Pediatric hand and wrist injuries

In the last 40 years, childhood hand and wrist injuries have become progressively more common as children have become heavier and more active in high impact sports. The majority of children with such injuries do well, but treatment is not always straightforward. Distal radius fractures, scaphoid fractures, metacarpal and phalangeal fractures, nailbed injuries, and amputations are among the pediatric hand and wrist injuries most often seen by orthopedists. These are all discussed, with a focus on the most recent literature and areas of evolving controversy.     

早期康复介入对手部肌腱损伤后运动功能的影响

目的　观察早期康复治疗对手肌腱损伤修复术后主动活动度及日常生活活动能力恢复的影响。方法　 75例手部肌腱损伤病人分为早期康复组和对照组 ,测定手的总主动活动度与功能独立评定 (FIM ) ,康复组病人 (3 6例 )术后 2d内即进行规范的康复治疗 ,对照组病人 (3 9例 )早期仅行对症治疗。经过康复治疗一个疗程 (6～ 8周 )进行第 2次评定。结果　经过早期康复治疗后病人手的总主动度达到优良的比例较对照组明显增加 ,经 2 检验P <0 .0 5 ,同时手的FIM评分 (自我料理六项 )分别为 3 4.2 2± 8.0 8,2 9.5 2± 9.0 7,经t检验P <0 .0 1。结论　手部肌腱损伤后早期康复介人能有效地促进手功能的恢复 ,减少并发症发生 ,改善日常生活能力。     

手外伤156例临床分析

目的探讨手外伤术中及术后有利于手功能恢复的方法。方法系统回顾性分析156例手外伤患者的临床资料。结果全部肌腱损伤、部分合并神经伤、指骨和(或)掌骨、腕骨骨折病例手术恢复良好,优良率为83.89%。结论手外伤及时显微处理是保证手功能恢复的前提,同时配合术后的功能锻炼有助于手功能的恢复。     

音乐疗法干预在减轻手外伤患者疼痛方面的作用

目的 探讨音乐疗法在减轻手外伤患者疼痛中的作用及临床价值. 方法 采用随机抽选方法,选取2012年1月至2013年1月来我院就诊的60例手外伤患者,随机将其分为对照组和实验组. 对照组患者在安静状态下休息30 min,实验组患者采用音乐疗法30 min. 比较两组患者在安静或音乐疗法前后的生理指标及心理反应变化情况. 结果 实验组患者心率、呼吸、收缩压、舒张压及疼痛得分均明显优于对照组( P<0. 05 ). 结论 音乐疗法应用于外科手外伤患者的护理过程中,可减轻患者的疼痛及平缓生理指标,从而减轻焦虑,值得临床推广应用.     

心脑血管急症救治现状与进展

本文通过查阅大量文献并结合近些年（尤其是近十年）心脑血管急救领域所取得的进步,介绍了急性冠脉综合征介入治疗的进步尤其是药物洗脱支架（DES）的临床应用,很好的改善了既往支架内再狭窄的状况;急诊床旁快速检测技术,如心梗心衰标志物心肌肌钙蛋白I（CTNI）、心肌肌钙蛋白T（CTNT）、脑钠素（BNP）的应用,大大缩短了急诊临床判断的时间,也提高了判断的准确性;介绍了2010年新的国际心肺复苏指南的变化,强调了持续不间断的、高质量的心脏按压在心肺复苏（CPR）中的重要性,埋藏式心律转复除颤器（Implantable Cardioverter-Defibrillator,ICD）、自动体外除颤器（AED）在防治恶性心律失常及心源性猝死时所起到的重要作用;高血压脑出血目前治疗方法的选择及各自的优缺点,并探讨了未来治疗的趋势。     

英文版腕关节功能患者自评量表的汉化及其信度研究

目的 研究中文版腕关节患者自行评估量表(PRWE)在桡骨远端骨折患者功能评定中的重测信度和内部的一致性。方法 运用中文版和英文版的PRWE分别对5l例桡骨远端骨折患者进行量表的重测信度和内在一致性对比观察。用Intra-class Correlation Coefficient(ICC)来表示量表的重测可信度；用Cron-bach Alpha来表示量表的内部一致性。结果 中文版的PRWE信度良好，ICC范围为0．88～0．92；内部一致性也较高，Cronbach Alpha值介于0．87-0．97之间，均大于0．70。结论 中文版PRWE具有良好的重测信度和内部一致性．可以作为桡骨远端骨折华人患者的主观功能评定量表。     

Emergency department evaluation and treatment of wrist injuries

This article provides the emergency physician a thorough understanding of the basic and surface anatomy required to accurately diagnose wrist injuries in the emergency department. Functional and neurologic examinations are discussed in detail as they increase precision in diagnosis. Special radiographic studies, guided by exam findings, are often crucial in adequately visualizing an otherwise occult injury. Radiographic evidence of injury is not present at time of initial evaluation in a small but noteworthy percentage of significant injuries. For these reasons, the appropriate use of radiographic studies is included. Finally, a rationale for performing conservative mobilization and promptly referring a suspected occult fracture is provided.     

腹部多脏器损伤合并胰腺损伤47例诊治体会

目的探讨腹部多脏器损伤合并胰腺损伤的诊断和治疗方法。方法对47例腹部多脏器损伤合并胰腺损伤患者的诊断、手术方法,治疗效果进行总结和分析。结果对于腹部多脏器损伤合并胰腺损伤的病例检查中,CT检查的正确阳性率最高。所有病例共治愈41例,治愈率为87．23％;术后并发症的发生率为23．40％。结论胰腺损伤严重而复杂,多合并伤,准确诊断,合理运用损伤控制手术,才能提高治愈率,减少并发症。     

护理干预对减轻手外伤患者术后疼痛效果比较研究

目的:探讨护理干预对减轻手外伤患者术后疼痛的效果观察。方法:随机将128例手外伤患者分为干预组和对照组各64例。对照组给予常规手外伤术后护理,干预组在对照组基础上实施心理、行为、认知等护理干预。采用视觉模拟评分法评估疼痛,并做比较分析。结果:两组护理干预前后疼痛比较无显著性差异(P0.05),护理干预组术后疼痛低于对照组,差异显著(P0.01)。护理干预组止痛药物使用情况与对照组比较有显著性差异(P0.01)。结论:护理干预可减轻手外伤患者术后疼痛,加快患者术后康复,也有利于责任制整体护理质量的提高。     

紧急子宫切除术在难治性产后出血治疗中的应用

目的探讨产科紧急子宫切除术在难治性产后出血治疗中的应用。方法对2002年3月至2012年5月收治的27例因产后大出血而紧急子宫切除的孕产妇临床资料进行回顾性总结分析。结果 27例孕产妇均出现难治性产后出血,其中紧急子宫全切除8倒,子宫次全切除19例,1例因术后发生阴道残端渗血并发多脏器功能衰竭死亡,其余26例治愈,治愈率为96.3%;产后出血的主要原因是胎盘因素(59.3%)及软产道损伤(22.2%)。结论对于难治性产后出血,紧急子宫切除是能够在短时间内彻底止血的有效方法。     

Emergency department evaluation and treatment of hand injuries

This article focuses on disorders of the hand most commonly presented to the practitioner in an emergency setting. An initial review of functional anatomy is followed by discussions of the clinical findings and treatment of fractures, tendon injuries, infections, nailbed injuries, high-pressure injection injuries, and nerve injuries. The information presented in this article provides a basis for proper evaluation, diagnosis, and treatment of hand injuries.     

Growth plate injuries of the wrist and hand

Growth plate or physeal injuries are classified according to the zones of the physis that are affected and the disruption of bony structure. All physeal injuries should be reduced anatomically, particularly when an articular surface is involved. Inability to restore normal configuration can result in malunion, incongruous articular surfaces and premature cessation of growth plate activity in the region of injury. Innocuous-appearing injuries that do not involve articular surfaces may result in severe abnormalities.     

Medico-legal risks associated to hand and wrist trauma

BACKGROUNDAcute hand and wrist injuries are common and may lead to long-term disability if not managed adequately. Claims for negligence have been increasing in medical practice over the past few decades, with hand and wrist injuries and their treatment representing a significant percentage of orthopedic surgery lawsuits. There is no available literature regarding medical malpractice claims in hand and wrist injuries and surgery in Greece.AIMTo identify claims related to hand and wrist trauma and surgery and to define the reasons of successful litigations.METHODSWe performed a retrospective study of all legal claims of negligence for hand and upper extremity surgery that went to a trial, attributed to all surgical specialties, in Greece for a 20-year period. Data was further analyzed to identify claims related to hand and wrist trauma and surgery.RESULTSThere were six malpractice claims related to hand and wrist trauma that ended in a trial. A missed diagnosis, which resulted in failure of initial management of the injury, was the main reason for a claim. Three of the six cases resulted in complete or partial loss of a finger. Two cases are still open, requiring an expert witness’s report, two cases were closed in favor of the defendant, and two cases were closed in favor of the plaintiff with a mean compensation of €2000 (€1000-€3000).CONCLUSIONMissed diagnosis was the main reason for a malpractice claim. Better understanding of factors leading to successful claims will help surgeons improve their practice to minimize legal implications and litigation.     

Review article: Best practice management of closed hand and wrist injuries in the emergency department (part 5 of the musculoskeletal injuries rapid review series)

Acute hand and wrist injuries are a common presentation to the ED and are associated with large individual and societal costs. Appropriate management of these injuries in the ED is crucial given that optimal hand function is essential for daily activities and quality of life. This rapid review investigated best practice for the assessment and management of common closed hand and wrist injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines published in English language in the past 12 years that addressed the acute assessment, management, follow‐up plan or prognosis were considered for inclusion. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence. The search revealed 2454 articles, of which 55 were included in the review (n = 23 primary articles, n = 26 systematic reviews and n = 6 guidelines). This rapid review provides clinicians who manage common closed fractures and soft tissue injuries of the hand and wrist in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is evidence to support taking a thorough history and physical examination with consideration of occupational and functional factors, restoring alignment and immobilising when necessary and referring onwards. Key points regarding the diagnosis and management of these injuries are provided.     

改良型手夹板治疗儿童伤残手的临床研究

目的：设计和制作改良型手夹板治疗儿童严重伤残手,代偿伤残手的夹捏和握持功能。方法：（1）夹板前期的准备：消除肿胀和创面、软化瘢痕,关节松动等;（2）手夹板的设计、制作和训练。根据伤残手的不同类型和残损程度,分别设计制作手指假体的“C”形手夹板和安装辅助具插孔的手夹板。结果：23例严重儿童伤残手经过改良型手夹板康复治疗后,代偿了夹捏和握持功能。ADL评分由治疗前的0分提升到6.3分。结论：对于没有手术条件或者虽经手术治疗,但手功能仍没有改善的严重伤残手,可采用改良的手夹板康复治疗,以代偿手的夹捏和握持功能。临床实践证明这是一种简便、实用、有效的方法。     

急诊手外伤患者疼痛状况的调查

目的 了解急诊手外伤患者术前的疼痛状况,分析影响疼痛的相关因素.方法 应用短式McGill疼痛问卷、状态焦虑量表对210例急诊就诊的手外伤患者进行问卷调查.结果 210例急诊手外伤患者受伤当时和就诊时的VAS评分分别为（4.87±2.42）和（4.70±2.31）分.就诊时PRI评分为（3.34±2.35）分,其中感觉PRI为（3.17±2.26）,情感PRI为（0.17±0.67）,PPI评分为（2.80±0.26）分.既往外伤严重程度不同的患者其本次就诊时VAS评分差异有统计学意义（F=2.29,P＜0.05）.相关分析发现本次手外伤的严重程度及就诊时S-AI得分与本次就诊时的VAS评分成正相关（P＜0.01）,文化程度与本次就诊时的VAS得分成负相关（P＜0.05）.结论 急诊手外伤患者就诊时的疼痛程度,通过分析为中等程度,而缓解患者就诊时的焦虑能够减轻患者当时的疼痛,利于接受手术治疗,促进病情痊愈.