截肢时神经断端肌肉内埋入预防残端神经瘤

目的 探讨截肢时将神经近断端埋入肌肉预防残端神经瘤的机制，报告该手术方法的临床疗效。方法 用此方法预防神经瘤的形成23例41个神经断端。根据患术后的自我满意程度，有无自发性疼痛，局部有无触痛和Tinel征，对术后效果做出评价。结果 23例患，术后随访时间为2个月～l0年，无自发性疼痛，局部无触痛。患满意。结论 神经近断端肌肉内埋入是一有效的预防残端神经瘤形成的方法。此方法疗效高，操作简单。     

静脉神经套接缝合法预防治疗神经瘤性残端痛

目的 观察静脉神经套接缝合法预防治疗神经瘤性残痛的疗铲。方法 采用此法防治神经瘤 性残端痛的50例患者分为新鲜 端离断伤组（40例）和残端神经瘤组（10例）。结果 治疗后随访1－2年,新鲜外伤组均无自发性疼痛,检查时亦无神经瘤症状;残端瘤组7例治愈,3例症状减轻,1例检查时仍有触痛及效工用痛。结论 静脉神经套接缝合法预防神经瘤性残端痛,不失为一种好的治疗方法。     

截肢病人残端综合征的康复治疗

目的：总结多年临床经验,探讨残端综合征的康复治疗。方法：对近５年来,在我院门诊及住院的截肢病人７０例的名种康复治疗进行总结分析。结果：经过综合性的康复治疗,９７．１％的残端综合征病人的症状得到不同程度的改善。结论：正确的综合性康复治疗,能有效地改善残端综合征的各种症状。     

超声引导下残端神经瘤毁损治疗截肢后疼痛回顾性分析

目的:截肢后疼痛是截肢术后病人常见的神经病理性疼痛,包括残肢痛、幻肢痛和幻肢觉。残端神经瘤形成是引起疼痛的重要外周发病机制,针对痛性神经瘤进行毁损治疗简单易行。旨在研究超声引导下残端神经瘤毁损治疗截肢后神经病理性疼痛病人的短期与长期疗效。方法:回顾分析2016年6月至2019年10月在上海市第六人民医院疼痛科就诊的截肢后残肢痛和/或幻肢痛的病人共53例,其中36例病人最终纳入分析。治疗前记录病人的年龄、性别、截肢位置、病程、残肢痛的疼痛数字评分法(numerical rating scale, NRS)评分、是否伴有幻肢痛。在末次治疗后随访至12个月,记录末次治疗后2周、6月和12月后残肢痛的NRS评分、残肢爆发痛发作次数、幻肢痛的变化,并观察治疗的并发症。结果:共36例病人,治疗后残肢痛NRS评分和幻肢痛均较治疗前缓解,爆发痛的发作次数降低。在术后2周时有效率86.1%,术后6月和12月时有效率均为77.8%。所有病人均无并发症发生。结论:对截肢后疼痛的病人,可以用超声技术寻找是否有残端神经瘤;射频消融和无水乙醇注射毁损痛性神经瘤能有效缓解截肢病人的残端疼痛和幻肢痛(随访12个月),...     

截肢技术与残端并发症——附34例残端再手术分析

预防和治疗残端并发症是关系患者早日康复的重要问题。本文报告34例(53次)残端并发症的再手术情况,分析了再手术的指征,为了减少并发症,探讨了截肢技术与残端并发症之关系,强调指出,必须重视截肢手术,力争获得一个理想的残端。     

截肢病人残端综合征的康复治疗

目的 :总结多年临床经验 ,探讨残端综合征的康复治疗。方法 :对近5年来 ,在我院门诊及住院的截肢病人70例的各种康复治疗进行总结分析。结果 :经过综合性的康复治疗 ,97.1%的残端综合征病人的症状得到不同程度的改善。结论 :正确的综合性康复治疗 ,能有效地改善残端综合征的各种症状。     

小腿截肢残端假体的实验研究

目的：利用残端假体增加下肢截肢后骨残端的横截面积，降低负重时截肢残端皮肤单位面积上的压强，减少由于穿戴假肢所引起的并发症。重建离断肌肉的下位附着点，使之保持肌肉的合适初长和原有肌力，并维持肌力平衡，防止关节挛缩畸形，以保持截肢平面上位关节的正常活动，提高截肢肢体穿戴假肢后的功能。方法：山羊10只，随机分为2组，左小腿膝下截肢后，分为对照组和假体放置组。假体采用超高分子聚乙烯材料制成，呈蘑菇状外观。术后穿戴假肢开始负重。观察站立和行走的时间，残端皮肤情况，并进行骨残端组织学检查。结果：假体放置组羊能在截肢术后较早穿戴假肢，负重站立和行走，无残端皮肤溃疡。假体与残端骨接合紧密，肌腱与假体连接良好，坚固。未发现任何假体放置后的不良反应和并发症。结论：截肢后骨残端安放假体能明显增加骨残端横截面积，很好保持残肢末端的圆锥形，加之假体材料的缓冲作用，明显减少截肢骨残端与假肢接受腔间软组织单位面积上的压强，使之能较早安装假肢，减少穿戴假肢所引起的并发症。增加假肢穿戴后的肢体功能。     

截肢术后残端康复治疗方法的选择

截肢术后的患者,如不施行较好的术后残端康复管理及功能训练,易产生一系列的并发症,给安装假肢带来一定的困难。为使患者成功地安装假肢,早日恢复行走功能及身心和躯体的健康,参加社会活动,作为骨科和康复科     

神经搭桥术治疗截指后残端神经疼痛20例报告

我科于2000年7月～2004年9月采用神经搭桥术治疗截指后残端疼痛20例，取得了满意的临床效果，现报告如下。     

装配假肢的残端处理临床体会

科学技术的快速发展,尤其是机械电子工业的发展,使假肢业有了突破性进展。现代假肢要求负荷腔要全方位接触肢体残端,以更好发挥残端作用,所以临床医生要掌握现代假肢的特点,恰当地、科学地进行截肢,废除以往的旧式截肢术。我们对４年来装配的２１５例假肢的残端处理...     

Malignant fibrous histiocytoma of the bone in a traumatic amputation stump: A case report and review of the literature

BACKGROUNDMalignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas among adults. It is characterized by large size, high grade, and biological aggressiveness. There are many reports of MFH after local stimulation, such as bone fracture, implants, and chronic osteomyelitis. In this paper, we report a patient who developed MFH 6 years after amputation, suggesting that wound healing and mechanical force play a role in the local stimulation of this disease.CASE SUMMARYA 66-year-old man complained of persistent pain in his residual mid-thigh. He had undergone amputation surgery due to a traffic accident 6 years prior. Physical examination showed tenderness but no abnormalities in appearance. X-ray radiographs and magnetic resonance imaging supported the diagnosis of a tumor, and a biopsy confirmed that the lesion was MFH. The patient received neoadjuvant chemotherapy and left hip disarticulation. During the 6-mo follow-up, there were no symptoms of recurrence.CONCLUSIONPostsurgery MFH has been reported before, and many studies have attributed it to the biological effects of implants. Our case report shows that this disease can develop without an implant and thus highlights the importance of local stimulation. The wound-healing process and mechanical force can both promote this tumor, but whether they directly cause MFH needs further investigation.     

对下肢截肢非理想残肢假肢装配问题的探讨

本文就六年来住院下肢截肢患者的非理想残肢91例，对其中未经手术矫治的48例假肢装配问题进行讨论，认为硅橡胶袜套、辅助悬吊带、假肢与矫形器的组合应用及调整好对线等，为某些非理想残肢患者的假肢安装提供了值得推广的好方法，使其穿戴上良好的假肢，充分发挥代偿功能。     

下肢截肢的非理想残肢及临床处理

对５９例下肢截肢患者理想残肢与非理想残肢进行了复习，其中非理想残肢５０例（８４．７％），分为不良残肢及残肢并发症２种，列举了它的各种表现，说明了非理想残肢对假肢穿戴的主要影响和临床处理方法。从非理想残肢发生率之高，强调了外科医生应重视截肢与假肢的现代理论与技术的必要性。现代假肢为闭合的全面接触全面承重的接受腔，故传统的截肢方法造成的园锥形残肢已不适用于现代假肢接受腔的安装。     

1195例胃大部切除术后残胃病变临床与内镜检查分析

目的通过分析胃大部切除术后残胃病变的临床特点及内镜表现,探讨不同手术方式对病变的影响。方法将本院1984年4月至2008年10月检出的1195例残胃患者按毕Ⅰ式和毕Ⅱ式进行分组,对其临床症状、内镜表现、病理结果及随访情况进行回顾性分析。结果胃大部切除术后残胃病变发生率高达98．08％,毕Ⅱ式术后残胃及吻合口炎（90．77％）、胆汁反流（71．59％）、残胃原发癌（4．55％）的发生率均显著高于毕Ⅰ式（51．15％、34．48％、1．72％）,P〈0．01,残胃及吻合口溃疡发生率则是毕Ⅰ式（28．45％）明显高于毕Ⅱ式（16．73％）,P〈0．01,其余残胃病变两组比较差异无统计学意义（P〉0．05）。结论胃大部切除术是治疗胃恶性肿瘤、消化性溃疡及其严重并发症的主要方法,毕Ⅱ式较毕Ⅰ式术后更易发生并发症;近年来,残胃病变发病率有下降趋势;定期复查内镜及病理是防治残胃病变尤其是残胃癌的重要措施。     

Long-term clinical outcomes of Iranian veterans with unilateral transfemoral amputation

Aim. To study long-term outcome of unilateral above-knee amputation.

Objective. Long-term clinical symptoms and functional status of above-knee amputees are not well documented. The purpose of this study was to document the long-term outcome of war related above-knee amputations.

Context. The study consisted of a comprehensive assessment and examination and review of history and wartime medical records of 31 Iranian above-knee amputees from the Iraq–Iran war by using a detailed questionnaire. The average follow-up was 17.5 years (range from15 to 22 years). All patients were males and had been combatants.

Results. The most common agent of war injury was a shell with an incidence of 45.1%, while land mines and direct bullet shots were the following causes of war injury resulting in amputation in 41.9% and 12.9%, respectively. Clinical symptoms included phantom sensation in 27 patients (87%), phantom pain in 14 patients (45.1%), phantom movement in 5 patients (16.1%) patients and stump pain in 20 patients (64.5%). Additionally, 19 patients (61.2%) suffered from back pain, 17 patients (54.8%) complained of contra lateral ( non-amputated) knee pain and 4 patients (14.8%) complained of ipsilateral hip pain. Seventeen patients (54%) reported psychological problems. Eighteen cases (58%) were employed or had been employed for multiple years after amputation. All patients (100%) were married and 30 (96.7%) had offspring.

Conclusions. The study showed that our patients had significant rates of amputation symptoms after an average of two decades of amputation, but on the other hand good family and social function of the patients were recorded. Amputation is not a static disability but a progressive deteriorating condition that affects the health condition of the amputee over time.