腕或小腿横韧带切开治疗筋膜间室综合征3例

1993年以来我们曾对9例因损伤致四肢筋膜间室综合征的患者施行筋膜间室切开减压治疗,其中3例肢体远端(足、手)肿胀严重伴有张力性水泡、疼痛异常剧烈,虽经筋膜室切开仍不能缓解,故顺沿切口至踝(腕)关节以下,切开踝(腕)横韧带,疼痛迅速缓解.现报告如下.     

半量甘露醇治疗早期骨筋膜室综合征的临床研究

四肢创伤后早期骨筋膜室综合征在临床较为常见 ,我院自 2 0 0 2年 9月～ 2 0 0 3年 1 1月应用半量甘露醇治疗该征 92例 ,取得满意效果 ,现报告如下。1　临床资料1 1　一般资料　本组 92例 ,男 6 1例 ,女 31例 ,年龄 1 4～6 7岁 ;单一肢体损伤 6 7例 ,多侧肢体损伤 2 5例 ;单纯软组织损伤 9例 ,骨折闭合整复外固定术后 2 5例 ,开放复位加内固定术后 5 8例 ;前臂 33例 ,小腿 5 9例 ;全部病例患肢均显著肿胀 ,肢体周径较正常侧增粗 6 0± 0 7cm ,皮肤明显紧张 ,局部软组织触压较硬 ,压痛明显 ,6 9例形成张力性水泡 ;主动活动障碍 ,被动牵拉…     

煤气中毒致小腿骨筋膜室综合征3例救治体会

小腿骨筋膜室综合征常见于重物挤压、石膏固定包扎过紧、肢体血管伤等原因 ,而煤气中毒致小腿骨筋膜室综合征临床少见 ,我们救治 3例 ,现报告如下。病例 1,李×× ,男性 ,2 7岁 ,煤气中毒后 16小时入院。查体 :血压 12 0 / 90 m m Hg(16 / 12 k Pa) ,神志清楚 ,右小腿肿胀明显 ,小腿外侧、右足背、足底感觉减退 ,小腿及足部诸肌肌力均为 级 ,被动牵拉试验阳性 ,尿常规蛋白 ( ) ,潜血( ) ,尿素氮 7.8mm ol/ L,肌电图示腓总神经及胫神经有轻度损害 ,入院后急行“右小腿骨筋膜室综合征切开减压术”,术后应用 2 0 %甘露醇脱水 ,低分子右旋糖…     

封闭式负压吸引技术治疗四肢骨筋膜室综合征

目的 探讨封闭式负压吸引技术在骨筋膜室综合征中的治疗作用。方法 16例四肢骨折并发骨筋膜室综合征患采用封闭式负压吸引技术持续治疗7d，维持40kPa负压。结果 16例骨筋膜室综合征患全部得到迅速控制，肢体肿胀消退。切开减压创面肉芽生长新鲜，无1例发生创面感染。结论 封闭式负压吸引技术能迅速彻底对骨筋膜室减压，避免创面污染，工作量小，患痛苦小。     

负压封闭引流技术在地震伤骨筋膜室综合征中的应用

目的探讨负压封闭式引流(VSD)技术在"5.12"汶川大地震所致骨筋膜室综合征切开减压中的应用。方法回顾性研究了自2008年5月12日～2008年6月1日,接受VSD治疗的15例汶川地震伤员18个患肢。术后记录引流量,肢体肿胀消退情况以及全身发热等症状。根据肢体肿胀程度及肉芽生长情况,采用延期缝合、植皮或者皮瓣转移覆盖创面。结果 15例术后病情得到迅速控制,负压引流量在520～2360ml之间。术后7d内有10个创面肿胀消退,肉芽组织新鲜。余下8个创面经过第二次更换VSD敷料,5处筋膜室切开减压创面肿胀消退,肉芽新鲜。经第三次更换VSD敷料后余下3处创面肿胀消退,肉芽新鲜,予闭合创口。上述切开减压创面无一例发生感染。结论地震致骨筋膜室综合征经早期切开减压结合VSD治疗能快速覆盖创面,减少污染,防止继发感染;能有效引流分泌物,减少毒素吸收;减轻肢体水肿,促进新鲜肉芽生长,利于创面修复。     

封闭负压引流术治疗骨筋膜室综合征

目的 探讨封闭负压引流术(vacuum sealing drainage,VSD)在骨筋膜室综合征中的治疗作用及效果.方法 27例四肢骨折并发骨筋膜室综合征患者手术减压后采用VSD持续治疗7～10d,维持125～450mm Hg负压.消肿后,需行游离植皮时同样使用VSD敷料覆盖.结果 27例骨筋膜室综合征患者全部得到迅速控制,肢体肿胀消退.切开减压创面肉芽生长新鲜,无一例发生创面感染.游离植皮表面再次使用VSD敷料覆盖后,植皮存活率100%,存活面积在95%～100%之间.结论 VSD能迅速彻底对骨筋膜室减压,避免创面污染.有利于创面早期愈合,缩短治疗时间,减少患者痛苦,并减轻医护人员工作量.     

腰骶部慢性骨筋膜室综合征所致慢性腰痛的诊断和治疗

目的 :探讨由慢性骨筋膜室综合征所致慢性腰痛的临床诊断、手术治疗的方法。方法 :对慢性腰痛患者采用临床检查、影像学检查、腰部竖脊肌骨筋膜室内压测量、骨筋膜室切开、减压手术治疗 ,术后腰、腹肌功能锻炼。结果 :慢性腰痛患者行骨筋膜室切开、减压治疗后较术前下腰痛症状和体征明显好转、步行能力明显增加、ADL得到明显改善 ,腰部骨筋膜室内压在静止、运动中和运动后 6min以内分别在 8、175和 8mmHg以下 (手术前分别为 8、175和 8mmHg以上 ) ,腰部前屈、后伸活动度较术前分别增加 ( 15± 0 .5 )°和 ( 7± 0 .7)° ,多普勒超声腰部骨骼肌内血流量较术前明显增加 ,竖脊肌肌力较术前增加 ( 1.0± 0 .3)kg。结论 :应用临床、影像学检查及骨筋膜室内压测定的方法诊断由慢性骨筋膜室综合征所致慢性腰痛及采用骨筋膜室切开、减压的方法治疗该疾病是非常有效的。     

一期减压骨折固定植皮治疗小腿筋膜室综合征

骨筋膜室综合征是指骨、骨筋膜、肌间隔和深筋膜形成的骨筋膜室区域内，由于不同原因所致压力升高，使组织的微循环灌注不良，导致以肌肉和神经急性严重缺血为特征的一种疾病。以胫腓骨骨折后发生最多。尤其交通、矿产、暴力损伤，此征并非少见，处理不当，将引起肢体残废，甚至危及生命。过去对骨筋膜室综合征先切开减压，骨折固定、张力缺损创面包扎换药。7～8d后肿胀消退，二期缝合或植皮消灭创面。这样，病人病程长，痛苦大，医疗费用高，易感染。行一次性切开减压，室腔置管引流、骨折固定、张力创面整张植皮，术后常规行20％甘露醇250mL，每日3～4次脱水治疗3d取得了满意的效果。     

三种方法治疗跟骨骨折后软组织肿胀的比较研究和临床意义

目的比较采用冰袋冷敷加甘露醇、冰袋冷敷及甘露醇3种方法治疗跟骨骨折后软组织肿胀的疗效和临床意义。方法本院自2006年5月至2012年5月收治SandersⅡ、Ⅲ、Ⅳ型跟骨骨折共87例(92足)。根据Sanders分类:Ⅱ型29例(29足),Ⅲ型42例(44足),Ⅳ型16例(19足);软组织肿胀程度采用改良Tscheme-Gotzen分类法:CO级:28例(30足);C1级:59例(62足)。采用冰袋冷敷加甘露醇治疗例39(41足),冰袋冷敷治疗例26(28足),甘露醇治疗22例(23足)。比较各组患者足跟部的肿胀情况,张力性水疱的发生,骨筋膜室综合症的发生,1周内皮肤皱褶的出现和术后切口并发症的发生。结果 3组患者在张力性水疱、骨筋膜室综合症的发生率和1周内皮肤皱褶的发生率进行比较,冰袋冷敷加甘露醇治疗组与冰袋冷敷对照组和甘露醇治疗对照组相比有显著差异(P<0.05),而冰袋冷敷对照组与甘露醇治疗对照组相比无明显差异(P>0.05)。3组患者在术后切口并发症的发生率无明显差异(P>0.05)。结论应重视软组织的治疗,早期采用冰袋冷敷加甘露醇治疗可有效的减轻软组织肿胀、减少张力性水疱、骨筋膜室综合症的发生;同时术中保护好软组织也至关重要,可以明显减少手术切口并发症的发生。     

甘露醇股动脉注入治疗骨筋膜室综合征

我院从1983—1989年采用甘露醇注入股动脉治疗骨筋膜室综合征31例,效果较好,报告如下。 本组男27例、女4例。年龄16—65岁。受伤原因:车祸伤19例、塌方砸伤11例、坠落伤1例。损伤部位:小腿29例、大腿2例。31例均表现伤肢剧烈进行性疼痛,紧胀感,明显肿胀。31例受损区组织压测量:最高11.33kpa、最低5.2kpa平均8.68±0.80kpa。组织压>4kpa即可诊断为骨筋膜室综合征。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.