下肢部位创伤后应用游离皮瓣移植术的术后护理及并发症预防

目的探讨分析下肢部位创伤后应用游离皮瓣移植术的术后护理及并发症预防。方法选取2022.1~2023.8期间,我院收治的90例行游离皮瓣移植术的下肢部位创伤患者,随机分为2组(对照组采用常规护理,观察组采用预见性护理),各45例,对比分析两组干预效果。结果组间干预后皮瓣评分比较,观察组较对照组高(P<0.05);组间并发症发生率比较,观察组较对照组低(P<0.05);组间满意度比较,观察组较对照组高(P<0.05)。结论下肢部位创伤后应用游离皮瓣移植术的术后护理采用预见性护理能改善患者皮瓣情况,减少并发症,且患者对护理更满意,值得推广。

下肢多部位截骨结合Ilizarov技术矫正青少年严重膝内翻畸形的应用研究

目的 研究下肢多部位截骨结合Ilizarov技术矫正青少年膝内翻畸形的临床疗效。方法 对自2019年9月至2021年3月收入潍坊医学院附属医院矫形骨科的13例(15膝)青少年严重膝内翻患者,行下肢多部位截骨结合Ilizarov外固定架治疗。其中男8例(61.54%),女5例(38.46%);年龄9~17岁,平均(13.57±2.71)岁;畸形部位:左膝9侧(60%),右膝6侧(40%)。比较患者术前、术后3个月、术后6个月以及末次随访时的解剖学股胫角(anatomic femur tibia angle,aFTA)、股骨远端外侧角(lateral distal femoral angle,LDFA),胫骨近端内侧角(medial proximal tibial angle,MPTA);术前以及末次随访膝关节活动度、牛津大学膝关节评分(Oxford knee score,OKS)、美国特种外科医院(hospital for special surgery,HSS)膝关节评分。结果 13例(15膝)膝关节畸形患者获得24~39个月随访,平均(29.63±3.29)个月。与术前相比,术后3个月、6个月和末次随访中患者aFTA及LDFA显著减小(P<0.001),MPTA显著增大(P<0.001)。与术前相比,末次随访时患者膝关节活动度未见明显异常(P>0.05),OKS显著降低(P<0.001),HSS显著提高(P<0.001)。结论 下肢多部位截骨结合Ilizarov技术治疗青少年膝内翻畸形的疗效显著,选择此种治疗方式可获得满意效果。

儿童下肢近关节部位骨折的外支架治疗

目的：探讨适合儿童下肢近关节部位骨折的固定方法。方法：对儿童下肢近关节部位骨折15例采用C臂X线透视下闭合复位＋HoffmannⅡ外支架固定治疗。结果：15例均固定2~3个月后骨折愈合,随访无并发症发生。结论：HoffmannⅡ外支架是儿童下肢近关节骨折较为理想的固定方法。

不同患肢下肢深静脉血栓患者临床特征及转归分析

目的:探讨不同患肢下肢深静脉血栓患者临床特征及转归。方法:查阅80例下肢深静脉血栓患者的病历资料,分析患不同下肢深静脉血栓患者的临床特征及不同治疗情况的血栓转归情况。结果:双下肢血栓占比18.75%(15/80),非双下肢占比81.25%(65/80)。双下肢血栓患者年龄≥60岁、受伤至手术时间≥7 d、血红蛋白、白蛋白、红细胞比容较非下肢血栓高,活化部分凝血活酶时间短(P均<0.05)。接受治疗患者中双下肢与非双下肢深静脉血栓患者的治疗方案对比有差异,所有患者中双下肢与非双下肢深静脉血栓患者治疗转归中好转/消失占比对比有差异(P均<0.05)。治疗时间≥15 d的血栓好转/消失占比明显较未治疗组高(P<0.05)。结论:双下肢深静脉血栓的发生率为18.75%,年龄≥60岁、受伤至手术时间≥7 d、活化部分凝血活酶时间、血红蛋白、白蛋白、红细胞比容较高,临床中需重视下肢深静脉血栓的防治,若需抗凝治疗,应在综合评估风险后制定个性化治疗方案,并建议抗凝疗程≥15 d。

Warm needling moxibustion versus electroacupuncture for simple obesity due to yang deficiency of the spleen and kidney: a controlled clinical trial

Objective: To compare the therapeutic efficacy between warm needling moxibustion and electroacupuncture (EA) in the treatment of simple obesity due to yang deficiency of the spleen and kidney. Methods: Seventy patients with simple obesity due to yang deficiency of the spleen and kidney were randomly divided into a warm needling moxibustion group and an EA group, with 35 subjects in each group. Same major acupoints were selected for the two groups, including Shuifen (CV 9), Guanyuan (CV 4), Daheng (SP 15), Shuidao (ST 28), Shousanli (LI 10), Zusanli (ST 36), Sanyinjiao (SP 6) and Taixi (KI 3). The warm needling moxibustion group received warm needling moxibustion, while the EA group received EA treatment. The interventions were performed once every other day, with 15 treatments as one course. The therapeutic efficacy, body weight and body mass index (BMI) were then observed and compared. Results: The total effective rate in the warm needling moxibustion group was 85.7% versus 77.1% in the EA group, and the between-group difference was statistically significant (P<0.05). The warm needling moxibustion was remarkably superior to the EA in weight loss and lowering BMI, both with statistical significance (P<0.05, P<0.01). At the three-month follow-up, the body weight and BMI further decreased in the warm needling moxibustion group (both P<0.05), and the levels were lower than those in the EA group (P<0.05, P<0.01). Conclusion: Warm needling moxibustion can produce reliable and consistent efficacy in the treatment of simple obesity due to yang deficiency of the spleen and kidney. Compared with EA, warm needling moxibustion shows advantage in both short-term and long-term efficacies, and thus is worth promotion in clinical practice.

Ectopic major transplantation for salvage of upper anct ower extremity amputations

Objective：Ectopic tissue transplantation is not a new idea.Godina and his colleagues pioneered this method in the 1980s.This method is a last resort method of preserving an amputated body part,which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date.In this article we present our experience with this demanding procedure.Methods：Debridement was the mainstay of this procedure.The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap.The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.Results：Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study.The overall success rate was about 70%,lower than expected but these are cases of severe crush injury.Although the functional recovery of these patients are very low,all of the successful cases except one could find a job as a janitor or light manual worker.No patient could return to his previous job.Conclusion：Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries.In our country an amputee has very little chance of finding a job instead a disabled person can.In addition in Iran cultures amputation is seen as punishment of either the God or the society,so it is not well accepted and many patients persist on saving the limb even with no functional recovery.None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.