皮瓣和肌皮瓣移植加创面灌洗修复截瘫后多发性压疮

背景:压疮是截瘫患者的常见并发症,严重的压疮通过保守治疗难以治愈。目的:观察皮瓣和肌皮瓣加创面灌洗治疗截瘫患者多发性压疮的修复效果。方法:纳入2007-01/2010-12在北京积水潭医院烧伤整形科治疗的16例多部位严重压疮的截瘫患者,均伴有不同程度的骨质破坏。手术中彻底扩创,去除死骨、瘢痕及感染肉芽组织,以皮瓣或肌皮瓣覆盖创面,术后灌洗治疗。结果与结论:纳入的16例患者创面全部Ⅰ期愈合,出院3个月后随访,修复部位压疮均未出现复发。说明皮瓣和肌皮瓣修复加创面灌洗治疗对截瘫患者压疮有良好的修复效果。     

皮瓣和肌皮瓣移植加创面灌洗修复截瘫后多发性压疮

背景：压疮是截瘫患者的常见并发症,严重的压疮通过保守治疗难以治愈。目的：观察皮瓣和肌皮瓣加创面灌洗治疗截瘫患者多发性压疮的修复效果。方法：纳入2007-01/2010-12在北京积水潭医院烧伤整形科治疗的16例多部位严重压疮的截瘫患者,均伴有不同程度的骨质破坏。手术中彻底扩创,去除死骨、瘢痕及感染肉芽组织,以皮瓣或肌皮瓣覆盖创面,术后灌洗治疗。结果与结论：纳入的16例患者创面全部Ⅰ期愈合,出院3个月后随访,修复部位压疮均未出现复发。说明皮瓣和肌皮瓣修复加创面灌洗治疗对截瘫患者压疮有良好的修复效果。     

Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants

The purpose of this review of the literature was to investigate the functional range of motion requirements of non-Western populations in respect to artificial hip and knee joint implants. It was discovered that in Asia and the Middle East many activities are performed while squatting, kneeling, or sitting cross-legged. These positions demand a greater range of motion than that typically required in Western populations. For example, authors report that to squat one requires 130 degrees-full hip flexion and 111 degrees-165 degrees (or full) knee flexion. To sit cross-legged one requires 90 degrees-100 degrees hip flexion and 111 degrees-165 degrees (or full) knee flexion. This study identified a lack of documented research in this area, and the research that has been done provided inconsistent data. Potential reasons for discrepancies in the data are discussed, including the use of different methods to collect range of motion measurements, unclear use of terminology, and variations in normal passive and active range. In conclusion, this study stresses the importance of culture and function in the design and use of any new joint or product.     

Measuring seated hip extensor strength using a handheld dynamometer: an examination of the reliability and validity of the protocol

[Purpose] The purpose of this study was to examine the reliability and validity of measurements of hip extensor muscle strength using a handheld dynamometer (HHD) with subjects in a sitting position. In doing so, we also aimed to establish a modified method of measurement for patients with flexion contractures in the trunk and lower extremities. [Subjects and Methods] In 20 healthy males, hip extensor muscle strength was measured using a handheld dynamometer in sitting, prone, and standing positions by contracting the hip extensor muscle isometrically with the knee flexed at 90 degrees. For each position, we investigated the relative and absolute reliability and validity of the measurements, and compared muscle strength between the different positions. [Results] The reliability and validity of measurements were highest in the sitting position and higher in both the sitting and standing positions as compared with those in the prone position. [Conclusion] Our findings suggest that measurements taken in a sitting position are accurate in assessing hip extensor muscle strength and would be applicable to patients with flexion contractures in the trunk and lower extremities.Key words: Hip extensor strength, Reliability, Bland-Altman analysis     

负压封闭引流技术在骨科创面修复中的临床应用

目的探讨负压封闭引流术(VSD)治疗严重皮肤损伤的临床疗效;总结VSD技术在骨科损伤中的修复特点。方法对韶关市粤北人民医院骨科收治的45例严重皮肤损伤(复杂创面)患者均使用VSD治疗。结果所有患者创面均得到了完全愈合,其中28例患者行1次VSD引流术后,创面肉芽组织生长良好,肉芽组织红润,颗粒细小,血运丰富,行第2次植皮后植皮成活,创面闭合良好,手术均取得了成功;13例患者行第2次VSD负压引流后,创面肉芽组织生长良好,肉芽组织红润,颗粒细小,血运丰富,行邮票植皮后取得成功;3例骨髓炎患者,经过2次清创VSD引流后,第3次使用皮瓣转移技术最后闭合创面;1例足背肌腱外露的患者因不愿做皮瓣,用VSD负压技术促进肉芽组织生长,经过3次VSD负压引流后,肉芽组织生长良好,配用生肌膏后肌腱全部覆盖肉芽组织,植皮后创面闭合。结论 VSD技术是治疗严重四肢大面积皮肤损伤较好的处理方法。     

Application of damage control surgery in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis

ObjectiveTo evaluate the clinical application of damage control surgery (DCS) in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis.MethodsWe conducted a 3-year retrospective clinical study of 32 patients with deep sacrococcygeal bedsores and sepsis admitted from January 2018 to January 2021. According to the concept of DCS, the wound was temporarily closed with vacuum sealing drainage after primary debridement, and a local rhomboid flap was designed to repair the wound in the second stage. Finally, the clinical therapeutic effect was observed.ResultsTwenty-nine patients were treated with skin flap translocation and were cured clinically. Specifically, the skin flap survived in 27 of the 29 patients after the first translocation attempt (success rate of 93.1%). One patient developed incisional dehiscence, and one patient developed a hydrocele under the skin flap.ConclusionsApplication of DCS in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis improves the therapeutic success rate and reduces the risks of the operation and complication rate. It has unique advantages and is worthy of clinical promotion.     

Development and testing of a pelvic goniometer designed to measure pelvic tilt and hip flexion

OBJECTIVE: To determine the reliability and validity of a pelvic goniometer designed to measure the pelvic tilt and hip flexion during seated posture. BACKGROUND: Assessment of the seated posture requires measurement of the pelvis and hip. Determining accurate pelvic tilt and hip flexion angles during sitting is often difficult using standard techniques. A pelvic goniometer has been designed to measure pelvic tilt and hip flexion angle of persons in a seated posture. METHODS: Validation of the pelvic goniometer was done radiographically. Ten male volunteers sat in three postures--erect, forward or anterior tilt, and posterior tilt. Pelvic tilt and hip angle were recorded using radiographs and the pelvic goniometer. Reliability of pelvic and conventional goniometers was done using seated nondisabled subjects with physical therapists performing measurements. RESULTS: Validation: the average differences and correlation between the pelvic goniometer and radiographic measures were as follows--pelvic tilt: -4.9 degrees, 0.93; hip angle 1.2 degrees, 0.81. Reliability: average range of hip angle across three measures was about 3 degrees for both goniometers. CONCLUSIONS: The data indicate that the pelvic goniometer has utility in measuring pelvic tilt and hip angle, especially within the seated posture. Because it measures both pelvic tilt and hip angle, the pelvic goniometer has an advantage over conventional goniometers that only measure the latter. RELEVANCE: A valid and reliable tool that measures pelvic tilt and hip angle of persons in a seated posture is needed for clinical research and practice. Its applications include wheelchair seating evaluations and ergonomic assessments of seated workers.     

瘢痕性秃发的皮瓣修复

【目的】探讨瘢痕性秃发的皮瓣修复方法。【方法】1998年2月至2008年7月收治由外伤、烧伤、溃疡、疖肿等所致的瘢痕性秃发患者37例，其中2例行分次切除缝合，4例行秃发区切除＋局部头皮瓣转移修复，31例行头皮扩张术修复。修复瘢痕性秃发最大面积22．3cm×25．8cm。【结果】除1例扩张头皮瓣部分坏死，行二期头皮扩张，扩张头皮瓣转移修复。其余皮瓣均完全成活，术后随访2年，效果满意。【结论】头皮扩张，扩张头皮瓣转移是修复瘢痕性秃发的一种有效方法。     

Comparison of the Lumbar Flexion Angle and EMG Activity in Trunk Muscles in Individuals with and without Limited Hip Flexion Range of Motion during Visual Display Terminal Work with Cross-Legged Sitting

[Purpose] The purpose of this study was to compare the lumbar flexion angle and electromyography (EMG) measurements of trunk muscle activity in individuals with and without limited hip flexion range of motion (ROM) during visual display terminal (VDT) work with cross-legged sitting. [Subjects] The 15 participants included a control group with sufficient hip flexion ROM (n = 7) and an experimental group with limited hip flexion ROM (n = 8). [Methods] All subjects performed VDT work with cross-legged sitting. The lumbar flexion angle was measured using a three-dimensional motion capture system, and the trunk muscle activity was recorded using a surface EMG system during VDT work with cross-legged sitting. The differences in trunk flexion angle and trunk muscle activity between the two groups were analyzed using independent t-tests. [Results] The lumbar flexion angle was significantly greater in the experimental group than the control group, although trunk muscle activity did not differ between the two groups. [Conclusion] These findings suggest that limited hip flexion leads to greater lumbar flexion during cross-legged sitting.Key words: Cross-legged sitting, Electromyography, Lumbar flexion     

腰骶筋膜皮瓣治疗骶部压疮

目的分析研究腰骶筋膜皮瓣治疗骶部压疮的临床效果。方法根据骶部压疮形状,分别应用横形和菱形腰骶筋膜皮瓣转移治疗骶部压疮18例。结果本组18例术后皮瓣全部成活,其中创面一期愈合16例,伤口部分裂开2例,总愈合率达88.9%。16例获随访,14例皮瓣良好,2例复发,经肌皮瓣转移好转,复发率为12.5%。结论腰骶筋膜皮瓣治疗骶部压疮具有操作简单,安全、可靠的优点,可作为临床治疗骶部压疮的首选。     

CO2 laser sterilization in the surgical treatment of infected median sternotomy wounds

BACKGROUND: We examined the use of CO2 laser sterilization in the surgical treatment of infected median sternotomy wounds. Deep wound infection after median sternotomy is infrequent (1% to 5% of all cases) but is associated with significant morbidity, mortality, and cost. METHOD: Twenty-four consecutive patients with median sternotomy wound infection were treated by one plastic surgeon using a CO2 laser to sterilize wounds after debridement and before flap closure. The rectus abdominis muscle flap was primarily used, but the choice of muscle flap was case dependent. RESULTS: To date, no patient in this series has had postoperative wound infection, breakdown, or flap loss. One patient did have superficial skin loss. CONCLUSION: Although the morbidity rate was 17%, all patients had intact wounds. None of the 5 deaths was related to wound infection. We found that CO2 laser sterilization in the surgical treatment of sternal wound infections decreased morbidity, mortality, and cost.     

An Examination of Limb Position for Measuring Toe-grip Strength

[Purpose] The purpose of the present study was to investigate the limb position at which the maximum toe-grip strength could be exerted as well as measurement reproducibility. [Subjects] Twenty healthy young women were selected. [Methods] We measured toe-grip strength under three conditions: 90° hip and knee flexion while sitting, 90° hip flexion and knee extension while sitting, and a standing position. [Results] We found that toe-grip strength was significantly lower in the 90° hip flexion and knee extension sitting position than in the 90° hip and knee flexion sitting position and standing position. Moreover, the 90° hip and knee flexion sitting position produced the best intraclass correlation coefficient (r = 0.813). [Conclusion] The results suggest that 90° hip and knee flexion while sitting is the most suitable limb position for measuring toe-grip strength, as this position allows maximum strength to be exerted and allows measurements to be repeated.Key words: Toe-gripping strength, Reproducibility, Healthy females     

Improving outcomes in the elderly after pressure ulcer repair.

Pressure ulcer repair with skin or muscle flaps may appear to close the wound, but elderly patients need extra precautions before and after surgery to improve the outcome. Nursing care of these patients include monitoring nutrition, removing devitalized tissue from the wound bed, providing proper pressure relief, administering proper patient positioning, and monitoring the flap.     

Preexpanded vertical trapezius musculocutaneous flap for reconstruction of a severe neck contracture after burn injury.

Preexpanded flaps are a method to replace a larger postburn contracture area. We describe the use of a preexpanded vertical trapezius musculocutaneous flap for reconstruction of a severe mentosternal contracture in a 10-year-old male patient with second- to third-degree burn wounds. A 500 cm(3) rectangular-shaped tissue expander was inserted under the trapezius muscle via a lateral incision in first stage. Two months later, after serial expansion of the expander, the neck scar was excised. The preexpanded flap (size = 27 x 9 cm) was harvested and rotated into the defect. The donor site could be closed primarily. The flap totally survived. The hospital stay was 7 days. After 6 months follow-up, a significant improved range of motion with good esthetic outcome was achieved. The use of a preexpanded trapezius flap can provide thin, large, and pliable tissue for reconstruction of a severe mentosternal scar contracture with excellent functional outcomes.     

The snapping iliopsoas tendon

Herein we describe a previously seldom recognized variety of snapping hip, which is caused by snapping of the iliopsoas tendon over the iliopectineal eminence when the femur is moved from the flexed position at the hip and extended through 45 degrees of flexion. The finding is demonstrated with the patient supine and gently resisting gravity with the iliopsoas muscle, thus placing it under tension. At approximately 45 degrees of flexion, the iliopsoas tendon in two patients was confirmed radiographically to snap abruptly, coincident with an audible sound over the iliopectineal eminence of the pelvis. We believe that this occurs relatively frequently and is generally asymptomatic.     

Twice-weekly complete decongestive physical therapy in the management of secondary lymphedema of the lower extremities

BACKGROUND AND PURPOSE: This case report describes the physical therapist examination, evaluation, and intervention for a patient with bilateral lower-extremity lymphedema who received complete decongestive physical therapy 2 days per week instead of the recommended daily frequency. CASE DESCRIPTION: The patient was a 55-year-old woman who developed bilateral lower-extremity grade II lymphedema 3 years after surgery and radiation for cervical cancer. She had impairments in hip and knee flexion range of motion and functional limitations in transfers, gait, and activities of daily living. Intervention. A twice-weekly intervention program was implemented consisting of education in skin care, manual lymph techniques, compression, and exercise. OUTCOMES: Outcomes related to the lymphedema were measured using the sum of the circumference of each limb. At discharge, the patient had reductions in lymphedema of 9% for the left lower extremity and 10% for the right lower extremity. Her hip flexion range of motion increased from 95 degrees to 110 degrees, and her knee flexion range of motion increased from 95 degrees to 130 degrees. She had resumed all premorbid activities and was independent in self-management. DISCUSSION: Twice-weekly management of lymphedema using a program of skin care, manual lymph techniques, compression, and exercise was followed by reduction of the impairments and functional limitations in a patient with bilateral lower-extremity lymphedema.     

VAC联合腓肠神经营养血管皮瓣修复足踝部创面的疗效观察

目的探讨封闭负压引流技术（vacuum—assisted closure,VAC）联合腓肠神经营养血管皮瓣修复足踝部损伤,皮肤缺损创面的临床疗效。方法2005年12月至2009年3月本科收治的22例腋部皮肤缺损的患者,男16例,女6例。年龄18～58岁;早期扩创后采用VAC待肉芽组织形成后,用腓肠神经营养血管皮瓣修复足踝部创面。皮瓣范围5cm×8cm至8cm×12cm。结果1例远端皮瓣下出现慢性瘘道,经换药后创口闭合,皮瓣成活良好。其余患者皮瓣成活,切口均一期愈合,小腿供区愈合良好。结论VAC促进创面局部血运,肉芽形成,清洁创面,抑制细菌生长,减少感染,为皮瓣修复提供了良好的组织床。VAC联合腓肠神经营养血管皮瓣是修复足踝部创面的良好方法之一。     

Proximal femoral focal deficiency: a clinical appraisal.

In patients with unilateral proximal femoral focal deficiency, the leg length inequality is almost always greater than five inches at skeletal maturity. Consequently, prosthetic management should be planned before the patient walks. A standard plan of treatment of the patient with unilateral PFFD is not possible at this time, primarily because of the varying percentage of femur missing and the controversy of management of the hip in patients with type A or B deformity. However, we found that ankle disarticulation with Syme flap closure combined with arthrodesis of the knee is a reasonable plan in many patients with unilateral PFFD. This allows correction of the knee and hip flexion contractures and gives the patient a functional, cosmetic stump. By the time he begins school, he is functioning as an above-knee amputee. This is not an undesirable goal, as one of us (E.G.R.) recently examined an above-knee amputee, a Captain in the United States Army, who continued his hobby of sky diving.     

负压封闭技术治疗下肢慢性大面积溃疡24例机制研究

目的:下肢慢性溃疡采用传统换药方法效果不佳,负压封闭技术(vacuumsealing,VS)治疗下肢慢性大面积溃疡的机制及疗效有待探讨。方法:24例患者接受VS治疗,清创后将Vacuseal材料覆盖在相应大小的创面上,接50～60kPa的负压,5～7d后植皮或皮瓣转移。结果:24例患者完全治愈,无一例因使用VS死亡,无全身和局部并发症发生;与传统换药方法比较,在植皮或皮瓣转移的时间、换药次数、总体治疗费用等方面差异均有显著性意义(P<0.01)。通过采用局部转移皮瓣关闭5个,植皮关闭19个。结论:VS能防止创面污染,充分引流和剌激创面肉芽组织快速和良好生长。     

Motor reaction time as a measure of rapid force generation of a muscle

Motor reaction time (MT) of the vastus medialis, latency from the EMG onset to initiation of the actual movement of the lower leg, was examined for 19 normal subjects during rapid extension of the knee joint at various angles from 90 degrees to 0 degrees in the sitting posture. Muscular tension produced by maximal voluntary contraction (MVC) was measured at 80 degrees of the knee joint for 19 subjects. Also, EMG activities during period of MT were integrated at each angle of the knee for five subjects. MT correlated linearly with the integrated EMG, indicating that MT was a variable representing muscular force required for initiation of the movement. MT increased with extension of the knee and the increment was attributed to the increased effective load of the lower leg due to gravity in the range from 90 degrees to 30 degrees of knee flexion. Thus, MT could be defined solely by the external load against the movement in the mid-range of the joint angle. Moreover, at 80 degrees knee flexion MT did not relate to MVC. It is suggested that MT provides a useful means to evaluate a muscular function in rapid movement and is applicable to both normal and pathological situations.