前锯肌下部肌皮瓣移植的应用解剖

目的：为前锯肌下部肌皮瓣移植提供解剖学基础。方法：在２５具（５０侧）成人尸体标本上，对前锯肌下部的形态、血供和神经支配进行了应用解剖学观测。结果：前锯肌下部的血供主要来自胸背动脉的前锯肌支，外径１．３±０．２ｍｍ，伴行静脉外径１．５±０．２ｍｍ，长４．９±１．１ｃｍ；由胸长神经支配，其横径为１．７±０．４ｍｍ，神经干长７．７±１．４ｃｍ。结论：以胸背血管及前锯肌支为血管蒂和胸长神经为蒂可切取前锯肌下部１２．０ｃｍ×９．０ｃｍ的肌皮瓣，修复较大创面或重建肌动力     

Relationship between core temperature and skin blood flux in lower limbs during prolonged arm exercise in persons with spinal cord injury

The purposes of the present study were to examine the response of the skin blood flux (SBF) in the paralyzed lower limbs of persons with spinal cord injury (PSCI) and to clarify the relationship between the SBF and core temperature during prolonged arm exercise. Eight male PSCI with lesions from T6 to L5 and six male control subjects (CS) participated in this study. The subjects rested for 60 min and then performed arm-cranking exercise at 20 W for 30 min at 25 °C. The tympanic membrane temperature (T _ty) and SBF in the anterior thigh (SBFT) and in the posterior calf (SBFC) were continuously measured throughout the experiment. The SBFC did not change in either PSCI or CS during the experiment. The SBFT in four PSCI with high lesions (T6 to T12), remained unchanged during exercise. The SBFT in the other four PSCI with low lesions (T12 to L5, SBFT+) began to elevate markedly when the T t, exceeded a threshold temperature of 36.69 °C. The pattern of increase of SBFT in SBFT+ was similar to that in CS, although onset of the increase in SBFT was delayed and the peak of SBFT during exercise was significantly lower in comparison with the CS. We consider that these differences between the SBFT+ and CS were largely attributable to the lowerT _ty in the former group, which took a prolonged time to reach the threshold of 36.69 °C.     

一氧化氮对犬下食管括约肌压力的作用

目的 :应用苄基二甲基十四烷氯化铵 (benzyldim ethyltetradecyl amm onium chloride,BAC)建立犬下食管括约肌(L ES)无神经动物模型 ,研究一氧化氮 (NO)对 L ES压力的作用。方法 :将 BAC环周注入犬 L ES,对照组注入等量生理盐水 ,均于注射前及注射后 6周测定 L ES压力 ;并观察 L -精氨酸、D -精氨酸、硝普钠及一氧化氮合酶 (NOS)抑制剂 N-硝基 - L -精氨酸 (L - NNA)对 L ES压力的影响 ;此外还测定了两组犬 L ES中 NO含量和 NOS活性。结果 :BAC处理组 L ES压力 [(4 2 .43±4.19) m m Hg,1m m Hg=0 .133 k Pa]显著高于对照组 [(2 2 .71± 5 .19) mm Hg]。 L -精氨酸可使对照组 L ES压力降低 ;L - NNA使其增高 ,但对 BAC处理组 L ES压力均无影响。硝普钠可降低两组犬 L ES压力。对照组 L ES中 NO为 (6 .0 5 8± 2 .0 6 7)μm ol/g,NOS为 (1.45 8± 0 .146 ) U /mg;而 BAC处理组 NO为 (1.797± 0 .873)μmol/g,NOS为 (0 .46 3± 0 .0 39) U /m g,均较对照组显著降低 (P<0 .0 1)。 结论 :BAC可使犬 L ES压力增高 ,其机制可能与 L ES局部 NO减少有关。     

The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study

BackgroundOccupation-based intervention (OBI) in hand therapy has shown superior benefits in patient-reported performance and physical measures; however, only a few studies have used OBI. We developed a decision-aid to promote the use of an injured hand in the real world (Aid for Decision-making in Occupation Choice for hand; ADOC-H)PurposeTo investigate the clinical utility of the ADOC-H (paper version) in patients with distal radius fractures.Study DesignA prospective case series and a clinical survey for occupational therapists.MethodsThis study comprised a prospective patient case series of 8 patients with distal radius fractures, treated using Volar locking plates, and a clinical survey of 4 experienced occupational therapists.ResultsNo patient or therapist complaints or drop-outs were reported. Active range of motion (wrist), Grip strength, and Disabilities of the Arm, Shoulder, and Hand scores improved for all patients. The ADOC-H induced 158 activities using the injured hand, with activities of daily living (69.8%) selected earlier in the treatment period, and instrumental activities of daily living (63.3%) selected later. The feedback and case studies suggested that the ADOC-H was useful for patients who were afraid of using the hand and, interestingly, patients who were able to use their hand without pain or other problems. The clinical survey showed that most therapists found the ADOC-H effective in facilitating real-life use of an injured hand.ConclusionsThe ADOC-H paper version is an useful tool that can be applied to facilitate patients with distal radius fractures to use their injured hands in real-life settings.     

可调节式内膜剥离器用于亚急性下肢动脉栓塞治疗32例分析

正多数下肢动脉栓塞病人在急性期内(发病6～8 h以内)行手术治疗可取得较好的治疗效果,但部分病人可能因医疗条件或个人原因而选择保守治疗(如仅使用抗凝药物等),下肢动脉部分开放或仅侧支开放,将疾病由急性期拖入了亚急性期,此时的血栓机化,并且与血管内膜粘连紧密不易分开。笔者团队自制可调节式内膜剥离器用于取出亚急性下肢动脉栓塞病人的陈旧性机化血栓。现报告如下。     

小潮气量通气在急性呼吸窘迫综合征中的应用

应用小潮气量通气致容许性高碳酸血症方法对11例急性呼吸窘迫综合征（ARDS）进行临床观察。设定潮气量为6．4±1．1ml／kg,保持动脉血二氧化碳（PaCQ2）为5．97±1．41kPa,血氧分压8．54±3．19kPa。结果7例存活,未发现气压伤。说明小潮气量通气致一定程度高碳酸血症是临床上值得推荐使用的方法。