跟骨牵引植皮术治疗重度腘窝瘢痕挛缩畸形的护理应用

目的观察跟骨牵引植皮术在重度腘窝瘢痕挛缩畸形中的临床效果及护理措施探讨。方法对37例在我院就诊的重度腘窝瘢痕挛缩畸形患者进行跟骨牵引植皮术,总结合理的护理措施,观测患者膝关节功能恢复及美容效果。结果 37例患者均顺利完成跟骨牵引植皮术,皮瓣成活率达100%,仅1例患者出现足跟部压疮,未出现创面感染。功能及美容评价优良率达91.9%。结论跟骨牵引植皮术应用于重度腘窝瘢痕挛缩畸形效果良好,通过合理的护理方法促进了患者膝关节功能恢复,同时也达到了较好的美容效果,值得推广应用。     

白内障超声乳化联合人工晶体植入术后囊袋收缩综合征发生危险因素分析

目的 探讨白内障超声乳化联合人工晶体(intraocular lens,IOL)植入术后囊袋收缩综合征(capsular contraction syndrome,CCS)发生的危险因素.方法 回顾性分析行白内障超声乳化联合IOL植入术治疗的白内障2015例(2117只眼)的临床资料,根据术后3个月内CCS发生情况分为...     

青藏高原藏原羚携带海氏肠球菌的特征研究

目的研究青藏高原野生动物藏原羚携带的海氏肠球菌特征。方法分离细菌,采用16S rRNA、rpoA基因序列比对方法鉴定藏原羚携带的海氏肠球菌。采用K-B纸片法进行药敏试验;使用COGs、SwissProt、CARD和VFDB等数据库对基因组进行分析;采用MUMmer和TreeBest软件构建单核苷酸多态性系统进化树图。结果从15份藏原羚粪便样品分离到2株海氏肠球菌。生化分析、16S rRNA和rpoA基因序列分析支持其为海氏肠球菌的鉴定。基因组分析发现其携带荚膜多糖基因簇。系统进化树分析提示2株藏原羚源海氏肠球菌分别属于不同的进化分支,且都与动物源性菌株进化关系更近。2株菌对多种常用抗生素敏感。结论青藏高原藏原羚携带的病原菌海氏肠球菌基因组中存在荚膜多糖基因簇,利于其抵抗不利环境因素,提示YL69可能具备在人群中传播的潜力。     

Management of Neurogenic Heterotopic Ossification: Three case histories to illustrate the role of physiotherapy

Neurogenic heterotopic ossification is a process of abnormal bone formation of multi-factorial aetiology. It occurs at varying sites to produce deformity and restriction of joint movement, and has a major impact on physical ability. There is extensive literature on the medical management of heterotopic ossification, but the role of physiotherapy is poorly described.This article aims to illustrate the importance of proactive physiotherapy in the team management and treatment of this condition. The authors show that physiotherapy is not contra-indicated in the presence of neurogenic heterotopic ossification and illustrate how interventions for improving range of movement can be used. The authors suggest that integrated team management was essential to the successful outcomes in these complex cases.     

小切口治疗注射性臀肌挛缩症

目的:评价小切口注射性臀肌挛缩症的效果.方法:采用小切口治疗具有典型症状的臀肌挛缩症22例.所有病例均要求早期开始功能锻炼.结果:平均随访27个月,优良率100%.结论:采用小切口治疗注射性臀肌挛缩症具有创伤小,愈合快,瘢痕小,外形美观等优点.     

屈曲挛缩畸形膝关节置换的软组织平衡

目的：探讨屈曲挛缩畸形的膝关节行关节置换的方法,重点关注术中膝关节周围软组织平衡的方法。技巧及术后疗效。方法：自2010年6月～2012年6月共收治晚期膝关节疾病合并屈曲挛缩畸形患者156例,213膝,采取人工膝关节置换进行治疗,分别记录术前术后膝关节畸形程度,HSS评分,活动范围。并进行比较。本组病例平均年龄60．2岁（44～81岁）,女92例136膝,男64例77膝。膝骨性关节炎85例,类风湿性关节炎58例,创伤性关节炎13例。膝关节活动范围平均52．6°（33．5°～94．1°）。本组病例轻度屈曲畸形：83例117膝,中度屈曲畸形：58例76膝,重度屈曲畸形：15例20膝。平均屈曲畸形程度：45．8°。每例患者均进行术前及术后1年HSS评分进行疗效评价。结果：所有病例获得随访,屈曲挛缩畸形均得到改善,膝关节HSS评分由术前20．7分提高到术后平均73．6分。膝关节活动范围术前平均52．6°提高到术后平均92．7°。结论：晚期膝关节病所致的屈曲挛缩畸形的膝关节行膝关节置换术,除了在术中注意准确截骨外,应着重注意软组织松解,调整力线。     

超声乳化人工晶体植入治疗糖尿病患者白内障的临床分析

目的 探讨糖尿病患者白内障行超声乳化人工晶体植入术的临床疗效.方法 观察87例(92眼)糖尿病性白内障(PHACO组)与94例(102眼)非糖尿病性白内障患者(Control组)行超声乳化人工晶体植入术以及21例(23眼)糖尿病性白内障患者(ECCE组)行现代囊外摘除人工晶体植入术的临床疗效,比较它们视力恢复和术中、术后并发症的差异.结果 PHACO组和Control组比较近期和远期视力恢复无差异,P＞0.05;PHACO组的近期视力恢复明显好于ECCE组,P＜0.05,但两组远期视力恢复差异无显著性,P＞0.05.PHACO组和Control组的术中、术后并发症相似,两组比较无差异,P＞0.05;ECCE组的术中、术后并发症发生率明显高于PHACO组,P＜0.05,主要表现在术中虹膜色素播散发生的不同,术后纤维膜性渗出和虹膜后粘连的发生率在ECCE组明显高于PHACO组.结论 超声乳化人工晶体植入术具有切口小、愈合快、视力恢复好、并发症少等优点,经合理的术前准备和术中、术后处理,糖尿病患者白内障行超声乳化人工晶体植入术是安全可靠的.     

掌远端微型穿支皮瓣在指蹼挛缩修复中的应用

目的总结掌远端微型穿支皮瓣修复指蹼挛缩的方法及疗效。方法 2008年8月-2010年3月,收治6例指蹼挛缩患者。男4例,女2例;年龄16～68岁,平均45岁。致伤原因:深Ⅱ度烧伤2例,机器绞伤2例,压砸伤2例。瘢痕挛缩病程3个月～3年。瘢痕挛缩指蹼:示中指2例,中环指3例,环小指1例。指蹼最大外展度5～10°。指蹼斜坡和蹼沟消失。术中首先行挛缩指蹼开大,开大后指蹼缺损范围为20 mm×8 mm～30 mm×13 mm;然后采用大小为25 mm×10 mm～35 mm×15 mm的掌远端微型穿支皮瓣移位修复缺损;供区直接缝合。结果术后皮瓣完全成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合。患者均获随访,随访时间6～12个月。重建指蹼外形良好,质地柔软,有接近正常指蹼的指蹼斜坡和蹼沟。指蹼最大外展度达40～60°。手掌切口无瘢痕挛缩,掌指关节活动正常。结论掌远端微型穿支皮瓣具有不损伤主干动脉的优点,是修复指蹼挛缩的理想方法之一。     

Trapeze-flap plasty: Effective method for postburn neck contracture elimination

The new method for postburn neck contracture management is presented. The method is found to be most effective when using the local flap procedures on patients who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration (children, elderly patients, patients with inadequate donor sites, and patients with cosmetically acceptable scar appearance). The method consists of the opposite transposition of trapezoid scar-fascial flaps which are prepared one on each antero-lateral neck surface. Both flaps include scars, fat, platysma and deep cervical fascia. As a result of the trapeze-flap plasty, the anterior surface of the neck is lengthened approximately by 100–200%, the contracture is eliminated and mentocervical angle and head movement are restored. The flaps have reliable blood circulation through the superficial cervical artery perforators, therefore flap loss is rare. The functional results were good in 24 out of 26 patients. The flaps surface does not decrease; therefore, the mild contracture becomes an exception.