目的 探讨阳性激发点推拿联合依托芬那酯凝胶治疗对颈肩背肌筋膜炎的临床疗效。 方法 收集2011年2月－10月确诊为颈肩背肌炎的患者52例，采用随机对照试验,其中26例采用依托芬那酯凝胶加阳性激发点推拿（治疗组），另外26例采用传统推拿进行常规推拿手法治疗（对照组）。对两组患者5次治疗后的疗效率、每次治疗后的疼痛面谱量化评分、7个月后随访疼痛复发率等疗效进行对照分析。 结果 治疗组和对照组经连续治疗5次后，总有效率分别为96.15%和80.77%，差异均有统计学意义（P＜0.05）；疼痛面谱量化评分治疗组在第一次治疗后就较对照组改善明显，差异有统计学意义（P＜0.05）；7个月后随访疼痛复发人数治疗组较对照组少，差异有统计学意义（P＜0.05）。 结论 阳性激发点推拿联合依托芬那酯凝胶治疗方案对改善颈肩背肌筋膜炎引发的颈肩背部疼痛不适等症状优于传统推拿组，值得临床推广运用。
ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
Objective To evaluate the effect of internal fixation on the stability of pedicled fascial flap and the osteogenesis of exceed critical size defect (ECSD) of bone so as to provide theory for the clinical application by the radiography and histology observation. Methods The ECSD model of the right ulnar midshaft bone and periosteum defect of 1 cm in length was established in 32 New Zealand white rabbits (aged 4-5 months), which were divided into group A and group B randomly (16 rabbits in each group). The composite tissue engineered bone was prepared by seeding autologous red bone marrow (ARBM) on osteoinductive absorbing material (OAM) containing bone morphogenetic protein and was used repair bone defect. A pedicled fascial flap being close to the bone defect area was prepared to wrap the bone defect in group A (control group). Titanium miniplate internal fixation was used after defect was repair with composite tissue engineered bone and pedicled fascial flap in group B (experimental group). At 2, 4, 6, and 8 weeks, the X-ray films examination, morphology observation, and histology examination were performed; and the imaging 4-score scoring method and the bone morphometry analysis was carried out. Results All rabbits survived at the end of experiment. By X-ray film observation, group B was superior to group A in the bone texture, the space between the bone ends, the radiographic changes of material absorption and degradation, osteogenesis, diaphysis structure formation, medullary cavity recanalization. The radiographic scores of group B were significantly higher than those of group A at different time points after operation (P lt; 0.05). By morphology and histology observation, group B was superior to group A in fascial flap stability, tissue engineered bone absorption and substitution rate, external callus formation, the quantity and distribution area of new cartilage cells and mature bone cells, and bone formation such as bone trabecula construction, mature lamellar bone formation, and marrow cavity recanalization. The quantitative ratio of bone morphometry analysis in the repair area of group B were significantly larger than those of group A at different time points after operation (P lt; 0.05). Conclusion The stability of the membrane structure and the bone defect area can be improved after the internal fixation, which can accelerate bone regeneration rate of the tissue engineered bone, shorten period of bone defect repair, and improve the bone quality.
Objective To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects. Methods Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm × 0.6 cm to 2.3 cm × 2.1 cm. According to ZHOU Qingwen’s grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm × 0.6 cm to 2.5 cm × 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft. Results All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.
Objective To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture. Methods Between October 2009 and June 2011, 10 cases of Achilles tendon and soft tissue defects were treated. There were 7 males and 3 females, aged from 5 to 60 years (median, 40 years). Injury was caused by spoke in 5 cases, by heavy pound in 3 cases, and by traffic accident in 2 cases. The time between injury and admission was 2-24 hours (mean, 8 hours). The size of wound ranged from 11 cm × 7 cm to 18 cm × 10 cm; the length of Achilles tendon defect was 4-10 cm (mean, 7 cm). Three cases complicated by calcaneal tuberosity defect. After admission, emergency debridement and vacuum sealing drainage were performed for 5-7 days, anterolateral thigh fasciocutaneous flap transplantation of 11 cm × 7 cm to 20 cm × 12 cm was used to repair skin and soft tissue defects, and improved method of ilio-tibial bundle suture was used to reconstruct Achilles tendon. The flap donor site was closed directly or repaired with skin grafting to repair. Results All flaps and the graft skin at donor site survived, healing of wounds by first intention was obtained. All patients were followed up 6-18 months (mean, 10 months). The flap was soft and flexible; the flap had slight encumbrance in 3 cases, and the others had good appearance. At last follow-up, two-point discrimination was 2-4 cm (mean, 3 cm). The patients were able to walk normally. The range of motion (ROM) of affected side was (24.40 ± 2.17)° extension and (44.00 ± 1.94)° flexion, showing no significant difference when compared with ROM of normal side [(25.90 ± 2.33)° and (45.60 ± 1.84)° ] (t=1.591, P=0.129; t=1.735, P=0.100). According to Arner-Lindhoim assessment method for ankle joint function, all the patients obtained excellent results. Conclusion A combination of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defects and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture is beneficial to function recovery of the ankle joint because early function exercises can be done.
【Abstract】 Objective To investigate the method and effectiveness of repairing sacrococcygeal pressure sores with modified upper gluteal rhomboid fasciocutaneous flap. Methods Between January 2004 and March 2011, 43 patients with sacrococcygeal pressure sores were treated. There were 25 males and 18 females with an average age of 63 years (range, 38-95 years). The disease duration was 3 months to 2 years and 6 months (mean, 8.5 months). The size of pressure sores ranged from 6 cm × 5 cm to 18 cm × 13 cm. According to the extent and lesion degree of pressure scores, 23 pressure sores were rated as degree III and 20 pressure sores as degree IV. The modified upper gluteal rhomboid flap was designed, one-side upper gluteal fasciocutaneous flaps were transplanted to repair sacrococcygeal pressure sores in 19 cases and two-side flaps in 24 cases. The size of one side flap ranged from 6.5 cm × 4.5 cm to 18.0 cm × 11.5 cm. Results Fluid under flap occurred in 1 case and edge necrosis of the flaps in 3 cases at 7 days after operation, which were cured after drainage and dressing change; the other flaps survived, and incisions healed by first intention. All patients were followed up 6 months to 3 years with an average of 11 months. Two patients relapsed at 5 months and 8 months, respectively; the other patients had no recurrence. The color of the flaps was normal, and the appearance and elasticity of the flaps were good. Conclusion The modified upper gluteal rhomboid fasciocutaneous flap has the advantages of simple design and operation, less injury, and reliable effect in repairing sacrococcygeal pressure sores.