布带的力学性能测试分析

布带的约束力是夹板固定力的直接来源 ,在布带的约束力作用下 ,骨折的远近端与夹板连接成一个整体 ,恢复了肢体骨干的杠杆作用。使伤肢在骨折治疗过程中能进行适当的功能活动 ,促进骨折的愈合和功能的恢复。而布带对夹板的约束力是依靠布带的张力来维持的 ,所以布带在张力状态下的力学性质决定着夹板固定的稳定性及并发症的发生率[1] 。本实验对布带在拉伸载荷下进行测定 ,以确定其相应载荷下的变形和蠕变特性。1　材料与方法布带由天津医院小夹板治疗中心提供。测量布带的长度 ,采用“负荷法” ,即在一定的外力 (0 5ｋｇ)作用下测量。因布…     

纸压垫的力学性能测试和优化分析

纸压垫是夹板局部外固定系统的重要组成部分 ,它把布带的约束力和夹板的弹性固定力转变为纠正和防止成角或侧方移位的直接效应力。是小夹板局部外固定治疗骨折的主导力量和精髓。纸压垫的放置将改变夹板固定力的均匀分布状态 ,大大提高纸压垫放置部位的效应力值 (1.4～ 1.95倍 ) [1] ,有效的对抗骨折的移位倾向力和维持人体骨骼的正常生理弧度。因此针对骨折移位的倾向 ,合理地放置纸压垫 ,将能起到固定骨折和纠正残余畸形的效果。所以说纸压垫的正确应用和合理选材是小夹板局部外固定治疗骨折所不容忽视的重要问题。临床常用的由毛头纸折叠…     

夹板固定带的研究进展

夹板固定是以固定带、夹板、纸压垫、牵引等装置所组成的局部外固定力学系统，固定带的约束力是夹板固定骨折的动力来源和外载荷。现将临床常用夹板固定带的类型及力学研究进展进行综述，为夹板固定带的现代化改革提供重要的依据。     

夹板外固定治疗前臂双骨折的临床研究

目的 探讨二夹板外固定治疗前臂双骨折的疗效和可行性。方法 自1997年12月至2000年12月,对60例前臂双骨折患者随机分为二夹板组和四夹板组,分别予以手法复位和二夹板或四夹板(连旋中板共五块夹板)外固定治疗。结果 二夹板组与四夹板组外固定疗效差异无显著性,解除夹板后前臂旋转功能、腕关节功能恢复时间均为3～6个月。结论 二夹板外固定治疗前臂双骨折疗效满意,与传统的四夹板外固定比较,具有简便、易掌握等特点,值得临床推广和使用。     

塑性弹力夹板治疗桡骨远端骨折91例临床观察

[目的]探讨塑性弹力夹板治疗桡骨远端骨折的临床疗效.[方法]按照国家中医药管理局对“十一五”重点专科专病建设主攻病种验证方案的要求,应用塑性弹力夹板在3家建设单位进行临床验证.评价指标包括对肢体肿胀程度、疼痛情况、功能及放射学评价等多方面数据,借以评价临床疗效.观察周期结束后3个月按照《中华人们共和国中医药行业标准-中医骨伤科病症诊断疗效标准》进行评估.[结果]统计学处理显示在治疗期间的各阶段疼痛均有显著、持续改善.在拆除外固定后1d及3个月时监测前臂和腕关节功能,并与健侧比较,除腕关节屈曲功能第3个月与健侧比较P＝0.399,没有统计学意义,前臂和腕关节各项功能比较P＜0.05,有统计学意义,表明患腕屈曲活动完全恢复到健侧水平.尺偏角、掌倾角、桡骨长度测量中,整复后与拆除后比较,P ＞0.05无统计学意义,表明该夹板在尺偏角和桡骨长度的维持稳定方面具有一定优势.[结论]采用塑性弹力夹板治疗桡骨远端骨折进行中立位固定,对腕关节临床症状、体征和功能改善有确切疗效.     

利多卡因灌注对再植肢体血循危象后成活的影响

利多卡因局部灌注具有保护微小血管内皮细胞及血管平滑肌的超微结构；促进吻合口内皮细胞的愈合及扩张微小血管，防止血管痉挛的作用[１，２］。目前临床上已将利多卡因局部灌注作为显微外科游离组织移植与再植术中常用的解痉药物，并得到良好疗效。然而，对于再植或移植肢体出现血循危象后，再探查时局部运用利多卡因灌注能否有效地改善再植或移植肢体的血循环，解除微循环内的血管痉挛，挽救血循危象后的肢体尚未见报道。近年，我院对１例前臂离断再植，术后出现血循危象后局部运用利多卡因灌注，有效地改善了微循环，使再植肢体得以成活…     

手法整复硬纸夹板外固定治疗前臂双骨折

目的：探讨骨科手法外固定治疗前臂双骨折疗效及并发症。方法：2005年11月至2010年12月,采用骨科手法硬纸夹板外固定治疗前臂双骨折38例,其中男26例,女12例;年龄18～66岁,平均28岁。损伤至手法整复硬纸夹板外固定时间20min～2d,平均8h。施术前患肢肿胀、疼痛、畸形、异常活动,肘、腕屈伸功能及前臂旋转功能障碍,X线片显示均为前臂尺桡双骨折。术后通过对骨折的愈合情况、肘腕的屈伸功能及前臂的旋转功能进行疗效评定。结果：所有患者获得随访,时间3～8个月,平均5.7个月。根据Anderson前臂骨折治疗效果评价分级,优33例,骨折愈合,肘或腕关节的屈伸活动范围丢失〈10%以及前臂旋转丢失〈25%;良5例,骨折愈合,肘或腕关节的屈伸活动范围丢失〈20%以及前臂旋转丢失〈50%。结论：采用骨科手法外固定治疗前臂双骨折固定牢固且不会出现组织压疮及坏死,安全有效,值得临床推广。     

高龄患者桡骨下端骨折小夹板中立位和旋后位固定的康复效果对比

目的对比高龄患者桡骨下端骨折小夹板中立位和旋后位固定的康复效果,寻求一种功能恢复快,并发症少的骨折康复护理方法。方法对桡骨下端骨折高龄患者行前臂小夹板四夹固定,随机分两组:对照组采用中立位固定4~6周;治疗组采用中立位固定,从第3周开始改用旋后位再固定2~4周,3周后掌腕关节不固定,指导患者早期主动前臂旋转及腕关节活动。并分别按桡骨下端骨折护理常规进行护理。结果治疗组伤肢功能恢复时间显著快于对照组(P<0.001),无一例并发症发生。结论治疗组高龄患者桡骨下端骨折小夹板采用中立位固定,从第3周开始改用旋后位固定法,患者早期主动前臂旋转活动,能促进伤肢的功能康复进程。     

《手外科杂志》美国卷2001年第26卷5、6期部分文章的中文摘要

1 .以胶粘剂制作手指局部夹板这里我们向大家介绍一种新近设计的手指局部静止位夹板。夹板是通过将一定长度的金属线用双面胶粘剂包绕而制成的。制动区域的皮肤用含有粘合性的敷料覆盖 ,以利于夹板与之粘合。这种粘合方法使得医者更加自如地选择应用夹板固定的部位 ,同时还能防止固定物遮盖创口、阻碍感觉传导及损害血液循环。这种夹板轻巧、常温下可塑性强。有 5例患者夜间采用这种胶粘剂夹板保持虎口区处于张开位及僵硬的指间关节处于屈曲位。ＶａｌｄａｓＭａｃｉｏｎｉｓＴｈｅＣｌｉｎｉｃｏｆＰｉａｓｔｉｃａｎｄＲｅｃｏｎｓｔｒｕ…     

前臂毁损伤的修复与功能重建

目的 探讨前臂毁损伤的修复与功能重建的方法。方法 采用四种组织瓣对不同程度、不同组织缺损的前臂毁损伤进行修复与功能重建。结果 本组组织瓣全部成活，重建的骨支架均骨性愈合，重建肌肉的功能部分恢复，肌力达Ⅱ～Ⅳ级，尺神经移植修复正中神经者正中神经支配区触觉恢复好，而尺神经与正中神经端侧吻合时尺神经支配区触觉恢复差，运动功能无改善。结论 不同组织缺损的前臂毁损伤可采用不同的组织瓣修复和功能重建，既保全肢体，还获得部分功能。     

Wet or dry bandages for plaster back-slabs?

Cotton crêpe and stretch bandages are commonly used in back-slabs and casts in orthopaedic practice. In theory they allow swelling to occur after injury while splinting the fracture.The application of a wet bandage prevents the Plaster-of-Paris (POP) setting too rapidly, giving time to apply a mould or attain correct limb position. However, we hypothesised that a wet bandage contracts upon drying and may cause constriction of the splint.This study aimed at determining whether there was any significant change in length of commonly used bandages when wet as well as any further change when left to dry again. Two types of bandage were evaluated.250 mm strips of bandage were dipped into water, gently squeezed and laid flat on a bench. The bandage was then immediately measured in length. The strips were then left to dry and re-measured.This experimental study shows that both cotton crepe and cling significantly shrink by around 7% when wet. This phenomenon has the potential to significantly increase the pressure exerted on the limb by a back-slab. We speculate that the application of wet bandages is why some back-slabs may need released. It is therefore recommended that bandages should be applied only in the dry form.     

Microcirculation Under an Elastic Bandage During Rest and Exercise - Preliminary Experience With the Laser-Doppler Spectrophotometry System O2C

There is an abundace of studies on the influence of rest and exercise as well as external compression on cutaneous, subcutaneous and muscle tissue blood flow using different measurement techniques. As a novel approach, we simultaneously examined the influence of a custom- made elastic thigh bandage on cutaneous and subcutaneous venous blood oxygenation (SO₂), postcapillary venous filling pressures (rHb) and blood flow (flow) using the non-invasive laser- Doppler spectrophotometry system “Oxygen-to-see(O2C)”. Parameters were obtained in 20 healthy volunteers in 2 mm and 8 mm tissue depth during rest, 5 and 10 minutes of moderate bicycle exercise following a 10-minute recovery period. Without the bandage, results matched the known physiological changes indicating higher blood backflow from superficial and deep veins. Underneath the elastic bandage, we observed lower post-capillary filling pressures during exercise. However, after the bandage was removed in the post-exercise period, all obtained parameters of microcirculation remained increased, indicating a higher amount of local venous blood volume in this area. Our observations might be the result of external compression, thermoregulatory and exercise-dependent vascular mechanisms. With the O2C device, a promising new non- invasive technique of measuring local microcirculation in soft tissue exists. This study gives new insights in the field of non-invasive diagnostics with special regard to the influence of elastic bandages on local microcirculation.

Key Points

• It can be demonstrated that a novel non-invasive laser-Doppler spectrophotometry system allows the determination of capillary-venous microcirculation in an in-vivo study during exercise-rest cycles.
• The results received with this technique indicate that a) without an elastic thigh bandage, turnover rates of capillary and post-capillary microperfusion in skin and subcutaneous fat tissue increase under physical exertion, b) skin blood flow decreases while subcutaneous blood flow remained constant in the subsequent recovery phase. While wearing the bandage, c) venous back flow during exercise is increased, whereas d) in the recovery phase, microcirculation remained increased in both tissue depths after removing the bandage.
• In conclusion, the elastic bandage has a negative impact on local microcirculation and capillary-venous back flow, which is possibly due to a displacement of blood volume into the deep venous system and heat accumulation impairing the thermoregulatory response at the same time.

Key words: External compression, blood flow, non-invasive diagnostics, lower extremity, exercise     

Restoration of blood circulation in reperfusion of ischemic tissues

In experiment there were studied changes of the tissue blood circulation and microcirculation during postischemic reperfusion of skeletal muscles with various density of capillaries. It was established that reactive hyperemia, caused mainly by enhancement of extracapillary tissue blood flow. While persistence of durable arterial hypertension the capillaries quantity and potential volume of microcirculatory bed are reducing, negatively influencing the blood circulation restoration process during postischemic reperfusion. In chronic ischemia the potential volume of microcirculation is increasing, securing complete restoration of blood circulation in postischemic reperfusion.     

小夹板固定系统的骨干轴向牵引作用分析

目的:测量小夹板固定骨干骨折时骨干轴向牵引力。方法:通过有机玻璃材料加工成类似哑铃形状模拟长骨两端膨大的特征,在模拟骨干骨折截断处串联安装力传感器;同时,采用布袋液压囊模拟肌肉等软组织,测量夹板固定时断端骨干轴向牵引力。结果:轴向牵引力与横向夹板压力有正相关,产生的骨干轴向牵引力约为夹板横向加压力大小的1/10。结论:筋膜包裹的肌肉与布袋液压囊力学作用类似,夹板在肢体侧面横向加压时,在骨折端可以产生骨干轴向牵引力。     

桃仁注射液对家兔缺血皮肤切口愈合的影响

缺血是伤口愈合过程的重要影响因素。本实验应用兔耳缺血皮肤切口模型证明桃仁注射液（ＨＨＩ－Ⅰ）可改善皮下组织氧分压，增加缺血的皮肤组织在循环血流，从而使切口愈合加快，提高切口断裂强度。作者认为应用活血化瘀药物－桃仁注射液有益于缺血皮肤切口的愈合。     

Effects of artificial circulation by pulsatile and non-pulsatile flow on brain tissues.

We examined the effects of artificial circulation by pulsatile and non-pulsatile flow on microcirculation in the brain from the viewpoints of circulation and metabolism in the brain. A centrifugal pump was fixed in the bypass in the right heart of 10 pigs. In 5 of the 10 pigs, a pulsatile flow pump was fixed in the bypass in the left heart (P group), and in the remaining 5 pigs, a centrifugal pump was fixed in the bypass in the left heart (NP group). Hemodynamics were periodically monitored for 3 hours while maintaining about 100 mmHg of the mean aortic pressure. Intracranial pressure (ICP), cerebral tissue blood flow and cerebral blood flow (CBF) were measured and compared with the initial values. As the parameters of metabolism in the brain, the cerebral oxygen consumption and lactic acid - pyruvic acid ratio were evaluated. If the cerebral blood flow was reduced by cardiogenetic shock, we suggest that blood circulation and metabolism in the brain were maintained by artificial circulation. It also indicated that there was no significant difference in blood circulation and metabolism in the brain between artificial pulsatile and non-pulsatile flow circulation.     

The effect of antiseptics on the healing wound: a study using the rabbit ear chamber

The effects of several antiseptic agents on granulation tissue were studied using rabbit ear chambers as models of the healing wound. This enabled us to study dynamically the action of these agents on the microcirculation of the wound. All the agents tested caused some adverse effect, but in the cases of hypochlorite antiseptics Eusol and Chloramine T, blood flow in the capillary circulation of the granulation tissue ceased and the process of repair was subsequently delayed. A laser Doppler flowmeter was used to measure these changes in local perfusion which reflected the toxic effects seen on microscopy of the ear chamber.     

Decreased red cell deformability following open-heart surgery

Red blood cell deformability is essential for a normal microcirculation. The effect of extracorporeal circulation on red cell deformability was evaluated with a filtration technique in 25 patients undergoing open-heart surgery. During extracorporeal circulation there was a significant decrease in deformability, by on average 31% (p less than 0.001). No correlation was found between decrease in deformability and duration of the extracorporeal circulation procedure. In a subgroup of patients, deformability was followed also postoperatively. During the first postoperative day there was a further decrease of 17%. By the second to third postoperative days, deformability had decreased by another 23%, so that now it was less than half of the preoperative value. On the fifth to sixth postoperative days the values remained equally low. A reduction in red blood cell damage during extracorporeal circulation may be an important factor for improving nutritional blood flow. This in turn could reduce the number of complications in various organs following open-heart surgery.     

A local adhesive finger splint

A new design of a local static finger splint is proposed. The splint is made by enveloping a length of wire into double-sided adhesive tape. The skin of the region to be immobilized is covered with an adhesive skin dressing, to which the splint is then adhered. This method of attachment gives more freedom in choosing a site of splint application and prevents access obstruction to the wound, blocking of tactile areas, and circulation impairment. The splint is light, low profile, and malleable at ambient temperature. The adhesive splint was used in 5 patients to maintain the first web space open or to immobilize stiff interphalangeal joints in flexion overnight.     

Gipstechniken in der Handchirurgie

The correct placement of bandages for immobilization or a functional splint is an essential part of the conservative and postoperative treatment in hand surgery. The classical plaster cast is easy to model and inexpensive. This article gives an overview of the various types of plaster casts for immobilization in hand injuries.