超声检测技术在判断腕部电烧伤血管损伤中的应用

目的:应用超声检测技术判断腕部电烧伤后尺、桡动脉病理变化,探讨新的诊断方法.方法:选择腕部高压电击伤患者,用B型超声和彩色多普勒检测患者腕创面部、创缘上5 cm、10 cm、15 cm处的尺、桡动脉内膜、管壁厚度、管腔内径和血流量,并以正常人尺、桡动脉为对照.结果:1、血管内膜的主要病理变化有:内膜粗糙、水肿增厚、内膜脱落.2、管壁呈阶段性增厚,厚度不均,0.05～0.19cm,较正常对照厚约1倍,重者管壁坏死.3、管腔狭窄或扩张,可呈串珠状,创面段和创面上5cm段狭窄最明显,重者管腔闭塞血栓形成.4、血流量降低,以近创面处明显.5、血管损伤以腕创面部最重,距创面边缘约10～15cm处血管形态基本接近正常.结论:超声检测可以直观显示受损血管内膜形态变化,管径大小,管壁厚度和血流量,对判断电烧伤血管损伤程度和范围有指导意义，是一种无创、精确、方便的检测方法，值得应用和推广.     

应用数字减影血管造影与B超判断上肢高压电烧伤患者的血管损伤情况

目的　比较数字减影血管造影 (DSA)与B超在判断上肢高压电烧伤血管损伤中的作用。　方法　选择 19例上肢高压电烧伤患者的尺、桡动脉作为烧伤组 ,术前应用DSA及B超检测技术 ,观察患肢腕部创面及创面近端 5、10、15cm处尺、桡动脉的内膜、管壁厚度、管腔内径、血流量以及血栓形成等情况 ;以 12位正常人的尺、桡动脉作为对照组。术中 :结合DSA和B超检查结果 ,综合分析并判断尺、桡动脉损伤程度 ,出现栓塞或管壁坏死者予以切除并进行组织病理学检查。　结果DSA检测显示烧伤组患者 14条尺动脉、11条桡动脉出现异常 ,主要变化有栓塞形成、管腔狭窄、血流缓慢等 ,尺动脉损伤程度重于桡动脉。B超显示烧伤组 19条尺动脉和 16条桡动脉出现异常 ,主要表现为血管内膜粗糙不平、水肿或脱落 ,管壁增厚 ,管腔狭窄或串珠样改变 ,血流量减少 (P <0.0 5～ 0.0 1)其中创缘近端 5cm的尺动脉血流量 (31.6 0± 13.90 )ml/min,明显低于对照组 (47.70± 9.6 0 )ml/min(P <0.0 5)。术中探查及组织病理学检查结果与DSA、B超诊断相符。　结论　判断上肢高压电烧伤后的血管损伤情况可采用B超为主、DSA为辅的方法 ,以提高手术探查的精确度。     

超声检测技术在深度电烧伤诊断中的应用

目的　探讨超声检测技术在深度电烧伤诊断中的应用价值。　方法　以 12例深度电烧伤患者 2 5个患肢的创面及创面近心端 5～ 15cm处为对象 ,采用彩色及脉冲多普勒超声检测技术 ,观察该处皮下组织、肌肉组织及血管的损伤情况 (共检测血管 5 6条 ) ,得出血流动力学定量指标。　结果　 ( 1)经二维超声检测 ,深度电烧伤后各种组织的受损范围不同 :血管 >肌肉组织 >皮下组织 ;创面段血管内膜未显示者 7条 ,内膜水肿者 12条 ,管腔闭塞者 4条 ,血栓形成者 5条。 ( 2 )彩色多普勒检出 ,受测部位血管走行变异屈曲者共 12条 ,管腔狭窄者 2 1条 ,管腔增宽者 11条 ,均与随后手术治疗时所见情况一致。 ( 3)脉冲多普勒检出 ,狭窄段血管收缩期峰值流速增高 ,每分血流量减低。　结论　超声检测技术具有无创的特点 ,可直观地显示深度电烧伤后皮下组织、肌肉组织、血管的形态学改变 ,以利准确判断损伤程度 ,了解受损部位的血流动力学变化 ,为临床诊治提供依据。     

腹部联合轴型皮瓣修复腕部环状高压电烧伤创面

目的 探讨腕部环状高压电烧伤创面的修复方法. 方法 2009年1月-2011年12月,笔者单位收治6例腕部环状高压电烧伤患者,清创后采用腹部联合轴型皮瓣修复腕部创面,即用带部分腹直肌的脐旁皮瓣修复腕屈侧创面,其中腹直肌充填腕屈侧腔隙;下腹部皮瓣修复腕背侧创面,术后4～5周断蒂.供瓣区部分直接.拢缝合,部分在前鞘拉拢缝合后植皮修复. 结果 3例皮瓣术后成活良好;2例皮瓣下有液化坏死组织,经扩创愈合;1例皮瓣术后5周断蒂时出现腕部桡动脉栓塞,清创后立即行大隐静脉移植重建桡动脉后创面愈合.随访6个月～1年,患者腕部功能和外形恢复情况较好. 结论 带部分腹直肌的脐旁皮瓣联合下腹部皮瓣是修复腕部环状高压电烧伤创面的一条可行途径.     

含血栓静脉管壁病理形态学特征的比较性研究

目的 探讨含血栓的静脉管壁病理形态学特征及管腔内径变化.方法 收集含血栓的曲张大隐静脉主干标本18例(血栓组),单纯曲张大隐静脉主干标本18例(曲张组),另设正常大隐静脉主干标本12例(对照组).采用苏木精-伊红和Masson染色法,观察管壁组织结构,测量血管壁内径与内膜、中膜、外膜厚度.结果 血栓组管壁全层及血栓内见大量炎细胞浸润,血栓附着处内皮细胞缺失,大量增生的胶原纤维自破裂内膜处延伸至血栓内致部分血栓机化.曲张组管壁全层偶见炎细胞,内膜增厚,中膜平滑肌细胞不规则增生,排列紊乱,胶原纤维增生.对照组管壁内膜薄,中膜平滑肌束排列规则.血栓组管腔内径、内膜厚度、中膜厚度和外膜厚度与曲张组、对照组比较差异均有统计学意义(P＜0.05),曲张组管腔内径和内膜厚度与对照组比较差异有统计学意义(P＜0.05).结论 含血栓的曲张静脉管腔增大、管壁增厚是病理形态学改变的主要特征.     

血栓通静脉滴注配合电针对2型糖尿病下肢血管病变患者血流动力学的影响

目的:现察血栓通静脉滴注配合电针对2型糖尿病下肢血管病变患者血流动力学的影响.方法:采用美国 ACUSON 128XP/10型彩色多谱勒超声仪对LEAD患者股动脉、腘动脉的管壁的管腔内径、内膜-中层厚度(IMT)、收缩期血流峰值速度(Vs)及血流量进行检测.结果:观察组在改善2型糖尿病下肢血管病(LEAD)恚者的管腔内径、内膜-中层厚度(IMT)、收缩期血流峰值速度(Vs)及血流量,均明显优于对照组,两组比较差异有显著性(P<0.05～0.01).结论:血栓通静脉滴注配合电针治疗能显著改善LEAD忘者血流动力学的相关指标.     

尺浅动脉变异一例并文献复习

患者男,因右腕部锐器割伤就诊.急诊行清创探查术,术中探查见右腕部近端尺侧一长约5 cm横行伤口,尺侧腕屈肌腱于腕上3 cm处断裂,其深面尺神经完整、连续,尺神经内、外侧未见尺动脉血管束.向远、近端延长切口后,见有一动脉行于掌长肌与桡侧腕屈肌之间,在腕上6cm处越过掌长肌浅面,掌长肌表面可见动脉压迹,行于尺侧腕屈肌桡侧,与尺神经伴行进入Guyon管,因此可确认该血管为变异尺动脉.该动脉较正常者为细,位置表浅.掌长肌、桡侧腕屈肌及指浅屈肌腹较低,腕横纹处尚有肌腹延续.观察健侧前臂可见同样走行的尺浅动脉.     

手背尺侧皮瓣修复腕掌部深度烧伤

我科于 1992年利用手背尺侧皮瓣修复腕掌部深度烧伤14例 ,男 10例 ,女 4例 ;年龄 2～ 4 8岁。烧伤原因 :电击伤、炭火、钢水、碱及氢氟酸烧伤。部位 :掌根、小鱼际、腕部 ,均伴有肌腱、血管、神经、骨外露。皮瓣面积 1.5ｃｍ～ 4 .5ｃｍ× 2ｃｍ～ 7ｃｍ。方法 :腕背网由桡动脉     

桡动脉穿支蒂岛状皮瓣修复腕及前臂创面

目的 探讨桡动脉穿支蒂岛状皮瓣的解剖以及修复腕及前臂创面的手术方法和临床疗效.方法 以桡动脉搏动及体表投影为中心,采用多普勒血管仪探测桡动脉穿支的部位,以靠近缺损创面部的皮支作为血管蒂及旋转点,根据缺损创面大小、形状设计皮瓣,修复腕及前臂创面12例.结果 术后12例皮瓣中有2例出现静脉危象,经拆除部分缝线后存活,创面愈合,其余10例皮瓣均顺利存活.随访时间3～18个月,皮瓣质地软,外形及功能满意.结论 桡动脉穿支在桡骨茎突近端2.0cm、4.0～ 5.0 cm、7.0cm处较恒定,以此为蒂的岛状皮瓣血供可靠,操作简单,不损伤主干血管,修复后外形好,是修复腕及前臂皮肤软组织缺损的有效方法之一.     

超长斜方肌肌皮瓣修复腋部严重电烧伤一例

患者女 ,2 2岁 ,因接近 35kV高压电致伤 ,伤后 1d入院。查体 :左腋部有圆洞形创面 ,肌肉呈熟肉状 ,周围为Ⅲ度创面 ,面积 4 0cm× 2 0cm(图 1)。左上肢肿胀明显 ,皮肤苍白 ,尺、桡动脉搏动微弱 ,除上臂内侧浅感觉存在外 ,其余感觉、运动功能丧失。右腕部有椭圆形创面 ,桡动脉缺损 8cm,桡骨远端炭化 ,尺动脉搏动存在 ,右手血运尚可。双下肢有 10 %TBSAⅢ度创面。诊断 :高压电烧伤 ,总面积 2 3%TBSA,Ⅲ度 10 %TB SA。图 1　左腋部电烧伤创面入院后急诊行清创探查术 ,见肱三头肌、三角肌、肱二头肌部分坏死 ;胸大小肌、背阔肌及大圆肌肱…     

Can forearm flaps be selected by use of color-flow duplex Doppler scanning?

Color-flow pulsed duplex Doppler technology was used on 54 arteries in 27 healthy adult volunteers to determine dominance between radial and ulnar arteries. Volumetric flow (cc/s), flow velocity rates (cm/2), and vessel areas (mm2) were investigated to calculate vessel dominance. Although there were some problems in five cases, 22 cases have had an absolute dominance of one artery over the other (81%). Of these, 14 cases were ulnar dominant and eight cases were radial dominant. This study proposes that the transcutaneous, noninvasive color-flow Doppler scanning makes it possible to determine the dominance of wrist arteries and helps the surgeon choose the less detrimental flap to the hand circulation before the planning of pedicled or free forearm fasciocutaneous flaps.     

上肢热压伤合并主干血管损伤的治疗

目的探寻肢体热压伤合并主干血管损伤的治疗方案。方法对8例上肢严重热压伤合并骨筋膜室综合征患者实施减压术，但对肢体血运的改善不明显。行血管探查得知患肢均合并肱、桡、尺动脉或掌深、浅弓损伤，采用直接吻合、屈曲肢体吻合、大隐静脉移植等方式修复血管并移植中厚皮片或带蒂胸脐皮瓣封闭创面。结果l例肱动脉修复后创面植中厚皮片者因无良好的软组织覆盖，术后4周血管再度栓塞导致上臂中段截肢。7例血管修复后创面移植皮瓣的患者肢体血供完全恢复并得以完整保留。结论及时行血管探查和修复以及选择周围良好的软组织覆盖，是治疗热压伤合并主干血管损伤的关键措施。     

Blood flow changes at the wrist in manual workers after preventive interventions

Radial and ulnar artery circulatory changes at the wrist were studied at the work site in manual workers performing repetitive tasks to compare the effects of two preventive interventions, exercise and rest. The Doppler method was used for assessment of blood flow velocity, and systolic blood pressure measurements were made on 16 right hand-dominant female workers in a suture manufacturing industry. Radial and ulnar blood flow velocity decreased while systolic blood pressure at these arteries remained stable after 1 1/2 hours of manual work. After 5-minute interventions of either exercise or rest, blood flow velocity increased, radial blood pressure remained stable, and ulnar blood pressure decreased. A 5-minute exercise program produced greater increases in radial blood flow velocity than did a 5-minute rest program. Brief exercise programs have been shown to improve circulation at the wrist after circulation was compromised by the performance of manual work. Such programs may offer one practical method of preventing soft tissue injuries related to the sustained compromise of blood flow at the wrist.     

四肢主干血管损伤的诊治

目的探讨四肢主干血管损伤的早期诊断、治疗方法以及临床效果。方法2001年1月-2006年6月，收治72例四肢主干血管损伤患者。男50例，女22例；年龄5～60岁，中位年龄39岁。开放性损伤44例，闭合性损伤28例。动脉损伤部位：锁骨下动脉1例，股动脉23例，胭动脉20例，尺桡动脉同时损伤12例，肱动脉11例，腋动脉3例，胫前后动脉同时损伤2例。伤后至入院时间30min～27d。术中血管破口直接修补3例，端端吻合39例，自体大隐静脉移植修复30例，移植长度3～8cm。结果67例肢体成活，5例截肢。48例获6个月～5年随访，彩色多普勒血流仪检查血流速度及血管口径与健侧无明显差异。40例肢体功能恢复满意，8例残留不同程度功能障碍，其中4例行矫形或功能重建手术，功能及外形得到改善。结论了解损伤机制及受伤情况，认真体检，综合分析，是主干血管损伤早期诊断的关键；显微外科修复是提高血管通畅率的保障；术后筋膜间室综合征及肢体缺血时间超过4h的肱动脉、胭动脉以上的血管损伤，及时行筋膜间室切开是恢复肢体功能、避免伤残的有效手段。     

Evaluation of radial and ulnar blood flow after radial artery cannulation with 20- and 22-gauge cannulae using duplex Doppler ultrasound

This study evaluated ulnar and radial artery blood flow after radial artery cannulation during general anaesthesia using Doppler ultrasound. A total of 80 patients were randomly assigned to receive radial artery cannulation with either a 20‐G or 22‐G cannula. Arterial diameter, peak systolic velocity, end‐diastolic velocity, resistance index and mean volume flow were measured at four time points in both arteries: before anaesthesia; 5 min after intubation; immediately after cannulation; and 5 min after cannulation. After radial artery cannulation, ulnar diameters and blood flow were significantly increased, and persisted until 5 min after cannulation. Radial blood flow was decreased immediately after cannulation and recovered to pre‐cannulation values 5 min after cannulation. There were no statistical differences between groups at each time point. Radial artery cannulation causes compensatory increase in ulnar artery blood flow, and the difference in cannula size has minimal effect on this change.     

Analysis of flow changes in forearm arteries after raising the radial forearm flap: a prospective study using colour duplex imaging.

The purpose of this study is to assess the changes in flow patterns of forearm arteries produced by excision of the radial artery when harvesting the radial forearm flap, in order to clarify its vascular morbidity rationally. Eleven patients with elective surgery using the radial flap were included in this investigation. A prospective study was designed using colour duplex imaging for quantitative flow measurement in two stages: a few days before the operation, a first colour duplex scanning examination was done recording flow velocity and vessel section area from the radial, ulnar, posterior interosseous and anterior interosseous arteries around the wrist. Volumetric parameters and relative blood flow percentages were calculated and compared to those obtained from a second similar vascular investigation accomplished in the same limb 4-5 months after the operation. Statistical analysis was done using the Wilcoxon matched pairs test. After raising the radial forearm flap there was a trend for increased overall forearm flow (from 162 to 215 ml/min, P = 0.09 N.S.), the ulnar (P = 0.04), the posterior interosseous (P = 0.004) and the anterior interosseous (P = 0.003) arteries being responsible for this tendency. The anterior interosseous artery showed the greatest increase in blood (from 8.2 to 67.7 ml/min), reaching a relative flow percentage (33%) close to that of the radial artery before its excision (39%). Results of this study indicate that another 'major vascular axis' based on the anterior interosseous artery develops after sacrificing the radial artery and that global arterial inflow to the hand is not impaired.     

Duplex scanning to assess radial artery suitability for coronary artery bypass grafting.

OBJECTIVE: Radial artery suitability in coronary artery bypass grafting was assessed using duplex ultrasonography. SUBJECTS AND METHODS: The vascular condition along the entire radial artery was scanned in 55 patients, measuring the internal diameter and mean flow velocity at the wrist (distally), after ulnar artery branching (proximally), and midway between these 2 points (medially). Distally along the radial and ulnar arteries, the mean flow velocity was determined before and after radial artery occlusion. RESULTS: Atherosclerotic changes were detected in 4 patients. The internal diameter was 3.1 +/- 0.4 mm proximally, 2.7 +/- 0.3 mm medially, 2.4 +/- 0.4 mm distally. The distal flow velocity was 0, and a reverse flow (peak velocity: 11.3 +/- 6.0 cm/s) was observed after the occlusion test in patients with an intact palmar arch, their mean flow velocity, 21.1 +/- 8.9 cm/s, and flow distally along the ulnar artery 58.0 +/- 23.4 ml/min, were higher after the occlusion test than before it 14.7 +/- 6.7 cm/s mean flow and 38.1 +/- 15.9 ml/min distally. This was not observed in patients with an interrupted palmar arch. In 15 patients, radial arteries could not be used because of their small internal diameter, lack of a radial artery, poor vascular condition, or an interrupted palmar arch evaluated using duplex scanning. CONCLUSION: Reliable noninvasive assessment of radial artery anatomy and palmar arch continuity is thus possible using duplex ultrasonography.     

旋股外侧动脉横支为蒂的股前外侧皮瓣重建肘部复合组织缺损的临床应用

目的 探讨以旋股外侧动脉横支为蒂的股前外侧皮瓣,游离移植修复肘部肱动脉伴皮肤软组织缺损的临床疗效.方法 2000年3月-2008年2月,对8例肘部肱动脉损伤伴皮肤软组织缺损的患者,急诊一期采用旋股外侧动脉横支为蒂的股前外侧皮瓣游离移植修复,同时用横支血管桥接缺损的肱动脉(3～7cm),皮瓣切取面积为12cm×6cm～20cm×10 cm.结果 8例肢体及皮瓣均顺利存活,术后随访10～21个月,肘部皮瓣无明显臃肿及瘢痕挛缩现象,肘关节屈伸活动度平均为105°(95°～125°),8例患侧肢体前臂远端尺、桡动脉搏动强度与健侧相同,B超显示患侧肱动脉血流与健侧基本相同.结论 切取股前外侧皮瓣时,如发现旋股外侧动脉降支有变异,可切取以旋股外侧动脉横支为蒂的股前外侧皮瓣,重建肘部肱动脉损伤和软组织缺损.