原位缝合结合负压封闭引流治疗手及前臂皮肤逆行撕脱伤

目的探讨原位缝合结合负压封闭引流（vacuum sealing drainage。VSD）治疗手或前臂皮肤逆行撕脱伤的临床疗效。方法对2012年3月-2013年3月收治的10例手或前臂皮肤逆行撕脱伤患者,共计11处逆行撕脱皮肤（其中1例为手掌和手背2处逆行撕脱伤）,根据每例逆行撕脱皮肤局部血运情况,分别采取不同的手术方法。其中,3处采取对整块逆行撕脱皮肤原位缝合后辅以VSD治疗（原位缝合组）;2处采取对整块逆行撕脱皮肤反取植皮并辅以VSD治疗（反取植皮组）;其余6处分别同时进行了原位缝合辅以VSD治疗和反取植皮辅以VSD治疗方法,即对每处逆行撕脱的皮肤一部分进行原位缝合（原位缝合组,6处）,另一部分进行反取植皮（反取植皮组,6处）。因此,研究对象包括原位缝合组（3＋6）处和反取植皮组（2＋6）处,共计17处逆行撕脱皮肤。比较两组术后的皮肤功能。结果术后所有逆行撕脱皮肤均成活,全部患者均获2-6个月随访。平均3．7个月。原位缝合组皮肤感觉：S3＋5处,S33处,S21处;反取植皮组皮肤感觉：S22处,S16处。原位缝合组皮肤在外观、耐磨度上均优于反取植皮组。结论原位缝合结合VSD治疗手及前臂皮肤逆行撕脱伤临床效果好．术中应尽可能保留有血运、适合原位缝合的皮肤及皮下组织。     

COMPARTMENT SYNDROME IN A PATIENT WITH X-LINKED AGAMMAGLOBULINAEMIA AND ECTHYMA GANGRENOSUM

Compartment syndrome is a surgical emergency that requires immediate decompression. We know of no documented cases that describe ecthyma gangrenosum as a primary cause of compartment syndrome. We present a case of a baby with x-linked agammaglobulinaemia who developed compartment syndrome associated with systemic Pseudomonas aeruginosa infection and ecthyma gangrenosum of the leg. He was treated by debridement and fasciotomies followed by primary closure and skin grafting and made an uneventful recovery.     

Bilateral symptomatic supernumerary muscle belly syndrome

A 32‐year‐old woman with a longstanding history of bilateral forearm pain had been unable to open her fingers and use her left arm (treated as reflex sympathetic dystrophy) since the age of 14. On physical examination there was fullness and tenderness of the distal volar forearms bilaterally; the quadriga test (when the patient was asked to make a tight fist quickly, with one finger fully extended passively) elicited burning pain. Operation confirmed that she had anomalous reversed forearm muscles bilaterally, and these were successfully resected.     

Residual small artery impairment in hypertensive patients with normal albumin–creatinine ratio

Objectives Previous studies have suggested that urine albumin excretion (UAE) mirrors generalized vascular damage; however, it is unclear to which degree UAE mirrors small artery impairment. Design We enrolled 67 patients with uncomplicated essential hypertension (EH) during stable antihypertensive therapy. F-R_min, ACR on three non-consecutive morning urine samples, pulse wave velocity (PWV), and 24-h ambulatory blood pressure (ABPM) were measured. Results ACR was low (0.39 and 0.30–0.60), but abnormal small artery structure defined as F-R_min?>_?mean?+?2 standard deviations of normotensive value (1.99?+?1?mmHg min/(ml/100?ml)) was present in 45% (n?=?30). The mean F-R_min was 2.89?±?0.09?mmHg min/(ml/100?ml). ACR correlated significantly to PWV (r^2?=^?0.11; p?<?0.05) and pulse pressure (r^2?=^?0.15; p?<?0.001), but not F-R_min and (r^2?=^?0.05, p?=?0.07). Conclusions Abnormal microvascular structure was present even in EH patients with low UAE. ACR correlated to arterial stiffness and not to small artery structure; therefore, UEA did not reflect microvascular damage in this population. ACR and F-R_min thus reflect two distinct types of subclinical organ damage in hypertension.     

Management of common upper limb fractures in adults

Upper limb fractures are common, and potentially disabling, injuries. This article provides an overview of common upper limb injuries in adults that present to the emergency department, and subsequently the fracture clinic. We highlight some of the clinical aspects and pitfalls to consider for each injury, and provide a brief overview of the classification systems often used. Furthermore, we discuss the non-operative and operative management options available.     

两种内固定方法治疗尺桡骨中段双骨折的预后比较

目的对比尺桡骨双钢板固定和尺骨髓内钉加桡骨钢板固定治疗尺桡骨中段双骨折的临床疗效。方法我院于2007年7月至2011年12月,共收治前臂双骨折患者57例,平均随访24.3个月,对其进行回顾性分析。其中,28例患者行尺桡骨双钢板固定,29例患者行尺骨髓内钉加桡骨钢板固定。比较两组患者手术时间、切口长度、骨愈合情况及时间、术后前臂旋转功能恢复情况(Grace-Eversmann评分)以及术后并发症情况。结果两组患者的骨愈合时间以及Grace-Eversmann评分差异无统计学意义,两组患者各有1例发生骨不连。共有10例患者出现术后并发症,其中双钢板组6例,尺骨髓内钉加桡骨钢板组4例。结论尺桡骨双钢板固定和尺骨髓内钉加桡骨钢板固定对于尺桡骨中段双骨折都可以获得满意疗效,但尺骨髓内钉加桡骨钢板创伤相对较小,手术操作简单,在生物力学和生物学固定上达到良好的组合,是一种比较适合的治疗方法。