益气化痰软坚汤联合高压氧治疗老年下肢动脉硬化闭塞症的临床研究

目的：通过研究探讨益气化痰软坚汤联合高压氧治疗老年下肢动脉硬化闭塞症的临床疗效,为该疾病的临床治疗提供可靠依据。方法：选取2019年6月-2020年8月本院收治的老年下肢动脉硬化闭塞症患者80例,采用随机数表法将患者分为观察组和对照组,各40例。对照组患者均接受常规西药治疗以及控制血压、控制血糖、调节血脂、抗血小板聚集等药物的针对性内科治疗,观察组患者在对照组治疗基础上,加用益气化痰软坚汤联合高压氧法治疗,连续治疗8周,观察两组患者的临床疗效,比较两组患者治疗前后腘动脉、足背动脉血管内径及血流量、血清内皮素-1（ET-1）、一氧化氮（NO）水平变化和不良反应情况。结果：观察组治疗总有效率显著高于对照组（P＜0.05）;治疗8周后观察组患者腘动脉、足背动脉血管内径及血流量与对照组比较均有明显增加（P＜0.05）;治疗8周后观察组患者血清ET-1水平明显低于对照组（P＜0.05）,NO水平明显高于对照组（P＜0.05）;两组患者均未出现相应的不良反应症状。结论：益气化痰软坚汤联合高压氧治疗老年下肢动脉硬化闭塞症,能明显缓解患者症状,改善患者下肢循环和血管功能,疗效显著。     

老年高血压及糖尿病患者下肢动脉病变的超声检查特点

目的 观察伴有高血压或糖尿病的老年患者下肢动脉病变的特点.方法 110例老年人分为正常组、高血压组和糖尿病组,用彩色多普勒超声技术检查双侧下肢股总动脉、股浅动脉、胭动脉、胫前动脉及胫后动脉中膜厚度(IMT),IMT＞1.2 mm或闭塞者为有病变.结果 正常组、高血压组和糖尿病组下肢动脉病变率分别是28.6%、42.4%和81.4%,差异有显著性.股总动脉、股浅动脉、胭动脉、胫前动脉和胫后动脉总的病变率分别是48.2%、47.7%、50.0%、60.0%和48.2%.其中糖尿病组胫前动脉的病变率达到94.4%.糖尿病组有42支胫前动脉闭塞(58.3%).结论 高血压和糖尿病对老年人下肢动脉病变有非常明显的影响,彩色多普勒超声对于评价老年人下肢动脉病变有重要价值.     

Anatomical consideration for the venous drainage of the reverse-flow island flaps in the extremities (in the upper versus in the lower extremity)

In order to obtain information about the mechanism of the venous drainage in reverse-flow island flaps in the extremities, we dissected 10 radial, 10 peroneal, 10 anterior, tibial, and 10 posterior tibial arteries and veins in cadavers. We examined the cutaneous perforators nourishing those flaps, venous valves, communicating branches and collateral branches of the accompaning veins, then calculated whether or not there was a smooth reverse venous flow in relation to the above locational relationship. From these findings, in almost all reverse-flow island flaps, there are some valves so located as to block the reverse venous flow in the accompaning, veins. This induces us to consider that some valves, not all, would be incompetent for the reverse venous flow to take place in the reverse-flow flap. In some clinical cases, however, some valves would be so competent as to block the reverse venous flow. A comparison between, the radial and the peroneal accompaning vein suggests that the reverse venous flow in the lower extremity is more disturbed than in the upper extremity. Presented at 30th Annual Meeting of Japanese, Society of Plastic and Reconstructive Surgery, Tokyo, April, 1987, and at the 8th International Symposium of Reconstructive Microsurgery, Yamanashi, April, 1988, Japan     

Verbesserte intraoperative leckkontrolle bei der isolierten zytostatikaperfusion von extremitätentumoren

Zusammenfassung Die Effektivität der Extremitdtenperfusion und die Sicherheit vor systemischen Nebenwirkungen wird wesentlich durch die Verhinderung des Ubertritts von Cytostatika aus dem Extremitdten- in den Kbrperkreislauf bestimmt. Durch die Anwendung von autologen 111-Indium-markierten Erythrozyten zur Leckkontrolle ist eine kontinuierliche exakte Überwa-chung und frühzeitige Tourniquetkorrektur möglich. Bei 97 Extremitdtenperfusionen führte eine Leakage von fiber 20% bei 6 Patienten (6%) zum Abbruch der Perfusion, da these auch durch mehrfache Manipulationen am Tourniquet nicht behoben werden konnte. Bei 31 Patienten (32%) konnte zumeist vor Applikation des Zytostatikums durch Neuplazierung des Tourniquets die Leckage auf ein akzeptables Niveau (unter 5% des Perfusatvolumens) gesenkt werden, bei 50 Perfusionen (51%) fanden sich schon nach primärer Plazierung eine ausreichende Abdichtung. Dutch die gewählte Vorgehensweise blieben systemische Nebenwirkungen im eigenen Krankengut völlig aus. Die Vorteile der regionalen Chemotherapie können mit Hilfe der beschriebenen Leckkontrolle mittels 111-Indium-markierter autologer Erythrozyten optimal genutzt werden. Die Extremitätenperfusion wird so zur sicheren und risikoarmen Operation.

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Improved intraoperative leakage control in isolated perfusion of tumours of the extremities with systemic drugs

Summary The success of extremity perfusion and the protection from systemic side effects largely depend upon the prevention of systemic drug leakage from the extremity circulation. The use of autologous 111-Indium labelled erythrocytes for leakage control allows a continous exact surveillance and timely correction of the tourniquet position in case a major leak should occur. A total of 97 patients were studied. In 6 patients (=6%) the perfusion had to be discontinued within the first 30 min due to an uncorrectable leak of >20%. In 31 patients (=32%), a major leak could be reduced by manipulation of the tourniquet. No systemic side-effects could be observed in any of our patients. Applying leakage control by means of 111-Indium labelled erythrocytes extremity perfusion has proved to be a safe procedure in patients with high risk or recurrent malignant melanoma and soft tissue sarcoma.

     

异体手移植二例报告

目的 探讨异体肢体移植重建肢体缺失的可行性。方法 筛选两例右手外伤性撄如病人,人者行ＡＢＯ、Ｒｈ血型,人类白细胞抗原（ＨＬ）配型、群体反应性体（ＰＲＡ）检测及淋巴细胞毒性交叉试验,以确定合适的两傅脑死亡者。供体上肢切取后用４℃ＵＷ器官保存液灌注、泳桶内保存、运输、随机选择其中一个肢体在再植前经８ＣｙＸ射线照射。移植手术有、尺骨固定,吻合尺、桡动脉,尺、正中神经、头朵静脉,缝合除指浅屈肌外所有肌腱及     

自体干细胞移植联合血管成形术治疗糖尿病足或肢体缺血性疾病的系统评价

目的:系统评价自体干细胞移植联合血管成形术(PTA)治疗糖尿病足或肢体缺血性疾病的疗效和安全性。方法:计算机检索多个国内外数据库,搜集自体干细胞移植联合PTA治疗糖尿病足或肢体缺血性疾病患者的临床对照试验。检索时限均为从建库至2017年11月。由2位评价员按照文献质量评价方法、纳入与排除标准,筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Revman 5.3软件进行Meta分析。结果:最终纳入12个临床对照试验,共630例糖尿病足或肢体缺血患者。Meta分析结果显示,与单纯PTA治疗组患者比较,自体干细胞移植联合PTA治疗组患者踝肱指数(MD=0.07,95%CI=0.02~0.13,P=0.01)、经皮血氧分压(MD=4.03,95%CI=2.94~5.12,P0.00001)、患肢冷感(RR=1.29,95%CI=1.14~1.45,P0.0001)、跛行距离(MD=372.89,95%CI=108.97~636.81,P=0.006)、疗效评定(RR=1.18,95%CI=1.08~1.29,P=0.0004)均明显改善。结论:自体干细胞移植联合PTA治疗糖尿病足或肢体缺血病变的疗效优于单纯PTA、安全性好,但该结论仍需大型多中心临床随机试验支持。     

Post-metastasis survival in extremity soft tissue sarcoma: A recursive partitioning analysis of prognostic factors

BackgroundRecursive partitioning analysis (RPA) enables grouping of patients into homogeneous prognostic groups in a visually intuitive form and has the capacity to account for complex interactions among prognostic variables. In this study, we employed RPA to generate a prognostic model for extremity soft tissue sarcoma (STS) patients with metastatic disease.MethodsA retrospective review was conducted on 135 patients with metastatic STS who had undergone surgical removal of their primary tumours. Patient and tumour variables along with the performance of metastasectomy were analysed for possible prognostic effect on post-metastatic survival. Significant prognostic factors on multivariate analysis were incorporated into RPA to build regression trees for the prediction of post-metastatic survival.ResultsRPA identified six terminal nodes based on histological grade, performance of metastasectomy and disease-free interval (DFI). Based on the median survival time of the terminal nodes, four prognostic groups with significantly different post-metastatic survival were generated: (1) group A: low grade/metastasectomy; (2) group B: low grade/no metastasectomy/DFI ⩾ 12 months or high grade/metastasectomy; (3) group C: low grade/no metastasectomy/DFI < 12 months or high grade/no metastasectomy/DFI ⩾ 12 months; and (4) group D: high grade/no metastasectomy/DFI < 12 months. The 3-year survival rates for each group were: group A, 76.1 ± 9.6%; group B, 42.3 ± 10.3%; group C, 18.8 ± 8.0%; and group D, 0.0 ± 0.0%.ConclusionOur prognostic model using RPA successfully divides STS patients with metastasis into groups that can be easily implemented using standard clinical parameters.     

Non-hip/non-vertebral fractures – How to treat best?

Fractures of the extremities in the elderly constitute more than two-thirds of all fragility fractures befalling frail, osteoporotic and sarcopenic patients. Although treatment controversies abound, consensus exists. Upper extremity fractures hinder activities of daily living and are debilitating. Open fractures or displaced fractures will need surgical intervention. Wrist fractures treated operatively allow early use of the hand. Most pelvic fractures are treated conservatively. In the lower extremities, fractures of the long bones, tibia and femur need surgical intervention. Non-displaced fractures around the foot may be treated with immobilisation and avoidance of full weight-bearing. As a rule, fractures take four months for consolidation. Individually tailored solutions are needed for frail patients with comorbidities. Maintaining joint mobility and muscle strength preserves mobility and autonomy. Caring for extremities trauma is team work, involving family and health care providers. Prevention efforts are mandatory.     

损伤控制在骨科下肢创伤临床急救中应用探讨

目的：探讨损伤控制在骨科下肢创伤临床急救中的应用。方法整群选取该院2013年1月-2014年1月收治的76例骨科下肢创伤患者，并将76例患者随机分为2组。对照组给予常规创伤治疗方案，实验组则根据损伤控制理念，对患者分3个阶段治疗。对比观察两组患者的治疗效果及术后并发症发生情况。结果对照组患者治疗总优良率和术后并发症发生率分别为73.68%和52.63%，实验组患者治疗总优良率和术后并发症发生率分别为94.74%和13.16%。实验组患者在治疗优良率及术后并发症发生率上均优于对照组(P<0.05)。结论在骨科下肢创伤临床急救中应用损伤控制理念对患者进行治疗，对提高治疗效率和降低术后并发症发生率效果显著，值得临床上广泛推广使用。