臀大肌代肛门括约肌治疗高位无肛术后大便失禁

目的探讨臀大肌代肛门括约肌控便手术治疗高位无肛术后大便失禁的疗效。方法 2002年12月-2010年11月,收治25例高位无肛行腹会阴联合肛门成形术后完全性大便失禁患者,采用臀大肌代肛门括约肌控便手术治疗。男11例,女14例;年龄3～22岁,平均10.2岁。术前直肠造影、肛管直肠测压及肌电图检查显示肛门括约肌功能缺失或严重不良。采用Wexner评分、大便失禁生活质量调查问卷(FIQL)、自测健康评定量表(SRHMS)评定患者生活质量,并行肛管直肠测压、肛管直肠腔内超声检查、动态排便造影检查。结果术后1周2例患者发生直肠切口瘘,其余患者切口Ⅰ期愈合。患者均获随访,随访时间1～9年,平均6.3年。大便次数由术前每天10余次减少至4～6次。术后1年及术后2年及以上Wexner评分及SRHMS自测评分与术前比较,差异均有统计学意义(P<0.05);术后2年及以上FIQL评分较术前及术后1年明显改善(P<0.05)。肛管直肠测压结果示术后2年及以上患者肛管最大收缩压、收缩持续时间及最大收缩容积较术前及术后1年明显提高,差异有统计学意义(P<0.05)。结论臀大肌代肛门括约肌手术能一定程度改善高位无肛术后大便失禁患者的控便能力。     

大转子疼痛综合征的MRI表现

目的:探讨大转子疼痛综合征(GTPS)患者的MRI表现。方法:回顾性分析2018年1月-2020年4月在本院经临床诊断为GTPS的20例患者的临床及MRI资料。MRI扫描序列主要有冠状面和横轴面T₁WI、T₂WI和STIR序列。结果:20例患者累及26髋。主要MRI表现:臀中肌或臀小肌肌腱增厚或信号增高(n=9);臀中肌或臀小肌肌腱纤维局灶性缺失(n=16);臀中肌或臀小肌肌肉萎缩、脂肪浸润、肌肉肌腱钙化(n=1)。多伴有周围软组织水肿(n=26)和转子区滑囊扩张、积液(n=26),可伴有肌肉肌腱“羽翼状”水肿信号(n=4)及股骨大转子骨髓水肿(n=8)。结论:MRI可较为直观显示GTPS的影像学特征,为临床干预提供客观依据。     

BILATERAL INFRAORBITAL NERVE BLOCK IS SUPERIOR TO PERI-INCISIONAL INFILTRATION FOR ANALGESIA AFTER REPAIR OF CLEFT LIP

Cleft lip repair is a common operation in infants and requires that the child is pain-free during the postoperative period so that handling does not affect the integrity of the delicate surgical site. This study was designed to compare the efficacy and duration of effect of 0.125% bupivacaine given preoperatively as a bilateral infraorbital nerve block with peri-incisional infiltration of the same local anaesthetic for postoperative analgesia in cleft lip repair. It was a randomised, double blind, prospective study in 30 children aged 4-20 months (ASA grade 1). After a standard induction, group A (n = 15) were given a bilateral infraorbital nerve block with 0.125% bupivacaine and group B (n = 15) had peri-incisional infiltration with the same solution. No additional systemic analgesics were given before or during the operation. Intraoperative monitoring comprised measurement of heart rate and blood pressure and postoperatively pain relief was recorded using a behavioural pain relief score. The heart rate, respiratory rate, and blood pressure were also monitored at 0, 1, 2, 4, 8, and 24 hours after tracheal extubation. The results showed that group A had significantly better pain relief (higher scores) than group B for eight hours postoperatively (p &lt; 0.05). The analgesic requirement in group B became significant at two hours postoperatively, while group A had significant analgesic requirements only after eight hours. The significant rise in heart rate and blood pressure that accompanied tracheal intubation in both groups suggested that while both methods of analgesia may be adequate to prevent responses to skin incision, they do not substitute for adequate systemic analgesia during the operation. We conclude that infraorbital nerve block with 0.125% bupivacaine provides better and more prolonged analgesia than peri-incisional infiltration in cleft lip repair.     

Gluteal muscle activity during running in asymptomatic people

BackgroundHip abductor muscle function is associated with running-related injuries. Previous electromyography (EMG) studies that reporting gluteal muscle activity when running have failed to account for the multiple segments of the gluteals, and have used surface electrodes, which may be contaminated by cross-talk of surrounding muscles.Research questionThis study aimed to: (i) develop EMG profiles of gluteus medius (GMed – anterior, middle and posterior) and gluteus minimus (GMin – anterior and posterior) segments during running; (ii) compare the activation patterns of each gluteal segment between running and walking; and (iii) compare surface EMG signals of running and walking to fine wire EMG signals of middle GMed.MethodsTen physically active and asymptomatic people participated. Gluteal segment activation was assessed during running and walking over 10 m. Muscle activation was assessed using bipolar fine wire intramuscular EMG electrodes and GMed activation was also assessed using surface EMG.ResultsDuring running, all gluteal segments presented peak amplitude during the stance phase and anterior GMin presented additional second peak amplitude during the swing phase. All gluteal segments evaluated demonstrated consistently higher amplitudes during the stance and swing phases of running compared to walking. The mean amplitude assessed using surface EMG was 32–87% higher compared to fine wire during both phases for running and walking.SignificanceGreater activation of GMed segments during the stance phase and the increased anterior GMin activity during the swing phase indicate a potentially important role for pelvis and hip stabilization, respectively, which should be considered during development of targeted rehabilitation for running populations. The overestimated activation using surface electrodes highlights a limitation of using surface EMG during running and walking.     

大菱鲆的营养成分分析

大菱鲆 (Scophthalmus maximus)属于鲽形目 ,鲆科 ,菱鲆属 ,是欧洲著名的海水养殖良种 ,是世界市场共同认可的优质比目鱼类之一。其商品价格很高 ,是因它的肌肉丰厚白嫩、骨刺少、内脏团小、出肉率高。鱼肉煮熟后不老 ,无腥味和异味 ,口感爽滑甘美 ,尤其它的鳍边和皮下含有极为丰富的胶原 ,赛过甲鱼的裙边和海参 ,属上等佳肴 ,深受消费者欢迎。我国 90年代初引进 ,现已在山东半岛和辽东半岛海域育苗和养殖 ,目前对大菱鲆的研究仅局限于形态结构、生态分布及生活习性 [1 ] ,有关其营养成分的研究 ,国内尚未见报道。本研究以牙鲆 (Paralichth…     

岛状臀大肌肌皮瓣修复骶部褥疮

为提高修复成功率，采用带蒂部分臀大肌岛状皮瓣转位一次完成修复骶部褥疮１４例。经临床观察及随访，皮瓣愈合良好，无一例复发。结论认为，本肌皮瓣具有成活率高，手术操作简单，供区无需植皮，可一次完成骶部较大褥疮的修复，是较理想的手术方法。     

臀肌挛缩症治疗方法选择探讨

目的：通过对臀肌挛缩症治疗方法选择的探讨，使患者得到更合适的治疗。方法：将290例患者按病情轻重分为I、Ⅱ、Ⅲ度。I度(轻度)42例采用物理疗法；Ⅱ、Ⅲ度(中重度)248例首先采用手术治疗，术后配以适当物理治疗。结果：I度优良牢为41％。Ⅱ、Ⅲ度优良率达98％。结论：对I度患者应首先选择物理疗法。对Ⅱ、Ⅲ度患者手术治疗后及时、正确的物理治疗能巩固手术疗效，提高治疗的优良率。     

欢迎订阅2007年《中国脊柱脊髓杂志》

1989年9月～2001年4月，我院共收治臀肌挛缩症47例，其中5例合并有臀大肌发育不良，均行手术治疗，效果较满意。     

微创手术治疗注射性臀肌挛缩症（附39例报告）

目的应用一种新的、独创的微创术式治疗儿童注射性臀肌挛缩症，并探讨此术式的疗效。方法自2000年6月～2004年3月，我院共收治臀肌挛缩症患者39例，所有患者均有臀部肌肉反复多次注射药物的病史，并具有外“八”字步态、膝呈蛙式蹲位、跑跳受限、划圈征及交腿试验阳性、Obet’s征阳性等典型的臀肌挛缩症的临床表现。根据臀肌挛缩症的分级标准，将39名分级为Ⅰ、Ⅱ、Ⅲ度的注射性臀肌挛缩症患者。采用一种新的微创手术治疗，术后早期进行积极的屈髋屈膝功能锻炼，防止粘连。结果Ⅰ度患者9人，Ⅱ度患者25人，Ⅲ度患者5人全部行微创手术治疗，有效率100％，优良率97．4％。结论应用该术式治疗注射性臀肌挛缩症，疗效满意。     

臀下动脉的解剖学研究

目的 研究臀下动脉的走行及变异情况，为临床手术应用该动脉供养的臀大肌肌皮瓣提供解剖依据。方法 选用10具18侧经红色乳胶液动脉灌注的标本，直视下解剖标本，显露臀下动脉及其周围组织，观察其走行情况。其中男性11侧，女性7侧，左9侧，右9侧。结果 臀下动脉通常自梨状肌下孔出骨盆，沿坐骨神经内侧向下走行，在出骨盆后平均于17．3、33．2及51.8mm处依次发出髋关节支、坐骨神经支及臀大肌支分别营养其支配区组织。18侧中共有7侧(其中女性5侧)属变异。结论 臀下动脉走行相对比较稳定，但变异较多，故术前宜行相关检查如彩色多普勒超声以大致确定动脉走行及分布情况。