Therapeutic Effect and Mechanism of Jipei Dilong Ointment on Acute Soft Tissue Injury in Rats

[Objectives]This study was conducted to observe the therapeutic effect of Jipei Dilong Ointment on rats with acute soft tissue injury caused by heavy objects and to explore its action mechanism.[Methods]Thirty six rats were randomly divided into six groups(control group,model group,high-dose Jipei Dilong Ointment group(JP-H),medium-dose Jipei Dilong Ointment group(JP-M),low-dose Jipei Dilong Ointment group(JP-L)and diclofenac group).Except for the Control group,other groups were subjected to modeling of acute soft tissue injury by the weight impact method.All administration was performed once a day for nine consecutive days.The local appearance score and activity disorder score were determined after soft tissue injury in rats.HE staining was used to detect the pathological changes of injured soft tissues in rats.RT-PCR was used to detect the relative mRNA expressions of Bax,Bcl-2,MMP-9 and TIMP-1 in injured soft tissues of rats.Western Blot was used to detect the protein expressions of MMP-9,TIMP-1,TLR4,MyD88 and NF-κB p65 in injured soft tissues of rats.Results were statistically analyzed.[Results]Compared with the model group,Jipei Dilong Ointment could significantly improve the appearance symptoms such as swelling and ecchymosis in the injured area and the movement function of the affected limb(P<0.05).It could also improve the infiltration of inflammatory cells and widening of the intermuscular space caused by injury.Among them,the JP-H group and the diclofenac group had more significant curative effects.After 9 d of administration,each administration group could significantly up-regulate the ratio of Bcl-2/Bax mRNA expression level(P<0.05 or P<0.01),and the ratio of MMP-9/TIMP-1 mRNA expression level showed a downward trend(P>0.05).The expression level of NF-κB p65 protein in each administration group was significantly decreased(P<0.01).The protein expression levels of TLR4 and MyD88 and the ratio of MMP-9/TIMP-1 protein expression level in each administration group decreased to varying degrees.Among them,the JP-H group and diclofenac group significantly decreased(P<0.05).[Conclusions]Jipei Dilong Ointment has the functions of relieving pain,swelling and inflammation.It could improve the local appearance,functional activity and tissue morphology of affected limbs in rats,and has a therapeutic effect on acute soft tissue injury in rats.Its mechanism of action might be related to the inhibition of TLR4/MyD88/NF-κB p65 signaling pathway and the regulation of Bcl-2/Bax and MMP-9/TIMP-1 balance.

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.

A New Model to Study Healing of a Complex Femur Fracture with Concurrent Soft Tissue Injury in Sheep

High energy bone fractures resulting from impact trauma are often accompanied by subcutaneous soft tissue injuries, even if the skin remains intact. There is evidence that such closed soft tissue injuries affect the healing of bone fractures, and vice versa. Despite this knowledge, most impact trauma studies in animals have focussed on bone fractures or soft tissue trauma in isolation. However, given the simultaneous impact on both tissues a better understanding of the interaction between these two injuries is necessary to optimise clinical treatment. The aim of this study was therefore to develop a new experimental model and characterise, for the first time, the healing of a complex fracture with concurrent closed soft tissue trauma in sheep. A pendulum impact device was designed to deliver a defined and standardised impact to the distal thigh of sheep, causing a reproducible contusion injury to the subcutaneous soft tissues. In a subsequent procedure, a reproducible femoral butterfly fracture (AO C3-type) was created at the sheep’s femur, which was initially stabilised for 5 days by an external fixator construct to allow for soft tissue swelling to recede, and ultimately in a bridging construct using locking plates. The combined injuries were applied to twelve sheep and the healing observed for four or eight weeks (six animals per group) until sacrifice. The pendulum impact led to a moderate to severe circumferential soft tissue injury with significant bruising, haematomas and partial muscle disruptions. Posttraumatic measurements showed elevated intra-compartmental pressure and circulatory tissue breakdown markers, with recovery to normal, pre-injury values within four days. Clinically, no neurovascular deficiencies were observed. Bi-weekly radiological analysis of the healing fractures showed progressive callus healing over time, with the average number of callus bridges increasing from 0.4 at two weeks to 4.2 at eight weeks. Biomechanical testing after sacrifice showed in- creasing torsional stiffness between four and eight weeks healing time from 10% to 100%, and increasing ultimate torsional strength from 10% to 64% (relative to the contralateral control limb). Our results demonstrate the robust healing of a complex femur fracture in the presence of a severe soft tissue contusion injury in sheep and demonstrate the establishment of a clinically relevant experimental model, for research aimed at improving the treatment of bone fractures accompanied by closed soft tissue injuries.

EIGHTY CASES of SOFT TISSUE INJURY TREATED WITH LOCAL CONTRALATERAL NEEDLING METHOD

Contralateral needling method is a common and effective one of acupuncture analgesicmethods.It is used to treat a local pain in the limbs and trunk with a short course of disease,pain and swelling will disappear or be relieved immediately for one or two treatments.Really,there isan effect of relieving pain as soon as the needle is inserted.When the local contralateral needlingmethod is used,the key to improving the effectiveness lies in determining the pain position and its correspondingpoint correctly,the more correct the pain position and its corresponding point are determined,the better the effectiveness will be.In this group,80 cases soft tissue injury were treatedwith local contralateral needling method,the cure rate was 82％,and the total effective rate was100％.

Electrical Resistance as A Measure of Soft Tissue Injuryfrom Delayed Onset Muscle Soreness

Assessment of muscle damage relies commonly on subjective sensation of pain. The purpose of this research was to test thevalidity of microcurrent conductance on skin over injured tissue to quantify soft tissue injury and recovery following heavy exercisecompared to other indexes of muscle soreness. A randomized, controlled, single-blinded, 1-week trial on 60 subjects.Setting-University Interventions： Subjects did 3 sets of squats for 5 min each. There were 3 groups of 20 subjects. One did nothing andone had heat applied for 8 h post exercise. The final group had heat 24 h after exercise. Tissue resistance and muscle strength force tomove the knee, analog visual pain scale. In the control group, microcurrent continually decreased, eventually decreasing 32% by thethird day post exercise. When heat was given immediately following exercise, microcurrent was 26% greater （P 〈 0.001）. The painscale rose to 3.1/10 as opposed to 5.4/10 for controls. Strength and muscle elasticity stayed mostly constant after heat as opposed to a28% decrease in strength and increase in stiffness in the control subjects. For 24 h delayed heat, microcurrent was 14% greater（P 〈 0.02）, and was unchanged for the first 24 h when no therapy was given. Pain scale rose to 4.8/10. Stiffness was unchanged whilemuscle strength decreased the same as controls. Microcurrent shows agreement with loss of strength, and stiffness from DOMS but notthe subjective pain measure. It appears that microcurrent is a good measure of muscle damage.

TREATMENT OF SOFT TISSUE INJURY BY PUNCTURING CLEFT-POINTS

Objective: To observe the therapeutic effect of acupuncture of "Xi" (Cleft) points in treatment of soft tissue injury. Methods: 335 cases of soft tissue injury patients were divided into Cleft point group (264 cases) and Ashi point group (control group, 71 cases) randomly. In Cleft point group, the 16 Cleft points were used in combination with Ahshi points. In control group, only local Ahshi points were punctured. The treatment was conducted once every day, with 5 sessions being a therapeutic course. After 2 courses of treatment, the therapeutic effect was analyzed. Results: Results showed that the therapeutic effect of cleft point group was significantly better than that of control group (P<0.05), particularly in treatment of acute soft tissue. Conclusion: Cleft point acupuncture has a better therapeutic effect in treatment of soft tissue injury in comparison with Ashi point.

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Background: Maxillofacial injury may vary from simple soft tissue lacerations to complex fractures of the orofacial region. Soft tissue injuries, whether isolated or in combination with other injuries, form part of the frequent traumatic craniofacial injuries seen at the emergency department. The force of impact and the injury type is directly related to the severity of the injury sustained. This study aimed to analyze the etiological factors, prevalence, and management of oral and maxillofacial soft tissue injuries at the Komfo Anokye Teaching Hospital. Methods: This was a prospective study that involved children presenting with oral and maxillofacial injuries at the Accident and Emergency Department and the Oral and Maxillofacial Surgery unit of the Komfo Anokye Teaching Hospital in Kumasi between the period of April to October 2020 (6 months). Patient selection was by convenience sampling targeting all children with injuries who met the inclusion criteria. Inclusion criteria were children below the age of 18 years whose parents or caregivers consent to participation. Children with maxillofacial injuries as a result of burns were excluded from the study. Results: During the study period a total of 134 children were reviewed with oral and maxillofacial injuries at KATH. Of these, 107 (78.9%) were recorded cases of orofacial soft tissue injuries. There were 63 (58.9%) males and 44 (41.1%) females and the male-to-female ratio was 1.5:1. The age range of patients studied was 8 months – 17 years, with mean age ± SD being 9.5 ± 5.3 years. Road Traffic Crash (50.5%) was the most common etiology of which Motor cycle crash constituted 24.3% and Pedestrian knockdown was 19.6%. Falls (42.1%) were the next most common etiology. The lips (19.8%) and the forehead (18.5%) were the most frequently injured sites on the face whiles the tongue (3.3%) had the most injuries intraorally. Laceration (45.7%) was the most frequent injury reviewed, followed by abrasions (35.8%). Most of the soft tissue injuries underwent primary closure (56.3%). A complication rate of 21.2% was recorded in this study and hypertrophic scarring (11.3%) was the most observed.

One case of shoulder soft tissue injury treated with cangguitanxue needling technique and cupping therapy

The combined treatment of cangguitanxue(green turtle probing its cave)needling technique and cupping method achieved the significant therapeutic effects on 1 case of traumatic soft tissue injury.Such therapeutic method provides the reference for the clinical treatment of soft tissue swelling due to injury.

Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?

Cold therapy has been used regularly as an immediate treatment to induce analgesia following acute soft-tissue injuries,however,a prolonged ice application has proved to delay the start of the healing and lengthen the recovery process.Hyperbaric gaseous cryotherapy,also known as neurocryostimulation,has shown the ability to overcome most of the limitations of traditional cold therapy,and meanwhile promotes the analgesic and anti-inflammatory effects well,but the current existing studies have shown conflicting results on its effects.Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries,and therefore no need to be entirely put out to pasture in the rehabilitation practice.Strong randomized controlled trials with good methodological quality are still needed in the future to evaluate the effects of different cryotherapy modalities.

One-year clinical study of NeuroR egen scaffold implantation following scar resection in complete chronic spinal cord injury patients

The objective of this clinical study was to assess the safety and feasibility of the collagen scaffold, Neuro Regen scaffold, one year after scar tissue resection and implantation. Scar tissue is a physical and chemical barrier that prevents neural regeneration. However, identification of scar tissue is still a major challenge. In this study, the nerve electrophysiology method was used to distinguish scar tissue from normal neural tissue, and then different lengths of scars ranging from 0.5–4.5 cm were surgically resected in five complete chronic spinal cord injury(SCI) patients. The NeuroR egen scaffold along with autologous bone marrow mononuclear cells(BMMCs), which have been proven to promote neural regeneration and SCI recovery in animal models, were transplanted into the gap in the spinal cord following scar tissue resection. No obvious adverse effects related to scar resection or Neuro Regen scaffold transplantation were observed immediately after surgery or at the 12-month follow-up. In addition, patients showed partially autonomic nervous function improvement, and the recovery of somatosensory evoked potentials(SSEP) from the lower limbs was also detected. The results indicate that scar resection and Neuro Regen scaffold transplantation could be a promising clinical approach to treating SCI.

Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.

Terrorist attacks in the largest metropolitan city of Pakistan: Profile of soft tissue and skeletal injuries from a single trauma center

BACKGROUND: Pakistan has been hugely struck with massive bomb explosions(car and suicide bombs) resulting in multiple casualties in the past few years. The aim of this study is to present the patterns of skeletal and soft tissue injuries and to review the outcome of the victims who presented to our hospital.METHODS: This is a retrospective chart review from January 2008 to December 2012. The medical record numbers of patients were obtained from the hospital Health Information and Management Sciences(HIMS) as per the ICD-9 coding.RESULTS: During the study period, more than 100 suicide and implanted bomb blast attacks took place in the public proceedings, government offices, residential areas and other places of the city. Altogether 262 patients were enrolled in the study. The mean age of the patients was 31±14 years. The shrapnel inflicted wounds were present on to the upper limb in 24 patients and the lower limb in 50.CONCLUSION: Long bone fractures were the most common skeletal injuries. The fractures were complicated by penetrating fragments and nails which result in post operative infections and prolonged hospital stay.

化瘀止痛贴膏调节IL-6/STAT3信号通路对急性软组织损伤大鼠炎症反应的影响

目的探讨化瘀止痛贴膏调节白细胞介素-6(IL-6)/信号转导与转录激活子3(STAT3)信号通路对急性软组织损伤(ASTI)大鼠炎症反应的影响。方法将SPF级SD大鼠随机分为对照组、模型组、化瘀止痛贴膏低、中、高剂量组、精制狗皮膏组。利用机械冲击挫伤法建立ASTI动物模型,建模成功后,各组贴敷相应药物,1次/d,每次给药8 h,连续7 d。对大鼠进行ASTI损伤评分;采用血液流变检测仪检测血液流变学指标;苏木精和伊红(HE)染色法观察大鼠损伤部位肌肉组织病理变化;酶联免疫吸附法(ELISA)检测各组大鼠损伤部位肌肉组织中IL-6、IL-β、肿瘤坏死因子-α(TNF-α)水平;实时荧光定量PCR(qRT-PCR)法检测损伤部位肌肉组织中IL-6与STAT3 mRNA表达;蛋白免疫印迹(Western blot)法检测大鼠损伤部位肌肉组织中IL-6/STAT3信号通路蛋白表达。结果与对照组比较,模型组大鼠软组织损伤评分、全血黏度、血浆黏度、红细胞压积、肌肉组织病理学评分、IL-6、IL-β、TNF-α水平、IL-6与STAT3 mRNA表达水平及IL-6、p-STAT3/STAT3蛋白表达水平升高(均P<0.05);与模型组比较,化瘀止痛贴膏低、中、高剂量组和狗皮膏药组大鼠软组织损伤评分、全血黏度、血浆黏度、红细胞压积、肌肉组织病理学评分、IL-6、IL-β、TNF-α水平、IL-6与STAT3 mRNA表达水平及IL-6、p-STAT3/STAT3蛋白表达水平降低(均P<0.05);化瘀止痛贴膏高剂量组与精制狗皮膏组大鼠以上指标差异均无统计学意义(P>0.05)。结论化瘀止痛贴膏可能通过下调IL-6/STAT3信号通路缓解ASTI大鼠的炎症反应。

基于JAK2/STAT3信号通路探究利咽糖浆对慢性咽炎大鼠咽喉组织损伤及咽黏膜修复的影响

目的:基于Janus激酶2(JAK2)/信号转导和转录激活因子3(STAT3)信号通路探究利咽糖浆对慢性咽炎大鼠咽喉组织损伤及咽黏膜修复的影响。方法:取SD大鼠随机分为对照组、模型组、利咽糖浆组、RO8191(JAK2/STAT3激活剂)组、利咽糖浆+RO8191组,模型组与药物干预组大鼠采用氨水刺激咽部构建慢性咽炎模型,对照组大鼠咽部注射等剂量生理盐水,经利咽糖浆与RO8191干预后,检测大鼠一般情况及咽部表观状态,并进行咽部表观状态评分;HE染色检测大鼠咽部病理形态变化;流式细胞术检测大鼠外周血T淋巴细胞亚群CD4^(+)T与CD8^(+)T表达、CD4^(+)T/CD8^(+)T;试剂盒检测大鼠血清肿瘤坏死因子-α(TNF-α)、IL-6、IL-10、丙二醛(MDA)、活性氧(ROS)、总抗氧化能力(T-AOC)水平;以免疫印记法检测大鼠咽部组织JAK2/STAT3通路相关蛋白表达。结果:与对照组比较,模型组大鼠咽部组织出现明显病理形态损伤,外周血CD4^(+)T与CD4^(+)T/CD8^(+)T、IL-10、血清T-AOC水平降低(P<0.05),咽部表观状态评分、CD8^(+)T、血清TNF-α、IL-6、MDA与ROS水平、咽部组织p-JAK2/JAK2与p-STAT3/STAT3水平升高(P<0.05);与模型组、利咽糖浆+RO8191组相比,利咽糖浆组大鼠咽部组织病理形态损伤减轻,外周血CD4^(+)T表达与CD4^(+)T/CD8^(+)T、IL-10、血清T-AOC水平均升高(P<0.05),咽部表观状态评分、CD8^(+)T、血清TNF-α、IL-6、MDA与ROS水平、咽部组织p-JAK2/JAK2与p-STAT3/STAT3水平均降低(P<0.05);RO8191组大鼠各指标变化趋势与利咽糖浆组相反。结论:利咽糖浆可通过抑制JAK2/STAT3信号激活减轻炎症及氧化应激,增强抗炎及抗氧化能力,缓解慢性咽炎大鼠咽喉组织损伤,修复咽黏膜。

四肢创伤性软组织缺损患者游离皮瓣移植失败的危险因素及预测模型构建

目的探讨四肢创伤性软组织缺损(STI)患者游离皮瓣移植(FFT)修复失败的危险因素,并构建预测模型。方法选取2017年1月至2023年6月期间行FFT的575例四肢创伤性STI患者为研究对象,7︰3随机分为建模组(n=403)和验证组(n=172)。多因素Logistic回归分析确定四肢创伤性STI患者FFT修复失败的危险因素。利用R3.6.3软件中rms程序包构建预测四肢创伤性STI患者FFT修复失败的列线图模型,并采用受试者工作特征(ROC)曲线和霍斯默-莱梅肖(H-L)拟合度曲线,对列线图模型预测区分度和一致性进行评估。结果多因素Logistic回归分析显示,受伤至手术时间≥6 h(OR=2.179)、吻合血管选择不合理(OR=6.770)、并发感染(OR=4.980)、术中止血不彻底(OR=3.054)、术后固定不牢固(OR=2.132)等,均为四肢创伤性STI患者FFT修复失败的独立危险因素(P<0.05);建模组H-L检验χ^(2)=11.889、P=0.546,ROC曲线下面积为0.809(95%CI:0.748~0.869);验证组H-L检验χ^(2)=6.990、P=0.322,ROC曲线下面积为0.827(95%CI:0.722~0.932)。结论基于受伤至手术时间、吻合血管选择、并发感染、术中止血不彻底、术后固定不牢固等5个危险因素构建的预测四肢创伤性STI患者FFT修复失败的列线图模型具有较好的区分度和一致性。

基于气滞血瘀理论探讨五虎口服液治疗急性软组织损伤的疗效

目的基于气滞血瘀理论探讨五虎口服液治疗急性软组织损伤的疗效。方法选取2020年9月—2022年9月于我院就诊的130例急性软组织损伤(ASTI)患者作为研究对象,通过随机数字表法分为研究组(65例)和对照组(65例),对照组给予吲哚美辛巴布膏治疗,研究组在对照组基础上给予五虎口服液治疗。并建立五虎口服液治疗ASTI的效益与风险多准则决策分析模型。采用RevMan5.3软件合并数据,得出各效益指标和风险指标效应值,采用Hiview3软件计算出研究组和对照组的效益值、风险值和效益-风险总值,改变效益-风险中一级指标的权重来评价模型的灵敏度。结果治疗后,研究组患者在压痛、瘀斑、肿胀、功能障碍、VAS评分、疼痛缓解时间、肿胀缓解时间、不良反应、临床疗效、功能障碍缓解时间方面改善显著优于对照组(均P<0.05);且IL-6、TNF-α水平均显著低于对照组(P<0.05),其余指标比较差异无统计学意义(P>0.05);研究组和对照组的效益值分别为66和50,风险值分别为71和83,效益-风险总值分别为67、57。研究组的效益-风险总值最高。无论效益-风险的相对权重如何改变,模型评价结果均保持不变,表明该模型稳定型良好。结论基于气滞血瘀理论下,五虎口服液治疗ASTI获益高于风险,可降低不良反应的发生率,能够为临床合理用药提供依据。

胫骨远端骨折伴软组织损伤3种不同微创固定方式的有限元分析

背景:伴软组织损伤胫骨远端骨折的治疗一直具有挑战性,新型逆行胫骨髓内钉是一种新的选择。目前关于新型逆行胫骨髓内钉、顺行髓内钉、外置接骨板之间的生物力学性能研究未见报道。目的:通过有限元分析方法,探讨新型逆行胫骨髓内钉、顺行髓内钉、外置接骨板治疗伴软组织损伤胫骨远端骨折的生物力学稳定性,为临床应用提供科学参考。方法:利用1名42岁健康男性的胫骨CT数据,通过相关软件建立胫骨远端横行骨折的有限元模型,根据骨折的固定原则,构建新型胫骨逆行髓内钉、胫骨顺行髓内钉、外置股骨远端外侧接骨板固定有限元模型。使用ANSYS 2019软件进行网格划分、施加载荷、数据处理,比较各模型胫骨和内固定的应力分布及位移情况。结果与结论:(1)3组模型的骨折端位移量随着载荷的增大而增加;所有模式载荷中,逆行髓内钉组位移最小,外置接骨板组次之,顺行髓内钉组平均位移最大;在800 N垂直载荷中,各组位移差异有显著性意义(P<0.05);其余载荷模式下各组无显著性差异;(2)不同载荷模式下3组模型中胫骨应力均表现为胫骨中段最高,向近、远端缓慢过渡降低;胫骨干部位应力分布均呈现逆行髓内钉组最高、外置接骨板组次之、顺行髓内钉组应力最小的情况;(3)不同载荷模式下3组模型中胫骨应力集中部位的应力,外置接骨板组明显高于另外两组,差异均有显著性意义(P<0.05);(4)不同载荷条件下3组模型中固定物的应力值,外置接骨板组最大,逆行髓内钉组次之,顺行髓内钉组最小;不同载荷条件下3组固定物应力集中部位的应力差异均有显著性意义(P<0.05);(5)提示3种固定方式均具有良好的抗旋转能力及轴向稳定性,其中新型胫骨逆行髓内钉具有更好的生物力学稳定性。

肌骨超声检查对创伤性浅表软组织损伤的临床诊断价值分析

目的探讨肌骨超声检查对创伤性浅表软组织损伤的临床诊断价值。方法选取本院收治的疑似创伤性浅表软组织损伤206例患者,均行超声检查及磁共振成像(Magnetic Resonance Imaging,MRI)检查,以手术病理检查结果为“金标准”,观察超声检查诊断结果及其安全性与准确性、超声检查声像图特点。结果以手术病理检查结果为“金标准”,超声检查与MRI检查两种方式对诊断效能、损伤类型及阳性预测值与阴性预测值比较,差异无统计学意义(P>0.05),但MRI检查对半月板撕裂检出率高于超声检查,差异有统计学意义(P<0.05)。12例神经损伤患者超声检查可见受压部位横断面减小,回声逐渐降低,彩色多普勒检查可探及少量血流信号;19例实性肿块患者声像图可见形态不规则回声区,边缘模糊,多普勒探查无血流信号;28例囊性肿块患者声像图可见部分液性暗区或无回声区,部分可探及血流信号,边缘清晰;24例韧带撕裂患者声像图可见患侧韧带弥漫性增厚且回声减低、结构紊乱,并可见血流信号;15例肌腱损伤患者声像图可见呈条带状低回声,且有连续性中断伴裂隙样低回声,断端可见血流信号;61例半月板撕裂患者声像图显示半月板连续性中断伴内部不均匀回声,彩色多普勒检查可探及血流信号。结论肌骨超声检查在创伤性浅表软组织损伤的检查中,可有效鉴别损伤类型及其范围,准确率较高,可作为患者初步筛查手段,且具有无创、安全及可重复性等优点,应用价值高。

带蒂旋髂浅动脉穿支皮瓣与躯干任意皮瓣修复手部电击伤致软组织缺损疗效对比

目的对比分析带蒂旋髂浅动脉穿支皮瓣与躯干任意皮瓣修复手部电击伤致软组织缺损的临床疗效。方法选取2017年5月至2022年6月河南科技大学第一附属医院收治的82例手部电击伤致软组织缺损患者作为研究对象,按照不同治疗方式将其分为试验组(40例)和对照组(42例),试验组患者软组织缺损创面采用带蒂旋髂浅动脉穿支皮瓣进行修复,对照组患者软组织缺损创面采用躯干任意皮瓣进行修复,对比观察两组患者皮瓣血管蒂长度、住院时间、创面愈合时间、手指关节总主动活动度、皮瓣受区支配区域感觉功能与并发症(淋巴瘘、血管危象、瘢痕挛缩)发生情况。结果试验组患者皮瓣血管蒂长度为(789±113)cm,明显长于对照组患者的皮瓣血管蒂长度(629±121)cm(t=6181,P<0001);住院时间为(3114±492)d、创面愈合时间为(4019±1023)d,明显短于对照组患者的住院时间(3358±503)d、创面愈合时间(4662±1141)d(t=2219、2682,P=0029、0009)。术后4个月,试验组患者手指关节总主动活动度为良20例、中16例、差4例,明显优于对照组患者的手指关节总主动活动度为良10例、中20例、差12例(Z=-2762,P=0006);试验组患者皮瓣受区支配区域感觉功能为5级8例、4级12例、3级11例、2级7例、1级2例,明显优于对照组患者的皮瓣受区支配区域感觉功能为5级1例、4级10例、3级10例、2级13例、1级7例、0级1例(Z=-3005,P=0002)。试验组患者术后并发症发生率为1750%,明显低于对照组患者的术后并发症发生率4048%(χ^(2)=5224,P=0022)。结论与躯干任意皮瓣相比,带蒂旋髂浅动脉穿支皮瓣可有效修复手部电击伤所致的软组织缺损,促进手部运动功能及感觉功能恢复,降低淋巴瘘等并发症发生率。

拇指桡背侧皮神经营养血管皮瓣瓦合邻指皮瓣修复拇指末节脱套样软组织缺损

目的:探讨拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复拇指末节脱套样软组织缺损的临床治疗效果。方法:2017年10月-2021年2月,笔者医院对12例拇指末节脱套样软组织缺损患者采用拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复,创面面积2.0 cm×5.5 cm~3.5 cm×7.5 cm,门诊随访皮瓣外观与感觉、手功能及术后并发症情况。结果:拇指桡背侧皮神经营养血管皮瓣切取范围为2.0 cm×2.0 cm~3.5 cm×4.0 cm,示指近节背侧邻指皮瓣切取范围为1.5 cm×2.0 cm~3.0 cm×3.5 cm。术后随访6~18个月,平均9.4个月,11例拇指桡背侧皮神经营养血管皮瓣及10例邻指皮瓣成活良好,伤口甲级愈合。远期随访,10例拇指指腹饱满,外观满意,2例拇指指尖皮瓣萎缩。12例皮瓣供区均愈合良好,无明显瘢痕增生,功能恢复良好。12例拇指恢复良好的对捏及对掌功能,拇指指腹两点感觉辨别试验为7~16 mm,指背两点感觉辨别试验为6~11 mm。评定手功能:优8例,良2例,中2例。结论:拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复拇指末节脱套样软组织缺损,手术操作简便、安全,临床效果好,值得在基层医院推广。