手外伤术后的康复护理

不同程度手外伤均可导致手的功能不同程度丧失或障碍。手外伤手术的目的在于修复或重建手部的解剖结构，而手的功能恢复主要在于术后康复护理，因此，术后的功能康复护理至关重要。康复是在治疗的基础上，强调预防挛缩，防止肌腱粘连、组织水肿等。应用训练方法，可以锻炼肌肉力量，刺激潜在能力以恢复丧失的功能。南京大学医学院附属鼓楼医院重视术后护理及早期康复，使患者获得术后早期功能锻炼，有效地减少或者减轻术后功能障碍，取得了较好临床效果。     

手外伤术后的康复护理

不同程度手外伤均可导致手的功能不同程度丧失或障碍[1]。手外伤手术的目的在于修复或重建手部的解剖结构,而手的功能恢复主要在于术后康复护理,因此,术后的功能康复护理至关重要。康复是在治疗的基础上,强调预防挛缩,防止肌腱粘连、组织水肿等[2]。应用训练方法,可以锻炼肌肉力量,刺激潜在能力以恢复丧失的功能。南京大学医学院附属鼓楼医院重视术后护理及早期康复,使患者获得术后早期功能锻炼,有效地减少或者减轻术后功能障碍,取得了较好临床效果。1临床资料2003年-2005年共收治各种类型手外伤患者22例,其中男18例,女4例;年龄20-50岁,平均…     

手指再植与再造的康复治疗与护理

不同程度手外伤均可导致手的功能不同程度丧失或障碍[1].手外伤手术的目的在于修复或重建手部的解削结构,而手的功能恢复主要在于术后康复护理.康复是在治疗的基础上,强调预防挛缩,防止肌腱粘连、组织水肿等[2].     

手部肌腱修复术后患者分期训练改善功能

肌腱修复术后良好的固定是肌腱愈合的基础，而术后固定易形成肌腱与周围组织粘连，影响手功能恢复，根据手部伸屈肌腱修复术后患不同阶段进行系统康复治疗，明显改善患手部功能。     

59例手部肌腱损伤的术后及康复护理

总结了59例手部肌腱损伤修复术后的康复护理体会,包括心理护理,防治术后水肿及功能锻炼,物理治疗等的护理,认为手部肌腱损伤修复术后早期有效的康复护理及科学系统地进行康复训练是防止肌腱粘连、恢复手功能的重要措施,对防止和减少肌腱修复术后粘连和手功能恢复起着重要的作用。     

手部肌腱损伤修复术后的运动康复治疗与护理

是运动和感觉器官,在生活和劳动中最易遭受创伤.手部肌腱损伤是手外伤中常见而又严重的一个类型,常同时伴有骨折和神经损伤,大多数需要接受外科手术治疗.由于组织损伤及手术的因素,往往发生粘连、瘢痕、挛缩、关节僵硬、肌肉萎缩等并发症,从而影响手的功能恢复,给工作和生活带来不便.因此,手外伤康复的最终目标是恢复和补偿伤手的残余功能.2006年2月-2011年3月我院共收治手部肌腱损伤25例,进行肌腱修复术治疗,术后按康复训练程序进行运动治疗与护理,效果满意.现将康复治疗及护理方法报告如下.     

手部肌腱修复术后患者分期训练改善功能

肌腱修复术后良好的固定是肌腱愈合的基础,而术后固定易形成肌腱与周围组织粘连,影响手功能恢复。根据手部伸屈肌腱修复术后患者不同阶段进行系统康复治疗,明显改善患者手部功能。     

手部烧伤后瘢痕挛缩畸形的整形治疗

目的：探讨手部烧伤后瘢痕挛缩畸形的整形治疗方法。方法：1990－2004年收治手部烧伤后瘢痕挛缩畸形50例，行瘢痕切除矫形后固定，皮片及皮瓣移植修复创面。结果：48例随访1～3年，所有受累关节得到完全或大部矫正，功能恢复满意。结论：整形手术应在瘢痕稳定后及早进行。创面无肌腱、骨骼裸露者宜用全厚皮片修复。需皮瓣修复者，手、足部皮瓣修复效果最佳。     

手部烧伤后严重瘢痕挛缩的手术及康复治疗

目的探讨手术及功能康复计划在严重手部烧伤瘢痕治疗中的应用。方法手术松解手部瘢痕,利用皮片移植或皮瓣转移修复缺损,术后早期开始功能康复治疗,侧重病人手部关节活动度（ROM）及日常生活活动能力（ADL）的训练。结果本组共24例（38只手）,术后ROM及ADL各项积分均明显提高。结论不间断的康复训练是手部瘢痕术后获得功能恢复的重要环节。     

手部屈肌腱修复术后的康复护理

手外伤是常见的多发病,其发病率约占创伤总数的1/3以上。而手部的解剖结构精细复杂,因此手组织损伤后均留有不同程度的功能障碍。手部屈肌腱损伤修复术后往往因肌腱粘连而使临床上达不到满意的疗效。为使患者早日恢复手部功能,除要有精湛的手术技术外,手外伤后的康复护理也非常关键。我科5年来对158例手部屈肌腱修复术后患者进行了系统的康复护理,疗效较好,现报告如下。1　一般资料本组158例患者,其中男107例,女性51例;年龄9～43岁,平均年龄24.75岁,右手89例,左手69例。单侧肌腱损伤112例,伴骨折及神经损伤46例。2　方法将患者按伤后时间分…     

Penetrating orbital trauma by stiletto causing complex cranial neuropathies

Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. Long, sharp stiletto objects may penetrate deeply, causing catastrophic damage to orbital structures, despite seemingly trivial entry wounds. The authors present two cases of penetrating orbital injuries by stiletto objects, both entering via small eyelid wounds. Traumatic optic neuropathy occurred in both cases, and was treated with corticosteroids, however the globes escaped direct injury. Injuries to the IIIrd and VIth cranial nerves were also observed. Deep orbital injuries must be excluded in patients presenting with small eyelid wounds caused by sharp penetrating objects.     

The Epidemiology and Diagnosis of Penetrating Eye Injuries

It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.     

Common Upper Extremity Injuries in Pediatric Athletes

Purpose of ReviewThe aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation.Recent FindingsShoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes.SummaryThere is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.     

Volar Plate Injuries of the Proximal Interphalangeal Joint

The proximal interphalangeal joint (PIPJ) is the articulating joint between the proximal and middle phalanges of the fingers. Hyperextension injuries to the PIPJ of the finger are one of the most common injuries of the hand. Volar plate injuries (VPIs) of the PIPJ typically occur as a result of forced hyperextension, sometimes with a degree of axial loading. As such, VPIs are a distinct possibility to consider in all hyperextension finger injuries. Recognition of the signs and symptoms of the different types of VPI encountered will assist in accurate diagnosis, thus ensuring that the treatment provided is optimal. This clinical feature provides an overview on the assessment, diagnosis, and treatment of “closed” VPIs of the PIPJ.     

严重腹部多发伤38例临床分析

目的：通过总结严重腹部多发伤的诊治经验,以进一步提高其救治水平。方法：回顾性分析2005年1月至2007年12月收治的38例严重腹部多发伤患者的临床资料。结果：38例均采用手术治疗,术中死亡2例,术后死亡1例,原因为失血性休克和多器官功能障碍综合征。结论：结合病史、体检、腹腔穿刺、腹部彩超、CT、X线检查等可提高诊断率．为腹部外伤治疗提供可靠依据。尽早行确定性手术治疗、快速有效止血、术中探查避免遗漏脏器损伤、正确处理合并伤是减少并发症、降低死亡率的主要措施。     

Needlestick and sharps injuries among Turkish nursing students: A cross‐sectional study

Irmak Z, Baybuga MS. International Journal of Nursing Practice 2011; 17 : 151–157 Needlestick and sharps injuries among Turkish nursing students: A cross‐sectional study This cross‐sectional study was performed to investigate the prevalence of and other factors associated with needlestick and sharps injuries (NSIs) among nursing students in Turkey. A total of 60 (19.4%) nursing students reported NSIs during the past 1 year. The most common item causing injury was from a syringe needle (54.0%). Among nursing students, giving intravenous/intramuscular injections (60.0%) was the most common cause of NSIs. In total, 31.7% were not using gloves when injured. A total of 68.3% of NSIs were said to have gone unreported in any official report. A total of 43.5% of the nursing students had not received the hepatitis B vaccine. Finally, no single sociodemographic variables were shown to be significant as a risk factor for needlestick and sharps injury during logistic regression analysis. To decrease NSIs among nursing students, an education programme related to NSIs and standard precautions must be provided and immunized against hepatitis B before beginning clinical practice.     

腹部创伤1076例临床分析

【目的】提高腹部创伤及合并伤的早期诊断和手术治疗水平。【方法】回顾分析2001年1月至2008年12月收治的严重腹部创伤1076例的临床资料。其中闭合伤893例（83．0％）,开放伤183例（17．0％）;手术治疗969例;腹内主要脏器损伤依次是脾、肝、胃、小肠、肾、结肠等。【结果】全组存活1040例（96．7％）,入院时血压为零被抢救成功114例,因手术并发症再次手术17例;死亡36例（3．3％）,多死于失血性休克。【结论】在严重腹部创伤时,耗时的诊断程序是不允许的,只有当病人血流动力学稳定时才可作必要的检查以避免遗漏多脏器伤;同时应积极手术,手术止血被认为是最根本的抗休克措施;多脏器损伤处理坚持“保全生命第一,保全器官第二”的手术原则。