臀大肌注射深度探索及护理对策

目的进一步明确肌肉注射的深度。方法以臀大肌注射为研究对象 ,通过B超观察 5 2 4例皮肤到臀大肌之间的距离 ,以确定针头进入的深度。结果男性组皮肤与皮下组织的平均厚度为 1 34± 0 6 3cm ,女性组平均厚度为 3 4 1± 0 98cm ,两组相比P <0 0 5 ,差异有显著性意义。结论教科书上的进针深度标准 ,目前只适用于男性。故在执行肌肉注射时 ,除了根据药物的性质和粘稠度选择不同的针头外 ,还要根据性别、胖瘦选择合适的针头     

成人肥胖者臀部肌肉注射深度的探讨

目的:探讨成人肥胖人群臀部肌肉注射的深度.方法:选择符合条件的肥胖成人男女各100例,B超测量臀大肌注射区皮肤到臀大肌间的距离,并计算7号注射针头能够达到肌层的百分率.结果:男性组皮肤脂肪厚度(22.86±8.15)mm,女性组皮肤脂肪厚度(26.35±7.53)mm,能够达到以7号针头长度32 mm的2/3(21.3mm)进针深度的男占49.54%,女占5.86%.结论:目前使用的7号注射针头大多不能到达肥胖成人的臀部肌肉注射层,建议研制加长型注射针头.     

B超诊断儿童卵巢囊肿蒂扭转1例

患儿女,6岁.因阵发性腹痛2天,加重3小时就诊.临床以“肠蛔虫病”申请B超检查.B超见:中、上腹部未见异常,膀胱充盈尚可,于膀胱右下方探及一大小为5.5cm×5.3cm×5.3cm无回声区,形态规则,边界清楚,包膜完整.该无回声暗区后半部见不规则条索状中等回声.子宫及左侧附     

B超诊断胎儿畸形2例

<正>1病例报告1.1 胎儿裂腹畸形 孕妇谭某某,26岁,第2胎,妊娠30周,腹大于正常妊娠月份,宫底于耻骨联合上41cm,腹围102cm,妇产科诊断为羊水过多.B超声像(见图1)见胎儿呈头位,颅骨环状强回声清晰,完整.双顶径7.4cm,脊柱排列整齐,胎心率124次/分.心率齐,探不清完整的腹围.在羊水中,可探及完整的肝、肾、脾及肠回声.羊水最大深度为11cm,超声诊断为胎儿裂腹畸形伴羊水过多,建议终止妊娠.3天后孕妇在我院引产娩出一名男婴,脐以下无腹膜及皮肤复盖,腹腔内脏全部外逸.     

重度Coats病误诊为脉络膜黑色素瘤一例

1 病例资料 男,24岁.因左侧头痛3d伴左眼胀痛1d入院.自幼左眼视力差、视物不见1年.眼科检查:左眼视力光感,定位差,眼压74.7 mmHg,左眼外斜约45°,睫状充血(+),角膜雾样水肿,周边前房约1/2CT(角膜厚度),瞳孔强直,直径7 mm,无青光眼斑,眼底窥不进,透见红光.右眼视力5.0,眼位正,眼前段及眼底大致正常.眼球B超检查示左眼玻璃体内探及2.0cm×1.5 cm大小的实质回声,与玻璃体分界尚清,形态不规则,以低回声为主,伴少许稍强回声;左眼球后壁相当于黄斑位置处可探及7.4 mm×2.2 mm大小的强回声斑,形态不规则;低回声团内部及强回声斑均未见明显血流.     

B超诊断婴儿左肾母细胞瘤1例

患儿,女,2个月。近20d来烦躁不安,哭闹,食欲不振,消瘦,腹部胀大明显就诊。体格检查:T:37.6℃,消瘦,营养不良貌,腹部膨隆明显。腹部触及一包块,边界不清,质较硬,表面凹凸不平,固定。血常规:Hb:10.8g/L,WBC:7.6×10/L,尿常规未见异常。B超检查:肝脏径线明显增大,肝内回声欠均,管系走行尚清。胆囊大小正常,壁薄,胆汁透声性好。右肾大小、形态正常,肾窦无分离。左肾未探及,左肾部位探及12.8cm×8.5cm的实质不均质的包块,边界规整,包膜完整,与周围组织界限清楚,包块内部回声偏低,中心部位回声稍偏强。脾、胰位置上移,胰大小、形态正常,脾厚3.…     

超声介入治疗宫外孕2例

例 1,女性 ,2 9岁。因停经 5 9天 ,不规则阴道流血 19天 ,门诊多次化验尿妊娠试验均为 ( ) ,入院。超声检查 :子宫体稍大 ,宫腔回声略欠均 ,左附件区探及 4.5 cm实性回声 ,内见2 .7cm囊性回声 ,囊内见胚芽 ,彩色多普勒探及胎心管搏动 16 6次 /分。 (图 1)尿妊娠试验 ( ) ,稀释试验 1∶ 2 5 0 ( )。诊断为左侧宫外孕。化验血常规 ,心肝肾功能均正常。住院后次日经B超确定病变部位后 ,随即在无菌操作下以 15 cm长 18号 B超穿刺针经穿刺架定位 ,经腹直刺入左附件包块的孕囊内然后拔出针蕊 ,抽吸出囊内清亮液体数毫升后孕囊缩小至 1.7cm,注入氨…     

钝性暴力致小肠破裂的超声诊断

例1 患者男18岁,腹部被板车柄碰撞后5小时,曾呕吐两次胃内容物,腹痛剧烈,查体:腹肌紧张,肠鸣音减弱.B超检查:脐上偏右探及两个形态不规则的低回声团块,大小分别为5.3×1.5cm、4.4×1.6cm,检查中腹部未见明显肠蠕动回声,腹腔内未见明显液性暗区.超声提示:小肠穿孔可能性大.X线检查:左侧腹部肠管胀气明显,双膈下未见游离气体 ,腹腔内未见液平面,血常规:白细胞14.2×10~9/L、分叶90%,淋巴10%,血红蛋白130g/L.于伤后24小的行剖腹探查、见空肠上段距Treitz韧带50cm处穿孔、口径约2×1cm,有胆汁样液体溢出.周围网膜包囊,行空肠穿孔修补术.例2 患者男40岁.腹部被人用膝盖猛烈撞击后3小时.患者腹痛难忍,以右上腹更为明显.查体:腹肌紧张,全腹压痛反跳痛明显,肠鸣音减弱.B超检查:中腹部偏右探及一形态不规则、边界不清的低回声团块,大小约7.8×2.9×4.5cm~3,下腹部膀胱直肠窝探及少许液性暗区,深度约1.7cm,检查中未见明显肠蠕动回声.超声意见:小肠穿孔可能性大.X线检查:空、回肠、结肠扩张,但未见液平面,未见隔下游离气体.血常规:白细胞14.2 ×10~9/L分叶94%、淋巴6%、血红蛋白124/L.于伤后8小时手     

B超诊断胎心畸形(单心室)1例

孕妇 ,2 6岁 ,停经 8个月余。 2 0 0 2年 3月 2 3日来我院做产前检查。妇产科申请做 B超检查。B超 :宫体大 ,宫腔内探及一胎儿 ;头位 (ROA) ,双顶径 8.4 cm,股骨长 6 .8cm。脊柱排列规整 ,四肢无异常。腹腔内无异常回声。胸腔心区见 6 .5 cm× 5 .6 cm× 5 .7cm的无回声区 ,前后壁清晰 ,相距 5 .4 cm处各有短带状心瓣膜成漂浮样搏动。14 8次 /分 ,律不规整。其无回声区内未见心室间隔声像。四腔观及长轴观均未探及胎心四腔声像图 ,如图 1。胎心呈囊状。胎盘 2度 ,羊水5 .4 cm。B超诊断 :(1)单胎晚孕 ;(2 )胎心畸形 (单心室 )。孕妇于 2 0…     

淋巴结弓形体病1例

患者男性,47岁.发现右腋窝淋巴结肿大12天,直径约3 cm,无疼痛和发热.血常规无异常.B超示右腋窝有一个3.3cm×2.1 cm的低回声团块,呈分叶状,压之变形;其内见高回声团,血流丰富.下方还见2个1.3cm×1cm和1.2 cm×1.2cm低回声团,均为椭圆形,内有高回声团,血流丰富.左则腋窝未探及异常回声团.手术切除右腋窝淋巴结活检.     

两种臀部肌内注射方法在临床实践中的应用启示

目的探讨两种臀部肌内注射方法对药物吸收的影响。方法选取2011年6月-2012年5月有机磷农药中毒患者83例,按双侧臀部轮流肌内注射的原则,左侧选择臀大肌（臀大肌组）进行注射;右侧选择臀中肌（臀中肌组）进行注射。72h后比较不同注射部位皮肤肿胀情况。结果臀大肌组肿胀62例,明显肿胀21例;臀中肌组肿胀79例,明显肿胀4例。结论采用臀中肌进行肌内注射,药物吸收效果好。     

Sex differences in the intramuscular absorption and bioavailability of cephradine.

Six male and six female volunteers each received a single intramuscular injection of cephradine, a new cephalosporin antibiotic, once weekly for 3 consecutive weeks. The drug was injected into the gluteus maximus, vastus lateralis, or deltoid muscle groups. Injection sites were rotated each week so that each subject received an injection into each muscle. Pharmacokinetic evaluation of serum concentrations and urinary excretion data indicated a sex difference with respect to the rate and extent of cephradine absorption from the three injection sites. Smaller areas under the curve and absorption rate constants were observed for females after injection into each muscle group. The most striking difference was observed when cephradine was injected into the gluteus maximus muscle, where the exponential function describing the alpha phase was observed to be 1.16 +/- 0.17 hr(-1) for females and 2.70 +/- 0.34 hr(-1) for males. Total area under the mean serum concentration-time curves, mean time to peak, and peak height parameters consistent with the slower rate of absorption and lesser bioavailability in females were observed. These results show that the vastus lateralis or deltoid muscle groups are preferable to the gluteus maximus as injection sites because of the more rapid rates of drug absorption from those muscles.     

无痛点联合定位法在臀部肌内注射中的应用效果

目的探讨肌内注射中臀中肌三角定位和臀大肌连线法联合定位确定无痛点进行无痛注射的效果观察。方法将1200例门诊肌内注射患者随机分为实验组和对照组各600例,对照组进行传统的肌内注射方法,实验组采用联合定位无痛点的方法进行肌内注射,比较两组注射时疼痛程度。结果实验组疼痛程度低于对照组,差异有统计学意义（P〈0．01）。结论无痛点联合定位法降低了患者在肌内注射时的疼痛感,操作方法简便,具有较好的推广应用价值。     

老年全髋置换者臀大肌及臀中肌的肌力训练

背景：人工全髋关节置换后早期介入功能训练对老年患者髋关节功能恢复有着重要作用.目的：观察老年人全髋关节置换后臀大肌、臀中肌肌力训练对髋关节功能恢复的影响.方法：将60例全髋关节置换者分为2组,对照组全髋关节置换后给予常规的功能训练,训练组在常规训练基础上强调臀大肌、臀中肌肌力训练.结果与结论：置换后16周应用Biodex系统对两组患者臀大肌、臀中肌肌力进行测试,训练组患侧臀大肌、臀中肌肌力分别为健侧的78.13%,75.28%;对照组臀大肌、臀中肌肌力分别为健侧的63.32%,61.32%.训练组Trendelenburg征阳性1例,对照组8例.臀大肌、臀中肌肌力训练组明显优于对照组（P 〈 0.01）.根据Harris髋关节评分,置换后功能恢复训练组明显优于对照组（P 〈 0.05）.提示全髋关节置换后早期开展臀大肌、臀中肌肌力训练能够增强髋关节的稳定性,促进髋关节功能恢复.     

Z-路径肌内注射法和常规肌内注射法对患者的影响

目的对常规肌内注射法和Z-路径肌内注射法进行比较,为临床肌内注射法提供一种更佳的注射方法。方法2007年8-9月对需要肌内注射给药的120例门诊患者,采用自身对照法,在每例患者两侧臀大肌注射给药时,分别使用常规肌内注射法和Z-路径肌内注射法,分别观察并记录注射后药（血）液外渗和疼痛不良反应发生情况。结果Z-路径肌内注射法较常规肌内注射法药液外溢、疼痛发生率低,两组比较,均P〈0．001,差异具有统计学意义。结论Z-路径肌内注射法所致药液外溢以及局部不适反应的发生率低,有助于药物的吸收和利用,减轻患者的疼痛,值得临床推广应用。     

Physical therapeutic options for residual sacrotuberous ligament pain after treatment of sacroiliac joint dysfunction

[Purpose] To evaluate the incidence of pain originating from the sacrotuberous ligament after sacroiliac joint treatment, and to determine effective physical therapeutic options for sacrotuberous ligament pain. [Participants and Methods] Among 303 patients with sacroiliac joint dysfunction, 57 patients (20 males, 37 females) with persistent lower-buttock pain after sacroiliac joint injections were included in the study. The incidence of sacrotuberous ligament pain and the physical findings from the first evaluation were investigated by physical therapists. [Results] Diagnostic sacrotuberous ligament injections identified lower-buttock pain originating from the sacrotuberous ligament in 57.9% of the patients (33 out of 57 patients) after treatment of sacroiliac joint dysfunction. Of these, 11 patients experienced relief after sacrotuberous ligament injection alone; the others required physical therapy. Sacrotuberous ligament relaxation alone was effective in eight patients; biceps femoris relaxation was required in eight patients; and gluteus maximus contraction exercise was required in six patients. [Conclusion] After sacroiliac joint treatment, the incidence of residual sacrotuberous ligament pain in the persisting lower-buttock pain was 57.9%. In addition to sacrotuberous ligament relaxation, biceps femoris relaxation was effective in patients who showed both higher differences in the straight leg raising test and biceps femoris tenderness, while gluteus maximus contraction exercises were effective in patients with gluteus maximus weakness.     

骨盆骶髂关节旁致密线的测量与臀肌挛缩

背景：临床中多发现以非臀肌挛缩症就诊患者的骨盆平片上骶髂关节旁靠近髂骨翼处存在纵行致密线影,经仔细体格检查及手术病理证实为臀肌挛缩症。目的：分析骶髂关节旁致密线与臀肌挛缩症之间的关系及其在诊疗中的作用。方法：分析50例臀肌挛缩症患者的骨盆平片,其中45例以臀大肌挛缩为主,5例以臀中肌挛缩为主。并以100例非臀肌挛缩症患者的骨盆平片作对照。结果与结论：臀肌挛缩组42例骨盆平片见骶髂关节旁致密线,位于髂骨翼部骶髂关节水平。对照组仅3例见骶髂关节旁致密线。臀肌挛缩组骶髂关节旁致密线的出现率较对照组明显增多（P〈0.01）;以臀中肌挛缩组中有4例表现为骨盆倾斜,仅1例可见髂骨致密线;而臀大肌挛缩组中有40例可见髂骨致密线,两组间差异有非常显著性意义（P〈0.01）,说明致密线的形成系臀大肌挛缩所致,而与臀中肌挛缩无关。提示骨盆平片上骶髂关节旁致密线是影像学检查诊断臀肌挛缩症的一种有价值征象。     

自体肌肉移植重建人工肛门括约肌

背景：有效的人工肛门括约肌重建能够改善肛门失禁患者的生存能力和生活质量。目的：评价白体肌肉移植重建人工肛门括约肌的效果。方法：分析自体臀大肌和股薄肌移植重建人工肛门括约肌的解剖学基础,并对应用自体臀大肌和股薄肌移植重建人工肛门括约肌的患者进行随访观察,通过评估人工肛门控便功能恢复情况以及相关并发症发生情况,明确自体臀大肌和股薄肌移植重建人工肛门括约肌的应用效果。结果与结论：臀大肌和股薄肌均有丰富的血液供应,并且营养肌肉的动脉均有相应静脉和神经伴行。对应用自体臀大肌和股薄肌移植重建人工肛门括约肌的患者随访观察发现,患者多为直肠癌或者肛管癌,经过自体肌肉移植重建人工肛门括约肌后,均能获得较好的肛门排控便功能,较少发生肛门狭窄、肛周感染等并发症,无机体排斥反应的发生。     

Electromyographic analysis of gluteus maximus and hamstring activity during the supine resisted hip extension exercise versus supine unilateral bridge to neutral

Hip extension strengthening exercises which maximize gluteus maximus contributions and minimize hamstring influences may be beneficial for persons with hip pain. This study’s aim was to compare muscle activation of the gluteus maximus and hamstrings from healthy subjects during a supine resisted hip extension exercise versus supine unilateral bridge to neutral. Surface electromyographic (EMG) signals were obtained from the right gluteus maximus and hamstrings in 13 healthy male and 13 healthy female subjects. Maximum voluntary isometric contractions (MVICs) were collected to normalize data and permit meaningful comparisons across muscles. Peak median activation of the gluteus maximus was 33.8% MVIC for the bridge and 34.7% MVIC for the hip extension exercise, whereas peak median recruitment for hamstrings was 28.4% MVIC for the bridge and 51% MVIC for the hip extension exercise. The gluteus maximus to hamstrings ratio was compared between the two exercises using the Wilcoxon signed-ranks test (α = 0.05). The ratio (p = 0.014) was greater in the supine unilateral bridge (median = 111.3%) than supine hip extension exercise (median = 59.2%), suggesting a reduction of hamstring recruitment in the unilateral bridge to neutral compared to the supine resisted hip extension exercise. The supine hip extension exercise demonstrated higher EMG activity of hamstrings in comparison with supine unilateral bridge and, therefore, may be less appropriate in subjects who need to increase gluteus maximus activation.     

Test-Retest repeatability of gluteus maximus strength testing using a fixed digital dynamometer in children with cerebral palsy

OBJECTIVE: To investigate the test-retest repeatability of the measurement of the gluteus maximus strength using a fixed digital dynamometer. DESIGN: Test-retest design. The strength of the gluteus maximus was measured in prone position during 2 sessions an average of 6 days apart. SETTING: Gait analysis laboratory. PARTICIPANTS: Eleven children with spastic diplegic (n=10) and hemiplegic (n=1) cerebral palsy (CP), age 6 to 14 years, and 11 aged-matched children. All were able to walk independently, but 2 in the CP group used walking aids. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: On 2 occasions, gluteus maximus strength was measured 3 times in 2 positions of the hip joint. Repeatability of the measurements was assessed by intraclass correlation coefficients (ICCs), coefficients of variation, and the coefficient of repeatability. RESULTS: When normalized to body mass, children with CP had significantly less gluteus maximus strength compared with the controls. The ICCs for the control group ranged from .76 to .85 and from .75 to .83 for the involved leg in the CP group. CONCLUSIONS: The reliability of measurement of gluteus maximus strength was good for both control group and the involved leg of the CP group. The normalized values for gluteus maximus strength and measures of reproducibility can be used when measuring gluteus maximus strength in children with CP.