应用臀大肌肌皮瓣修复骶尾部褥疮

目的研究应用臀大肌肌皮瓣修复骶尾部褥疮的临床疗效。方法对9例骶尾部褥疮患者应用臀大肌肌皮瓣修复术治疗,创面范围最大为12cm×9cm,供区原位缝合或植皮。结果8例肌皮瓣全部成活,1例肌皮瓣边缘坏死,经换药及缝合后痊愈。全部病例随访3个月～3年,均无复发。结论骶尾部褥疮病程长,合并症多,应用臀大肌肌皮瓣修复可获得较好的临床效果。     

Using Gluteus Maximus Muscle to Reconstruct the Anal Sphincter for Very Low Rectal Cancer

OBJECTIVE To assess the use of gluteus maximus muscle to recon- struct the anal sphincter for very low rectal cancer. This study aimed to evaluate the local recurrence and function of the new anal sphincter after operation. METHODS Sixteen patients underwent the replacement operation, and then received biofeedback treatments 1 month after the operation. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. The controls were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. RESULTS Median follow-up was 4.2 years. No local recurrence was observed. The Vaizey and Wexner scores and vectorial manometry 1 month after operation were significantly lower than those of the healthy and low anterior resection controls （ P 〈0.001） . After biofeedback treatments, the above indexes improved significantly （ P 〈0.001）, especially after 1 year （ P 〈0.001）, but still remained lower than the controls（ P 〈0.001）. The rectoanal reflex only increased to 31.3 % 1 year after operation. CONCLUSION The local recurrence after the replacement operation was low. The defecation function was poor early after operation, but increased markedly after biofeedback treatments and long-term functional exercise. This therapy can be one choice for very low rectal cancer.     

以臀上动脉浅支穿支血管为蒂分叶皮瓣修复骶尾部软组织缺损

目的探讨一种安全、有效、快速修复骶尾部软组织缺损和/或伴骨外露的方法。方法2003年2月～2006年4月,应用臀上动脉浅支穿支血管为蒂分叶皮瓣移位修复骶尾部巨大褥疮及软组织缺损6例。男4例,女2例,年龄28～67岁。骶尾部软组织缺损范围为15cm×12cm～25cm×20cm,平均20cm×16cm;褥疮5例,肿瘤1例;按褥疮分度度3例,度3例;病程3周～20年。切取分叶皮瓣范围为18cm×15cm～30cm×25cm。结果术后6例移位皮瓣均成活,其中5例切口期愈合,1例皮瓣周缘皮肤少量缺血、坏死,经间断换药32d后期愈合。随访2～38个月,平均19.3个月,分叶皮瓣生长良好,褥疮无复发,臀大肌保留良好伸髋功能。结论带臀上动脉浅支穿支血管为蒂分叶皮瓣是修复骶尾部软组织缺损和/或伴骨外露的一种有效方法,具有操作简便、皮瓣血运好、并发症少、成功率高等优点。     

臀大肌上部肌皮瓣在修复骶尾部巨大褥疮的应用

目的　探讨一种安全、有效、快速修复骶尾部巨大褥疮的方法。方法　应用带臀上动脉浅支的臀大肌上部肌皮瓣转移修复骶尾部巨大褥疮 17例。结果　 17例患者均一期修复成功 ,切取肌皮瓣面积最大 16cm× 10cm ,最小 10cm× 8cm ,随访 1～ 9年 ,肌皮瓣生长良好 ,无复发 ,供区臀大肌保持良好的伸髋功能。结论　应用带臀上动脉浅支的臀大肌上部肌皮瓣修复骶尾部巨大褥疮具有操作简便、皮瓣血运好、供区无需植皮、并发症少、成功率高 ,可一期完成修复等优点 ,值得推广应用     

Local skin pressure and its effects on skin microcirculation as evaluated by laser—Doppler fluxmetry

Summary. The effect of prolonged local pressure on the skin microcirculation was investigated in the regions of the sacrum and gluteus maximus muscle to determine the aetiology of pressure sores. Thirty normal subjects (15 female, 15 male) were investigated. The subjects were divided into three age groups: group 1, ≤ 35 years; group 2, 36–64 years; and group 3, ≥ 65 years. Local pressure was applied with a specially designed instrument according to the sequence 0→ 110→ 0→ 110→ 0→ mmHg. Skin blood cell flux (SBF) was measured with a laser–Doppler technique and the local skin temperature measured with a thermistor. No significant differences were seen in SBF due to sex or age. However, differences between the two areas studied were observed. SBF was maximal over the sacrum at 12–50 mmHg (1.6–6.7 kPa) applied pressure. With further pressure increases, the SBF signal decreased successively, reaching minimum level at 110 mmHg (14.6 kPa), where it was approximately 43% below the initial value. The SBF in the gluteus region showed a more stable pattern, with a maximum SBF at 13–60 mmHg (1.7–8.0 kPa). At both locations, an increased SBF at zero pressure was seen when the pressure was decreased from 110 to 0 mmHg. The skin temperature (n = 7) increased by 2.7°C (range 1.9–3.5°C) over the gluteus and by 1.3°C (range 0.8–2.5°C) over the sacrum. This increase was more rapid over the gluteus region. Concomitantly a temperature-dependent increase of SBF could be seen. It is concluded that a cause for the greater frequency of pressure sores over the sacrum than over the gluteus region is the comparatively poorer regulation of microvascular flow in this area.     

笑肌、颧大肌、颧小肌的测量

目的探讨与笑相关的笑肌、颧大肌、颧小肌的解剖学规律 ,为颜面部整形美容提供解剖学依据。方法选取正常成年尸体 3 0例 ,解剖观察笑肌、颧大肌、颧小肌的形态 ,并测量其长度与夹角。结果颧大肌起自颧骨前面 ,止于口角皮肤 ,颧小肌起自颧骨 ,止于鼻唇沟下部附近皮肤 ,笑肌起自腮腺咬肌筋膜 ,止于口角皮肤 ;颧大肌、颧小肌、笑肌长依次为 5 5 .2± 2 .3mm、5 2 .3± 1 .8mm、5 0 .1± 1 .6mm ;笑肌、颧大肌、颧小肌长径与口裂间以及笑肌与颧大肌间的夹角依次为 8.9± 1 .1、3 2 .6± 1 .8、40 .1± 2 .5、2 4.6±2 .7度。结论为临床颜面部整形美容提供了解剖学依据     

Muscles & Pelvic Clutch

Abstract

The forward bending test has served manual medicine practitioners for many years in determining the side of a stiff sacroiliac joint in cases of somatic dysfunction. This study evaluated the frequency of an apparently ‘abnormal’ forward bending test in a cohort of young individuals, without back pain. Pseudo-leg-length discrepancy from asymlocation (asymmetric, but not dysfunctional positional asymmetry, of the sacroiliac articulations) was assessed. The ease in which the asymlocation could be changed, in this apparently healthy cohort, was recorded. Finally the strength of the abductors of the hip was measured in the short and long positions of the legs (anterior and posterior positions of the ilia). The observations led to the postulate that the abductors of the hip playa physiologic role in initiating force closure with heel strike in human walking.     

An unorthodox innervation of the gluteus maximus muscle and other associated variations: A case report

Knowledge of peripheral nerve morphology, location, and variation is important for facilitating appropriate diagnosis and intervention. We present a unique case of absence of the inferior gluteal nerve and high division of the sciatic nerve. In this instance, the common peroneal nerve was found piercing the piriformis muscle and emerging distally in the form of two trunks: thin medial and thick lateral. The medial trunk presented an interesting course, supplying the gluteus maximus muscle before joining the lateral trunk to form the common peroneal nerve. Additionally, the arteria nervi ischiadisci was also observed accompanying and supplying the tibial nerve passing inferior to the piriformis. These variations are important for clinicians and surgeons for some radiological diagnoses and surgical procedures in the lower limb.     

FDG-PET imaging of lower extremity muscular activity during level walking

 We analyzed muscular activity of the lower extremities during level walking using positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG). We examined 17 healthy male subjects; 11 were assigned to a walking group and 6 to a resting group. After ¹⁸F-FDG injection, the walking group subjects walked at a free speed for 15 min. A whole-body image was then obtained by a PET camera, and the standardized uptake ratio (SUR) was computed for each muscle. The SUR for each muscle of the walking group was compared with that for the corresponding muscles in the resting group. The level of muscular activity of all the muscles we examined were higher during level walking than when resting. The activity of the lower leg muscles was higher than that of the thigh muscles during level walking. The muscular activity of the soleus was highest among all the muscles examined. Among the gluteal muscles, the muscular activity of the gluteus minimus was higher than that of the gluteus maximus and gluteus medius. The concurrent validity of measuring muscular activity of the lower extremity during level walking by the PET method using ¹⁸F-FDG was demonstrated. Received: January 28, 2002 / Accepted: September 25, 2002 Acknowledgments. This work was supported in part by Grant-in-Aid (C) 11835007 from the Ministry of Education, Science, Sports, and Culture of the Japanese Government. The authors thank Misaki Hidaka, Naomi Yoshino, Yasuhiro Okada, and Jinro Takato of the Department of Rehabilitation Medicine for Persons with Physical Disability and the entire staff at the Cyclotron and Radioisotope Center, Tohoku University, for their support and collaboration. Offprint requests to: N. Oi     

腹主动脉瘤腔内隔绝术中栓塞双侧髂内动脉后右部臀肌大面积坏死1例报告

正腹主动脉瘤累及髂总动脉是腹主动脉瘤病变的常见症状之一,其中以单侧髂总动脉较常见,而双侧髂总动脉同时受累较罕见。术中需栓塞髂内动脉以防止血液反流。由于髂内动脉承担臀肌、盆腔以及脊髓等组织的血液供应,所以同时栓塞双侧髂内动脉极可能出现严重臀肌、骶尾坏死等并发症。无锡市人民医院血管外科收治1例腹主动脉瘤累及双侧髂总动脉病人,术中栓塞双侧髂内动脉后导致右侧臀肌大面积缺血坏死。现报告如下。