【Abstract】 Objective To investigate and evaluate the effectiveness of covering amputated raw surface with freetissue transplantation from damaged limbs. Methods Between August 2010 and June 2011, 5 cases of severe injury of lower extremities were treated, including 4 males and 1 female with an age range of 3 years and 8 months to 43 years. Of them, 3 cases suffered from traffic accident injury and 2 had machine injury. The disease duration was 2-9 hours. Among the 5 cases, 1 suffered from half pelvis destruction and traumatic amputation of hip joint, 1 from comminuted open fracture of proximal femur, and another 3 from thigh destruction with survival soft tissue of legs. All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm × 10 cm to 20 cm × 20 cm in size. Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs. The flap size ranged from 15 cm × 10 cm to 25 cm × 20 cm. The wounds were repaired with free tissue transplantation. Results Five transplanted tissue flaps were survival. Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue, dressing change or vacuumed drainage for 1-2 months. All wounds healed and the patients were followed up 1-3 months. No sinus tract or ulceration was observed. The appearance of stumps was satisfactory. Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory. It is an effective procedure to repair the raw surface of amputated stumps.
摘要:目的: 探討本次汶川大地震中擠壓綜合征的診斷和治療的有效方法。 方法 :對8例擠壓綜合征患者依據病史、癥狀、體征及實驗室檢查結果進行診斷,并主要針對急性腎衰和局部創傷給予綜合治療。 結果 :7例完全治愈,1例基本治愈,沒有死亡病例,優良率100%。 結論 :以補液、利尿和全身營養支持為主的綜合治療配合血液透析可很好地控制病情發展,促進轉歸;一旦明確診斷,應盡早實施局部骨筋膜室切開減壓或截肢術。Abstract: Objective: To study the treatment of crush syndrome after the Wenchuan earthquake. Methods : The crush syndrome was diagnosed in 8 cases based on the medical history, symptoms, physical examinations and laboratory findings. The amputation was performed on 2 patients. Partial bone compartment open decompression was done on 4 patients. And hemodialysis were used in two of them. Meanwhile the acute renal dysfunction and the local injuries were treated correspondingly. Results : Seven cases were completely recovered, 1 case was recovered partly. Conclusion : Fluid, diuretic and general nutritionbased treatment with hemodialysis if necessary can control disease progression and promote the patients recovery. Once crush syndrome was diagnosed, partial bone compartment open decompression or amputation should be implemented as soon as possible.
目的:了解汶川地震后截肢患者存在的功能障礙及康復需求情況。方法:選取我院骨科2008 年5 月12 日至2008 年6 月1 日收治的19 例截肢患者為研究對象,采用自行設計的調查表,由康復醫師在征得研究對象同意的情況下完成資料的收集。結果:63.2%的患者存在肌力下降,36.8%的患者生活需要幫助,其中生活依賴明顯占31.6%,完全依賴占5.3 ％,幾乎所有患者存在參與功能障礙。 結論:大多數截肢患者存在不同程度的功能障礙,應該引起高度重視其康復鍛煉。
ObjectiveTo explore the clinical effect of systematic rehabilitation nursing for patients with lower limb amputation before prosthesis fitting. MethodsFifty patients with lower limb amputation before prosthetic fitting from January 2009 to December 2012 were assessed by rehabilitation team members, and then received the nursing progress according to the assessment results. The conditions of the patients before and after nursing intervention were evaluated and compared. ResultsAfter the patients received systematic rehabilitation nursing intervention, the standard rate of rehabilitation nursing knowledge and satisfaction rate of the nursing quality at the departure of the patients was 87.24% and 93.25% respectively. The muscle strength reached level 4 or higher in 4 patients, who could have the prosthesis fitting. ConclusionSystematic rehabilitation nursing for patients with lower limb amputation before prosthesis fitting can help patients to reserve the function as possible, improve the ability of living and quality of life, and reduce the burden of the patients and family to return to society earlier.
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal people, and the risk of developing coronary atherosclerosis is much higher than that in other high-risk groups. Numerous studies have confirmed that high systolic and diastolic blood pressures are potential risk factors for coronary artery disease, and it has been demonstrated that the ascending aortic pressure during diastole increases after amputation. However, the relationship between lower limb amputation and coronary atherosclerosis has not been fully explained from the perspective of hemodynamic environment. Therefore, in this study, a centralized parameter model of the human cardiovascular system and a three-dimensional model of the left coronary artery were established to investigate the effect of amputation on the hemodynamic environment of the coronary artery. The results showed that the abnormal hemodynamic environment induced by amputation, characterized by factors such as increased diastolic pressure in the ascending aorta, led to a significant expansion of the low wall shear stress (WSS) region on the outer lateral aspect of the left coronary artery bifurcation during diastole. The maximum observed increase in the area of low WSS reached up to 50.5%. This abnormal hemodynamic environment elevates the risk of plaque formation in the left coronary artery. Moreover, the more severe the lower limb atrophy, the greater the risk of coronary atherosclerosis in amputees. This study preliminarily reveals the effect of lower limb amputation on the hemodynamic environment of the left coronary artery.
【摘要】 目的 觀察綜合康復治療對汶川地震截肢傷員功能障礙的臨床療效。 方法 對5?12汶川大地震22例擠壓傷截肢患者的24條截肢殘端實施護理、擺放良肢位、運動治療、殘端塑形、紫外線療法、紅外線療法、石蠟療法、音頻電療法、經皮電刺激神經療法、關節松動、按摩和拍打、超短波治療、作業療法和心理治療等綜合康復治療，直至截肢傷員出院為止。視覺模擬評分法量表評定幻肢痛疼痛強度、測定膝關節和髖關節活動范圍、Barthel指數評定日常活動。 結果 治療前幻肢痛疼痛強度為2.95±1.33，治療后為0.50±0.96；治療前肘關節活動范圍為（90.0±28.3）o，治療后為（135.0±7.1）o；治療前肩關節屈伸活動范圍為（68.8±27.8）o，治療后為（137.5±9.6）o；治療前肩關節收展活動范圍為（53.8±7.5）o，治療后為（96.3±4.8）o；治療前膝關節活動范圍為（91.0±23.0）o，治療后為（123.0±6.7）o；治療前髖關節屈伸活動范圍為（86.9±25.9）o，治療后為（132.3±13.8）o；治療前髖關節收展活動范圍為（46.9±10.9）o，治療后為（64.6±8.7）o；治療前Barthel指數為57.05±18.69，治療后為78.18±13.85，康復治療前后均有統計學意義（Plt;0.05）。 結論 地震后截肢不良殘肢發生率高，綜合康復治療能促進截肢殘端傷口愈合和消除殘肢疼痛，可明顯改善殘肢條件，有利于地震截肢患者功能恢復和日常生活能力的提高，為后期的假肢安裝及步態訓練創造了條件。【Abstract】 Objective To observe the efficiency of comprehensive rehabilitation therapy on amputation patients after Wenchuan earthquake. Methods Twenty-two amputation patients after Wenchuan earthquake with 24 stumps were treated with postoperative wound care, maintaining the correct position of the limbs, exercise therapy, stump shaping, ultraviolet therapy, infrared therapy, paraffin therapy, audio electrotherapy, transcutaneous electrical nerve stimulation therapy, joint mobilization, massage, beat, ultrashort wave therapy, occupational therapy and psychotherapy and so on until discharged. The results were measured from the following aspects: pain intensity using VAS, rangement of knee joint and hip joint, Barthel index of ADL before and after rehabilitation. Results Pain intensity of phantom limb pain were (2.94±1.53) before rehabilitation,and (0.44±1.03) after; the movement range of elbow was (90.0±28.3)o before and(135.0±7.1)o after; the movement range of shoulder flexion and extension was (68.8±27.8)o before and (137.5±9.6)o after; the movement range of shoulder abduction and adduction was (53.8±7.5)o before and (96.3±4.8)o after rehabilitation; the movement range of knee was (91.0±23.0)o before and (123.0±6.7)o after rahabiliation; the movement range of hip flexion and extension was (86.9±25.9)o before and (132.3±13.8)o after; the movement range of hip abduction and adduction was (46.9±10.9)o before and (64.6±8.7)o after; the score of Barthel index was 57.05±18.69 before and 78.18±13.85 after. The difference between before and after rehabilitation were statistically significant (Plt;0.05). Conclusion The incidence of adverse amputation stumps after the earthquake was high. Integrative rehabilitation has an positive effect on promoting wound healing, by eliminating stump pain and recovering lower limb function, improving daily living function and social ability, and creating conditions for installing prosthesis limbs and gait training in later period.
ObjectiveTo carry out an investigation on the life quality of amputees in the “5·12” Wenchuan earthquake before and after rehabilitation of one year (short term), three year (intermediate term) and five year (long term) and find out the best program of recovery. MethodsIn September 2008, 52 patients who were treated in the higher-level hospital and came back to the Second People’s Hospital of Mianzhu City for rehabilitation were divided into two groups: group A and B with 26 patients in each. Phased rehabilitation program was adopted for group A while traditional program was chosen for patients in group B. “The Personal Information Table of Amputees of Deyang City” and The Life Quality Measurement Table of World Health Organization were chosen as the research tools before the program and one year, three years and five years after the program. ResultScores of the life quality of both groups showed a general rising tendency, while group A was higher than group B in each single phase, especially in the longterm one. For positive feeling, group A got a score of 193.0±12.3 and group B got 126.0±11.2; for ability to work, group A had a score of 62.0±5.2 and group B had 41.0±2.3; for life satisfaction, group A achieved 150.0±2.1 and group B achieved 101.0±6.2; for ability of action, the score of group A was 17.0±2.6 and group B was 11.0±5.2. The differences were statistically significant (P ＜ 0.05) . ConclusionCompared with conventional rehabilitation program, phased rehabilitation program can better enhance and consolidate the amputees’ quality of life and promote their returning to family and society, which can make up for the deficiency of the existing rehabilitation programs and is worth popularization and application.