中药烫熨疗法辅助治疗腰腿痛80例的临床体会

目的：观察中药烫熨疗法对腰腿痛的辅助治疗作用。方法：将160例腰腿痛病人随机分成2组,每组各80例,对照组仅采用推拿按摩法治疗,观察组在对照组基础上加用中药烫熨疗法。观察两组的临床疗效。结果：观察组与对照组治愈率（43．75％与15％）比较差异有显著性（P〈0．01）。结论：推拿组合中药烫熨疗法治疗腰腿痛较单纯推拿疗法具有更好的临床疗效。     

浅析中医药治疗复发性口腔溃疡

通过了解复发性口腔溃疡的病因、病机,重点探讨了辩证分型的治疗法,证明复发性的口腔溃疡与患者的日常生活是息息相关联的。     

郭子光教授治疗反复发作性口腔溃疡一则

通过中医治疗一例反复发作性口腔溃疡,体现了中医治疗疾病辨证论治的重要性,并说明中医治疗疾病以纠正阴阳失衡为总纲,逐渐促使机体达到阴平阳秘的状态。     

Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial

To test the efficacy of surgical treatment of non-infected neuropathic foot ulcers compared to conventional non-surgical management, a group of diabetic outpatients attending our diabetic foot clinic were studied. All patients who came to the clinic for the first time from January to December 1995 inclusive with an uncomplicated neuropathic ulcer were randomized into two groups. Group A received conservative treatment, consisting of relief of weight-bearing, regular dressings; group B underwent surgical excision, eventual debridement or removal of bone segments underlying the lesion and surgical closure. Healing rate, healing time, prevalence of infection, relapse during a 6-month period following intervention and subjective discomfort were assessed. Twenty-four ulcers in 21 patients were treated in group A (17 Type 2 DM/3 Type 1 DM, age 63.24 ± 13.46 yr, duration of diabetes 18.2 ± 8.41 yr, HbA_1c 9.5 ± 3.8%) and 22 ulcers in 21 patients in group B (19 Type 2 DM/2 Type 1 DM, age 65.53 ± 9.87 yr, duration of diabetes 16.84 ± 10.61 yr; HbA_1c 8.9 ± 2.2%). Healing rate was lower (79.2% = 19/24 ulcers) in group A than in group B (95.5% = 21/22 ulcers; p < 0.05), and healing time was longer (128.9 ± 86.60 days vs 46.73 ± 38.94 days; p < 0.001). Infective complications occurred significantly more often in group A patients (3/24, 12.5% vs 1/22, 4.5%; p < 0.05), as did relapses of ulcerations (8 vs 3; p < 0.01). There were only two minor perioperative complications in group B patients. Patients reported a higher degree of satisfaction in group B (p < 0.01) as well as lower discomfort (p < 0.05) and restrictions (p < 0.05). Thus surgical treatment of neuropathic foot ulcers in diabetic patients proved to be an effective approach compared to conventional treatment in terms of healing time, complications, and relapses, and can be safely performed in an outpatient setting. © 1998 John Wiley & Sons, Ltd.     

Evaluation of the long pulsed high fluence alexandrite laser therapy of leg telangiectasia

BACKGROUND AND OBJECTIVES: The treatment of larger leg veins with laser or intense pulsed light often shows varying degrees of success and inconsistent clinical response rates. Aim of this study was to evaluate the effectiveness and safety of the 755 nm long pulsed high fluence alexandrite laser in the treatment of larger leg veins. STUDY DESIGN/MATERIALS AND METHODS: Twenty female volunteers aged 25-51 years (mean 39) with 0.3-1.3 mm leg telangiectasias received laser treatment, 10 of them with an additional pass done right after the first pass. Their skin type ranged from 1 to 3 (five type 1, seven type 2, eight type 3). After test spots with increasing fluences (40-90 J/cm(2)) to determine the individual safe fluence, the maximum fluence of 90 J/cm(2) could be used in all 20 subjects. The spot size was 3 x 10 mm, a spray cooling system was used with 80 milliseconds spray and delay time, respectively. The number of pulses administered ranged from 30 to 467 per subject (mean 139). The treated area was controlled 1 day, 1 month, and 3 months post-treatment and the side effects were quantified. At each visit, the treatment area was photographed. The percent clearance in the treated areas was scored by two observers. Subject satisfaction was evaluated at the 3 months post-treatment visit. RESULTS: After 3 months, in all 20 test subjects some clearance was visible. It ranged from low-grade to complete clearance. Most subjects (15 of 20) had a clearance between 26 and 75%. Hyperpigmentation was observed in 15 subjects. Hypopigmentation was seen in two subjects. No edema, no purpura, no erythema, no scarring, no blistering, and no crusts were observed. Mean subject satisfaction score was assessed and all volunteers reported to be "satisfied." CONCLUSIONS: The long pulsed high fluence alexandrite laser is effective and safe in the treatment of leg veins 0.3-1.3 mm in diameter.     

Measuring tissue perfusion during pressure relief maneuvers: insights into preventing pressure ulcers

BACKGROUND/OBJECTIVE: To study the effect on tissue perfusion of relieving interface pressure using standard wheelchair pushups compared with a mechanical automated dynamic pressure relief system. DESIGN: Repeated measures in 2 protocols on 3 groups of subjects. PARTICIPANTS: Twenty individuals with motor-complete paraplegia below T4, 20 with motor-complete tetraplegia, and 20 able-bodied subjects. METHODS: Two 1-hour sitting protocols: dynamic protocol, sitting configuration alternated every 10 minutes between a normal sitting configuration and an off-loading configuration; wheelchair pushup protocol, normal sitting configuration with standard wheelchair pushup once every 20 minutes. MAIN OUTCOME MEASURES: Transcutaneous partial pressures of oxygen and carbon dioxide measured from buttock overlying the ischial tuberosity and interface pressure measured at the seat back and buttocks. Perfusion deterioration and recovery times were calculated during changes in interface pressures. RESULTS: In the off-loading configuration, concentrated interface pressure during the normal sitting configuration was significantly diminished, and tissue perfusion was significantly improved. Wheelchair pushups showed complete relief of interface pressure but incomplete recovery of tissue perfusion. CONCLUSIONS: Interface pressure analysis does not provide complete information about the effectiveness of pressure relief maneuvers. Measures of tissue perfusion may help establish more effective strategies. Relief achieved by standard wheelchair pushups may not be sufficient to recover tissue perfusion compromised during sitting; alternate maneuvers may be necessary. The dynamic seating system provided effective pressure relief with sustained reduction in interface pressure adequate for complete recovery of tissue perfusion. Differences in perfusion recovery times between subjects with spinal cord injury (SCI) and controls raise questions about the importance of changes in vascular responses to pressure after SCI.     

合并下肢多处骨折的股动脉损伤的诊疗体会

目的探讨合并下肢多处骨折的股动脉损伤的临床诊断及治疗效果。方法手术治疗15例下肢多发性骨折伴股动脉损伤患者,从解剖、诊断及手术治疗等方面总结经验。结果15例患肢均成活。术后肢体肿胀约2周消退9例,自觉存在反复轻度肿胀5例。术后1-3个月出现了不同程度足踝和（或）足趾屈曲挛缩畸形,5例早期行康复治疗后畸形改善,6例后期行肌腱延长及踝关节松解,4例行屈肌腱延长术。随访8-2个月,所有病例均恢复行走功能,足底感觉完全恢复。结论下肢多发骨折伴发股血管损伤一般位于收肌裂孔附近,需手术探查血管移植修复;对〉24h甚至6d的股动脉损伤患者积极手术修复仍可挽救部分功能。     

复杂断肢再植临床分析(附5例报告)

目的探讨断肢再植术的处理方法,提高断肢再植成活率及患肢功能。方法5例断肢患者,包括断上臂中段、腕、大腿中下段、小腿中上段及断掌并多个断指各1例,断端污染严重,均予再植。离断至吻合时间约4~7 h。所有病例均以8-0显微丝线吻合主要动静脉及神经。结果随访12~36月,断掌功能良好;再植上臂、大腿均成活;断上臂术后8月,肘关节活动范围约5°,其他关节无功能,感觉无恢复;断大腿者能行走,小腿中段以上感觉恢复;腕、小腿再植者失活。结论复杂断肢再植应妥善行术前处理,彻底清创,行断肢再灌注和血管吻合,重视围术期处理和功能重建,以提高断肢再植成活率和功能恢复。