经皮腔内血管成形术在糖尿病足治疗的临床应用

目的探讨经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）在糖尿病足治疗中的价值。方法对32例临床诊断糖尿病足的患者行患侧肢体下肢数字减影血管造影（DSA）技术,并对狭窄处实施PTA,术后给予控制血糖,抗感染,抗凝治疗,其中4例6个月后行血管造影对比观察。结果在动脉造影中,4例病人显示有狭窄,血管直径〈50%,在28例狭窄〉50%的病人中,23（82.1%）进行了PTA。在2例病人中（8.7%）仅在近端主干施行了PTA。11（47.8%）病人仅在下主干施行了PTA,10（43.5%）在股及下主干施行了PTA。PTA之后,患肢动脉血液灌注获得明显的改善。仅在3例病人中出现临床复发。其中2例成功进行了第二次PTA。进行过PTA的23例病人中,1（4.3%）进行了踝上截肢术。结论作为一项高度准确的成像技术和微创治疗方法,经皮腔内血管成形术（PTA）可用于治疗大多数糖病病人的局部缺血性足溃疡。对于足部血管再生是极为有效的。     

动态血管造影(DA)模式下三束带联合对比剂团注法下肢静脉造影的应用

目的探讨动态血管造影（Dynamic angiography简称DA）模式下三束带联合对比剂团注法下肢静脉造影的技术控制方法、标准以及此造影方法应用的临床意义。方法设备采用GE公司的LCE＋大型血管机,用套管针穿刺患侧足背静脉并固定,在1.5-2分钟内完成对比剂的手推团注,采集图像时用检查床控制手柄控制检查床的纵向移动,根据检查进程需要依次松解患肢的三条束带,并让患者配合做Vasalvas实验,获得一系列反映下肢静脉形态、血液回流状况以及静脉瓣功能的实时动态数字化序列影像。结果对68例患者进行了116次动态血管造影模式下三束带联合对比剂团注法下肢静脉造影研究。116次下肢静脉造影中,114次造影的动态序列影像质量优良,约占98.28%;2例次造影的动态序列影像质量欠佳,约占1.73%。结论动态血管造影采集模式下三束带联合对比剂团注法下肢静脉造影改进了下肢静脉造影的方法 ,不但能完全满足诊断的需要,而且实现了对比剂的团注,节省了对比剂的用量,并减少了患者和医师的X线辐射,客观准确性更强,是一种全新的具有临床推广意义的下肢静脉造影诊断新方法。     

产后下肢深静脉血栓形成33例分析

目的探讨产后下肢深静脉血栓形成的原因及防治方法。方法对33例产后下肢深静脉血栓病例进行分析总结。结果急性下肢深静脉血栓形成与血液高凝状态、血流缓慢以及产后活动少,剖宫产损伤等多种因素有关。结论溶栓及抗凝疗法是治疗下肢静脉血栓形成的有效方法,严格掌握剖宫产手术指征及产后早下床活动可减少深静脉血栓形成。     

介入溶栓治疗下肢动脉血栓5例的治疗体会

目的:探讨介入溶栓治疗下肢动脉血栓的治疗体会。方法:诊断明确的下肢动脉血栓患者,采用Seldinger穿刺健侧留置导管,造影明确血栓的部位及血管狭窄的程度。用尿激酶30万u 30分钟注射完毕,之后造影如未通畅则保留导管继续溶栓,尿激酶5-8万u/h经导管灌注,连续3-7天。视情况再次造影,评价血栓溶解情况。结果:5例患者患肢均恢复血供。结论:介入溶栓治疗下肢动脉血栓简便、安全、可靠、有效,有效的护理观察对良好的预后有较大帮助。     

Dissection of a rare accessory muscle of the leg: the tensor fasciae suralis muscle

We report a case of the rare tensor fascia suralis muscle. This muscle was found during the routine dissection of the lower extremity in an adult male cadaver. No other anomalies were noted in this specimen. The innervation of this muscle was via the tibial component of the sciatic nerve. Although seemingly rare, the tensor fascia suralis muscle may be considered by the clinician in the differential diagnosis of masses over the posterior lower extremity.     

Physical disability after severe lower-extremity injury

OBJECTIVE: To investigate the use of a combined measure of decreased walking speed and gait deviation to identify high physical disability in patients with lower-limb salvage. DESIGN: Longitudinal study of patients with severe lower-extremity trauma. SETTING: Eight level I trauma centers. PARTICIPANTS: Patients (N=276) with lower-limb salvage from the Lower Extremity Assessment Project. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disability from the physical dimension of the Sickness Impact Profile (SIP), walking speed, and gait deviation were measured at 24 months of follow-up. A 1-way analysis of variance and planned comparisons compared mean SIP scores across and between the following 3 outcome groups: no impaired speed and no gait deviation, impaired speed or gait deviation, and impaired speed and gait deviation. RESULTS: Mean SIP scores for the physical dimension and its 2 categories of ambulation and body care and movement differed statistically across the planned comparisons. The mobility category showed that the impaired speed or deviation group was statistically similar to the group without impaired speed and gait deviation. CONCLUSIONS: The combination of decreased walking speed and gait deviation appears to provide a valid measure of physical disability among patients with lower-limb salvage.     

妇科手术后下肢静脉血栓形成20例临床分析

目的 观察妇科手术后下肢静脉血栓形成的原因及预防. 方法 回顾性分析20例妇科手术后下肢静脉血栓形成患者的临床资料. 结果 手术时间与下肢静脉血栓发生的关系：＜2 h 3例（15%）,2～3 h 5例（25%）,＞3 h 12例（60%）;手术方式：经腹子宫切除术1 746例,并发下肢静脉血栓形成4例（0.23%）;阴式子宫切除术984例,并发下肢静脉血栓形成9例（0.91%）;子宫广泛切除加盆腔淋巴清扫和卵巢癌细胞减灭术108例,并发下肢静脉血栓形成5例（4.6%）;子宫肌瘤剔除术691例,并发下肢静脉血栓形成2例（0.29%）;＞50岁患者17例（85%）,≤5岁3例（15%）;全部治愈出院. 结论 围术期加强术后下肢静脉形成的预防措施,规范化治疗可显著改善预后.     

Hypodermic needle to guide Kirschner-wire placement in paediatric supracondylar humerus fractures: a technical trick

PurposeSupracondylar humerus fractures are among the most common injuries in the paediatric population, accounting for 16% of all paediatric fractures and roughly 60% to 70% of all paediatric elbow fractures. Typical treatment for displaced and unstable supracondylar humerus fractures is surgical intervention, often with percutaneous Kirschner-wire (K-wire) fixation. Timing of surgery is dependent on the patient’s neurovascular status on presentation, with surgical emergencies being performed at all hours of day and night. Percutaneous fixation of paediatric elbow fractures can be challenging as a result of the propensity for the elbow to become quite swollen with these fractures, particularly in smaller and physiologically more immature elbows.MethodsWe have developed a simple operative technique to guide placement of percutaneous wires for supracondylar humerus fractures using a hypodermic needle as a reference marker.ResultsIn our experience, trainees utilizing this technique demonstrate greater appreciation for start point and trajectory of wires during percutaneous pinning, with better communication amongst surgical team members about necessary adjustment for optimal placement of K-wires.ConclusionUtilization of this technique has the potential to refine surgical technique by minimizing errant wire passes, radiation and operative time when performing percutaneous pinning of reduced type III supracondylar humerus fractures.Level of EvidenceV, Novel Surgical Technique     

灯盏细辛注射液联合奥扎格雷治疗下肢动脉硬化性闭塞症100例临床观察

目的：观察灯盏细辛注射液联合奥扎格雷治疗下肢动脉硬化性闭塞症的临床疗效.方法：100 例下肢动脉硬化性闭塞症随机分为治疗组和对照组,并检测患者下肢血管彩超、血流变学、肝肾功能等各项指标.治疗前后对临床疗效和彩超疗效进行评价,比较2 组治疗下肢动脉硬化性闭塞症的疗效.结果：两组经过治疗后临床疗效和彩超疗效进行评价,治疗组显效80 例,占80%,有效13 例,占13%,总有效率为93%.对照组显效27 例,占54%,有效13 例,占26%,总有效率80%.治疗组和对照组有效率比较治疗组也明显优于对照组（P0.01）.结论：灯盏细辛注射液联合奥扎格雷：治疗下肢动脉硬化性闭塞症效优于对照组.     

Upper extremity deep venous thrombosis in the population-based Malmö thrombophilia study (MATS). Epidemiology, risk factors, recurrence risk, and mortality

Background

Deep venous thrombosis (DVT) is much less common in the upper than in the lower extremity. Furthermore, there is limited information on risk factors for and the prognosis of upper extremity (UE)DVT in the general population.

Aims

To estimate incidence, risk factors, and prognosis in UEDVT.

Material and methods

Among a total of 1203 patients with venous thromboembolism (VTE) diagnosed during 1998-2006 in the prospective population-based Malmö thrombophilia study, 63 (5%, 33 men [52%, age 54 ± 17 years], and 30 women [48%, age 55 ± 22 years]) had UEDVT and were evaluated concerning risk factors, treatment, recurrent VTE, and mortality.

Results

At diagnosis, 19(30%) patients had known malignancy and 6(10%) had VTE heredity. Among female UEDVT patients 4(13%) used hormone therapy, 1(3%) was pregnant, while none was in the postpartum period. Of all 63 UEDVT patients, 12(19%) were heterozygous, and 3(5%) homozygous for the Factor V Leiden (FVL)-mutation. Two (3%) patients were heterozygous for the prothrombin mutation, and 1 patient (1.6%) showed both heterozygous FVL-mutation and lupus anticoagulant antibodies. Phlebography had been used for diagnosis in 48(76%), ultrasonography in 16(25%), and computer tomography (CT) in 9(14%) patients. Twenty-two patients (35%) were treated in hospital, and the remaining 41(65%) as out-patients. Sixty-two (98%) was treated with low molecular weight heparin (LMH), 60(95%) with oral anticoagulants (OAC), 3(5%) with unfractionated heparin, and 3(5%) with thrombolysis. VTE recurrence rate during median 62 (range 31-117) month of follow-up was 8/63(13%). Fifteen (24%) UEDVT patients died during follow-up; 9(47%) of the 19 patients with known malignancy at diagnosis and 6(14%) of the other patients. Yearly incidence of UEDVT was 3.6/100.000 (95% confidence interval [CI], 3.3 – 4.03).

Conclusion

Malignancies and the FVL mutation were common among patients with UEDVT. Mortality during follow-up vas high.