半骨盆截肢后用废弃自体骨重建骨盆承重功能的解剖学与生物力学研究

目的 探讨对骨盆肿瘤行半骨盆截肢后,应用废弃自体骨重建坐骨结节和骨盆环以恢复骨盆承重功能的可行性.方法 带双侧下肢骨的10具骨盆标本,测量坐骨结节至正中矢状面和经骶骨耳状面中心冠状面的垂直距离、坐骨结节至同侧的骶骨耳状面和耻骨联合的距离.测量股骨髁和胫骨平台的最大径,对股骨和胫骨进行CT扫描并纵向剖开,观察骨质分布情况.根据解剖测量结果,选择4具成人尸体标本,应用电子万能试验机对完整骨盆和重建标本进行生物力学检测,比较两者在0-500 N的垂直加压下的稳定性.结果 坐骨结节至正中矢状面和经耳状面中心至冠状面的垂直距离分别为(4.52±0.48)cm和(3.31±0.57)cm.坐骨结节至同侧骶骨耳状面和耻骨联合的距离分别为(11.75±6.19)cm和(15.72±5.19)cm.股骨髁最大斜径在外后至内前方向平均为(7.93±0.44)cm,胫骨平台的最大径在冠状面上,平均为(7.19±0.61)cm.股骨髁和胫骨平台主要为松质骨,股骨髁松质骨平均纵向长度为(6.24±0.22)cm,胫骨上端平均纵向长度为(5.64±0.18)cm.在生物力学试验中,重建骨盆的抗压缩能力较完整骨盆弱,但在载荷去除后,重建骨盆和完整骨盆均可恢复原来的状态,说明重建骨盆和完整骨盆同样为弹性良好的刚体结构,具有较好的即刻稳定性.结论 半骨盆截肢后,可应用废弃股骨或胫骨重建坐骨结节和骨盆环,为患者坐立和装配假肢提供力学支持点,以降低半骨盆截肢者的残废程度.     

Heterotope Replantation nach bilateraler Unterschenkelamputation

Zusammenfassung. Einleitung: Die Replantation ist in der rekonstruktiven Chirurgie ein etabliertes Verfahren. Bei beidseitigen Amputationen der unteren Extremit?t sollte, soweit dies die Vitalfunktionen zulassen, immer zumindest die Replantation einer Extremit?t angestrebt werden. Patient und Methode: Wir berichten über einen Patienten, der eine beidseitige Unterschenkelamputation erlitt und dem aufgrund der komplexen Verletzungen der linke Unterschenkel heterotop (cross-over) an den rechten replantiert wurde. Linksseitig erfolgte eine Stumpfbildung. In einem Zweiteingriff wurde eine Weichteilnekrose am replantierten Unterschenkel entfernt und der Defekt mit einem freien M. latissimus dorsi gedeckt. Zugleich erfolgte die Rekonstruktion des N. tibialis. 13 Monate nach dem Trauma ist der Patient ohne Gehstützen mit einer Prothese für das linke Bein mobilisiert. Diskussion: Die Indikation zur Replantation h?ngt vom Ausma? der Begleitverletzungen und den Vitalfunktionen ab. Im Vergleich zu einer Stumpfversorgung verl?ngert die Unterschenkelreplantation den station?ren Aufenthalt, verz?gert die Mobilisation des Patienten und erh?ht die Zahl der notwendigen rekonstruktiven Zweiteingriffe. Das funktionelle Ergebnis nach einer Replantation der unteren Extremit?t ist allerdings meist besser als nach Versorgung mit einer Prothese, vor allem wenn eine ausreichende Schutzsensibilit?t der Fu?sohle wiederhergestellt werden kann. Gerade bei einer beidseitigen Amputation ist die Bewegung und Stabilit?t der Beine, und damit auch die Lebensqualit?t des Patienten bei einer erhaltenen eigenen Extremit?t deutlich verbessert.      

Phantom limb pain: A literature review

Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb pain has increased every year. Especially in recent decades, scientists have achieved a better understanding of the mechanism and treatment of phantom limb pain. Although many hypotheses have been agreed and many treatments have been proven effective, scientists still do not have a very systematic understanding of the phantom limbs. The purpose of this review article is to summarize recent researches focusing on phantom limb in order to discuss its definition, mechanisms, and treatments.     

股前外侧肌皮瓣修复小腿截肢残端软组织缺损

目的 探讨股前外侧肌皮瓣修复小腿截肢残端软组织缺损,保留小腿长度或膝关节以利于假肢装配.方法 2013年4月-2016年11月,应用股前外侧肌皮瓣对小腿截肢残端软组织缺损进行修复4例,其中游离肌皮瓣3例,带蒂肌皮瓣1例.患者均为男性,截肢肌创面位于小腿近端,年龄8~48岁,平均20岁,创面面积7.0 cm×6.0 cm^25.0 cm×10.0 cm.一期清创后二期修复,肌皮瓣面积13.0 cm×10.0 cm^28.0 cm×12.0 cm,保留胫骨长度5.2~9.4 cm.结果 肌皮瓣全部成活,1例肌皮瓣边缘出现浅表感染经换药处理后愈合,供区无并发症.所有患者随访12~37(平均19)个月,末次随访时皮瓣血运好、质地柔软、耐磨.皮瓣感觉恢复程度:S22例, S31例,S3+1例. 6 min步行测试:Ⅳ级2例,Ⅲ级2例;Stanmore运动分级:V级2例,Ⅳ级2例.结论 股前外侧肌皮瓣是修复小腿截肢残端软组织缺损的理想皮瓣.     

Bone Histomorphology May Be Unremarkable in Diabetes Mellitus

Abstract Background and Purpose:  Histomorphological studies on bone in human diabetes mellitus are scarce. The aim of this study was to observe the histomorphological appearance of bone in amputation specimens from feet of patients with diabetes mellitus. Material and Methods:  Routine histopathology reports on 45 amputation specimens were evaluated, provided the osteotomy was located in unaffected bone tissue. The bone morphology of regions affected with gangrene and/or osteomyelitis was considered, as well as the morphology at the dissection margin at a distance from the affected parts. The specimens were obtained from 43 diabetic patients, most of whom exhibiting the so-called neuroischemic diabetic foot with infection. The patients' age ranged from 50 to 92 years, duration of diabetes from 0 to 52 years; polyneuropathy was present in 36, peripheral ischemic vessel disease (PIVD) in 30, and renal failure in 24 of them, respectively. Results:  There were 22 clinical cases of osteomyelitis, 20 cases of gangrene (including three cases of necrosis without surrounding inflammation), and three cases of pressure ulcer, which were treated by amputation of 24 toes, and resection of 21 metatarsal bones, respectively. Histomorphology showed osteomyelitis (n = 29), bone necrosis (n = 1), myelofibrosis (n = 8), and normal bone (n = 7) at the affected sites, compared to normal bone (n = 26), myelofibrosis (n = 12), and osteoporosis (n = 7) at the osteotomy sites. In cases of clinical gangrene, bones were also affected by osteomyelitis, but less so than in cases of clinical osteomyelitis (8/18 vs. 22/22; p < 0.001). Bone tissue at the osteotomy sites was normal – with some myelofibrosis – in both conditions. Conclusion:  This pilot study shows that histomorphology of unaffected foot bone is mostly not abnormal in diabetic patients with neuropathy and PIVD. Further study is necessary to corroborate this preliminary evidence of absence of a “diabetic osteopathy” in the diabetic foot.      

Houghton Scale of prosthetic use in people with lower-extremity amputations: Reliability, validity, and responsiveness to change

OBJECTIVE: To evaluate the responsiveness to change and the floor and ceiling effects of the Houghton Scale. DESIGN: One-week and 3-month test-retest to evaluate reliability, validity, and responsiveness to change. SETTING: Amputee rehabilitation program. PARTICIPANTS: Persons (N=125) with unilateral or bilateral lower-extremity amputation who were wearing a prostheses: 1 group (n=49) for the reliability component and another group (n=76) for the responsiveness and validity component. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responsiveness to change, ceiling and floor effects, and reliability and convergent validity. RESULTS: Evaluation of responsiveness to change (n=76) showed that the total score increased from a mean +/- standard deviation of 6.14+/-2.40 at discharge to 7.70+/-2.62 (P<.001) at follow-up 3 months later. Floor and ceiling effects were not detected for the overall score but were noted for the individual subscales. The internal consistency was moderate at discharge (Cronbach alpha=.71) and follow-up (Cronbach alpha=.70). The Houghton Scale correlated significantly, although moderately, with the physical composite score of the Medical Outcomes Study 36-Item Short-Form Health Survey (r=.393, P<.01) and the 2-minute walk test at admission (r=.620, P<.01) and discharge (r=.653, P<.01). The reliability (intraclass correlation coefficient=.96) of the Houghton Scale was high (n=49). CONCLUSIONS: The Houghton Scale is appropriately responsive to change in prosthetic use in individuals with lower-limb amputation after rehabilitation.     

Traumatic neuroma of the intestine

A traumatic neuroma of the intestine arising at the site of a previous ileocolic anastomosis is reported. Barium enema examination showed an extramucosal mass in a patient who presented with abdominal pain, rectal bleeding, and anemia. Although rare, traumatic neuroma should be included in the differential diagnosis of an intestinal mass occurring after intestinal surgery.     

Secondary reconstruction of below knee amputation stump with free anterolateral thigh flap

Below knee stump preservation reduces ambulatory energy expenditure and improves the quality of life. Reconstruction of soft tissue loss around the stump is a challenging task. Below knee stump reconstruction demands stable skin with sufficient soft tissue to allow weigh bearing. Microsurgical tissue transfer is increasingly being used as a salvage option. Anterolateral thigh flap with additional vastus lateralis muscle provides extra cushioning effect. We report two cases of amputation below knee successfully salvaged. The anterolteral flap with abundant tissue and stable skin offers a reliable option for cover. Two patients with below knee amputation were reconstructed secondarily. After 6 to 20 months of follow -up, stumps showed no signs of pressure effects. Patients are able to bear 50-70 hours of weight per week.     

青年男性截肢患者的个性化心理护理

目的:探讨青年男性截肢患者个性化心理护理的方法.方法:针对我院23例20-38岁男性患者,分别与之沟通交流,掌握他们对截肢后各自的心理变化,社会观和人生观的改变,再针对性的予以心理护理和指导.结果:23例中有22例身心愉悦,能积极面对生活,面对现实,适应社会,仅有1例存留抑郁寡欢.结论:青年截肢患者因其年龄特殊性,均存在不同方面不同程度的心理隐患,需要积极引导和帮助.