足踝部毁损伤患者皮瓣移植术后康复护理策略

目的 总结2016年2月至2019年10月收治的50例足踝部毁损伤患者皮瓣修复术后的康复护理经验。方法 采用皮瓣移植对患肢进行治疗,1～2周,维持生命体征的稳定,保证皮瓣存活,预防早期并发症;3～4周,增加主动活动量、神经感觉恢复训练;5周～3个月,应用工具辅助早期行走;3～6个月,过渡到正常活动,预防足底溃疡等潜在风险的发生。针对患者康复的不同时间段提供不同侧重点的康复护理。术后6～24个月进行随访,评估患者下肢功能恢复情况、足底的感觉恢复情况及皮瓣外观。结果 1例患者行截肢手术,49例采用皮瓣移植术,术后功能均恢复良好。回访50例患者,40例术后平均7个月行皮瓣整形术。8例患者感觉功能恢复至S4,32例足底感觉恢复至S3+,8例恢复至S2,1例患者恢复差。结论 先进的皮瓣移植手术及完善的术后护理康复策略,能够帮助患者康复,为临床护理提供经验。     

保留甲床的指脱套伤修复术

目的报道一种保留甲床的指脱套伤的修复方法。方法2000年2月～2004年6月,应用腹部带蒂真皮下血管网皮管修复指脱套伤同时保留甲床8例。8例均为机器绞拉引起的撕脱伤,伤后1～5小时急诊手术,于下腹部切取皮瓣后将远端2/3处修薄,皮下脂肪保留2～4mm,然后制成皮管状,将伤指套入缝合创缘。结果术后8例皮管全部成活。随访5～18个月,皮管质地柔软、平整,断蒂后不需要再修整,保留甲床的指甲生长正常,伤指外形接近正常指,功能恢复满意。结论应用腹部带蒂真皮下血管网皮管修复指脱套伤,疗程短,可保留指末节及甲床,术后外形及功能恢复佳,是一种修复较理想的方法。     

尺神经麻痹行肌腱移位术后正中神经的功能

1961年Brand提出应用桡侧伸腕长肌,经前臂背侧引至掌侧,取路肌腱或阔筋膜以延长,分成四股,经腕管引至手掌,各股分别与相应手指的侧束缝合,以矫正爪形指。从此,该方法被广泛应用于麻风内在肌瘫痪和神经损伤的修复。然而,尚有一些外科医生担心,移位肌腱经过腕管内,使之更加拥挤,正中神经可受挤压,会导致腕管综合征。为此,作者对128例因单纯尺神经麻痹行肌腱移位修复爪形指的麻风患者,进行了正中神经的长期随访观察。随访期限2～17年(平均5年)。128只手中,97只手肌腱经     

O-Z-O皮瓣在面部相邻皮肤缺损修复中的应用

【摘要】 目的 探讨应用O-Z-O皮瓣修复面部相邻皮肤缺损的效果。方法 回顾性分析2015—2018年于杭州市第三人民医院皮肤科采用O-Z-O皮瓣修复面部相邻皮肤缺损的60例患者。其中，色素痣50例，脂溢性角化病4例，寻常疣3例，基底细胞癌2例，鳞状细胞癌1例。男14例，女46例，年龄18 ~ 75岁。 根据皮损情况，原位切除皮损，设计最佳切口，离断“皮瓣桥”（即相邻缺损之间的正常组织），根据皮肤张力线以及皱纹线，将两皮瓣桥残端相互交错，间断缝合固定，进行创面修复。结果 60例患者应用O-Z-O皮瓣均能完全覆盖皮肤缺损，术后皮损均Ⅰ期愈合，无瘢痕增生。结论 O-Z-O皮瓣设计灵活，切口小，可以同时切除相邻皮损并进行减张缝合，临床疗效满意，是修复面部相邻皮肤组织缺损的良好选择。     

手术切除联合重组α-2b干扰素治疗肢端恶性黑素瘤15例

目的　探讨手术切除联合生物治疗肢端恶性黑素瘤的疗效。方法　应用病灶切除、创面植皮或皮瓣修复的方法，对2004年以来的15例肢端黑素瘤进行手术治疗，切除范围距病灶1 ～ 2 cm，其中，4例切除后直接缝合；10例较大损害，切除后植皮及邻近皮瓣转移修复；1例较大损害累及第一跖趾关节，行第一趾截趾并保留趾背皮肤修复足底前端创面。术后肌注α-2b干扰素3个月。结果　15例患者中，肿瘤浸润厚度为1.8 ～ 3.9 mm，原位黑素瘤6例，侵袭性黑素瘤9例。术后皮片、皮瓣全部成活，随访1 ～ 3年，有1例侵袭性黑素瘤在术后３年复发。术后患足功能正常。结论　根据肿瘤厚度决定切除范围大小，联合α-2b干扰素治疗，在避免截肢的情况下不影响患者存活率。     

风筝皮瓣修复鼻背部皮肤缺损38例疗效观察

目的探讨应用风筝皮瓣修复中小面积鼻背缺损的效果。方法自2010年1月-2016年12月,应用风筝皮瓣修复38例中小面积鼻背缺损。缺损面积0.5cm×0.7cm~0.8cm×1.2cm。根据鼻背缺损面积的大小,在缺损皮肤松弛一侧设计三角形皮瓣,将皮瓣周围游离且保留部分皮下蒂,再将皮瓣推进至缺损部位进行间断缝合。结果有37例取得良好效果,1例出现部分组织瓣坏死,经高压氧治疗后,恢复良好。随访3个月~2年,手术切口瘢痕小,患者对总体外观均比较满意。结论应用风筝皮瓣修复中小面积鼻背缺损可以很好地恢复鼻背外观,避免鼻背牵拉畸形,简单易行。     

11例阴囊乳房外湿疹样癌手术及创面处理的临床分析

目的通过对11例阴囊乳房外湿疹样癌手术切除及创面处理效果的分析,为临床治疗提供安全可靠的治疗方法。方法根据肿瘤的大小和累及的部位,手术彻底切除病变组织,较小的创面采用直接缝合,较大的创面采用对侧阴囊旋转皮瓣修复。结果11例患者中1例直接切除缝合,10例应用对侧阴囊旋转皮瓣修复。术后随访5年,2例复发,复发率为18.91%。结论治疗阴囊乳房外湿疹样癌,彻底切除病灶并应用对侧阴囊旋转皮瓣修复创面是较为理想的手术方法。     

应用足外侧皮瓣治疗足跟部恶性黑色素瘤

目的修复足跟部恶性黑色素瘤切除后遗留的足跟部创面。方法应用足外侧皮瓣转移修复创面,皮瓣供区以中厚皮片移植。结果6例患者皮瓣全部成活,随访3～12个月,2例患者因黑色素瘤全身转移死亡,4例患者足跟部皮瓣形态、感觉及功能均满意。结论足外侧皮瓣具有皮瓣薄、质地好、血运好,解剖容易,转移方便,感觉好,抗磨耐压等特点,是修复足跟部皮肤缺损的理想皮瓣。     

头面部皮肤软组织外伤清创美容缝合体会

目的探讨头面部皮肤软组织外伤的急诊美容修复方法,总结手术缝合要点。方法在保守清创,彻底减张和无创基础上修复不规则创伤,用无张力缝合、植皮、皮瓣转移等技术进行修复,精确缝合皮肤各层组织。结果 37例患者中,术后3个月至1年中随访23例,均无瘢痕增生及其他并发症。结论修复头面部皮肤软组织创伤按照美容外科原则和技术,使用无创美容缝合线及美容缝合技术,能避免患者术后皮肤错位畸形,减少瘢痕,及时清创美容缝合可以获得满意的修复效果。     

头面部皮肤软组织外伤清创美容缝合体会1卜彬彬,李兴

目的 探讨头面部皮肤软组织外伤的急诊美容修复方法,总结手术缝合要点。方法 在保守清创,彻底减张和无创基础上修复不规则创伤,用无张力缝合、植皮、皮瓣转移等技术进行修复,精确缝合皮肤各层组织。结果 37例患者中,术后3个月至1年中随访23例,均无瘢痕增生及其他并发症。结论 修复头面部皮肤软组织创伤按照美容外科原则和技术,使用无创美容缝合线及美容缝合技术,能避免患者术后皮肤错位畸形,减少瘢痕,及时清创美容缝合可以获得满意的修复效果。     

Nerve conduction studies in paucibacillary and multibacillary leprosy: a comparative evaluation

Involvement of peripheral nerves in patients with leprosy results in sensory, motor and autonomic dysfunctions along with deformities and disability. Pattern of nerve involvement is different for different forms of leprosy. In this study, we evaluated and compared the nerve conduction parameters of paucibacillary leprosy with that of multibacillary leprosy. In this study, 40 consecutive patients of leprosy (19 cases of paucibacillary and 21 cases of multibacillary leprosy) were included. Nerve conduction studies were performed according to the standard procedure described in the manual of the machine. We observed that patients with multibacillary leprosy had significantly more severe changes in nerve conduction parameters as compared to that of paucibacillary leprosy. In paucibacillary leprosy, the dominant pattern of nerve involvement was that of mononeuropathy, however, in 6 paucibacillary cases the nerve involvement was in form of mononeuritis multiplex. Electrophysiological assessment also revealed involvement of clinically uninvolved nerves. Nerve conduction parameters were suggestive of mixed axonal as well as demyelination of the peripheral nerves.     

麻风无痛性神经炎早期发现的研究

目的 :　了解麻风无痛性神经炎在各型及实施MDT治疗的不同时期的发生情况。方法 :　定时测试周围神经的感觉和运动功能 ,前后对照 ,以发现早期无痛性神经炎。结果 :　观察 4 5 6例MDT治疗期 ,监测期及解除监测期患者 ,发现无痛性神经炎 4 8例 ,累计检出率 10 .5 3%。治疗期患者的发生率明显高于监测期及解除监测期患者 (P <0 .0 1) ,尺神经和胫神经检出率明显高于其它神经 (P <0 .0 1)。结论 :定期检测周围神经功能 ,早期发现无痛性神经炎十分重要     

Ulnar and median nerves in paucibacillary leprosy--a follow-up study of electrophysiological functions in patients before and after nerve trunk decompression

Electrophysiological functions of ulnar and median nerves in paucibacillary leprosy patients were studied. Patients who showed deterioration of sensory motor functions in spite of steroid therapy were offered nerve decompression together with oral steroids. On periodic follow-up of those who opted for surgery, it was observed, in general, that NCV and amplitude remained reduced even though clinical recovery occurred. Only 80% recovery of electrophysiological functions was seen (as compared to control levels), even in cases that showed good results. Motor function recovered better than sensory function. Complete electrophysiological recovery, if it occurs at all, takes much longer than clinical recovery.     

Clinical and electrophysiological evaluation of nerve function impairment following cessation of multidrug therapy in leprosy.

Seventeen multibacillary (MB) and 15 paucibacillary (PB) cases of leprosy who had had regular and adequate multidrug therapy (MDT) were examined clinically and electrophysiologically at periodic intervals for 1 year following cessation of MDT. All the major nerves were assessed for nerve function impairment (NFI). Overall, two MB (13.3%) and three PB (20%) cases showed signs of deterioration clinically and/or electrophysiologically. The nerve conduction (NC) follow-up studies revealed no significant improvement in the sensory conduction in both the MB and PB groups of nerves, whilst motor conduction showed a significant improvement at the first 6-monthly follow-up among the MB group of nerves. At the study onset, sensory impairment (MB = 62%, PB = 25%) predominated over motor in terms of both severity and frequency. The lower extremity was more frequently and severely affected than the upper in both groups of patients. As an individual test, NC measurement proved to be more sensitive in detecting NFI, but the combination of physical palpatation for nerve thickening and graded nylon test (GNT) was closely comparable to measurement of nerve conduction.     

腹腔镜在腹部创伤早期诊治中的作用

目的探讨腹部创伤应用腹腔镜诊断及治疗的方法。方法对45例腹部创伤患者进行腹腔镜探查,其中闭合性腹部损伤36例,开放性腹部损伤9例。入院时18例有明显的腹膜刺激征,14例超声示腹腔积液,18例腹穿阳性,8例腹透见膈下游离气体,有失血性休克表现5例。结果发现腹部多脏器伤17例,单脏器伤28例。肝破裂12例,脾破裂9例,小肠破裂15例,结肠破裂4例,肠系膜血管破裂出血6例,大网膜血管破裂出血3例,腹膜后血肿9例,阴性探查5例。9例肝破裂缝合修补加填大网膜止血,3例肝破裂因损伤严重中转开腹手术。3例边缘型脾破裂行缝合修补术,6例脾破裂损伤接近脾门伴活动性出血而行睥切除。10例小肠破裂5例直接缝合修补,5例较严重的小肠广泛损伤加腹壁小切口将损伤肠管提出切口外行部分肠切除吻合。4例结肠破裂均中转开腹手术,其中1例升结肠破裂行破口修补,3例降结肠损伤行肠修补加肠外置术。6例肠系膜血管破裂出血及3例大网膜血管破裂均行缝扎止血。9例腹膜后血肿未作处理。术后无并发症,所有病例均治愈出院。结论腹腔镜用于诊治腹部创伤安全、准确、并发症少,对早期难以确诊的腹部创伤具有优越性。     

Nerve function impairment in leprosy: design, methodology, and intake status of a prospective cohort study of 2664 new leprosy cases in Bangladesh (The Bangladesh Acute Nerve Damage Study).

The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study designed to investigate epidemiological, diagnostic, therapeutic and operational aspects of acute nerve function impairment in leprosy. The study is based at a single centre in Bangladesh, in an area with a high prevalence of leprosy. The centre, Danish Bangladesh Leprosy Mission, has a well-established vertical leprosy control programme. In this paper, the study design and methodology are described, together with definitions of nerve function impairment (NFI) used in this and subsequent papers. The study recruited 2664 new leprosy cases in a 12-month period. The male:female ratio is 1.25:1, and 17.61% of the cohort are under 15 years of age. In all, 83.33% of the cohort are paucibacillary (PB), and 16.67% multibacillary (MB). However, the MB rate amongst males is 19.72%, and amongst females is 12.85%, despite an equal period of delay to diagnosis. 55% of patients presented for treatment within 12 months of developing symptoms 6.12% of the total number of cases were smear positive, and 36.71% of the MB cases were smear positive. 9.61% of the total number of cases were graded as having World Health Organisation (WHO) disability grade 1, and 5.97% had grade 2. Amongst MB cases, 27.48% had WHO grade 1 disability present, and 18.24% had grade 2 present, compared with 6.04% and 3.51%, respectively, amongst PB cases. A total of 11.90% of the cohort had sensory NFI of any kind, and 7.39% had motor NFI. Ninety patients presented with NFI needing treatment (3.38%), and of these, 61 (67.78%) had silent NFI. MB patients had a prevalence of reaction/NFI needing treatment nearly 7 times higher than PB cases (15.32% amongst MB; 2.30% amongst PB), and males nearly double that of females (5.67% amongst males, 2.96% amongst females). The most commonly affected nerve by function impairment was the posterior tibial (sensory) with 6.46% of nerves affected (9.38% of patients), followed by the ulnar nerve with 3.23% of nerves impaired (5.56% of patients). Future research and publications, building on this foundation, will focus on the following areas: the incidence of NFI and reactive events, the risk factors for developing NFI, and the response to treatment of patients developing acute NFI.     

麻风病神经损伤分子机制的研究进展

麻风病的神经病变是导致患者残疾、丧失劳动力而成为公共卫生问题的关键。为早期预测神经损伤,研发防止或干预神经损伤的药物,本文综述麻风杆菌侵犯人外周神经施万细胞后导致的免疫炎性反应、脱髓鞘与轴损伤等病变的分子机理。另一方面,评述可早期预测神经损伤的生物标记物的研究进展。     

陕西省70例新发麻风患者畸残情况分析

目的：分析陕西省2012-2017年新发麻风患者畸残情况。方法：采集中国麻风防治管理信息系统（LEPMIS）中陕西省新发患者数据，运用WPS office 2007软件建立数据库进行分析。结果：陕西省70例新发麻风患者1级畸残占42.86%、2级畸残占40.00%；周围神经累计损害351条，其中胫神经损害26.00%、尺神经损害25.00%、腓总神经损害19.00%、正中神经损害12.00%、耳大神经损害12.00%、面神经损害4.00%、桡神经损害2.00%、三叉神经损害0.00%；累及手足眼的2级畸残分别有17处、13处、11处。结论：麻风病所致周围神经损害严重的依次是胫神经、尺神经、腓总神经。     

Fine needle aspiration cytology (FNAC) of nerves in leprosy

Leprosy is primarily a disease of the peripheral nerves and a technique that is simpler than nerve biopsy is required to evaluate nerve involvement, especially in pure neuritic (PN) leprosy. This study was designed to evaluate the role of FNAC of the nerve in the diagnosis and classification of leprosy. A prospective study was carried out on 25 patients with clinically active leprosy and at least one thickened peripheral sensory nerve. Nerve aspirates were evaluated by May-Grunwald-Giemsa and Fite's staining. Lepromin test, slit skin smears (SSS), skin biopsies (except PN cases) and nerve biopsies were performed and compared with FNAC. FNAC of nerve from 23 cases (92%) yielded diagnostic aspirates. Acid fast bacilli were observed in six cases by FNAC. FNAC and nerve pathology were equally comparable with the other parameters evaluated. Based on the results, cytological criteria were developed for interpreting nerve aspirates and the cases were classified as paucibacillary (18), BB (2), BL (2), LL (1) and non-diagnostic (2). All PN cases showed diagnostic paucibacillary type cytology. FNAC of the nerve yields diagnostic aspirates in leprosy comparable with nerve pathology and the proposed cytological criteria may be useful in classification of nerve aspirates.     

Nerve thickening in leprosy patients and risk of paralytic deformities: a field based study in Agra, India

This paper examines the extent of nerve thickening among leprosy patients detected in the field in Agra district. All the clinically diagnosed leprosy patients were examined in detailed for thickening of local cutaneous nerves and peripheral nerve trunks. In each case all the major nerve trunks in both upper and lower extremities, forehead and neck were examined for thickening. Nerve thickening was found in 94% of multibacillary (MB) patients and among 52% paucibacillary (PB) patients. Nerve thickening was found to be more in males, in prevalent cases than in new (untreated) cases and increased significantly with age and delay in diagnosis (P<0.001). Visible deformities of grade > or =2 were found in 10% (58/573) of the leprosy patients; paralytic deformity accounted for 78% (45/58). Claw hand alone or in combination was seen in 82% (37/45) of patients with paralytic deformities. Risk (odd ratio) for deformities was observed to be high (15-18 times) with increasing number of nerves among patients with neuritic leprosy but correlated with delay in diagnosis of over 5 years. Likewise, deformities were more often seen in those with skin lesions, provided they had > or =3 thickened nerves. Findings suggest that early detection and treatment is useful in preventing deformities.