静脉淋巴管复合组织瓣移植在治疗下肢继发性淋巴水肿中的作用

目的：探讨大隐静脉淋巴管脂肪复合组织移植在治疗阻塞性淋巴水肿中的作用。方法：单侧阻塞性淋巴水肿患者10例分别于术前、术后2周以及术后半年进行肢体周径测定、同位素淋巴管造影检查。5例应用大隐静脉淋巴管复合组织结合负压抽吸治疗（A组），5例行单纯肢体淋巴水肿负压抽吸治疗（B组）。结果：A组术后2周肢体周径较术前明显缩小（P〈0．05）；半年后肢体周径与术前比较亦明显改善（P〈0．05）；而术后2周与术后半年的肢体周径无明显变化（P〉0．05）。同位素淋巴管造影显示淋巴回流有不同程度改善。B组肢体周径半年内改善较明显，但淋巴回流改善不明显。结论：采用带蒂大隐静脉淋巴管复合组织瓣移植结合负压抽吸治疗单侧肢体继发性淋巴水肿在临床上具有一定的可行性。     

下肢深静脉血栓形成的预防性治疗与护理

目的 评价对具有下肢深静脉血栓形成的高危因素患者进行恰当的预防性治疗与护理的临床意义。方法 对近期医学文献进行回顾性分析总结。结果 随着诊断技术的提高,临床发现住院患者中下肢深静脉血栓形成的发病率逐渐升高,特别是具有各种高危因素的患者。下肢深静脉血栓形成可导致深静脉血栓后综合征,给患者带来痛苦,严重者可发生肺栓塞,危及患者生命。近年来,低剂量肝素和小分子量肝素的应用安全、有效,对下肢深静脉血栓形成预防性治疗具有重要作用。结论 对于具有高危因素的患者,应加强护理,做好深静脉血栓形成的早期诊断及预防性治疗,避免严重并发症的发生。     

淋巴管静脉吻合治疗肢体获得性淋巴水肿临床效果

  目的  探讨应用淋巴管静脉吻合治疗肢体获得性淋巴水肿的初步治疗效果。  方法  2013年9月至2014年8月在北京协和医院整形外科应用淋巴管静脉吻合进行治疗的肢体获得性淋巴水肿患者15例, 其中单侧肢体淋巴水肿12例, 双侧肢体淋巴水肿3例。术前应用吲哚菁绿荧光显像明确淋巴水肿分期及淋巴管通畅度。应用显微外科技术, 根据患肢水肿位置确定每例患者拟吻合的平面及吻合数目。术前术后在相同位置进行患侧肢体周径测量, 计算周径减少度。  结果  15例患者淋巴管静脉吻合手术均顺利完成。术后随访6~10个月(平均8.3个月), 上肢肢体周径减少度33.7%, 下肢周径减少度20.0%, 所有患者术后均再无淋巴管炎发生。  结论  淋巴管静脉吻合可用于治疗早期可凹性淋巴水肿, 术前经淋巴管荧光造影明确淋巴管通畅、无纤维化的淋巴水肿可以获得良好的治疗效果。     

Puncture Wound to Right Lower Extremity With Ecchymosis

This case report presents a 35-year-old man who comes to the emergency department in South Florida with a chief complaint of pain, redness, and puncture wound to the right lower extremity. The pain is radiating upward and began 40 minutes before arrival. It is described as severe, with associated ecchymosis, edema, and erythema.     

Lecture 16 ORTHOTICS Bracing the Lower Extremity

A long leg brace allows patients to walk despite weakness. When prescribing a brace, the physician should consider its six components—trunk attachment, thigh piece, knee joint, calf piece, ankle joint and foot piece. Short leg braces and foot braces pose different problems, but, like the long leg brace, they should be comfortable, durable and accomplish their purpose.     

POEMS综合征合并慢性肾功能不全行肾穿刺术后心脏骤停1例护理

POEMS综合征是由于浆细胞瘤或浆细胞增多引起的多系统器官损害的临床综合征,临床表现为多发性神经病(polyneuropathy)、脏器肿大(organomegaly)、内分泌病(en-docrinopathy)、M蛋白(M-protein)和皮肤改变(skin changes)等.POEMS综合征是一种罕见的克隆性浆...     

梯度压力治疗仪对预防乳腺癌术后患肢淋巴水肿的效应

目的探讨运用梯度压力治疗仪对乳腺癌术后患肢淋巴水肿的发生与功能恢复作用。方法将100例Ⅱ～Ⅲ期乳腺癌且行乳腺癌改良根治术后康复患者随机分为对照组和试验组,各50例。2组均行常规乳腺癌术后护理并由专业护士指导按照临床康复路径进行康复锻炼,试验组配合梯度压力治疗仪治疗护理。观察2组患肢周长及肩关节活动度。结果试验组患者淋巴水肿发生率明显低于对照组(p<0.01);肩关节前屈、后伸、外展及内收的活动范围显著增加(p<0.01)。结论梯度压力治疗仪运用于乳腺癌术后患者可明显降低患肢淋巴水肿的发生率,减轻患肢肌肉的疲劳,促进患肢功能恢复,提高生活质量。     

下肢肌肉训练计划在下肢静脉溃疡患者创面治疗中的应用

目的评价下肢肌肉训练计划在下肢静脉溃疡患者创面治疗的效果。方法2018年7月至2020年6月,便利抽样法选择在某院治疗的下肢静脉溃疡患者72例为研究对象.按随机数字表法将其分为对照组和观察组,每组36例。对照组接受常规护理、创面治疗以及压力治疗;观察组在对照组的基础上实施下肢肌肉训练。两组随访治疗6个月,比较两组患者压疮愈合计分量表(pressure ulcer scale for healing,PUSH)计分、踩-后足评分系统(ankle hindfoot scale,AOFAS)评分、细菌培养计数、伤口愈合率及创面复发率。结果两组患者脱落率分别为13.9%和11.1%,差异无统计学意义(P>0.05)。两组患者PUSH计分、AOFA S评分和细菌培养计数在组间效应、时间效应和交互作用上均存在统计学意义(均P<0.05)。两组患者在1个月和6个月时创面愈合率,差异无统计学意义(P>0.05);3个月时创面愈合率,差异有统计学意义(P<0.05);随访期内对照组患者创面复发6例,观察组复发1例,差异有统计学意义(P<0.05)。结论下肢肌肉训练计划可加速下肢静脉溃疡创面愈合且降低复发率,是行之有效的辅助治疗手段。     

Lower Extremity Muscle Injuries in the Overhead Athlete

Purpose of ReviewLower extremity (LE) injuries are a common source of disability and time-loss for overhead athletes, and muscles have been found to be the predominant soft tissue structure affected. The current review highlights the orthopaedic literature examining lower extremity muscle injuries in overhead athletes in regard to epidemiology, diagnosis, and conventional and emerging treatment measures.Recent FindingsThe hamstring muscles have been found to be the most commonly injured lower extremity muscle group in professional baseball, followed by the adductors, quadriceps, iliopsoas, and gastrocnemius-soleus complex. Strains and contusions comprise over 90% of these muscle injuries. Various advanced imaging grading systems have been developed to help characterize the nature of a muscle injury, although a clear and consistent prognostic utility of these systems is still unclear. The vast majority of lower extremity muscle injuries in overhead athletes are managed nonoperatively, and there is promising data on the use of emerging treatments such as platelet-rich plasma and blood flow restriction therapy.SummaryLower extremity muscle injuries—often referred to as strains—are a relatively common issue in high-demand overhead athletes and can be a significant source of time-loss. Within baseball, position players are affected far more often than pitchers, and sprinting and fielding are the most common activities leading to strains. Magnetic resonance imaging (MRI) is considered the gold standard imaging modality to evaluate these muscle injuries and will allow for a detailed assessment of tissue damage. Nonetheless, return-to-play is often dictated by a given athlete’s progression through a nonoperative rehabilitation protocol, with surgical intervention reserved for less common, select injury patterns.     

脑梗塞后遗症病人的护理

脑梗塞是中老年人的常见病、多发病之一。此病发病急 ,病程长 ,疗效慢 ,致残率高 ,给病人心理上造成很大的精神压力。几年来 ,我所家庭病房对脑梗塞后遗症病人给予针对性护理 ,收到了一定成效。现将其护理总结如下。1　临床资料　　我所家庭病房自 1999年 1月— 2 0 0 1年 1月共收治脑梗塞后遗症病人 2 8例 ,男 2 2例 ,女 6例 ,年龄 40岁～ 70岁 ,均有不同程度的语言及肢体活动障碍 ,生活不能自理。2　护理2 .1　心理指导　解除病人的不良心理 ,调整心理平衡 ,让病人认识疾病的性质 ,端正对疾病的态度 ,从而促进健康的恢复 ,这是心理护理的…