there was no significant difference between two groups （P=0.193）. Most of the patients feel a notable improvement of the the QOL; nevertheless, there was no significant difference between the groups （P=0.588）. Conclusions Both electrocautery hook and titanium clip used for sympathetic block at the T4 level are effective, safe, and minimally invasive for palmar hyperhidrosis. Because of the lower severity of CS and the similar improvements in the QOL after operation, we prefer to use of titanium clip for treating palmar hyperhidrosis.
文摘Primary palmar hyperhidrosis(PPH)is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’social activity,professional life,and psychological state.Endoscopic thoracic sympathicotomy(ETS)is by far the treatment choice for PPH with the most stable and durable curative effects,but special attention should be given to the side effects of the surgery,especially compensatory hyperhidrosis(CH).This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis(CECPH),which was published 10 years ago.This consensus emphasizes the need for special attention and careful assessment of the patients’feelings,as well as their emotional and mental state,and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis.It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect.New evidence of the epidemiology,pathogenesis of PPH,and indications for surgery were also assessed or recommended.
