模塑式颈椎矫形器对颈部烧伤患者屈曲畸形的预防作用

背景：颈椎矫形器是矫正颈部畸形的非手术治疗方法之一，引入因颈部烧伤而导致屈曲畸形的治疗中，可以让患者的颈部功能得以最大限度的恢复。目的：分析模塑式颈椎矫形器(moulded cervical orthosis，MCO)在颈部烧伤临床上的应用形式及其影响。设计：以患者为研究对象，前后对照，验证性研究。单位：一所省级假肢中心假肢矫形部。对象：2003—01／09福建省假肢中心门诊接收19例头、颈、胸严重烧伤植皮术后患者，男13例，女6例。方法：通过对19例颈部烧伤患者进行配戴矫形器的治疗与随访，分析MCO的治疗效果。主要观察指标：疗效评估结果。结果：19例因烧伤而引发颈部屈曲症的患者，通过配戴MCO，均能达到纠正颈部屈曲、恢复颈部功能的效果。7例颈部功能完全恢复正常；8例颈部功能基本恢复；4例畸形程度有所减轻。结论：MCO能够对因颈部烧伤而引起的颈部屈曲畸形症，具有良好的矫治及康复作用。     

模塑式颈椎矫形器在颈部烧伤的应用

目的：分析模塑式颈椎矫形器(MCO)在颈部烧伤患者临床应用的形式。方法：19例颈部烧伤植皮术后患者采用MCO全天配戴治疗并进行随访。结果：随访3～11个月，19例患者均达有效以上。结论：MCO重量轻，透气性好，穿戴舒适。便于训练，应用于颈部烧伤患者可达到理想的矫正效果。     

早期康复介入对膝部烧伤患者屈曲畸形的预防作用

目的:探讨早期康复介入对预防膝部烧伤患者屈曲畸形的作用。方法:烧伤累及膝部患者30例,随机分为康复组及对照组各15例,均按烧伤常规治疗,待烧伤创面愈合后康复组立即使用动态关节矫形器固定为主,配合硅凝胶瘢痕贴膜贴敷和运动疗法等早期运动训练;对照组给予硅凝胶瘢痕贴膜贴敷。治疗前后评定患者瘢痕增生及膝关节主动活动度的变化。结果:随访18个月,2组患者膝关节主动活动度与治疗前比较均明显提高,康复组明显高于对照组(均P0.05)。治疗后膝部瘢痕评定,康复组显效率明显高于对照组(P0.01)。结论:早期综合协调应用动态关节矫形器、运动训练和敷贴硅凝胶膜,可有效抑制烧伤肥厚性瘢痕增生,预防关节畸形和肢体肌肉萎缩,是全身无中厚供皮区患者治疗的最佳选择。     

面颈部烧伤畸形患者围手术期护理

作者总结了７８４例面颈部烧伤畸形患者围手术期护理体会。其护理要点为：麻醉尚未清醒前按全麻术后护理２常规处理外，重点加强呼吸不规则及呕吐的护理；术后功能位制动是整形术后护理重点，严密观察后皮瓣血运，皮温，出血，肿胀等情况，并将心理护理贯穿于整个护理过程。护理实践证明加强围手术期的护理是保证手术成功的关键。     

下肢矫形器对巩固脊髓灰质炎后遗症矫治术后患儿运动功能的作用

目的：探求矫形器在康复工程上的治疗作用，分析下肢矫形器(髋膝踝足矫形器膝踝足矫形器，踝足矫形器)在脊髓灰质炎后遗症(简称儿麻)矫治术后康复上的应用。方法：2002—10／2004—06，在福建省石狮市，通过对19例术后儿麻患者佩带矫形器的治疗，分析下肢矫形器的治疗与矫治效果。结果：19例术后儿麻患者均达到了控制髋屈曲、膝反张、膝屈曲、马蹄足、高弓足，纠正畸形步态等，保持正确站立姿势及改善步态的效果，显效率为79％、有效率为21％、总显效率为80％。结论：下肢矫形器在巩固儿麻患者术后的下肢稳定功能、运动功能方面起到积极的作用。     

下肢矫形器对巩固脊髓灰质炎后遗症矫治术后患儿运动功能的作用

目的:探求矫形器在康复工程上的治疗作用,分析下肢矫形器(髋膝踝足矫形器膝踝足矫形器,踝足矫形器)在脊髓灰质炎后遗症(简称儿麻)矫治术后康复上的应用。方法:2002-10/2004-06,在福建省石狮市,通过对19例术后儿麻患者佩带矫形器的治疗,分析下肢矫形器的治疗与矫治效果。结果:19例术后儿麻患者均达到了控制髋屈曲、膝反张、膝屈曲、马蹄足、高弓足,纠正畸形步态等,保持正确站立姿势及改善步态的效果,显效率为79%、有效率为21%、总显效率为80%。结论:下肢矫形器在巩固儿麻患者术后的下肢稳定功能、运动功能方面起到积极的作用。     

面颈部烧伤疤痕挛缩畸形的综合治疗

本文报告采用不同的整复方法和术后压力治疗１２６例面颈部烧伤疤痕挛缩畸形，取得了显著的疗效。     

烧伤后期颈部瘢痕挛缩畸形的康复治疗

目的：通过对34例颈部瘢痕挛缩畸形整复方法的临床总结,找出修复颈部瘢痕挛缩畸形的最佳方法。方法：采用Z成形术、植皮术及皮瓣转移术配舍功能锻炼修复颈部瘢痕挛缩。结果：34例患均获满意疗效。结论：手术及术后抗挛缩治疗为修复颈部瘢痕挛缩畸形的关键。     

重症头面颈部烧伤患者的护理

总结38例头面颈部烧伤患者的护理。护理重点是休克期加强休克的观察及护理、呼吸道梗阻护理、体位护理、输液护理;加强创面护理,防止感染,重视营养支持,以促进创面愈合;创面修复期对患者进行指导,减少色素沉着及瘢痕形成。经过积极治疗和护理,除1例死亡、1例自动出院外,36例创面愈合出院。     

烧伤后膝关节瘢痕屈曲畸形整复16例观察

目的：探讨腘窝烧伤后膝关节瘢痕屈曲畸形的治疗方法。方法：采用手术、理疗和功能锻炼等治疗手段。结果：膝关节功能恢复良好。结论：手术是基本的治疗方法,康复治疗是同样重要的治疗措施。     

Unilateral cervical burn scar deformity elimination with contralateral cervicothoracic flap--a new approach

Unilateral postburn cervical deformity is a severe cosmetic and functional defect and a challenging reconstructive problem. Many flaps have been suggested; however, after surgery, operational scars, located along the anterior neck's middle line, and the flap's skin differ from cervical healthy skin. A small flap resembles a patch. A more effective and safer technique is neck resurfacing with cervicothoracic adipocutaneous flap which had been used by the author in 32 burned patients. The flap's peculiarities are as follows: axis blood circulation via superficial cervical artery perforator; exclusion of platysma (flap is thin and elastic); and undamaged donor site. The mobilized healthy neck's skin with thin fat layer and adipocutaneous layer of the chest wall are elevated as a whole large flap. After scar excision, the cervicothoracic flap is advanced on the wound with tension. As a result of flap tension, the skin of neck's back, thoracic wall, and axilla are displaced to the anterior neck surface covering the donor wound. On an average, 6 cm of the deformed neck anterior surface was restored. No flap loss but only local superficial scar necrosis along the flap's border occurred. The cervical contracture and scar deformity (25 patients) were eliminated in all cases by a single procedure. For complete neck skin restoration, seven patients underwent staged reconstruction using the same technique. Excellent functional and good cosmetic follow-up results were achieved. The proposed technique is easy to plan and perform and yields good results; therefore, the author believes that the contralateral cervicothoracic flap's use is an exclusive option for unilateral cervical contracture and deformity elimination in adults and pediatric patients.     

A patellar-tendon-bearing orthosis used in pediatric burn rehabilitation.

Burn rehabilitation in children presents a difficult challenge. Hypertrophic scar formation is accelerated in this population due primarily to the growth of normal surrounding tissue. Many patients who develop burn wound contractures of the foot and ankle are rendered nonambulatory. We describe a pediatric patients who developed fixed bilateral equinovarus deformities secondary to thermal injury. A patellar-tendon-bearing orthosis was fabricated for this patient to unload the foot-ankle complex with major weight bearing forces at the patellar tendon and tibial condyles. Through the incorporation of this orthosis with a full therapeutic rehabilitation program, the patient was able to ambulate independently using a rolling walker. We recommend the use of the patellar-tendon-bearing orthosis for those pediatric burn victims who develop foot-ankle contractures to allow for ambulation until such time as additional, more aggressive treatment is tolerated, or on a more permanent basis, if necessary.     

手屈曲功能障碍患者佩戴动力矫形器的护理

对30例手屈曲功能障碍患者采用动力性矫形器进行治疗。30例患者应用矫形器后手部关节活动度均有不同程度的改善,无1例发生并发症。手屈曲功能障碍者佩戴动力性矫形器治疗的同时,配合精心的护理可获得良好的临床效果。     

Immediate effects of active cranio-cervical flexion exercise versus passive mobilisation of the upper cervical spine on pain and performance on the cranio-cervical flexion test

This study compared the immediate effects of an assisted plus active cranio-cervical flexion exercise (exercise group) versus a passive mobilisation plus assisted cranio-cervical flexion (mobilisation group) on performance of the cranio-cervical flexion test (CCFT), cervical range of motion (ROM) and pain in patients with chronic neck pain. Eighteen volunteers with chronic idiopathic neck pain participated in the study and were randomised to one of the two intervention groups. Current level of pain, cervical ROM and pain perceived during movement, pressure pain threshold (PPT) and surface electromyography (EMG) during performance of the CCFT were measured before and immediately after the intervention. A significant reduction in resting pain and PPT measured over cervical sites was observed immediately following both interventions, although a greater change was observed for the exercise group. No change in cervical ROM was observed after either intervention. Reduced sternocleidomastoid and anterior scalene EMG amplitude were observed during stages of the CCFT but only for the participants in the active exercise group. Although both active and passive interventions offered pain relief, only the exercise group improved on a task of motor function highlighting the importance of specific active treatment for improved motor control of the cervical spine.     

Development of an orthosis for simultaneous three-dimensional correction of clubfoot deformity

BackgroundClubfoot is a three-dimensional deformity of the foot in which the foot is twisted in three mutually perpendicular planes from the normal shape of the foot. Of the various treatment methods that are available to manage clubfoot, non-operative approaches are preferred. The conventional non-operative method of treatment is to apply a series of casts to the infant's clubfoot to gradually manipulate its position. However, prolonged use of casts can result in skin rash, skin dehydration and ulcers on the soft skin of an infant. Treatment using orthosis represents an alternative non-operative and convenient technique because an orthosis can be put on and taken off at any time.MethodsIn the present study, an orthosis was developed according to the rotation of three mutually perpendicular planes and was subsequently tested on five patients over the duration of one week.FindingsIn all five cases, the desired incremental correction to the clubfoot was achieved through the one week intervention with the orthosis. No form of rash, dehydration, ulcers, and so on were observed on the skin of any baby involved in the study during or following application of the orthosis.InterpretationBy using the developed orthosis, partial correction of the clubfoot deformity was achieved over a short period of time. However the widespread use of this device for extended durations and with a larger number of patients will generate further evidence of the extent to which this orthosis can reliably treat clubfoot.     

大腿逆行易位皮瓣对儿童腘部烧伤后瘢痕挛缩畸形的修复作用

BACKGROUND: There're many kinds of correction methods to the contraction due to the cicatrix after popliteal burn.