指甲延长术在指尖损伤中的临床应用

目的总结指甲延长术在指尖损伤中的临床应用经验。方法用这种方法对8例（拇指3例,食指4例,中指1例）指尖损伤的患者进行了指甲延长术。在距甲根皮缘0.5～0.6cm处,去除一块矩形皮肤,勿损伤皮下血管网,其高度0.2～0.3cm,宽度与甲相等,将“U”形皮瓣向近端柔和推剥并缝合。结果1例术后供区发生表浅感染,经交换敷料逐渐愈合。所有甲延长的手指术后经过顺利,随访7个月～2年（平均13个月）,指甲外形较好,取得较满意的临床效果。结论在指尖损伤中应用指甲延长术,可延长指甲2～3mm,改善了手指的外形,没有发生甲生长畸形,是一种简单有效的指甲延长手术方法。     

Loads applied tangential to a fingertip during an object restraint task can trigger short-latency as well as long-latency EMG responses in hand muscles

Electrical stimulation of the digital nerves can cause short- and long-latency increases in electromyographic activity (EMG) of the hand muscles, but mechanical stimulation of primarily tactile afferents in the digits generally evokes only a long-latency increase in EMG. To examine whether such stimuli can elicit short-latency reflex responses, we recorded EMG over the first dorsal interosseous muscle when subjects (n=13) used the tip of the right index finger to restrain a horizontally oriented plate from moving when very brisk tangential forces were applied in the distal direction. The plate was subjected to ramp-and-hold pulling loads at two intensities (a 1-N load applied at 32 N/s or a 2-N load applied at 64 N/s) at times unpredictable to the subjects (mean interval 2 s; trial duration 500 ms). The contact surface of the manipulandum was covered with rayon—a slippery material. For each load, EMG was averaged for 128 consecutive trials with reference to the ramp onset. In all subjects, an automatic increase in grip force was triggered by the loads applied at 32 N/s; the mean onset latency of the EMG response was 59.8±0.9 (mean ± SE) ms. In seven subjects (54%) this long-latency response was preceded by a weak short-latency excitation at 34.6±2.9 ms. With the loads applied at 64 N/s, the long-latency response occurred slightly earlier (58.9±1.7 ms) and, with one exception, all subjects generated a short-latency EMG response (34.9±1.3 ms). Despite the higher background grip force that subjects adopted during the stronger loads (4.9±0.3 N vs 2.5±0.2 N), the incidence of slips was higher—the manipulandum escaped from the grasp in 37±5% of trials with the 64 N/s ramps, but in only 18±4% with the 32-N/s ramps. The deformation of the fingertip caused by the tangential load, rather than incipient or overt slips, triggered the short-latency responses because such responses occurred even when the finger pad was fixed to the manipulandum with double-sided adhesive tape so that no slips occurred.     

Fingertip contact influences human postural control

Touch and pressure stimulation of the body surface can strongly influence apparent body orientation, as well as the maintenance of upright posture during quiet stance. In the present study, we investigated the relationship between postural sway and contact forces at the fingertip while subjects touched a rigid metal bar. Subjects were tested in the tandem Romberg stance with eyes open or closed under three conditions of fingertip contact: no contact, touch contact (<0.98 N of force), and force contact (as much force as desired). Touch contact was as effective as force contact or sight of the surroundings in reducing postural sway when compared to the no contact, eyes closed condition. Body sway and fingertip forces were essentially in phase with force contact, suggesting that fingertip contact forces are physically counteracting body sway. Time delays between body sway and fingertip forces were much larger with light touch contact, suggesting that the fingertip is providing information that allows anticipatory innervation of musculature to reduce body sway. The results are related to observations on precision grip as well as the somatosensory, proprioceptive, and motor mechanisms involved in the reduction of body sway.     

指尖离断再植的血运重建

目的 探讨指尖离断再植时血运重建的方式。方法 临床上采用4种血运重建的万式对352例401指尖离断进行再植:①吻合指动脉与静脉的断指再植;②动-静脉转流方式的断指再植;③只吻合指动脉的断指再植;④静脉动脉化的断指再植。结果 352例401指,成活381指,成活率95％,手指外形和长度与健指相似,两点辨别觉2～6mm,指甲生长良好。结论 依据显微镜下清创所见离断指尖动静脉损伤状况,选用不同的血运重建方式,有助于扩大指尖再植适应证,提高再植成功率。     

Regeneration of nails with artificial dermis

Abstract

We treated fingertips injured through the proximal half of the nail bed using artificial dermis in 22 patients from 2004 to 2009. We classified the injuries to the nail bed into three types according to where the wounds were. Type ? was localised to the nail bed with or without minor injury to the surrounding structure; type II was an avulsion and amputation of the fingertip including the nail bed, the finger pulp, and the distal phalanx at the level of the proximal nail bed; and type III was post-traumatic shortening of the nail, in which the pulp and distal phalanx were intact. Regeneration and elongation of the nail was achieved in every patient by applying artificial dermis. All patients were satisfied with the results.     

即时检验血糖仪检测指尖血及静脉全血血糖的临床分析

目的：探讨即时检验血糖仪检测指尖血及静脉全血血糖检验结果的临床可行性。方法随机选取该院2011年6月—2012年7月所接收治疗的50例糖尿病患者,采取静脉血和指尖血,采用即时检验血糖仪检测所有患者的血糖数值,同时,还在生化分析仪上进行检测血浆葡萄糖,对比分析两部位生化分析仪检测结果和血样检测结果的偏倚程度。结果即时检验血糖仪指尖血血糖为（9.38±4.28）mmol/L,静脉全血血糖为（9.17±4.05）mmol/L,生化仪测定血浆葡萄糖为（9.96±5.01）mmol/L,三者之间进行统计学分析,差异有统计学意义（P＜0.05）,两部位生化分析仪检测结果和血样检测结果的偏移程度都是负偏倚,其中,偏倚范围最高是13.8%,最低为1.4%,都没有超过20%。静脉全血血糖偏倚显著高于指尖血血糖偏倚,差异具备统计学意义（P＜0.05）。结论对于即时检验血糖仪检测指尖血及静脉全血血糖检验结果的临床可行性,不管是采用静脉采血,还是指尖采血,即时检验血糖的数值都在接受范围内,但是采取指尖血样,检测结果更加接近血浆葡萄糖。     

对采用空腹指尖毛细血管血血糖筛查糖尿病和糖耐量减低偏性的研究

目的探讨采用空腹指尖毛细血管血血糖（FBG）≥6．1mmol／L作为界定值筛查糖尿病（DM）和糖耐量减低（IGT）出现的偏性。方法筛查设A、B、C、D四个自然人群组。各组分别为8151、9168、9096及8355人。A、B、C三组均先做FBG，其界定值依次为6，1mol／L、55mol／L、5，0mol／L，各组超过或等于其界定值者再做OGTT，筛查DM和IGT。D组则直接做OGTT筛查DM和IGT。DM和IGT诊断按照WHO1999年标准。结果A、B、C、D四组DM的检出率分别为6．91％、8．21％、8．30％、8．32％，IGT的检出率分别为2．48％、6.10％、8．05％、8．16％。A组行OGTT的人数比例占被调查总人群的11．3％，与D组比较，DM、IGT漏检率分别为16，95％、69，61％；B组行OGTT的人数比例占被调查总人群的27．79％，与D组比较，DM、IGT漏检率分别为1.32％和25．25％；C组行OGTT的人数比例占被调查总人群的58．37％，与D组比较，DM、IGT漏检率分别为0．24％和1．35％。结论选择FBG≥5．0mmol／L作为界定值，是开展糖尿病流行病学调查获得DM和IGT患病率的成本-效益-效果最佳方案。