Anterior abdominal wall closure in bladder exstrophy

Anterior abdominal wall closure without pelvic osteotomy for bladder exstrophy can be very diffecult and more often than not calls for various reconstructive measures. A technique is described that involves bilateral detachment of the rectus abdominis from the pubic ramus, midline vertical closure, and refixation to the pubic rami after medial and caudal advancement. A relaxing fascial incision may be required. This technique has been used in 15 patients and has obviated the need for pelvic osteotomy, thereby decreasing the postoperative morbidity. It has resulted in good cosmetic repair in all patients in addition to the ease of abdominal wall closure. The healing has been remarkably good. This technique is particularly useful in children coming for primary surgery after the neonatal period. Correspondence to: V. Bhatnagar     

Validity of ultrasonograph muscle thickness measurements for estimating muscle volume of knee extensors in humans

This study aimed to investigate the suitability of using ultrasonograph muscle thickness (MT) measurements to estimate the muscle volume (MV) of the quadriceps femoris as an alternative approach to magnetic resonance imaging (MRI). The subjects were 46 men aged from 20 to 70 years who were randomly allocated to either a validation or a cross-validation group. In the validation group, multiple and simple regression equations, which used a set of MT values determined at mid-thigh and thigh length (l) and the product of π, (MT/2)², and l [π·(MT/2)²·l], respectively, as independent variables, were derived to estimate the MV measured by MRI. Because the two equations were cross-validated, the data from the two groups were pooled to generate the final prediction equations: MV (cm³)=(MT×311.732)+(l×53.346) –2058.529 as the multiple regression equation and MV (cm³)=[π·(MT/2)²·l]×1.1176+663.040 as the simple regression equation. In the multiple regression equation, MT explained 75% of the variation in the MV measured by MRI. The r ² and the standard error of the estimate (SEE) of the equations were 0.824 and 175.6 cm³ (10.6%), respectively, for the multiple regression equation and 0.829 and 173.7 cm³ (10.5%), respectively, for the simple regression equation. Thus, the present results indicate that ultrasonograph MT measurements at mid-thigh are useful for estimating the MV of knee extensors. However, the observed SEE values suggest that the prediction equation obtained in this study may be limited to population studies rather than individual assessments in longitudinal studies. Electronic Publication     

大鼠股直肌肌纤维型组成及分布研究

目的 探讨大鼠股直肌的肌纤维型组成和分布,以了解该肌功能.方法 取成年SD大鼠股直肌组织进行冰冻切片(8μm厚),采用Guth-Samaha肌球蛋白ATP酶组织化学染色法并稍做改良,对其进行肌纤维分型研究.结果 大鼠股直肌经肌球蛋白ATP酶组织化学染色后可明确分出2种肌纤维型,即白色的I型纤维(慢缩纤维)和深褐色的Ⅱ型纤维(快缩纤维),2种肌纤维在肌内呈棋盘样均匀分布;图像分析仪计数I纤维占(24.6±3.1)%,Ⅱ型纤维比例为(75.4±6.3)%,2者比较差异显著(P<0.01).结论 大鼠股直肌的肌纤维组成以Ⅱ型纤维为主,属于力量速度型肌.     

股方肌蒂骨瓣移植治疗股骨颈骨折

青壮年股骨颈骨折引起的骨不连和股骨头缺血性坏死的发生率较高 ,治疗上常难以收到理想的效果 ,我院自 1995年9月起 ,采用股方肌骨蒂骨瓣移植加螺丝钉内固定治疗股骨颈骨折 14例 ,获得满意疗效。1　临床资料本组 14例 ,男 8例 ,女 16例 ;年龄 18— 45岁 ,平均 35岁。骨折类型 :头下型 6例 ,经颈型 8例 ;新鲜骨折 9例 ,陈旧性骨折 5例。伤因 :交通事故伤 8例 ,坠落伤 6例。2　治疗方法　　患者侧卧位 ,连续硬膜外麻醉 ,取后侧切口 ,分离出股方肌 ,于股方肌止点股骨转子间嵴处凿下 4ｃｍ× 2ｃｍ× 1ｃｍ骨块 ,可见骨块连接股方肌蒂并有血液外…     

Salvage of vascular graft infections via vacuum sealing drainage and rectus femoris muscle flap transposition: A case report

BACKGROUNDThe management of vascular graft infections continues to be a significant challenge in a clinical situation. The aim of this report is to illustrate the novel vacuum sealing drainage (VSD) technique and rectus femoris muscle flap transposition for vascular graft infections, and to evaluate the prospective of future testing of this surgical procedure.CASE SUMMARYWe report the case of a 32-year-old male patient, who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure. Using the VSD and muscle flap trans-position, the groin wound and vascular graft infection were finally treated successfully.CONCLUSIONOur case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure, especially in consideration of treatable conditions.     

Endovascular treatment of diabetic foot ischemic ulcer – Technical review

This article is a technical review of the common techniques used in the treatment of lower-limb occlusive arterial disease associated with diabetes. The techniques described here reflect the author’s own practice and are methods that the author finds helpful in avoiding complications and in making the technical aspects of the procedures easier.     

双桥运动时下肢肌的肌电分析

目的：了解双桥运动时偏瘫病人下肢主要屈伸肌群的收缩情况。方法：测定１０例正常人和３６例偏瘫病人在双桥运动时股四头肌、绳肌、胫前肌和小腿三头肌的表面积分肌电值，并比较两侧同名肌的比值。结果：双桥运动时，仅大腿肌有明显的肌电活动，正常人两侧对称（Ｐ＞００５），偏瘫病人患侧大腿肌的肌电变化明显低于健侧（Ｐ＜００５）；小腿肌在运动前后肌电变化不明显。结论：双桥运动对抑制偏瘫病人下肢的协同模式有利。     

老年人股骨颈骨折的临床护理和康复指导

股骨颈骨折是老年人的常见病,因其解剖生理特点,诸器官退行改变,组织再生能力差,伤后愈合慢,长期临床制动,极易发生一系列并发症。对老年性股骨颈骨折病人的临床护理和出院后的康复指导,进行适宜的、循序渐进的早期功能锻炼是防残的关键。     

Local Cooling Provides Muscle Flaps Protection from Ischemia-Reperfusion Injury in the Event of Venous Occlusion During the Early Reperfusion Period

Clinicians often place patients in heated rooms following muscle flap transfers. We hypothesize that exposure of flaps to heated room temperatures could result in an unnecessary hyperthermic ischemic insult if the flaps were to be compromised by venous outflow obstruction, while exposure of elective flaps to local cooling during early perfusion may provide protection in the event of venous occlusion. The rat rectus femoris muscle flap was elevated and clamped for 1 h. The muscle was then exposed to various temperatures for 1 h of perfusion followed by complete venous occlusion for 3 h. Occlusion clamps were removed and flaps were allowed to reperfuse for 24 h. Flaps were assessed for muscle necrosis and edema. Venous occluded muscles demonstrated decreased muscle necrosis and edema in the locally cooled group (8.5 +/- 6.7%, 3.06 +/- 0.14; P < 0.001) compared to the room temperature group (76.2 +/- 23.0%, 3.73 +/- 0.13), and the local warming group (97.3 +/- 1.4%, 3.84 +/- 0.29) respectively. No difference was noted in muscle necrosis nor edema amongst non-ischemic muscles irrespective of temperature exposure. These results suggest a beneficial role for exposure of elective flaps to local cooling during the early perfusion period in order to provide protection from ischemia reperfusion injury in the event of a venous occlusion insult. The prophylactic exposure of flaps to local cooling is further supported by the lack of a harmful effect when flaps were not compromised by venous occlusion.