手部屈肌腱松解术后早期微波辅助治疗的疗效观察

目的观察手部屈肌腱粘连松解术后早期使用微波辅助治疗的临床疗效．评价微波治疗对屈肌腱松解术后手指功能恢复的影响。方法将40例40指指屈肌腱松解术后患者,随机分为A,B两组。A组20例,术后24h开始功能训练;B组20例,术后24h功能训练的同时,给予微波治疗,疗程为2周。术后随访12周,第2周末进行疼痛评价和TAM评定,第12周末进行TAM评定,对所有资料进行统计分析和疗效评定。结果术后第2周末,对两组间疼痛评分、TAM评定两项指标进行统计分析,有明显的统计学意义（P〈0．05）。术后12周末,B组的手功能均明显优于A组,TAM评定的统计学分析差异有显著性（P〈0．01）。结论手部屈肌腱粘连松解术后,在功能训练的基础上,早期使用微波辅助治疗,对缓解疼痛、消炎消肿、减轻粘连形成、改善手指ROM、提高TAM、恢复手功能有显著的疗效。     

便携式温控水疗仪的研制及应用

为了促进手部外伤术后功能恢复，于1998年1月研制成便携式温控水疗仪，用于92例（观察组）中、重度手外伤术后病人功能锻炼6个疗程，并与70例（对照组）进行常规功能锻炼者比较，结果观察组功能恢复效果明显，优于对照组（P＜0.05）。提示应用水疗仪进行手外伤术后功能锻炼可预防关节挛缩、关节僵直，利于手部功能恢复，病人乐于接受，具有推广价值。     

高压氧联合mNGF对颅脑外伤中颅神经损伤的临床研究

目的分析颅脑外伤中颅神经损伤的临床治疗效果,为制定临床治疗措施提供依据。方法176例颅脑外伤致颅神经损伤的患者进行随机分为单独高压氧治疗和高压氧联合神经因子治疗两组,治疗组在常规治疗的基础上,给予鼠源性神经生长因子（mNGF）。所有患者尽早行高压氧（HBO）治疗。分别记录两组患者治疗前、治疗3个月后的临床疗效,对其结果进行统计分析。结果治疗后两组患者颅神经功能均有改善,各组治疗前后差异有显著性（P〉0．01）,其中治疗组改善明显优于对照组（P〉0．05）。结论早期应用mNGF联合HBO治疗颅脑外伤后颅神经损伤患者更能显著改善患者功能预后。     

30例全手皮肤套状撕脱伤临床疗效分析

目的 比较全手套脱伤三种不同治疗方法的临床疗效.方法 随访我院2002年7月至2012年1月治疗的30例全手皮肤套脱伤患者.根据治疗方法不同,分为再植组(15例)、带蒂皮瓣组(5例)和游离组织组(10例).按照手功能评定标准对三组患者的手功能情况进行评定.结果 全手总失能百分比分别为再植组35.79％、带蒂皮瓣组82.80％、游离组织组68.15％.结论 三种治疗全手套脱伤的方法,疗效从优到劣依次为再植、游离组织修复和带蒂皮瓣修复术.     

镜像理论指导下的康复护理模式对断指再植患者术后功能恢复和应对方式的影响

目的：探讨镜像理论指导下的康复护理模式在断指再植患者术后恢复中的应用效果。方法：选取2018年1月-2021年12月于笔者医院接受断指再植术治疗的150例患者，采用随机数字表法分为对照组（n=75）和观察组（n=75）。对照组术后接受常规康复训练，观察组在常规康复训练基础上结合镜像理论指导下康复护理，比较两组再植指感觉功能分级、Michigan手功能评估量表（Michiganhandoutcomequestionnaire,MHQ）评分、静态两点辨别觉（Statictwo-point discrimination,S2PD）以及医学应对方式量表（Medicalcopingmodesquestionnaire,MCMQ）评分。结果：术后3个月，观察组面对维度得分高于对照组（P<0.05），回避、屈服维度得分低于对照组（P<0.05）；术后6个月，观察组再植指感觉功能分级优于对照组（P<0.05），观察组MHQ量表的外观、日常活动、工作情况、满意度和总体功能维度评分均高于对照组（P<0.05），观察组再植指S2PD低于对照组（P<0.05）。结论：镜像理论指导...     

毁损性手外伤的显微外科救治

毁损性手外伤的显微外科救治周围，周广恒，赵胡瑞，张文德，牟宇科，贾志英严重暴力所致毁损性手外伤，处理极为复杂，以往只能截肢（１）。自１９８９年１１月以来我们采用残指异位再植，局部皮瓣转移方法，共救治７例。其中６例术后患手恢复捏、持、功能。１例因皮肤坏...     

毁坏性断掌再植与功能重建

目的扩大毁坏性断掌再植的适应证，提高再植肢体功能恢复的效果。方法１９７９～１９９６年，根据伤情特点和重建手功能的要求，通过４种术式再植毁坏性断掌２３例：（１）２个断指移位再植于前臂残端；（２）２或３个断指移位再植于腕部；（３）５个手指全部移位再植于前臂残端；（４）示指移位再植于第１掌骨基底，修整第２掌骨形成虎口，其余３个手指分别再植于第３、４、５掌骨近端残端。结果２３例断掌再植后全部成活。５例经１年以上随访，综合评定手功能，平均失能值为３２％。结论许多严重毁坏的断掌，不仅可以再植成活，而且可以恢复较好的功能     

关节镜辅助微创手术治疗累及后外侧的胫骨平台塌陷骨折

目的：探讨关节镜辅助微创手术治疗累及后外侧的胫骨平台塌陷骨折的临床效果。方法回顾性分析2010年8月至2013年5月阳江市中医医院收治的累及后外侧的胫骨平台塌陷骨折患者的临床资料,其中对照组（n=31）采用传统切开复位内固定手术治疗,观察组（n=31）采用关节镜辅助微创手术治疗。记录两组手术时间、术中出血量及骨折愈合时间,观察并发症发生情况,采用膝关节功能评分进行疗效评定。结果术后随访3～13个月,平均随访7个月。观察组术中出血量、骨折愈合时间、术后膝关节功能评分均优于对照组,并发症发生率低于对照组,两组比较,差异有统计学意义（P＜0.05）。结论与传统切开手术相比,关节镜辅助微创手术治疗可加速骨折愈合,促进膝关节功能恢复,减少并发症发生,是累及后外侧的胫骨平台塌陷骨折患者的较好选择。     

毁损性断掌的急诊再植与再造

目的探讨毁损性断掌急诊再植与再造的方法及临床疗效。方法38例毁损性断掌按手掌和手指的毁损程度选择两类方法急诊修复：（1）异位短缩再植：将2～5个离断手指连同部分手掌异位短缩再植于腕部或前臂残端,结合术后系统的康复锻炼,重建部分手功能;（2）前臂残端手再造：从足部切取相应的组织如足趾、第1趾蹼、趾骨、足背皮瓣等移植修复。上述组织都是足背动脉及其分支供应．静脉回流也主要依靠大隐静脉系统,手术时可以整体切取,行一期移植再造手术。结果本组术后平均随访5．5个月（4~12个月）。除1例再植手指部分坏死外,其余全部成活,手的功能和外形均得到较好改善与恢复。按中华医学会手外科学会断指再植功能评定试用标准评定,手指功能优良率85．2％。结论畀位短缩再植和前臂残端手再造,能够使手的功能和外形得到较好地改善与恢复;充分认识毁损性断掌的特点,合理应用解剖关系及残存组织是决定手术成败的关键。     

断肢（指）再植术后的手功能康复

目的 探讨断肢（指）再植术后手功能分期康复的治疗方法.方法 对我院2400例断肢（指）再植成活患者进行随访及统计,术后970例在院接受正规康复治疗,1100例定期来院接受复诊及康复指导,330例在家不正规训练.结果 接受正规康复治疗的病例手功能恢复明显优于其他对照组.结论 断肢（指）再植术后,康复治疗早期介入,运用正确的物理和运动疗法等,手功能康复效果满意.     

高压氧治疗重症颅脑损伤26例临床分析

目的探讨高压氧对重型颅脑损伤患者的治疗效果。方法对26例重型颅脑损伤患者进行常规加高压氧治疗,21例进行常规治疗,比较两组的疗效。结果高压氧组显效21例,无效5例。常规组显效11例,无效10例。两组差异有统计学意义(P0.05)。结论早期给予高压氧治疗,可明显提高重型颅脑损伤患者治愈率和生存质量。     

高压氧在重度肛周脓肿术后消炎促愈作用

目的探讨高压氧治疗（Hyperbaric oxygen Therapy,HBOT）在重度肛周脓肿术后消炎促愈作用。方法将100例重度肛周脓肿患者随机分为两组,同样接受常规临床手术和换药治疗,HBOT组另加高压氧治疗,对照组不加。治疗后将对两组临床疗效进行评价。结果 HBOT组创面渗出、组织水肿消退、切口愈合时间明显短于对照组,差异有统计意义;术后平均创面愈合时间HBOT组为（23±1.2）d,对照组（26±5.2）d,差异有统计学意义（P〈0.01）。结论术后配合高压氧治疗,可以有效促进伤口愈合、迅速控制感染、减少炎症反应。     

高压氧治疗在脊髓损伤中的应用

目的探讨高压氧综合治疗脊髓损伤的临床疗效及其对患者炎症因子水平的影响。方法 85例确诊为急性脊髓损伤患者按治疗方法分为两组:对照组42例,行椎弓根系统内固定及椎板切除减压手术等常规外科治疗及其他对症治疗;观察组43例,在应用对照组治疗方法的基础上加行高压氧治疗。比较两组患者临床疗效(总有效率);分别于治疗前后应用功能独立性评分表(FIM)、美国脊髓损伤协会(ASIA)评分、改良Barthel指数评分(MBI)对患者康复效果进行评估,并于治疗前后测定血清白细胞介素-6,8(IL-6、8)及肿瘤坏死因子-α(TNF-α)水平。结果观察组总有效率显著高于对照组(97.67 vs 57.14%,P0.05)。两组患者治疗后ASIA运动、感觉评分,FIM评分及MBI评分较术前均显著提高,且治疗后观察组各项评分均高于对照组(P0.05)。两组治疗后IL-6、IL-8及TNF-α水平显著低于治疗前,且观察组治疗后IL-6、IL-8、TNF-α水平显著低于对照组(P0.05)。结论对脊髓损伤患者,应用高压氧治疗可有效抑制炎症因子的生成,有助于降低继发性炎性损伤的发生,从而提高临床疗效,改善脊髓功能。     

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury

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高压氧对快速扩张皮肤血流影响的实验研究

目的：探讨高压氧对快速扩张皮肤血流量的影响。方法：以新西兰大白兔为动物模型,实验分为3组：①高压氧治疗快速扩张组（A组）;②单纯快速扩张组（B组）;③仅埋置扩张器不扩张的对照组（C组）。测量各组术前、术后、注射盐水前后及高压氧治疗结束后即刻血流量及皮肤温度的变化,进行比较和统计学分析。结果：术前A组扩张区域皮肤血流量为93.32±11.93pu,B组为96.35±14.31pu,扩张前两天,两组血流量无显著性差异（P〉0.05）,扩张第四天至扩张结束A组扩张皮肤血流量较B组多（P〈0.01）,扩张最后一天,注水前A组扩张皮肤血流量为130.63±16.68pu,B组为35.05±4.89pu;在扩张前7天,A组与B组注水前后皮肤温度均下降约0.6℃,从第8天开始至扩张期结束,A组注水前后皮温仅轻微下降,而B组下降约0.6℃。结论：在本实验条件下,将高压氧疗法应用于快速扩张术中可有效增加扩张皮肤血流灌注量,对扩大组织扩张术的应用范围、减少并发症、提高手术效果有一定的参考价值。     

高压氧对脑肿瘤、脑动脉瘤术后康复疗效的观察

目的：探讨高压氧（HBO）治疗脑肿瘤、脑动脉瘤术后康复的临床疗效。方法选取我院2009年12月~2013年12月收治的脑肿瘤、脑动脉瘤术后患者200例,根据治疗方法不同分为两组,将100例HBO治疗的脑肿瘤、脑动脉瘤术后患者设为观察组,将病情相似未作HBO治疗的100例患者设为对照组,两组均常规药物治疗。采用头颅彩色多普勒超声检查患者脑血管痉挛（CVS）情况,并采用神经功能缺损评分和日常生活活动能力评定评判患者临床恢复情况,并对临床疗效进行对比分析。结果两组患者治疗前NF评分和Barthel评分比较差异无统计学意义（P＞0.05）;观察组患者治疗后NFD评分和Barthel评分与对照组治疗后比较差异均有统计学意义（P＜0.05）;两组患者治疗前大脑中动脉流速及CVS比较差异无统计学意义（P＞0.05）;观察组患者治疗后大脑中动脉流速及CVS与对照组治疗后比较差异均有统计学意义（P＜0.05）。结论HBO综合治疗效果显著,能够减少神经功能缺损评分,提高患者生活质量,值得推广使用。     

Effect of hyperbaric oxygen therapy as a monitoring technique for digital replantation survival.

There have been few clinical reports of successful replantation assisted with hyperbaric oxygen (HBO) therapy. In order to improve replant survival, the author has used HBO in ten digital replantations of crush, avulsion, and degloving amputations. Seven of ten replants survived and the other three failed. The failed three digits demonstrated remarkable color changes during HBO therapy. No color changes were observed in six of the seven surviving digits under HBO. The remaining digit showed a slight color difference between pre- and post-therapy. It appears that hyperbaric oxygen is potentially effective in distinguishing "uneventful" replants in which color does not change during HBO therapy, while hyperbaric oxygen could not salvage those "congestion to necrosis" replants in which the color became bright vermilion under hyperbaric oxygen therapy. The difference in digital color reaction to hyperbaric oxygen may be helpful in early decisions to employ salvaging procedures.     

Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis

BACKGROUND: Necrotizing fasciitis (NF) is an uncommon but serious infection of fascia and skin associated with considerable morbidity and mortality. One modality proposed for improving the outcome of this condition is hyperbaric oxygen (HBO) therapy. This is a form of medical treatment that involves intermittent inhalation of 100% oxygen under pressures exceeding the atmosphere. The aim of this article is to review current practice and evidence for the use of HBO as adjunctive therapy in the management of NF. METHODS: A survey of published English literature through searches of Medline and PubMed was carried out using the following key words: "necrotizing fasciitis," "Fournier's gangrene," "necrotizing soft tissue infections," "hyperbaric oxygen therapy," "and hyperbaric oxygen chambers." RESULTS: The results of studies on the use of HBO therapy in NF are inconsistent. Some studies have demonstrated that HBO can improve patient survival and decrease the number of debridements required to achieve wound control, whereas others have failed to show any beneficial effect. CONCLUSIONS: Encouraging results have been achieved with the addition of HBO therapy to standard treatment regimes, thus justifying further research in this field. More robust evidence by way of a prospective randomized trial is necessary before widespread and routine use of HBO in the management of NF can be recommended.     

Hyperbaric Oxygen Therapy for Malignancy: A Review

One unique feature of tumors is the presence of hypoxic regions, which occur predominantly at the tumor center. Hypoxia has a major impact on various aspects of tumor cell function and proliferation. Hypoxic tumor cells are relatively insensitive to conventional therapy owing to cellular adaptations effected by the hypoxic microenvironment. Recent efforts have aimed to alter the hypoxic state and to reverse these adaptations to improve treatment outcome. One way to increase tumor oxygen tensions is by hyperbaric oxygen (HBO) therapy. HBO therapy can influence the tumor microenvironment at several levels. It can alter tumor hypoxia, a potent stimulus that drives angiogenesis. Hyperoxia as a result of HBO also produces reactive oxygen species, which can damage tumors by inducing excessive oxidative stress. This review outlines the importance of oxygen to tumors and the mechanisms by which tumors survive under hypoxic conditions. It also presents data from both experimental and clinical studies for the effect of HBO on malignancy.     

Hyperbaric oxygen therapy (HBO): current standing

For more than thirty years hyperbaric oxygen therapy (HBO) has been an important and ultimate therapeutic tool in special indications. Hyperbaric oxygen improves tissue oxygenation, stimulates important mechanisms in wound healing and exerts beneficial effects on other biochemical and cellular processes. The properties of hyperbaric oxygen have built the rationale for its use as therapy of choice in patients with severe carbon monoxide poisoning, decompression sickness and arterial gas embolism, and as adjunctive therapy for the treatment of osteoradionecrosis, necrotizing fasciitis and compromised skin grafts and flaps. The efficacy of adjunctive hyperbaric oxygen in the treatment of lower extremity problem wounds in diabetic patients seems to be proven. There is little scientific support for other uses of hyperbaric oxygen and its therapeutical benefit should be further investigated. When used according to standard protocols hyperbaric oxygen treatment is a safe therapy with little adverse effects.