组合组织移植在修复手毁损伤中的应用

目的：介绍应用组合组织移植修复手毁损伤及重建手部分功能的疗效。方法：对5例手毁损伤患者,应用带足皮瓣的第二足趾、第二、三足趾,及股前外侧皮瓣、腹直肌皮瓣等组织瓣,组合移植修复手部大面积创面及重建拇手指。结果：所有移植组织均成活,重建后的手功能平均值比术前平均增加40％。结论：组合组织移植具有一期修复手部创面并同时重建手功能的优点,是治疗手毁损伤的较好方法。     

高压氧治疗在手指末节离断伤再植中的应用

目的 探讨拔甲结合急诊高压氧治疗在手指末节离断伤中的疗效.方法 将2006年9月至2012年9月收治的37 例（43指）手指末节离断伤患者,行清创原位缝合手术,术中拔除指甲,术后立即行高压氧治疗.结果 43指中39指成活,成活率90.6%,术后随访3～12个月,平均8个月,伤指外形、感觉与健侧相近.结论 上述方法可提高手指末节离断伤原位缝合术后的成活率,最大程度的保留了手指长度和感觉功能.     

高压氧治疗弥漫性轴索伤的临床研究

弥漫性轴索损伤（Diffuse axonal injury DA1）是头部遭受加速性旋转暴力时，因剪应力而造成的神经轴索损伤。患者昏迷时间长、伤残率高、死亡率高。本文总结本院2003年3月至2007年10月早期应用高压氧治疗DAI患者110例的疗效观察。     

高压氧治疗四肢挤压伤53例

我院自1996～2000年7月应用高压氧治疗四肢挤压伤53例,疗效满意.现报告如下:1 临床资料本组病例男38例,女15例.年龄6～62岁,平均35岁.受伤部位:手25例,前臂5例,上臂3例,足10例,小腿7例,大腿3例;致伤原因:机器压砸42例,石块砸伤7例,塌方4例;合并伤:胫腓骨裂2例,手部多发性骨折20例,足部多发性骨折5例;有开放性伤口40例.     

手掌皮肤逆行撕脱伤原位修复5例

对手掌皮肤逆行撕脱伤的治疗 ,既往常采用游离植皮、皮肤削薄回植及皮瓣移植等方法覆盖创面〔1〕。由于手掌皮肤结构的特殊性 ,以上方法即使修复了皮肤缺损 ,其功能也与伤前相去甚远。近年来 ,我们应用显微外科技术原位修复手掌皮肤逆行撕脱伤 ,取得满意疗效。1　材料与方法1 1　病例资料　 本组 5例 ,男 2例 ,女 3例 ,年龄 18～ 38岁。伤因 :机器碾伤 3例 ,挤伤 1例 ,绞伤 1例。伤情 :手掌皮肤从掌横纹处逆行撕脱至近侧指间关节3例 ,撕脱至指蹼处 2例 ;撕脱平面位于掌腱膜浅层 4例 ,位于掌腱膜深面 1例 ;单纯手掌皮肤撕脱 3例 ,连同拇指皮…     

组织联合移植修复手部毁损伤的临床应用

目的 探讨应用组织联合移植修复手部毁损伤的方法.方法 1996年10月至2011年10月共收治手部毁损伤185例,应用(躅)甲皮瓣、第二足趾、股前外侧皮瓣、足背皮瓣等多种组织瓣进行一期联合移植修复.结果 术后185例(341指)联合移植组织全部存活,按中华医学会手外科学会上肢部分功能评定试用标准评定:再造拇指优60指,良33指,可16指;再造手指优87指,良114指,可23指,差8指.结论 应用组织联合移植能一期重建手的功能和外观,是修复手部毁损伤的理想方法.     

高压氧辅助治疗严重手外伤的疗效观察

目的：探讨高压氧（hyperbaric oxygen, HBO）辅助治疗严重手外伤的临床疗效。方法对我院2008年10月—2011年6月收治的48例严重手外伤患者,随机分为高压氧辅助治疗组（高压氧组）和传统治疗组（对照组）,术后平均随访1.5年,根据全国手功能评定具体方案中断指再植功能评定标准进行两组手功能恢复状况的评价。结果高压氧治疗组功能评定结果明显优于传统治疗组。结论高压氧辅助治疗严重手外伤可明显提高术后再植手指的成活率,改善手部功能。     

Effects of hyperbaric oxygen therapy on caustic esophageal injury in rats

Background/purpose

Caustic esophageal burn is a serious problem in pediatric surgery. Even though many clinical and experimental studies had been performed, the complication rate could not be reduced to a satisfying level. In this study, the authors evaluated the effects of hyperbaric oxygen (HBO) therapy in caustic esophageal burn in rats.

Methods

Rats were divided into 4 groups, and caustic burn at the distal esophagus was created by applying 50% NaOH for 3 minutes in all groups. The first and third groups did not receive HBO therapy. HBO therapy was applied to the second group for 2 days and to the fourth group for 28 days. To evaluate the effects of short-term HBO therapy, the first 2 groups were compared for ulceration, inflammation, and submucosal vascular thrombosis after 2 days. The third and fourth groups were compared for the long-term effects of HBO therapy. Rats in these groups were killed after 28 days and compared for the collagen content, weight, and mortality rate.

Results

In the second group, which received 2 days of HBO therapy, ulcer depth and vascular thrombosis were significantly lower than these in the first group (P = .022 and P = .020, respectively). The fourth group, which received 4 weeks of HBO therapy, had a significantly reduced mortality rate, weight loss, and collagen score and hydroxyproline level if compared with the third group (P = .035; P = .016; P = .028; and P = .033, respectively).

Conclusions

These results indicate that HBO therapy is useful in caustic esophageal burn both in short-term and long-term use.     

Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy

The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21–73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r = 0.445; P = 0.0414). The Frankel grade (r = 0.036; P = 0.871) and ASIA motor score (r = 0.029; P = 0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r = 0.586; P = 0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r = 0.752; P = 0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury. Received: January 27, 2001 / Accepted: May 11, 2001     

高压氧治疗重症颅脑损伤26例临床分析

目的探讨高压氧对重型颅脑损伤患者的治疗效果。方法对26例重型颅脑损伤患者进行常规加高压氧治疗,21例进行常规治疗,比较两组的疗效。结果高压氧组显效21例,无效5例。常规组显效11例,无效10例。两组差异有统计学意义(P0.05)。结论早期给予高压氧治疗,可明显提高重型颅脑损伤患者治愈率和生存质量。     

清创术对手部创面细菌分布的影响

目的：了解清创过程对开放性手外创面常见污染细菌种类的影响。方法：200例开放性手外伤，于急诊室、手术室刷洗创面后、清创后、关闭伤口前分四次取材，作细菌培养及药敏试验。结果：急诊室、手术室刷洗创面后、消创后及关闭伤口前的细菌检出率分别为71．5％(143／200)，74．0％(148／200)，33．5％(67／200)及25．50％(51／200)。术后伤口感染率为3．5％(7／200)。结论：开放性手外创伤面菌种分布广泛，彻底的清创及保持手术室常用器具的清洁是降低术后感染的有效措施。     

高压氧治疗急性氯气中毒5例临床分析

目的观察高压氧治疗急性氯气中毒的疗效。方法对5例急性氯气中毒患者在内科常规治疗的同时,根据患者中毒的程度,给予不同次数的高压氧治疗。结果 5例急性氯气中毒患者治疗效果明显,均痊愈出院。结论高压氧可以作为辅助治疗急性氯气中毒的一种有效的方法。     

Synergistic neuroprotective effects of hyperbaric oxygen and methylprednisolone following contusive spinal cord injury in rat

ObjectiveRecent studies revealed the neuroprotective effects of hyperbaric oxygen (HBO) on spinal cord injury (SCI). Meanwhile, the use of methylprednisolone (MP) is one of the current protocols with limited effects in SCI patients. Accordingly, the aim of the present study was to investigate the effect of combined HBO and MP treatment on SCI.DesignThe present study was conducted on five groups of rats each as follows: Sham group (underwent laminectomy alone at T9 level vertebra); SCI group (underwent moderate contusive SCI); MP group (underwent SCI and received MP); HBO group (underwent SCI and received HBO); HBO + MP group (underwent SCI and simultaneously received MP and HBO). Blood serum and Spinal cord tissue samples were taken 48 h after SCI for analysis of serum ferric reducing antioxidant power (FRAP) and tissue malodialdehyde (MDA) levels as well as immunohistochemistry of caspase-3 and tumor necrosis factor-alpha (TNF-α). Neurological function was evaluated by the Basso–Beattie–Bresnehan (BBB) locomotion scores until the end of experiments. Additionally, histopathology was assessed at the end of the study.SettingMazandaran University of Medical Sciences, Sari, Iran.ResultsCombination therapy with HBO and MP in the HBO + MP group significantly decreased MDA as well as increased FRAP levels compared to other treatment groups. Meanwhile, attenuated TNF-α and Caspase-3 expression could be significantly detected in the HBO + MP group. At the end of treatment, the neurological outcome was significantly improved and the extent of injured spinal tissue was also significantly reduced in the HBO + MP compared to other treatment groups.ConclusionThe results suggest that combined therapy with MP and HBO has synergistic effects on SCI treatment.     

A retrospective study of diabetic foot ulcers treated with hyperbaric oxygen therapy

A retrospective review of patient medical records was conducted to assess what factors influence the outcomes of diabetic foot ulcers treated with hyperbaric oxygen (HBO) therapy. Patients referred to the Diving Diseases Research Centre for HBO therapy for the treatment of diabetic foot ulcers during a 2‐year period were included in this study. Data collected from 30 sets of patient records were entered into SPSS and statistical analysis was undertaken to investigate whether any underlying pathologies or confounding factors appeared to influence patient outcome. A 73·3% of patients achieved a successful outcome of partial healing, major amputation no longer required, amputation level lower than anticipated prior to HBO or healing at the end of HBO therapy and 70% remained successful 3 months later. A 13·3% of patients were lost to follow‐up at 3 months and one patient (3·3%) had a major amputation. Steroid therapy, peripheral vascular disease, previous minor amputation, type of diabetes, previous HBO therapy, larvae therapy, the use of interactive dressings and haemoglobin A1c levels were all observed to have had a significant relationship with patient outcome (P < 0·05). These results were compared with data from other published research conducted in this area on similar patient groups. A larger scale study focussing on the factors found to be significant in this study is recommended. An improvement of patient documentation would allow patient outcomes to be more consistently monitored in the future.     

Effects of hyperbaric oxygen therapy on fibrovascular ingrowth in porous polyethylene blocks implanted under burn scar tissue: an experimental study

Effects of hyperbaric oxygen (HBO) therapy on biointegration of porous polyethylene (PP) implanted beneath dorsal burn scar and normal skin were experimentally examined in Sprague–Dawley rats. In Group One (n = 20), daily HBO treatments were given after the implantation of PP material under dorsal burn scar, whereas, in Group Two (n = 20) no treatment was given following the same surgical procedure. In Group Three (n = 20), PP was placed under dorsal normal skin and subsequently HBO therapy protocol was applied while Group Four (n = 20) stayed without HBO treatment after the implantation. One, 2, 3 and 4 weeks after the implantations, sections were respectively taken from five rats from each group. Biointegration process and effects of HBO therapy were evaluated microscopically and the ratio of fibrovascular ingrowth (FVI) was determined for each rat. The results showed significantly superior FVI in Group One compared to Group Two and again FVI into PP under normal skin treated with HBO revealed better results against Group Four (p < 0.05). Well-vascularized capsule formation and tissue integration was delayed both in Group Two and in Group Three in the first 3 weeks. In conclusion, HBO therapy enhances biointegration of PP in hypoxic burn scar areas via improving collagen synthesis and neovascularization; otherwise, it apparently delays tissue ingrowth into porous structure implanted in normal healthy tissues.     

高压氧治疗对严重烧伤患者血中sIL-2R和Fn含量变化的影响

目的通过观察高压氧治疗(Hyperbaric Oxygen Therapy,HBOT)对烧伤患者血中可溶性白介素2受体(Soluble interleukin-2 receptor,sIL-2R)及纤维连接蛋白(Fibronectin,Fn)含量的影响,探讨 HBOT 防治烧伤感染的价值。方法选择42例严重烧伤患者(烧伤面积>30%或Ⅲ度面积>10%),随机分为 HBOT 组(25例)和非 HBOT 组(17例),另选40名健康献血员作正常对照组。于伤后8h 及1,2,3,5,7,10,14,17,21,28,35天采集静脉血,ELISA 法测定血清 sIL-2R,火箭免疫电泳法测定其血浆 Fn,同时观察两组患者脓毒症发生率。结果非 HBOT 组:与正常对照组相比,伤后各时相点血清 sIL-2R 水平显著升高,而血浆 Fn 含量明显降低(P<0.05或 P<0.01);HBOT 组:与正常对照组相比,除伤后21天外,其余各时相点血清 sIL-2R 升高不明显;除伤后8h外,其余各时点血浆 Fn 降低不明显(P>0.05)。但与非 HBOT 组相比,伤后各时相点血清 sIL-2R均显著降低,而血浆 Fn 则明显增高(P<0.05或 P<0.01);与此同时,脓毒症发生率亦明显降低(P<0.05)。结论 HBOT 可显著降低严重烧伤患者血清 sIL-2R,而明显增高血浆 Fn,故对防治烧伤感染可能有益。