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1.
钙拮抗剂对大鼠腹部皮瓣抗氧化作用的研究   总被引:9,自引:0,他引:9  
Objective To observe the protective effect of calcium antagonist on the ischemia - reperfusion injury in rat abdominal skin flap.Methods 33 SD rats were randomized into three groups. The abdominal island flap based on the inferior epigastric vessels was used as the ischemia - reperfusion model. In the control group, normal saline was given intraperitoneally for 3 consecutive days preoperatively, while Verapamil (Ver) and Tetrandcin (Tet) were given in the other two groups respectively. Samples from the flap were harvested during ischemia and reperfusion periods to measure the changes of superoxide dismutase SODactivity,glutathione peroxidase GSH - Pxactivity and malonyl dialdehyde MDAcontent. Results SOD activity and GSH - Px activity were much higher in the Ver and Tet groups than in the control group, while the MDA content was remarkably decreased in these two groups.Conclusions Calcium antagonist, Verapamil and Tetrandcin, plays an important role in oxygen free radical scavenging and in reducing lipid peroxidation.  相似文献   

2.
第二跖背动脉逆行岛状皮瓣修复Mu甲瓣切除后的创面   总被引:9,自引:4,他引:5  
Objective To introduce a new surgical procedure for coverage of the donor area of wrap - around flap using the reverse second dorsal metatarsal artery island flap.Methods From June 1992 to December 1998,the reverse second dorsal metatarsal artery flap was used to cover the defect after harvesting of wrap - around flap in 12 cases.The size of the flaps ranged from 3 cm × 2 cm to 6 cm × 4 cm.The cutaneous nerve included in the flap was sutured with the proper digital nerve.The donor site on the dorsum of the foot was repaired by split thickness skin graft.All the patients were followed for 4 months to 6 years.Results The flaps survived with good consistency,texture,and near normal sensation.No compressive ulcer and phalangeal necrosis was noted.There was no obvious impairment of the walking function of the foot.Conclusion The reverse second dorsal metatarsal artery flap is a new and effective option for repair of the defects of the toes.  相似文献   

3.
Objective To introduce a new device of external fixator for olecranon fracture,and evaluate its clinical treatment outcome.Methods After close reduction under the supervision of the image intensifier,15 cases of olecranon fracture have been treated by the external fixator of self-design.The patients were followed for 6 to 8 weeks postoperatively.Results Clinical observation and follow-up revealed that all these fractures healed up well with full recovery of elbow joint function.The average period for bony union was 7 weeks,ranging from 6 to 8 weeks.Normal range of motion of the elbow joint was regained,without any complications.Conclusions This kind of external fixator used for olecranon fractures showed the advantages of minimal invasiveness,simple manipulation, reliable fixation,early post-operative joint movement,and no need for implant removal procedures.The author believes it is worth introduction and using clinically.  相似文献   

4.
双侧苍白球切开术治疗原发性帕金森病   总被引:4,自引:0,他引:4  
Li Y  Shi C  Shao M  Ding Y 《中华外科杂志》2000,38(3):165-168
Objective To clarify the benefits and risks of patients undergoing bilateral posteroventral pallidotomy (BPVP) for patients with idiopathic Parkinsons disease (PD) and the differences between contemporaneous BPVP (CBPVP) and staged BPVP (SBPVP).  相似文献   

5.

肝包虫囊肿破入胆道是包虫病较为常见的严重并发症之一。笔者就肝囊型包虫病破入胆道的诊断和治疗现状进行综述。

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6.
Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the > 50%reduction in amplitude or > 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to > 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.  相似文献   

7.
Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the > 50%reduction in amplitude or > 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to > 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.  相似文献   

8.
目的 探讨修复腕掌尺侧皮肤神经同时缺损的新方法.方法 2000年4月至2009年8月,应用游离足底内侧皮瓣修复腕掌尺侧皮肤并神经缺损5例.足拇趾胫侧趾底固有神经修复小指尺掌侧固有神经缺损1例;桡神经浅支修复尺神经及其深浅支缺损2例,修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例;尺神经手背支修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例.足底内侧血管与尺血管吻合.供区取同侧大腿皮片移植修复.结果 术后皮瓣及移植皮片全部成活.5例获得6个月至4年的随访,皮瓣质地好、外观满意,无手内肌萎缩和爪形手畸形,皮瓣和手指感觉恢复达S3~S3+,皮瓣两点辨距觉为7~10 mm.尺神经深浅支缺损病例术后综合评价均为优.结论 游离足底内侧皮瓣是修复腕掌尺侧皮肤神经缺损的有效方法.
Abstract:
Objective To explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side. Methods From April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps.Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomozised with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg. Results All the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.Conclusions Free medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.  相似文献   

9.
目的 介绍腕管综合征内窥镜手术(endoscopic carpal tunnel release,ECTR)预防正中神经损伤并发症的方法.方法 利用彩色多普勒超声仪(B超)对37例74手患者术前进行检测.结果 71例正中神经走行在桡侧腕屈肌腱与掌长肌腱之间,3例走行在掌长肌腱与尺侧腕屈肌腱之间,并术中确认.结论 正中神经变异走行在掌长肌腱与尺侧腕屈肌腱之间是ECTR的禁忌证,B超能准确定位正中神经与掌长肌腱关系,避免内窥镜手术损伤正中神经,更具有简单、经济、方便可靠等优点.
Abstract:
Objective To introduce a method of preventing median never injury during endoscopic carpal tunnel release (ECTR). Methods Ultrasonography of both wrists was done to 37 patients of carpal tunnel syndrome who were going to undergo open release of the transverse carpal ligament. Structures in the carpal tunnel were visualized to guide surgical decision-making. Results Ultrasonography showed that median never lies between the tendon of flexor carpi radialis and palmaris longus in 71 patients and lies between the tendon of palmaris longus and flexor carpi ulnaris in 3 patients. These findings were confirmed during the surgeries. Conclusion It is a contraindication of ECTR if median never lies between palmaris longus and flexor carpi ulnaris. Ultrasonography can accurately reveal the relative position of median never to the palmaris longus tendon. Pre-operative ultrasonography of the wrist is a simple, inexpensive and convenient method to exclude these contraindications and thus prevent median never injuries in ECTR.  相似文献   

10.

肝外胆管缺损的修复是胆道外科的难题。笔者仅就近年来开展的保留Oddi括约肌的自体组织修复胆道缺损的研究进行综述;主要内容包括保留Oddi括约肌的意义、胆道缺损修复的技术要求、手术适应证及手术方式。

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11.
关节镜镜视下行腕横韧带切开术   总被引:6,自引:1,他引:5  
目的 介绍在关节镜镜视下行腕横韧带切开术治疗腕管综合的方法。方法 1999年3月以来,对15例(18侧)腕管综合征采用Chow两点法在关节镜镜视下行腕横韧带切开术。腕管入口位于腕横纹近端2-3cm,掌长肌腱尺侧缘。腕关节背伸位时,将带槽套管自腕管入口处对准第3指蹼方向插入,从腕管远端穿出。在关节镜监控下用钩刀切开腕横韧带。结果 术后随访2-16上月,平均7个月。术后桡侧3指半的感觉已恢复正常。3例有拇指对掌功能和大鱼际肌萎缩者,术后3-6个月均恢复正常。无血管神经损伤和感染等并发症发生。结论 关节镜镜视下切开腕横韧带治疗腕管综合征是安全有效的微创手术。  相似文献   

12.
张君  桑秋凌  李墨  赵文海 《中国骨伤》2008,21(2):139-140
目的:探讨应用内镜的两点单侧钩切法切断腕横韧带,解除正中神经压迫的手术方法和疗效。方法:临床治疗原发性11例13侧(左侧3例,右侧6例,双侧2例)43~68岁女性腕管综合征患者。全部患者均有桡侧3个半指的指端刺痛觉减退,腕部正中神经Tinel征阳性,11例大鱼际肌萎缩,同时4例存在拇指对掌功能减弱。术中局部麻醉,分别采取近侧腕横纹线处,掌长肌腱与桡侧屈腕肌腱之间1cm皮肤横切口(入口)和患者拇指最大桡侧外展位,拇指尺侧平行线与中环指间的长轴线交叉点向尺侧1cm处呈45°切口(出口)。预制隧道后入口处置入腕关节镜,由出口插入钩刀。钩刀钩住腕横韧带近段后,内镜随钩刀移动而远行,全程镜视下由近及远切断腕横韧带。结果:患者经随访4~20个月全部疗效满意,捏握功能明显改善。术后3个月时恢复至S3+M3以上。无血管、神经或屈肌腱损伤等并发症。结论:两点单侧钩切法操作步骤简单,是一种有效的手术方法。  相似文献   

13.
目的 观察微型钩刀治疗腕管综合征的疗效。方法 在掌长肌腱尺侧,距腕横纹近侧1cm作1cm长的横切口,分离到深筋膜并切开,插入槽型扩张导管,在槽的导引下插入微型钩刀,从远至近把腕横韧带完全钩割开。结果 术后4周随访,12例中10例症状完全消失,2例症状改善;术后随访1年,3例术前大鱼际肌肉明显萎缩,都有明显好转。结论 微型钩刀治疗腕管综合征是一种简单、安全有效的治疗方法。  相似文献   

14.
We describe the acute development of ulnar nerve compression following carpal tunnel release in a patient with an accessory palmaris longus muscle. Although anomalous muscles in the wrist are relatively common and may produce ulnar nerve compression, this particular occurrence following carpal tunnel release has not been previously described in the literature. We theorize that the compression of the ulnar nerve proximal to Guyon's canal was caused by increased tension along the long axis of the anomalous accessory palmaris longus muscle as a consequence of transverse carpal ligament division.  相似文献   

15.
This prospective, randomized study compares two treatment methods in patients with primary carpal tunnel syndrome. Decompression of the transverse carpal ligament was done in thirty-two hands (thirty patients) and decompression of the transverse carpal ligament with the addition of an internal neurolysis of the median nerve was done in thirty-one hands (twenty-nine patients). Relief of symptoms was described in eighty-eight percent of the patients with carpal ligament release and eighty-one percent of patients with carpal ligament release plus internal neurolysis. Improvement in hand sensibility testing, in thenar muscle strength, and atrophy was noted in both treatment groups with no statistical difference between groups. The addition of an internal neurolysis to division of the transverse carpal ligament does not add significant improvement in the sensory or motor outcome of patients with primary carpal tunnel syndrome.  相似文献   

16.
内窥镜下松解腕管综合征的神经并发症   总被引:8,自引:7,他引:1  
目的 报道内窥镜治疗腕管综合征时引起神经损伤的原因。方法 1997年至2003年,应用内窥镜治疗腕管综合征136例。对其中2例在内窥镜术后发生并发症的患者,在直视下再次进行手术探查,以明确神经损伤的部位及性质,并探讨引起神经损伤的原因。结果 1例正中神经在腕管内与腕横韧带粘连,在切断腕横韧带时同时损伤相连的正中神经外膜与部分束膜。经神经外膜松解后症状缓解。另1例正中神经掌皮支起始部发生变异,在内窥镜插入腕上切口处,直接损伤该皮支;经神经松解后症状缓解。结论 内窥镜治疗腕管综合征,通常是安全有效的。但在解剖变异及内窥镜下手术有困难时,易发生神经损伤,再次进行手术松解,症状缓解。  相似文献   

17.
Carpal tunnel syndrome is often treated nonoperatively with temporary wrist immobilization and local steroid injections. A direct injection into a peripheral nerve can result in permanent damage. Two cases of median nerve injection injury and one involving the ulnar nerve are presented; all were treated with neurolysis and debridement of the injected material. At follow-up ranging from 1 to 11 years, all patients showed significant improvement, but with some functional loss. The literature is confusing because of the variety of injection techniques used for the treatment of carpal tunnel syndrome, some of which put the median nerve at risk. We recommend that the injection be made midway between the palmaris longus tendon and the flexor carpi ulnaris tendon just proximal to the proximal edge of the transverse carpal ligament in a line with the superficialis tendon of the ring finger. The injection should be stopped and redirected if the patient experiences paresthesia of any kind.  相似文献   

18.
目的 报告使用手掌近侧小切口的腕管切开松解减压术的疗效。方法 自大、小鱼际纹交界处向远侧腕横纹做纵行切口,长2~2.5cm,直视下切开屈肌支持带,解除正中神经卡压。术后随访并与同期采用传统长切口的病例比较,观察小切口的疗效。结果 随访病例19例30腕,其中小切口6例11腕,长切口13例19腕,它们在手指麻木、腕痛、握力及两点辨别觉改善等方面无明显差异,在切口长度、手术时间、恢复正常生活与工作时间以及术后瘢痕触痛、墩柱部疼痛等方面,前者优于后者。结论 经手掌近侧小切口实施腕管切开松解减压术,较传统方法有更多优点,是一种安全、有效的治疗方法。  相似文献   

19.
Several authors have written about the co-existence of thumb carpometacarpal arthritis and carpal tunnel syndrome, and 4% to 43% of patients undergoing thumb carpometacarpal arthroplasty also have a carpal tunnel release. Some authors advocate that carpal tunnel release and thumb carpometacarpal arthroplasty should be performed at the same time. We perform a combined thumb carpometacarpal arthroplasty and radial approach carpal tunnel release through a single incision. The purposes of this study are to (1) determine the safety of this approach and (2) evaluate the effectiveness of this approach in decreasing the pain and numbness observed prior to surgery. Eight patients had combined thumb carpometacarpal arthroplasty and radial approach carpal tunnel release. With an average follow up of 14 weeks, all patients reported an improvement in pain and numbness. No nerve injuries occurred, and no difficulty in wrist flexion was observed. One patient had pillar pain persisting at 19 weeks follow-up. One patient had basilar thumb pain at 19 weeks, though this was improved over pre-operative levels.  相似文献   

20.
内镜在腕管综合征治疗中的应用选择   总被引:1,自引:1,他引:0  
目的探讨内镜治疗腕管综合征(carpal tunnel syndrome,CTS)的病例选择。方法2004年7月~2007年9月,用内镜技术治疗21例(24腕)CTS。手术在局麻下进行,距腕横纹近侧3cm处掌长肌腱尺侧横切口1cm,前臂筋膜深层分离将专用外套管置入腕管,在内镜监视下用专用钩刀切断腕横韧带。术后1、2、3、5个月随访。结果术后5个月时按Kelly法疗效评级:优11例;良6例;一般2例(3腕);差2例。其中疗效差1例于内镜术后7个月行传统开放手术神经干束间松解而缓解,1例存在明显的手指皮肤痛觉过敏并皮肤干燥等交感神经症状而继续保守治疗。结论按如下原则选择内镜处理或开放手术治疗CTS:①特发性病例内镜处理;继发性病例开放手术,如类风湿关节炎所致的滑膜增生肿胀,腕内骨折后畸形,腕管内肿瘤、囊肿、炎症、痛风,神经干自身病变等。②拇指对掌功能有障碍及晚期CTS选择开放手术。③老年患者(〉60岁)优先考虑开放手术;年轻、有较高职业和外观要求的患者可以优先考虑内镜治疗。  相似文献   

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