27例上肢毁损伤患者皮瓣移植术后的护理

总结了2012年2月~2014年10月我科收治的27例上肢毁损伤患者保肢术后的观察与护理,从环境、体位、心理、疼痛及对患肢肿胀及血管危象的观察等方面对患者采取针对性的护理措施。认为精心的护理,能最大限度恢复肢体的功能,更好地提高患者生存质量。     

截肢患者幻肢与幻肢痛的护理

幻肢与幻肢痛是患者截肢后的特殊心理不适应。这种心理不适应反应与患者文化程度、心理素质以及截肢前是否存在肢体疼痛密切相关。在64例截肢患者进行护理后,总结经验得出：对患者提供恰当的心理护理是消除患者心理不适反应的重要措施,重视护患之间的沟通交流,建立良好的信任的护患关系是帮助患者减轻或消除心理不适反应的基本保证。术前与术后的精心护理,提供整洁舒适的环境,让患者的心理、生理处于一个最佳状态,可帮助截肢患者减轻和消除幻肢与幻肢痛这一特殊的心理不适反应;对截肢残端施行恰当的冷热敷叩击以及理疗等综合措施可有效缓解幻肢痛,加强残肢运动,尽早安装假肢,是消除幻肢与幻肢痛的有力措施。     

地震后批量挤压综合征9例的保肢护理

目的：总结地震后批量挤压综合征伤员的保肢护理。方法：通过加强伤员的心理护理,合理配置医疗人员,采用分级救治程序,制定详细的护理措施。结果：9例均保肢成功,生命体征平稳,创面无感染迹象,肢端动脉搏动良好,毛细血管充盈时间正常。结论：依托良好的人员配置,ICU监护下脏器功能调整和科学的救治程序,部分严重挤压伤患者可以避免截肢。     

新辅助化疗联合保肢手术治疗青少年膝关节骨肉瘤的护理

总结了7例新辅助化疗联合保肢手术治疗青少年膝关节骨肉瘤的护理措施,包括术前心理护理、化疗护理、预防病理性骨折;术后生命体征监测、体位护理、患肢血液循环的观察、感染和深静脉血栓的预防、功能锻炼。认为实施各项护理干预措施,是新辅助化疗联合保肢手术成功的基础,对患者康复起到积极作用。     

乳腺癌治疗新术式——保乳手术的护理

介绍了对37例早期乳腺癌患者行保乳手术的术前和术后护理，注重患者的心理护理和健康教育；术后患肢功能锻炼；术后加强化疗、放疗的护理，减少术后局部复发，减少并发症，保证疗效。     

截肢患者术后护理及并发症的预防

总结24例截肢患者术后的观察及护理,术后严密观察患者生命体征及残端切口情况,预防术后继发性大出血,保持伤肢功能位及适当的心理干预。     

四肢毁损伤患者术后并发症的护理

目的探讨四肢毁损伤患者术后并发症的护理方法,以期为提高临床护理质量提供临床依据。方法回顾性分析2014年11月至2015年4月在上海第六人民医院显微外科治疗的四肢毁损伤术后出现并发症的38例患者的临床资料,总结其护理方法。结果 38例四肢毁损伤保肢患者中,均存在不同程度的低蛋白血症,20例患者存在食欲减退,31例患者存在肢体肿胀,其中2例发生严重胸腔积液,7例延迟愈合,其中3例截肢。患者经对症护理后,并发症症状均好转。结论针对并发症采取有效护理干预措施,积极配合医生治疗,可促进患者术后恢复。     

69例急性下肢动脉缺血的护理

[目的]探讨急性下肢动脉缺血的护理方法,以减少术后并发症、降低截肢率。[方法]回顾分析2000年1月—2006年12月69例急性下肢动脉缺血病人的护理。[结果]56例(81.2%)保肢,6例(8.7%)截肢,7例(10.1%)死亡。[结论]针对下肢动脉急性缺血不同治疗手段,采取相应的护理措施,对于解除患肢疼痛,提高保肢率和生存率有着积极的意义。     

69例足踝毁损伤患者保肢术后的护理

总结了69例足踝毁损伤患者保肢术后的观察与护理,护理重点包括疼痛护理,保温,皮温监测,对局部出血、肿胀及血管危象的观察,早期进行活动指导,加强环境管理和禁烟宣教等.经过精心治疗及护理,本组均未发生患肢血液循环障碍,保肢成功.对足踝部毁损伤患者保肢术后实施有针对性的护理措施,可以有效地抢救肢体,降低致残率,更好地提高患者生存质量.     

少数民族截肢术8例的术中心理护理

目的帮助少数民族截肢患者在实施截肢术中消除不良情绪,积极配合手术。方法对8例少数民族截肢患者在手术中的心理特点进行分析,提出心理问题,采取正确的术中心理护理措施。结果8例少数民族患者的截肢术顺利实施。结论少数民族截肢患者由于语言、宗教信仰等原因,在实施截肢术时的心理护理非常重要。正确掌握其心理护理特征,不但利于手术顺利进行．而且为患者进行下一步治疗和护理奠定了基础。     

下肢深静脉造影在诊断下肢静脉郁血综合征中的应用

本文报告了85例应用下肢深静脉造影法诊断下肢静脉郁血综合征。其结果显示:上行性造影可观察深静脉的全程及管腔情况;经皮腘静脉穿刺下行性造影可了解瓣膜的功能及功能不全的倒流程度。我们认为合理地应用造影对下肢静脉病变的诊断及正确选择手术方式有重要的意义。     

康复机器人训练对脑卒中偏瘫患者上肢功能的影响

目的:探讨上肢康复机器人训练结合常规康复治疗对脑卒中偏瘫患者上肢功能的影响。方法:80例脑梗死患者随机分为2组,均接受基础药物治疗和常规康复治疗;观察组增加上肢康复机器人训练。治疗前后分别进行上肢肌张力改良Ashworth量表(MAS)评分、上肢运动功能(FMA)评分及改良Barthel指数(MBI)评定。结果:治疗1个月后,2组患者上肢MAS评分均较治疗前明显下降(P<0.05),且观察组更低于对照组(P<0.05);FMA及改良Barthel指数(MBI)评分均较治疗前明显提高(P<0.05),且观察组较对照组更加显著(P<0.05)。结论:上肢康复机器人训练结合常规康复治疗不仅能改善脑梗死患者上肢功能,而且能促进日常生活活动能力的恢复。     

自制防足下垂固定器在下肢功能障碍患者中的应用效果

目的：为肢体瘫痪患者设计防足下垂固定装置,以防止患者长期足下垂引起肢体废用性萎缩,并探讨其对患者的康复效果。方法防足下垂固定器由放置下肢及足部的T型凹槽及覆盖在上面的海绵两部分组成。将108例下肢瘫痪患者按照随机数字表法随机分为对照组53例和研究组55例,对照组患者按常规护理,研究组患者在常规护理基础上使用防足下垂固定器。1个月后比较两组患者的Maryland足部功能评分和下肢简式Fugl-Meyer运动功能评分（仰卧位）。结果治疗前,两组Maryland足部功能评分和Fugl-Meyer 运动功能评分差异均无统计学意义（ P＞0．05）。治疗1个月后,研究组Maryland足部功能评分为（90．85±3．02）分,对照组为（83．50±2．43）分,差异有统计学意义（t＝12．52, P＜0．05）;研究组下肢简式Fugl-Meyer运动功能评分为（30．90±2．14）分,对照组为（22．13±2．26）分,差异有统计学意义（t＝19．75,P＜0．05）。结论防足下垂固定器有利于患者下肢功能康复,可有效替代护理人员手工固定,适合下肢瘫痪患者使用。     

降脂活血片治疗肢体闭塞性动脉硬化症

目的：观察降脂活血片治疗肢体闭塞性动脉硬化症的疗效。方法：应用降脂活血片治疗闭塞性动脉硬化症(ASO)患者26例，于治疗前后观察肢体彩色多普勒血流图、高低密度脂蛋白、胆固醇、血液流变学、甲襞馓循环的指标变化。结果：应用降脂活血片后微循环障碍得到改善，血液流变学各项异常指标均有明显好转。结论：降脂活血片是中成药，具有降脂、抗凝、溶纤、抑制血小板聚集、降低血液粘度的一种有效药物。     

下肢截肢后不良残肢的临床评估和处理

目的分析下肢截肢后不良残肢发生的原因，并介绍其临床处理方法。方法对109例下肢截肢者(共计110个残肢)进行评定，评定内容包括：残肢皮肤软组织状况、长度、形状、关节活动度、肌力、幻肢痛、残肢痛等，然后对不良残肢进行相应的理疗、体疗或手术处理。结果本组合格残肢64肢(占58％)，不合格残肢46肢(占42％)。不合格残肢主要表现为：残端形状不规则20肢，短残肢18肢，残端不稳定瘢痕伴感染13肢，残端肿胀及臃肿14肢，关节屈曲挛缩畸形18肢，神经瘤2肢，经理疗、体疗或手术处理后，均达到装配假肢的条件。结论对不良残肢要进行对症处理，使之能装配或穿戴假肢。由于假肢技术的不断改进，现在残肢的长度不再是影响假肢装配的主要原因，而残端皮肤软组织的条件已成为影响假肢装配的主要因素。     

Individual differences in response to phantom limb movement therapy

Purpose.?Phantom limb pain (PLP) is a distressing condition experienced by many amputees. The purpose of this study was to investigate whether motor imagery could be used to treat PLP.

Method.?Four single case studies were conducted. The participants kept a pain diary in which they recorded the intensity of their PLP during a baseline period, general motor imagery training, phantom limb movement therapy and a follow-up period. Qualitative and quantitative (i.e. interrupted time series) analyses were employed to determine whether phantom limb movement therapy had a significant effect on PLP intensity.

Results.?Phantom limb movement therapy significantly reduced intensity of PLP in one participant. One participant gained occasional relief by doing phantom limb movement therapy exercises but did not experience an overall reduction in PLP intensity. The third participant did not experience any relief and the fourth participant reported experiencing the re-emergence of an old pain.

Conclusion.?The results display individual differences in response to phantom limb movement therapy. Individual differences are discussed in the context of motor imagery ability and the phantom limb phenomenon as a multi-dimensional disorder.     

Children with congenital limb deficiency in Norway: issues related to school life and health-related quality of life. A cross-sectional study

Purpose: To describe clinical features, issues related to school life and health-related quality of life (HRQOL) for children with congenital limb deficiency (CLD) and compare these children to Norwegian school children on HRQOL.

Method: Cross-sectional study. In 2010, a postal questionnaire, designed for this study and the Paediatric Quality of Life Inventory (PedsQL), was sent to 154 eligible parents of children with CLD, aged 6–18 years and registered at TRS National Resource Centre for Rare Disorders in Norway.

Results: Response rate 44% (n?=?67), median age 11 years, 42% were girls. Of the total group, 46 had unilateral upper limb deficiency (UULD) and 21 had multiple/lower limb deficiency (MLD/LLD). The most common UULD was below-elbow deficiency, of these, 65% used grip-improving devices, and 35% used prostheses. Children with UULD-reported PedsQL score similar to Norwegian schoolchildren (NSC). The MLD/LLD group was heterogeneous; most had below-elbow/knee deficiency. In this group, PedsQL scores were reduced for physical and social functioning compared with NSC. Compared with children with UULD, more children with MLD/LLD were restricted in participation because of pain and fewer participated in physical education with peers.

Conclusions: Most children with CLD participated with their peers and managed well in everyday life. Children with MLD/LLD seemed to have more challenges than children with UULD. Approximately one-third of all the children had assistive devices and/or practical assistance in school.

• Implications for Rehabilitation

• Most children with upper-limb deficiency (UULD) in Norway manage well in everyday life and have HRQOL equal to other Norwegian children. Many choose grip-improving devices instead of prostheses. Their preferences should be respected and taken into account as the need for new assistive devices arise.

• For children with pronounced disabilities, access to, and use of, assistive devices, adaptions and practical assistance may be important for participation. Cooperation with the child and the parents is necessary to find useful measures.

• Physical education and practical subjects may provide special challenges, both for children and their teachers. Children themselves often find good solutions and the tasks should be planned ahead in cooperation with them.

     

Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a ‘virtual’ limb upon phantom limb pain,sensation and movement

The extent to which viewing a 'virtual' limb, the mirror image of an intact limb, modifies the experience of a phantom limb, was investigated in 80 lower limb amputees before, during and after repeated attempts to simultaneously move both intact and phantom legs. Subjects were randomly assigned to one of two conditions, a control condition in which they only viewed the movements of their intact limb and a mirror condition in which they additionally viewed the movements of a 'virtual' limb. Although the mirror condition elicited a significantly greater number of phantom limb movements than the control condition, it did not attenuate phantom limb pain and sensations any more than the control condition. The potential of a 'virtual' limb as a treatment for phantom limb pain was discussed in terms of its ability to halt and/or reverse the cortical re-organisation of motor and somatosensory cortex following acquired limb loss.