手指瘢痕挛缩屈曲严重畸形的矫形治疗研究

[目的]探讨手指瘢痕挛缩屈曲严重畸形的矫形治疗方法。[方法]将本院2013年8月~2015年1月期间收治的46例手指瘢痕挛缩屈曲严重畸形患者纳入本次研究,共对46例患者(54只患手)实施手指瘢痕挛缩松解,并根据皮损情况采用不同厚度的皮片进行植皮,观察移植皮片成活情况。术后随访6个月,评价手指功能。[结果]46例患者54只患手移植皮片完全成活率为16.7%,成活良好率为57.4%,基本成活率为24.1%。54只患手中,1只患手移植皮片发生部分坏死,经再次植皮手术治疗后愈合。术后6个月末次随访54只患手的手指功能优良率为66.7%。[结论]掌握手指瘢痕挛缩松解技巧,选择合适的皮片进行植皮,能够有效提高患者手指外表美观度,促进手指功能恢复。     

阶梯松解术修复手指掌侧严重瘢痕挛缩29例

手指掌侧瘢痕挛缩是烧伤后最常见的畸形之一,笔者单位自2001年10月以来,采用阶梯松解术修复手指掌侧严重瘢痕挛缩29例,效果满意。临床资料:本组29例患者共63指出现严重瘢痕挛缩,其中男21例、女8例。年龄3~39岁,以儿童多见。均为深度烧伤后瘢痕增生挛缩,瘢痕形成时间为3个月~2年     

小儿手烧伤后发育性手指尺偏畸形二例

小儿手烧伤后发育性手指尺偏畸形二例王大雄，胥少汀，季新民，邢玉林，李放手指尺偏畸形多由于软组织异常所引起，常见者为掌指背侧、尺侧瘢痕挛缩与伸指肌腱向尺侧滑脱所致。我们近年治疗２例系由于手烧伤后掌骨头的发育异常所致的手指尺偏畸形，结果满意。手术原则与方...     

烧伤后爪形手畸形的整复

目的 探讨烧伤后爪形手畸形的整复方法. 方法 1992年5月-2007年5月,笔者对97例(136只患手)烧伤后爪形手畸形患者进行手术整复,患手中,轻度畸形21只、中度92只、重度23只;手背创面植皮修复104只患手,皮瓣转移修复32只患手.掌指关节复位在手背部瘢痕组织充分松解后主要采用手法拔伸牵引复位,必要时松解侧副韧带、背侧关节囊和分离关节内粘连,肌腱挛缩明显者行肌腱延长术.手背瘢痕松解整复后根据情况行手指屈曲畸形整复、指蹼和虎口粘连松解植皮、指伸肌腱中央腱修复或指间关节融合术.31例患者因手指屈曲畸形严重,阻碍掌指关节复位,先行手指掌侧瘢痕松解植皮,再行手背瘢痕松解、掌指关节复位、皮瓣转移或植皮.术后采取综合康复治疗措施. 结果术后皮片全部成活;4只患手皮瓣远端边缘因瘢痕组织部分坏死,换药后愈合,其余皮瓣完全成活.患手绝大部分关节畸形完全或基本纠正,对掌、握拳功能恢复或部分恢复,效果较为满意. 结论个性化、系统全面地进行皮片移植和皮瓣转移是整复烧伤后爪形手的关键.     

小儿手烧伤后发育性手指尺偏畸形二例

手指尺偏畸形多由于软组织异常所引起,常见者为掌指背侧、尺侧瘢痕挛缩与伸指肌腱向尺侧滑脱所致。我们近年治疗2例系由于手烧伤后掌骨头的发育异常所致的手指尺偏畸形,结果满意。     

小儿手部烧伤后瘢痕畸形的功能重建

目的探讨小儿手部烧伤后瘢痕挛缩畸形的手术整复及功能重建。方法2002年1月～2005年1月对烧伤后手部瘢痕挛缩畸形的63例患儿(68只手)进行手术整复,并在术后采取综合康复措施。结果4例腹部带蒂皮瓣均成活;共行70例次瘢痕切除植皮术,术后皮片成活良好42例次,少许表皮坏死25例次,小块皮片坏死、经换药后创面愈合2例次,皮片部分坏死、经再次植皮创面愈合1例次。术后6月根据手部关节活动程度测量,结果优37只手,良19只手,中8只手,差4只手,患儿家属满意度为91%(62/68)。结论小儿手部烧伤后瘢痕畸形首选手术治疗,根据畸形程度采取不同的术式,辅以术后康复治疗,可以较好的恢复患手的功能。     

手烧伤后瘢痕挛缩畸形的治疗分析

<正>手由于暴露在外,经常需从事劳动,是人体最容易出现烧伤的部位,同时也是烧伤后瘢痕挛缩畸形的高发部位之一[1]。2003年6月~2013年12月,笔者科室共收治125例手烧伤后瘢痕挛缩畸形患者,给予畸形矫正后疗效满意,现报道如下。1资料和方法1.1一般资料:本组125例,共184只手,其中男78例,女47例,年龄1~77岁,平均(30.42±12.67)岁。烧伤时年龄在12岁以下者28例,入院时间为烧伤后     

手严重瘢痕挛缩专用骨牵引支架的设计和应用

在烧伤后手严重瘢痕挛缩畸形中 ,手深层结构包括运动系统各结构的挛缩粘连 ,多是继发于体表的瘢痕挛缩 ,根据这一发病机制和组织牵引原理 ,我们设计了手瘢痕专用骨牵引支架 ,在体表瘢痕松解后 ,行骨牵引松解手深部结构挛缩(如血管神经弓弦状挛缩 ) ,收到一定效果。1　治疗方法骨牵引支架由着力支架、牵拉杆和加力螺帽三部分组成(图 1)。因其由不锈钢材料制成 ,重量轻。先手术松解各患指的体表瘢痕挛缩 ,勿损伤运动系统结构的完整性 ,之后在各指挛缩处远端最着力的部位钻一克氏钢针横穿指骨 ,并将其按手指的宽度曲成“”形 ,同时将 2根克氏针…     

皮瓣整形修复小儿手烧伤后瘢痕挛缩畸形的功能恢复情况及疗效研究

目的:探讨小儿手烧伤后瘢痕挛缩畸形采用皮瓣整形修复的功能恢复及效果。方法:选择2014年1月-2017年1月笔者医院收治的60例手部烧伤后瘢痕挛缩患儿作为研究对象,采用随机数表法随机分为观察组(30例)和对照组(30例)。对照组给予常规瘢痕切除结合组织松解术进行修复,观察组在对照组基础上采取皮瓣整形修复措施,两组患儿术后均进行早期功能锻炼并随访6～12个月。采用温哥华瘢痕评定量表评价两组患儿治疗前后瘢痕修复效果,手指总活动度评价术后指关节功能恢复情况,比较两组患儿治疗效果、外观满意度及并发症发生情况。结果:术后6个月,观察组瘢痕修复评分(6.9±2.2)分明显优于于对照组(8.9±1.6)分,差异有统计学意义(P0.05)。术后12个月,观察组关节功能恢复优良率、手术治疗有效率、患儿及家属外观满意度均明显高于对照组[93.3%(28/30)、96.7%(29/30)、93.33%(28/30)vs60.0%(18/30)、80.0%(24/30)、66.67%(20/30)],差异均有统计学意义(P0.05)。观察组并发症发生率为6.7%(2/30)明显优于对照组的36.7%(11/30),差异有统计学意义(χ~2=7.9542,P0.05)。结论:皮瓣整形修复措施对小儿手烧伤后瘢痕挛缩畸形能有效修复瘢痕组织,改善挛缩畸形,关节功能恢复效果显著且不良反应少,值得在临床广泛推广。     

手指瘢痕挛缩屈曲畸形的矫正

手指瘢痕挛缩屈曲畸形是手部烧伤后较为常见的一种畸形,多见于儿童,可一指或多指,手指掌侧有条索状或蹼状瘢痕,手指掌指关节、指间关节屈曲挛缩,并常向一侧扭曲,以近指间关节最为严重（图１）。手指长期的屈曲挛缩,可导致深部血管、神经、肌腱的短缩,关节囊、韧带的挛缩,在儿童期由于指间关节长期处于屈曲位,使近节指骨头关节面掌侧长期受压,影响指骨头的发育,可导致指骨头的过度掌倾,这将影响手指松解后的效果和关节的稳定活动。手指屈曲挛缩的矫正,一般矫正至掌指关节、近指间关节屈曲３０°位即可,即满足功能和外观的要求…     

Rituximab removes intrarenal B cell clusters in patients with renal vascular allograft rejection

BACKGROUND: Intrarenal B cell clusters are associated with poor clinical outcome in acute interstitial rejection. The incidence of B cell aggregates in vascular rejection and the effect of therapy with the monoclonal CD20 antibody rituximab on intrarenal B cells are currently unclear. METHODS: We analyzed the incidence of B cell clusters in patients with vascular rejection by immunohistochemistry and compared the influence of rituximab treatment plus conventional therapy with that of conventional immunosuppression alone on intrarenal B cells. Furthermore intrarenal expression of the B cell attracting chemokine BCA-1/CXCL13 and the lymphoid chemokine SLC/CCL21 were analyzed. RESULTS: Nine of 16 patients with vascular rejection displayed intrarenal B cell clusters strictly co-localizing with expression of the B cell attractant chemokine BCA-1/CXCL13. Addition of rituximab to conventional treatment lead to complete depletion of intrarenal B cells (98.3+/-136.4 CD20, 90.7+/-113.2 CD19 vs. 0+/-0 CD20, 0+/-0 CD19 B cells/hpf, P<0.001). Creatinine decreased from 5.0+/-4.1 to 1.9+/-0.4 mg/dl at discharge, and to 1.9+/-0.5 mg/dl after three months (P<0.02). No effect on intrarenal B cells was observed in the patients not treated with rituximab (72.8+/-73.0 vs. 80.3+/-75.3 CD20, 75.6+/-86.6 vs. 85.7+/-82.0 CD19). At discharge, creatinine had improved in this group from 5.1+/-4.1 mg/dl to 1.8+/-0.5 mg/dl and to 1.7+/-0.6 mg/dl after 3 months (P<0.05). CONCLUSION: In summary, our study reports two main findings, namely the previously unrecognized high prevalence of intrarenal B cell clusters in 56% of biopsies with acute vascular rejection and a complete depletion of intrarenal B cells by addition of Rituximab to conventional treatment.     

Lower serum β-CrossLaps in male cardiac transplant recipients treated without prednisolone

Post-transplantation bone disease is a frequent problem after successful cardiac transplantation. We performed a cross-sectional analysis of male heart transplant recipients in the late post-transplantation period. Nine patients (group A) had received immunosuppressive therapy with cyclosporin A and mycophenolate mofetil (steroid-free treatment), and 12 patients (group B) remained on triple-drug therapy, which included glucocorticosteroids. Bone mineral density status was analyzed by osteodensitometry and by markers of bone turnover. Osteopenia was common in both groups (44.4% in group A and 50% in group B) as was osteoporosis (30% and 33.3% in groups A and B, respectively). beta-CrossLaps were significantly lower in sera of cardiac transplant recipients on double immunosuppressive (i.e., glucocorticosteroid-free) regimen than in sera of patients on triple-drug therapy (428.3+/-109.4 vs 661.7+/-337.0 pg/ml, P<0.05). Lower serum beta-CrossLaps levels in patients undergoing glucocorticosteroid-free treatment may indicate a lower risk of bone deterioration in the long term.     

The preemptive analgesic effect of intraarticular bupivacaine and morphine after ambulatory arthroscopic knee surgery

Intraarticular (IA) morphine provides effective postoperative analgesia after arthroscopic knee surgery. Some investigators have suggested that the preemptive administration of opioids may reduce postoperative analgesic requirements and hypersensitivity. We evaluated the analgesic effect of administering IA morphine either before or after surgical incision in patients undergoing arthroscopic knee surgery under local anesthesia. Forty patients undergoing arthroscopic meniscectomy were randomized into two groups. All patients received IA bupivacaine 0.25% before and after surgery together with IV sedation using midazolam and propofol. The Preemptive IA Morphine group received a single 3-mg dose of morphine with their preoperative bupivacaine. The Post-IA Morphine group received 3 mg of morphine at the completion of surgery with the postoperative bupivacaine. After surgery, pain scores, the time to first opioid use, and 24-h analgesic use were recorded. Analgesic duration, defined as the time from completion of surgery until first opioid use, was significantly longer in those patients receiving preoperative (953 +/- 209 min) versus postoperative (556 +/- 121 min) IA morphine. The 24-h acetaminophen and oxycodone use was less in the Preemptive group (2.2 +/- 1.2 pills) versus the Postoperative group (3.0 +/- 1.2 pills). We conclude that IA morphine provides a longer duration of postoperative analgesia with less 24-h opioid use when administered before surgery. Implications: The administration of intraarticular morphine 3 mg before arthroscopic knee surgery provides a longer duration of analgesia with less 24-h opioid use compared with the administration of the drug at the completion of surgery.     

C4d-positive acute humoral renal allograft rejection: rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil

OBJECTIVE: We investigated the efficacy of immunoadsorption (IA) in combination with tacrolimus (FK506) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants. METHODS: Six of 185 cadaveric renal allograft recipients developed AHR at a mean of 4.8 +/- 0.8 days after the operation. C4d deposits were observed in peritubular capillaries (PTC) with accumulation of granulocytes. IA with staphylococcal protein A and FK506-MMF combination therapy were administered. RESULTS: After treatment with IA for 6.3 +/- 1.03 sessions combined with FK506 (0.14 to 0.16 mg.kg(-1).d(-1)) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment to a serum creatinine decrease was 14 +/- 2.9 days. The pre-IA panel reactive antibody reactivity (PRA) peaked at 50.2% +/- 6.1%, and was significantly reduced to 8.3% +/- 2.9% after IA. In four of six patients repeat allograft biopsy revealed a remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100% and renal function remains stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL. CONCLUSION: The optimal treatment for alloantibody-mediated AHR remains uncertain. Our findings suggest that a therapeutic approach combining IA and FK506-MMF rescue improves the outcome of AHR.     

Efficacy of multidrug therapy combined with mizoribine in children with diffuse IgA nephropathy in comparison with multidrug therapy without mizoribine and with methylprednisolone pulse therapy

AIM: To evaluate the efficacy of prednisolone, warfarin, and dipyridamole therapy combined with mizoribine (PWDM) in the treatment of diffuse immunoglobulin A (IgA) nephropathy in comparison with prednisolone, warfarin, and dipyridamole therapy without mizoribine (PWD) and with methylprednisolone pulse therapy (PWD pulse). METHODS: We collected data on 61 patients diagnosed with diffuse IgA nephropathy, and these patients were retrospectively divided into three groups without randomization. Group A included 21 patients before 1987 who were treated with PWD for 24 months, group B included 20 patients from 1987 to 1989 who were treated with PWD pulse therapy for 24 months, and group C included 20 patients after 1990 who were treated with PWDM for 24 months. Clinical features and pathological findings in each group were analyzed retrospectively. RESULTS: The time from initiation of therapy in group A, group B, and group C was 8.9 +/- 5.2, 8.1 +/- 3.9, and 7.7 +/- 3.8 years, respectively. At the latest follow-up examination, the mean urinary protein excretion (mg/m2/h) was 17 +/- 10 in group A, 22 +/- 20 in group B, and 6 +/- 6 in group C and had decreased significantly in group C as compared with the other groups. The activity index in all three groups was lower at the second biopsy than that at the first biopsy (5.1 +/- 0.8 vs. 6.5 +/- 2.1 in group A, p < 0.05; 5.6 +/- 0.9 vs. 6.6 +/- 1.7 in group B, p < 0.01, and 4.5 +/- 1.0 vs. 6.8 +/- 1.9 in group C, p < 0.01). The chronicity index in groups A and B at second biopsy was higher than at first biopsy (7.3 +/- 1.4 vs. 4.8 +/- 1.0 in group A, p < 0.01, and 8.1 +/- 2.0 vs. 5.3 +/- 0.9 in group B, p < 0.01), but was unchanged in group C. At the latest follow-up examination, 1 patient (4.8%) in group A, 3 patients (15%) in group B, and none (0%) in group C had renal insufficiency. CONCLUSION: These results suggest that PWDM appears to be more effective than PWD or PWD pulse in ameliorating proteinuria and histological severity of patients with IgA nephropathy.     

Reconstruction of finger pulp defect with reversed fasciocutaneous island flap from same finger

Objective:To investigate the clinical curative effect of reconstruction of finger pulp defect by anastomosis of reversed fasciocutaneous island flap with dorsal branch of the digital nerve of the same finger. Methods: The restoration of finger pulp defect with fasciocutaneous island flap from the same finger was conducted in 25 cases (30 fingers) from January 2002 to June 2003. Nine patients (11 fingers) whose flaps with dorsal branch of the digital nerve anastomosed with the digital inherent nerve around the surface of the wound were Group A and the others were Group B. The follow-up was carried out at 3 and 9 months after the operation to observe the shape of finger pulp and the sense restoration between two groups. Results: All flaps of 25 cases (30 fingers) survived. Three months after operation, the patients had fully grown finger pulps and recovered the superficial sensation and tactile sense of finger pulps. The two point discrimination on average was 5. 00 mm±0. 23 mm in Group A and 6.00 mm±0.30 mm in Group B. The difference between two groups was highly significant. Nine months later, their senses of finger pulps between two groups were recovered basically. Conclusions: The reversed fasciocutaneous island flap from the same finger is the first choice to reconstruct the finger pulp defect, and the anastomosis of dorsal branch of the digital nerve shall be determined according to the specific condition.     

Novel rescue therapy for C4d-positive acute humoral renal allograft rejection

OBJECTIVE: To investigate the efficacy of immunoadsorption (IA) in combination with tacrolimus (TAC) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants. METHODOLOGY: Six of 185 cadaveric renal allograft recipients transplanted at our institute developed AHR over a mean period of 4.8 +/- 0.8 d after operation. The ages ranged from 35 to 51 yr (mean 42.6 +/- 5.6 yr). C4d deposits in peritubular capillaries (PTC) and accumulation of granulocytes in PTC were observed. IA with staphylococcal protein A and TAC-MMF combination therapy were given. RESULTS: After subjected to IA for 6.3 +/- 1.03 sessions combined with TAC (0.14-0.16 mg/kg/d) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment when serum creatinine decreased was 14 +/- 2.9 d. The pre-IA panel reactive antibody reactivity was as high as 50.2 +/- 6.1%, and was significantly reduced to 8.3 +/- 2.9% after IA. Repeated allograft kidney biopsy in four of six patients revealed a favorable remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100%, renal function remained stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL. CONCLUSION: The optimal treatment for alloantibody-mediated AHR remains undefined. Our findings suggest that a therapeutic approach combining IA and TAC-MMF rescue has excellence to improve the outcome of AHR.     

Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery

BACKGROUND AND OBJECTIVES: Up to 70% of patients report moderate to severe pain after shoulder surgery, which can compromise early rehabilitation and functional recuperation. Postoperative shoulder pain control is improved with both interscalene block and intra-articular local anesthetic injection. The present study hypothesized that perioperative interscalene analgesia would offer pain control superior to perioperative intra-articular local anesthetics over the first 24 hours after surgery. METHODS: Sixty patients undergoing shoulder surgery were randomly assigned to 1 of 2 groups: group IS had interscalene block with catheter installation, while group IA received intra-articular local anesthetic, also with catheter installation. All patients received 3 local anesthetic injections: 0.25 mL/kg of 2% lidocaine with epinephrine 2.5 microg/mL immediately before and after surgery, and 0.25 mL/kg of 0.5% bupivacaine with epinephrine 2.5 microg/mL 1 hour after the end of surgery, after which the catheters were removed, and no further local anesthetics were administered. Postoperative pain at rest was evaluated in the postanesthesia care unit (PACU), 3 hours, 6 hours and 24 hours after surgery. The area under the 24 hour pain over time curve was calculated. Hydromorphone consumption in the PACU and over 24 hours was recorded. RESULTS: Pain scores (IS: 0.4 +/- 2 vs. IA: 4 +/- 3, P < .0001) and opioid consumption (IS: 0.7 mg +/- 1.4 vs. IA: 1.5 mg +/- 1.2, P = .02) were significantly higher in the PACU for group IA. However, neither the mean pain scores over the first day after surgery (IS: 5 +/- 2 vs. IA: 5 +/- 3; P = .4) nor 24-hour opioid consumption (IS: 4.4 mg +/- 2.8 vs. IA: 4.2 mg +/- 2.6; P = .4) were significantly higher in group IA. CONCLUSIONS: PACU measurements of immediate postoperative pain and narcotic consumption favor perioperative interscalene analgesia over intra-articular analgesia. This benefit does not translate into lower overall pain for the first 24 hours after surgery.     

Effect of protein A immunoadsorption in nephrotic syndrome of various etiologies.

Protein A immunoadsorption (IA) has proved effective in reducing proteinuria in patients with nephrotic syndrome after recurrence of focal and segmental glomerulosclerosis (FSGS) in kidney transplants. The effect of IA in nephrotic syndrome of other etiologies remains unknown. Nine patients with nephrotic syndrome secondary to membranous nephropathy (four cases), diabetes mellitus (one case), IgA nephropathy (two cases), and amyloidosis (two cases) had three to five IA of 2.5 plasma volumes over 4 to 8 d. Patients received no concomitant immunosuppressive treatment, and antihypertensive drugs were left unchanged. Proteinuria decreased from 12.64 +/- 5.49 to 3.35 +/- 2.2 g/24 h (mean +/- SD) in all patients after three to five IA. Hematocrit decreased from 37.32 to 32.64% (12.5% hemodilution) and serum albumin from 25.43 to 18.6 g/L (26.4% decrease). Proteinuria returned to baseline levels within 1 mo, as described in recurrent FSGS following transplantation. When serum albumin balance was controlled by albumin infusion after IA in two patients, comparable decreases in proteinuria were observed. Therefore, IA is effective in producing short-term reduction of proteinuria in nephrotic syndromes related not only to FSGS but also to membranous and IgA nephropathies, diabetes mellitus, and amyloidosis, which suggests that IA removes a nonspecific circulating hemodynamic-altering or permeability-increasing factor.     

Polymyxin b-immobilized fiber reduces increased plasma endothelin-1 concentrations in hemodialysis patients with sepsis

We studied whether plasma endothelin (ET)-1 concentrations are altered in patients with septic shock who are undergoing hemodialysis and whether polymyxin B-immobilized fiber (PMX-F) treatment affects on these concentrations. Fifteen hemodialysis patients with septic shock treated with PMX-F (group A), 10 such patients who received conventional treatments (group B), 20 hemodialysis patients without septic shock (group C) and 20 healthy controls (group D) were included in this study. Plasma ET1 levels were measured by radioimmunoassay and endotoxin levels were determined by endospecy test. The survival rate in group A (67%) was higher than that in group B (30%). Blood endotoxin levels decreased significantly from 36.4+/-8.2 pg/mL to 10.6+/-3.8 pg/mL (p < 0.01) after PMX-F treatment in group A. The pretreatment plasma ET-1 levels in patients in group A (58.6+/-9.8 pg/mL) and group B (56.8+/-7.8 pg/mL) were significantly higher than those in group C (p < 0.01) and group D (p < 0.001). Plasma ET-1 levels in group C (11.2+/-3.2 pg/mL) were higher than those in group D (2.6+/-0.6 pg/mL) (p < 0.01). Plasma ET-1 levels following hemodialysis (10.9+/-3.0 pg/mL) were not altered significantly compared with those before hemodialysis. Plasma ET-1 levels decreased significantly in group A after PMX-F treatment (11.4+/-3.6 pg/mL) (p < 0.01); the levels in group B were not altered after conventional treatment. Our data suggest that ET-1 may be associated with septic shock in patients undergoing hemodialysis and that PMX-F is effective in reducing plasma ET-1 levels in these patients.