应用交腿皮瓣修复足踝关节严重损伤

目的　观察应用交腿腓肠肌肌皮瓣修复足、踝关节严重损伤的效果。方法　选取 2 0 0 2年 8月— 2 0 0 3年 11月我院 5例足严重损伤病人 ,均为男性 ,年龄 2 6～ 47岁。高压电伤 1例 ,为接触 3 5万V高压电致伤 ;热压伤 3例 ;重物砸伤 1例。设计对侧小腿腓肠肌内侧头肌皮瓣 ,皮瓣基部位于小腿后上方 ,后缘位于小腿后正中线 ,前缘位于大隐静脉内侧 ,皮瓣大小为 3 0cm× 11 5cm～ 18cm× 7cm。保护小隐静脉及腓肠神经 ,找到腓肠动脉进入腓肠肌的点 ,并分出腓肠肌外侧皮瓣的营养动脉 ,加以保护 ,切取皮瓣。行创面清创 ,尽量清除坏死组织 ,保留间生态组织 ,对于大血管周围坏死组织可予以适当保留 ,以过氧化氢溶液及 0 1%苯扎溴铵溶液反复清洗创面 ,彻底止血 ,将皮瓣移植缝合于创面 ,皮瓣下放置橡皮引流条 ,双下肢行石膏托固定。结果　所作 5个腓肠肌内侧头肌皮瓣及 1个腓肠肌外侧头肌皮瓣均顺利成活 ,创面修复满意。结论　腓肠肌肌皮瓣作为交腿应用具有可供切取的皮瓣面积大 ,应用灵活、有足够长的蒂 ,可再利用、抗感染能力强、容易固定、操作简便 ,成功率高、供区功能不受影响的优点     

Applicability of cutoff scores of Chinese Cumberland Ankle Instability Tool and Foot and Ankle Ability Measure as inclusion criteria for study of chronic ankle instability in Chinese individuals

ObjectiveTo examine the applicability of Chinese Cumberland Ankle Instability Tool (CAIT-C) and Foot and Ankle Ability Measure (FAAM-C) as inclusion criteria recommended by the International Ankle Consortium (IAC) for study of chronic ankle instability in the Chinese individuals.DesignCross-sectional comparative design with known groups.SettingResearch laboratory.Participants145 participants with chronic ankle instability (CAI) and 66 participants without injury.Main outcome measuresCAIT-C and FAAM-C Activities of Daily Living (FAAM-C-ADL) and FAAM-C Sports (FAAM-C-Sports).ResultsThe CAIT-C scores (18.2 ± 5.6), FAAM-C-ADL scores (97.0 ± 4.3) and FAAM-C-Sports scores (92.2 ± 10.3) of the CAI group were all lower than the CAIT-C scores (27.4 ± 3.1), FAAM-ADL scores (99.0 ± 2.1) and FAAM-Sports scores (98.4 ± 3.1) (P < 0.01) of the uninjured group. The recommended cutoff score of CAIT-C<24 by the IAC for identifying CAI had a sensitivity of 80.7% and a specificity of 84.9%. If the recommended cutoff scores of FAAM-ADL<90,FAAM-Sports<80 by the IAC as inclusion criteria for the study of CAI were applied, 97% of participants with CAI in this sample would be excluded.ConclusionThe results support the recommended cutoff score of CAIT-C<24 by the IAC to identify Chinese individuals with CAI for study. However, the recommended cutoff scores of FAAM-ADL<90 and FAAM-Sports<80 will exclude most Chinese individuals with CAI having only mild functional impairments.     

糖尿病足中医外治法应用现状及研究进展

【摘要】 糖尿病足具有高发病率、高致残率和高致死率等特点,治疗难度较大,治疗费用较高,给患者家 庭及社会均造成了极大影响? 目前,临床治疗糖尿病足的方法主要有自体富血小板凝胶、表皮生长因子、中医药外用等, 且经大量基础及临床研究证实,中医外治法在糖尿病足的治疗中具有明显优势? 根据患者具体情况在蚕食、鲸吞等方法“袪腐”的基础上,联合应用中药外敷、针灸、中药熏洗、穴位按摩、中频脉冲等中医外治法发挥了显著的 “生肌” 作用,不仅促进了创面的愈合,而且还改善了患肢疼痛、肿胀、麻木、发凉等不适症状,提高了患者的生存质量,“简、便、廉、验”的优势凸显? 本研究对糖尿病足中医外治法的应用现状及研究进展进行了综述,旨在为糖尿病足的临床治疗提供参考?     

中药口服联合中药汤剂熏洗治疗糖尿病足疗效分析

目的 探讨中药口服联合中药汤剂熏洗治疗糖尿病足的临床疗效.方法 选取2018年10月至2019年10月开州区人民医院收治的72例糖尿病足患者作为研究对象,按照治疗方法将其分为观察组与对照组,每组36例.观察组患者采用中药口服联合中药汤剂熏洗治疗,对照组患者单纯采用中药口服治疗,对比观察两组患者临床疗效及中医证候评分变化...     

A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome

Purpose

To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS).

Materials and methods

We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1 cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans.

Results

The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P > 0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each.

Conclusion

The individual performances of both scans were not significantly different in diagnosing CTS. Measuring both CSA and FA at P1 may be useful and efficient to utilize the merits of both scans and to increase the CTS diagnostic performance.     

新型国产双层人工真皮移植修复手足部肌腱及骨外露创面效果分析

目的探讨新型国产双层人工真皮移植修复手足部肌腱及骨外露创面的临床疗效。方法回顾性分析2017年1月至12月周口淮海医院收治的符合纳入标准的82例手足部肌腱及骨外露患者的临床资料,按照治疗方法不同将采用新型国产双层人工真皮+自体刃厚皮片移植治疗的42例患者设为观察组,将采用皮能快愈敷料+自体刃厚皮片移植治疗的40例患者设为对照组,对比两组患者的植皮次数、移植间隔时间、温哥华瘢痕量表(Vancouver scar scale, VSS)评分、皮片成活率及皮片破溃率等。结果观察组患者的植皮次数为(1.34±0.31)次、移植间隔时间为(18. 50±4.39) d、VSS评分为(4. 76±1.98)分、皮片成活率为92. 86%、皮片破溃率为2.38%,对照组患者的植皮次数为(1.25±0.34)次、移植间隔时间为(13.14±3.52) d、VSS评分为(5. 04±2. 14)分、皮片成活率为100%、皮片破溃率为5. 00%。两组患者移植间隔时间对比,P 0.01,差异具有统计学意义;植皮次数、VSS评分、皮片成活率及皮片破溃率对比,P均0.05,差异无统计学意义。结论在手足部肌腱及骨外露创面的治疗中,新型国产双层人工真皮可取得与皮能快愈敷料同等的疗效,但却存在移植间隔时间较长的弊端。     

异物损伤周围神经并存留体内40例

目的：探讨异物损伤周围神经并存留体内的诊治方法。方法：回顾分析异物损伤周围神经并存留体内40例，其中男，35例，女5例，平均年龄23．4岁。根据异物与神经的解剖位置关系和临床表现，采取不同的神经探查、修复、松解术，取出异物。结果：40例中随访32例，优23例，良6例，可3例。结论：异物损伤周围神经并存留体内诱治要点为正确判断神经与异物的位置关系，择期行神经探查修复、异物取除术。     

Contribution of power Doppler and gray-scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome

Aim of the work

To assess the role of gray-scale and power Doppler ultrasound (US) of the median nerve at the wrist in evaluating carpal tunnel syndrome (CTS).

Materials and methods

Seventy-one wrists in 51 patients with CTS in addition to 50 healthy volunteers that served as the control group were enrolled in this study. The following sonographic parameters were evaluated in both patients and controls: cross sectional area of the median nerve just proximal to the tunnel inlet (CSA1), at the pisiform bone level (CSA2), the CSA difference (ΔCSA), flattening ratio of the median nerve and bowing of the flexor retinaculum. The power Doppler US was used to assess the number of nerve vessels with estimation of the vascularity score.

Results

The ΔCSA revealed an excellent discriminative ability (AUC = 0.988) in differentiating patients with CTS at an optimal cut-off value of 3.9 mm². Intraneural hypervascularization was significantly correlated with the ΔCSA of the median nerve (P < 0.001), while not significantly correlated with the age of patients, median nerve flattening ratio and bowing of flexor retinaculum.

Conclusion

The ΔCSA and vascularity score of the median nerve are important and useful sonographic parameters in evaluation of CTS.