闭合性足部挤压伤致足部骨筋膜室综合征18例分析

目的：探讨闭合性足部挤压伤致足部骨筋膜室综合征的临床诊断标准和方法。方法：对18例闭合性足部挤压伤患者临床表现、体格检查疑似足部骨筋膜室综合征,通过Whitesider间室测压法6例诊断为足部骨筋膜室综合征并手术降压,其余保守治疗。结果：所有降压患者的切口均愈合,无感染,随访中1例降压患者出现爪状趾,其他患者没有永久性的功能丧失、挛缩、肌力减弱和神经功能障碍。结论：Whitesider间室测压法是早期诊断足部挤压伤后足部骨筋膜室高压及决定是否行切开降压的重要标准。     

特大地震中儿童骨筋膜室综合征的护理

通过对27例地震伤儿童肢体骨筋膜室综合征的诊治和护理,探讨其合理的判断指标及治疗护理措施。早期密切观察患肢肿胀情况、采取积极有效的护理措施,包括四肢末梢血氧饱和度检测,对血氧饱和度低于90%的2例行骨筋膜室切开减压术;予抗炎、半量甘露醇加β-七叶皂甙钠脱水消肿治疗;16例肢体骨折患者及时予石膏托或支具外固定。结果22例治疗成功保住了患肢;4例截肢(1例膝下、3例膝上);1例死亡。认为对儿童肢体骨筋膜室综合征进行早期密切观察并采取及时有效的护理措施是保证治疗成功和预防并发症的关键;患肢末梢血氧饱和度检测是一个可靠、直观、可行的判断指标;早期半量甘露醇加β-七叶皂甙钠脱水消肿、积极抗炎、配合支架外固定等综合治疗效果良好。     

经桡动脉冠状动脉介入术后并发骨筋膜间室综合征的护理

目的总结经桡动脉冠状动脉介入术后患者发生骨筋膜间室综合征的护理对策。方法对2009年1月~2014年12月经桡动脉冠状动脉介入术后并发骨筋膜间室综合征8例患者的临床资料进行回顾性分析,总结护理对策,包括密切观察病情、肿胀的观察和护理、用药护理、疼痛护理和凝血功能监测。结果所有患者出现疼痛,穿刺前臂明显肿胀、变硬,其中6例桡动脉搏动减弱,1例手指牵拉痛,1例肌力减退,1例右上肢无力,经对症治疗后缓解。结论骨筋膜间室综合征的早期观察至关重要,高度重视患者的主诉,针对并发症产生的原因及时采取有效的护理对策,争取内科保守治疗时间,可减少患者痛苦,促进患者早日康复。     

地震伤致骨筋膜室综合征56例治疗分析

目的：总结“5·12”地震中56例骨筋膜室综合征（OCS）早期诊断和治疗方法．以提高OCS的诊治水平。方法：对我科此次地震伤致骨筋膜室综合征56例的临床资料进行分析。结果：非手术治疗17例。手术治疗39例，其中截肢6例。结论：OCS临床以创伤后小腿多见，早期诊治能有效提高治愈率。     

普外科手术后应用自控镇痛泵患者的观察与护理

骨筋膜室综合征是下肢动脉栓塞常见并发症之一，处理不当，可导致肌肉坏死、神经麻痹、肢体残废，甚至死亡，小腿是其好发部位。骨筋膜室综合征患者应尽早行减张手术，深筋膜切开术是治疗骨筋膜室综合征唯一正确的方法。南京大学医学院附属鼓楼医院1992年2月～2005年7月共收治37例下肢动脉栓塞后小腿骨筋膜室综合征患者，采用微小切口切开减压，     

骨筋膜室综合征诊治失误21例分析

目的：总结骨筋膜室综合征的诊治失误病例,探讨骨筋膜室综合征的诊断标准与治疗原则,以降低致残率、致死率。方法：21例小腿及前臂骨筋膜室综合征予深筋膜切开减压术和（或）截肢术,术后常规予抗感染、扩血管、对症及支持治疗。结果：17例患者截肢,1例患肢保存完好,功能良好,3例有严重功能障碍。结论：骨筋膜室综合征的诊疗关键是早期诊断、密切观察、早期彻底减压,以降低致死率、致残率。     

胫腓骨骨折合并骨筋膜室综合征24例临床分析

目的　探讨胫腓骨骨折合并骨筋膜室综合征的早期诊断和治疗。方法　自 1990～ 2 0 0 3年来收治的胫腓骨骨折合并骨筋膜室综合征 2 4例患者 ,采用跟骨牵引或外固定支架、切开彻底减压并联合用药治疗。结果　所有骨折均解剖复位或接近解剖复位 ,无感染、皮瓣坏死等并发症发生 ,肢体均成活。随访 1～ 4年 ,平均随访 1年半 ,随访 2 3例 ,1例失访 ;经随访所有骨折均骨性愈合 ,创面愈合良好 ,膝关节活动范围除 1例 4 5°外 ,其余均大于 90° ,踝关节活动正常。结论　胫腓骨骨折合并骨筋膜室综合征 ,早期诊断 ,早期切开彻底减压引流 ,并联合用药 ,辅以跟骨骨牵引或外固定支架治疗 ,可获得满意疗效。     

医用冷敷器在治疗胫腓骨骨折中的疗效观察

目的:探讨医用冷敷器配合甘露醇静脉注射治疗胫腓骨骨折的疗效。方法:将160例胫腓骨骨折患者随机分为观察组和对照组各80例,两组患者入院后均按医嘱给予20%甘露醇250 ml静脉注射。观察组采用医用冷敷器冷敷,对照组采用自制冰袋冰敷。结果:两组患者疼痛程度、肿胀程度、张力性水疱情况、骨筋膜室综合征发生率及接受手术时间比较差异均有统计学意义(P0.05)。结论:胫腓骨骨折患者早期应用医用冷敷器,可以有效镇痛、减轻肿胀,使患者手术时间提前,有效降低骨筋膜室综合征的发生率,治疗效果优于自制冰袋。     

骨筋膜室综合征12例的护理

目的：探讨骨筋膜室综合征的护理措施。方法：回顾性的介绍12例骨筋膜室综合征的术前动态监护、术后护理的方法。结果：本组12例患者肢体功能恢复正常10例,功能部分丧失1例,功能全部丧失1例,无护理并发症发生。结论：骨筋膜室综合征是骨科较为严重的创伤综合征,除及时手术减压外,加强术前、术后动态监护及患肢功能锻炼才能取得满意的治疗效果,减少并发症的发生。     

药物治疗小腿早期骨筋膜室综合征

骨筋膜室综合征是任何原因导致骨筋膜室内的肌肉、神经急性缺血产生的一系列早期症状和体征 ,是危及生命的严重并发症 ,常发生于小腿。其早期病理改变是可逆的。通过治疗 6例早期骨筋膜室综合征结果分析 ,有效率10 0 % ,药物治疗早期骨筋膜室综合征具有良好的效果。2 0 %甘露醇连续用 2次 ,明显增加单位时间里血液中浓度 ,通过强大的高渗透性利尿作用 ,将大量水分排出体外 ,降低患肢组织压 ;10 %葡萄糖防止甘露醇反跳现象 ,维生素Ｃ促进血管再生 ,减少毛细血管通透性 ,减轻患肢水肿。复方丹参注射液具有扩张血管 ,增加血流量 ,抑制凝血和抗…     

Acute compartment syndrome following a minor athletic injury

An athletic young male presented with right calf pain following a twisting injury during a soccer game. Other than apparently severe calf pain, no symptoms or signs of compartment syndrome were noted. The patient later returned with lateral and anterior compartment syndrome, and suffered partial loss of peroneal nerve and muscle function despite fasciotomy. Although rare, acute compartment syndrome resulting from seemingly minor injury or exertion has been reported. Pain out of proportion to the apparent injury and a history of chronic leg pain with exertion may be helpful in identifying these patients prior to development of more obvious signs and symptoms. The diagnosis of acute compartment syndrome may be confirmed by compartmental pressure measurement. Prompt intervention is indicated once the diagnosis is established.     

Diagnostic imaging assessment of temporomandibular joint pain

INTRODUCTION: In the diagnostic process imaging is frequently performed for confirmation of pain symptoms or imaging-based signs were used for conclusions on pain. Therefore, the aim of this review was to show evidence about the association between temporomandibular joint (TMJ) pain - as a subgroup of orofacial pain conditions - and findings on TMJ images. METHODS: By handsearch and computer-based search statements of clinical studies, especially of the past 20 years, were collected and critically assessed. RESULTS AND CONCLUSIONS: In the literature there exist some references to and indications for an association between TMJ pain and structure-based findings on TMJ images, i.e. morphology of the condyle, condyle-fossa relationship, form and position of the disc, signs of effusion of the upper resp. lower joint compartment, bone marrow signal abnormalities of the condyle, signal characteristics of the retrodiscal tissue. Despite some hints the relation between TMJ pain and so-called abnormalities on TMJ images remains unclear, complex and little predictive in individual cases.     

利百素对术中静滴甘露醇所致静脉炎的防治作用

目的:观察利百素对静滴甘露醇所致静脉炎的防治作用。方法:78例神经外科手术患者被分为利百素组和常规组,利百素组患者在静脉穿刺成功后,固定针头覆盖针眼,将利百素凝胶适量涂抹于静脉穿刺点周围及沿穿刺点血管向上走行涂擦,每2h1次,至手术结束;常规组则不做此处理。观察患者术中静滴甘露醇250~500mL后静脉炎的发生情况。结果:与常规组相比,利百素组静脉炎发生率显著降低(P <0.01,χ2=43.18,P=0.0001)。结论:预防性应用利百素凝胶可以减少静脉炎的发生。     

慢性硬膜下血肿性痴呆的CT表现及临床意义

目的：研究慢性硬膜下血肿的CT表现与临床意义。材料与方法：回顾分析总结30例慢性硬膜血肿性瘤痴呆,主要CT表现为颅骨内板下新月状阴影,血肿密度与其期龄有关,随时间推移分别表现为等密度,混合密度和低密度,慢性硬膜下血肿性痴呆好发部位多见于额颞顶部颅骨内板,其血肿体积常常大于一般外伤性硬膜下血肿,其临床表现主要为进行性精神障碍,结论：慢性硬膜下血肿性痴呆的早期症状易被临床医师忽视,CT检是早期发现慢性硬膜下血肿性痴呆有效且方便的方法。     

逐级半卧位干预对急性心肌梗死早期患者近期临床症状的影响

目的观察逐级半卧位干预对急性心肌梗死早期患者近期临床症状的影响,探讨该干预措施的安全性和有效性。方法便利抽样法选择入住某医院心内科重症监护室且发病12~24h的急性心肌梗死患者29例,按随机数字表法随机分为观察组和对照组。观察组患者在发病12~24h内即给予逐级45°半卧位干预,对照组患者入院后前3d绝对平卧位休息。比较两组患者的相关心功能指标以及舒适度情况。结果两组患者早期相关心功能指标及临床体征比较差异无统计学意义(均P0.05),观察组患者住院后前3d腰酸背痛、排尿困难、焦虑等不适症状的发生率低于对照组,差异有统计学意义(P0.05)。结论逐级半卧位干预是安全有效的护理措施,可在不影响患者心功能的情况下缓解其部分不适症状。     

Acute compartment syndrome of the dorsal forearm following noncontact injury

Acute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.     

合用刺五加与甘露醇治疗脑梗塞的疗效观察

目的：观察合用刺五加与甘露醇治疗脑梗塞的疗效。方法：将１６８例脑梗塞患者随机分为治疗组９７例和对照组７１例。治疗组静滴刺五加和甘露醇，对照组静滴维脑路通和能量合剂，其它治疗２组基本相同，均１４日为１个疗程。分别观察治疗前后２组患者临床症状、体征及血液流变学指标变化。结果：治疗组痊愈１９例，显效４８例，进步２４例，无效６例，总有效率９３．８１％；对照组痊愈９例，显效１９例，进步３０例，无效１３例，总有效率８１．６９％。２组比较有非常显著性差异（Ｐ＜０．０１）。血液流变学指标，治疗组治疗后有显著进步，对照组个别指标有显著进步。结论：静滴刺五加与甘露醇治疗脑梗塞为安全有效的方法。     

Reciprocal influence on the incidence of symptoms in trigeminally and spinally innervated areas

Temporomandibular disorders (TMD), headaches, and spinal pain show co‐morbidity and may therefore influence each other. The hypothesis tested is that the presence of any of these conditions will increase the risk of onset of new symptoms within a 2‐year period. The study population comprised 280 dental students, who were examined three times at 12‐month intervals. The incidence was calculated for a 2‐year period, based on subjects without the defined symptom at baseline. Each participant was classified into five different case‐control groups, representing incidence cases or no incidence (controls) of: (1) nonpain TMD symptoms; (2) jaw pain; (3) headaches; (4) spinal pain; and (5) TMD pain. Presence of headaches and of spinal pain and signs and symptoms of TMD at baseline were used as independent variables in logistic regression analyses, controlling for age and sex. Incidence cases with TMD pain reported spinal pain at baseline significantly more often than the controls, and were mostly women. Incidence cases with headaches and incidence cases with jaw pain significantly more often had signs of TMD and reported spinal pain at baseline, compared to controls. Incidence cases with nonpain TMD symptoms or spinal pain significantly more often presented with signs of TMD at baseline. Our findings show that pain and dysfunction in trigeminally innervated areas and pain in spinally innervated areas mutually predict the onset of new symptoms in dental students, indicating common pathophysiological mechanisms and individual vulnerability. This may be of importance in risk assessment and treatment planning of individuals with musculoskeletal pain.     

中药热敷防治套管针输注甘露醇所致静脉炎的研究

[目的]探讨中药热敷对套管针输注甘露醇所致静脉炎的影响。[方法]选择脑外科需输注甘露醇的病人60例,随机分成两组,试验组在输注甘露醇同时局部给予中药热敷,对照组不采取任何干预措施。观察两组病人静脉炎发生率、发生时间、疼痛程度、套管针留置时间。[结果]试验组病人静脉炎发生率明显低于对照组;试验组静脉炎发生时间明显延迟,且疼痛程度轻,套管针留置时间明显延长。[结论]中药热敷能降低静脉炎发生率,推迟静脉炎发生时间,减轻疼痛强度,延长置管时间。     

多发性骨髓瘤的临床及影像分析

目的:探讨多发性骨髓瘤的临床特征和影像学的诊断价值。方法:结合临床资料回顾性分析我院43例多发性骨髓瘤的影像资料,对其临床特点和影像特征进行综合分析。结果:多发性骨髓瘤最常见的临床表现有骨痛、贫血、乏力、发热、肝脾肿大和浅表淋巴结肿大等;43例患者的X线平片无骨质改变6例(14%),仅表现为骨质疏松5例(11.6%),溶骨性骨质破坏伴广泛的骨质疏松32例(74.4%);脊椎CT检查100%显示有骨质破坏;脊椎MRI检查100%提示有信号改变,多数病变呈长T1、T2信号。结论:多发性骨髓瘤起病隐袭,临床表现多样化;典型影像表现为多发性穿凿样或虫蚀样骨质破坏及广泛的骨质疏松;X线平片检查,尤其是头颅、脊椎、肋骨及骨盆平片应作为多发性骨髓瘤初诊的常规检查,CT及MRI检查对早期和不典型多发性骨髓瘤脊椎病变的显示明显优于X线平片检查。