断指再植手术对手指钝性离断伤的治疗效果研究

目的：探析手指钝性离断伤采用断指再植手术治疗的临床效果。方法整群选择2013年6月—2014年6月期间该院收治的手指钝性离断伤患者59例为研究对象，对其临床治疗资料进行回顾性分析。结果该组的59例患者中，术后断指再成活54例，占91.53%，5例失败，占8.47%，其中手指远端坏死3例，占5.08%，2例术后感染，占3.39%。结论临床上给予手指钝性离断伤患者断指再植手术治疗，可以获得较好的效果，有助于恢复患者的手指功能。     

Extra phalangeal crease – A trait in forensic identification

In the past, many biological, anthropological and forensic studies have been conducted on variations in finger and palm ridge patterns, however, finger crease patterns have not received much attention in the literature. The photocase shows an obvious extra phalangeal crease in the little finger as an extremely rarely reported characteristic. Similar unique characteristics need to be reported for their rarity and significance in forensic investigations.     

手指软组织肉瘤的创面修复与重建

目的 回顾性分析手指原发软组织肉瘤病例,判断在根治肿瘤的同时是否能实施保指以满足手指外观功能的需要.方法 收集2007年4月至2009年11月期间11例手指软组织肉瘤保指的患者,采取肿瘤广泛切除后,对创面覆盖选用第一掌背动脉皮瓣7例,第二掌背动脉皮瓣修复4例;其中5例合并肌腱缺损患者同期行肌腱移植修复,1例骨质缺损行髂骨移植术.结果 术后6例接受新辅助化学治疗,1例接受辅助放射治疗.术后随访时间14个月至5年,9例肿瘤无复发,1例术后14个月肺转移死亡,1例肺转移带瘤生存.术后皮瓣全部存活,1例局部复发行截指.术后1年手指外观满意度为81％,功能评分为8～15分,平均12.6分,优或良10例,占91％.结论 建议对手指软组织肉瘤有保指可能时应尽可能实施保指,并同期进行功能重建.     

Analysis of the effects of surface stiffness on the contact interaction between a finger and a cylindrical handle using a three-dimensional hybrid model

Contact interactions between the hand and handle, such as the contact surface softness and contact surface curvature, will affect both physical effort and musculoskeletal fatigue, thereby the comfort and safety of power tool operations. Previous models of hand gripping can be categorized into two groups: multi-body dynamic models and finite element (FE) models. The goal of the current study is to develop a hybrid FE hand gripping model, which combines the features of conventional FE models and multi-body dynamic models. The proposed model is applied to simulate hand-gripping on a cylindrical handle with covering materials of different softness levels. The model included three finger segments (distal, middle, and proximal phalanxes), three finger joints (the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joint), and major anatomical substructures. The model was driven by joint moments, which are the net effects of all passive and active muscular forces acting about the joints. The finger model was first calibrated by using experimental data of human subject tests, and then applied to investigate the effects of surface softness on contact interactions between a finger and a cylindrical handle. Our results show that the maximal compressive stress and strain in the soft tissues of the fingers can be effectively reduced by reducing the stiffness of the covering material.     

小儿同指顺行指动脉神经蒂皮瓣修复指端（腹）缺损46例

目的：总结小儿同指顺行指动脉神经蒂皮瓣修复指端（腹）缺损的临床应用及疗效。方法2009年1月至2012年12月我们对46例小儿指端（腹）缺损的患儿应用同指顺行指动脉神经蒂皮瓣进行修复,其中25例切取时保留甲床神经分支。46例中,指端缺损24例,指腹缺损22例,皮肤缺损面积0．5 cm ×1．0 cm～0．8 cm ×1．0 cm。年龄2～11岁,平均年龄5．8岁。结果皮瓣全部成活,无动静脉危象发生。选择保留和不保留甲床神经分支病例各10例,经1～3年随访,皮瓣外形饱满,色泽、出汗正常,供受区仅有线样瘢痕。16例甲床者指甲发育正常,无甲板分离及勾甲畸形,4例出现轻度甲纵脊或横纹。两点辨别觉正常,精细触觉恢复,手指无活动障碍。结论在严格掌握适应证的前提下,同指顺行指动脉神经蒂皮瓣是修复小儿指端（腹）缺损的良好方法。     

针刺"下极泉"穴对中风后手指肌力的疗效观察

目的:寻找治疗中风后手指功能恢复的最佳方法。方法:将123例手指肌力为零级的中风患者随机分为观察组63例与对照组60例。对照组针刺曲池、手三里、外关等,观察组在对照组取穴基础上加取"下极泉"穴。治疗10次后评价疗效。结果:观察组的愈显率为74.6%,对照组为40.0%。经统计学分析,观察组疗效明显优于对照组(P<0.05)。结论:"下极泉"穴对手指肌力的引出有较好的疗效。     

早期康复训练促进手指皮瓣术后的感觉恢复

目的：观察手指末节掌侧皮肤缺损皮辨移植术后，早期康复训练对手部感觉功能恢复的影响。方法：146人198指掌侧皮肤缺损的病人分为早期康复训练组和对照组，在感觉训练前和训练过程中，按照国际标准分别评定手的感觉等级及两点辨别觉，康复组89人(112指)术后2周开始康复治疗，对照组仅行一般处理。经过康复一个疗程(6—8周)，进行第二次评定，以后每一疗程评定一次，共4—5次。结果：89人康复训练组手的感觉功能优良率达到96％，有效率为99％。结论：经过感觉康复训练组手的感觉功能明显好于对照组。     

断指再植9例报告

本文报告断指再植9例,再植20指,成功7例,成活12指,其中6例共9指功能恢复好,1例8指稍差待Ⅱ期功能重建术。作者认为:认真选择手术适应症;耐心细致完成每一操作,保证血管吻合质量,Ⅰ期修复屈伸肌腱;加强术后护理;早期功能练习是保证再植成活和功能恢复的重要措施。     

Fine motor control in adults with and without chronic hemiparesis: baseline comparison to nondisabled adults and effects of bilateral arm training

OBJECTIVES: To characterize fine motor control through finger tapping in both arms of 10 patients with chronic stroke, to make baseline comparisons with matched controls, and to examine the responsiveness of deficits seen in stroke patients after 6 weeks of bilateral arm-based training. DESIGN: Nonrandomized controlled, cohort before-after trial. SETTING: Research institution. PARTICIPANTS: Ten people from the community with chronic unilateral ischemic stroke and 10 age- and sex-matched healthy controls. Participants with hemiparesis had completed all conventional care and were more than 6 month poststroke. Inclusion criteria were at least 6 months since a unilateral stroke, ability to follow simple instructions and 2-step commands, volitional control of the nonparetic arm, and at least minimal antigravity movement in the shoulder of the paretic arm. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements included rate and timing consistency of unilateral tapping at a preferred and a maximal rate and the accuracy and stability of interlimb coordination in bilateral simultaneous (inphase) and alternating (antiphase) tapping at a preferred rate. RESULTS: Nonparetic finger control was similar to that of the nondisabled participants except under bilateral conditions, where it was less consistent. A subgroup with residual paretic finger function, had slower and less consistent paretic finger tapping, as well as less accurate and more variable interlimb coordination; however, basic bilateral coupling relationships were preserved. Bilateral arm-based training improved bilateral nonparetic consistency but slowed unilateral preferred tapping. Training also improved paretic fine motor control in 2 of 4 participants with mild stroke severity. The 2 responders, with dominant hemisphere lesions, indicated a possible recovery advantage with bilateral training for such lesions. CONCLUSIONS: In general, nonparetic finger control for tapping was preserved but paretic finger control was compromised. Disruption of nonparetic control of tapping, particularly consistency of tapping, occurred during bilateral tapping tasks but was responsive to 6 weeks of bilateral arm-based training. Despite the apparent lack of training specificity, the generalizable effects of bilateral arm training to fine motor interlimb coordination may reflect central motor control mechanisms for upper-extremity coordination, which may be accessed and may influence the recovery of arm function after stroke.