Since October 1975, 35 patients with congenital constriction bands were treated. Follow-up for 10 months to 14 years showed that the results of correction were satisfactory except 1 patient died from other disease. The etiolology, the concurrent deformities and the method of treatment were discussed.
ObjectiveTo systematically evaluate the efficacy of mirror therapy for phantom limb sensation and phantom limb pain in amputee. MethodsDatabases include PubMed, EMbase, The Cochrane Library (Issue 9, 2015), CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about mirror therapy for phantom limb sensation and phantom limb pain in amputee from inception to 1st Sept. 2015. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then metaanalysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 129 patients were included. The results of meta-analysis showed that, there was no significant difference between the mirror therapy group and the control group in relieving the phantom limb sensation and phantom limb pain in amputee (MD=-7.29, 95%CI -27.73 to 13.16, P=0.48). ConclusionMirror therapy could improve the control of phantom limb, however, there is no sufficient evidence to support the effect of mirror therapy on pain management in amputee. The long-term effect of mirror therapy is still under exploration. Due to the limited quantity and quality of the included studies, larger-sample, high quality designed RCTs are needed to verify the above conclusion.
目的：了解地震截肢伤员的伤情特点，为其康复提供依据。方法：2008年6月～2008年12月31日，华西医院康复中心收治33例地震伤截肢患者，观察分析其伤情特点和康复治疗变化。结果：男性15例（45.5%），女性18例（54.5%）；男性与女性的年龄相比无统计学意义（P＞0.05）；10～19岁青少年45.45%；学生51.52%，在职人员33.33%；重物砸伤占78.79%；膝上截肢占43.90%，上肢截肢21.95%，下肢78.05%；截肢合并症13种，肾功衰最多，占28.57%；手术次数平均2.55次；残端有2例愈合差，有14名培养出细菌；日常生活活动能力Barthel指数入院时50.92±16.76，出院时77.77±14.37。结论：地震截肢伤员伤情重，残端情况差，康复治疗效果明显。
【摘要】 目的 观察综合康复治疗对汶川地震截肢伤员功能障碍的临床疗效。 方法 对5•12汶川大地震22例挤压伤截肢患者的24条截肢残端实施护理、摆放良肢位、运动治疗、残端塑形、紫外线疗法、红外线疗法、石蜡疗法、音频电疗法、经皮电刺激神经疗法、关节松动、按摩和拍打、超短波治疗、作业疗法和心理治疗等综合康复治疗，直至截肢伤员出院为止。视觉模拟评分法量表评定幻肢痛疼痛强度、测定膝关节和髋关节活动范围、Barthel指数评定日常活动。 结果 治疗前幻肢痛疼痛强度为2.95±1.33，治疗后为0.50±0.96；治疗前肘关节活动范围为（90.0±28.3）º，治疗后为（135.0±7.1）º；治疗前肩关节屈伸活动范围为（68.8±27.8）º，治疗后为（137.5±9.6）º；治疗前肩关节收展活动范围为（53.8±7.5）º，治疗后为（96.3±4.8）º；治疗前膝关节活动范围为（91.0±23.0）º，治疗后为（123.0±6.7）º；治疗前髋关节屈伸活动范围为（86.9±25.9）º，治疗后为（132.3±13.8）º；治疗前髋关节收展活动范围为（46.9±10.9）º，治疗后为（64.6±8.7）º；治疗前Barthel指数为57.05±18.69，治疗后为78.18±13.85，康复治疗前后均有统计学意义（Plt;0.05）。 结论 地震后截肢不良残肢发生率高，综合康复治疗能促进截肢残端伤口愈合和消除残肢疼痛，可明显改善残肢条件，有利于地震截肢患者功能恢复和日常生活能力的提高，为后期的假肢安装及步态训练创造了条件。【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.
Objective To explore the effect of a teamwork intervention during their rehabilitation process for patients who had undergone an amputatation after an earthquake. Methods A total of 85 patients undergoing amputation were included in the study. A rehabilitation team consisting of orthopaedic doctors, orthopaedic nurses, physical therapists, professional therapists, psychology consultants, volunteers, social workers, patients and their relatives participated in the comprehensive rehabilitation program. The outcome of this teamwork intervention was evaluated. Results Statistically significant improvement was observed in terms of patients’ physiological, psychological and social roles after the teamwork intervention ( Plt;0.05). Conclusion The teamwork intervention can improve the overall outcome of rehabilitation, including quality of life, in amputated patients following an earthquake.
【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.
Objective To investigate the clinical features and risk factors of diabetic foot. Methods A total of 100 patients with diabetic foot and 158 diabetic patients without diabetic foot were selected from April 2012 to May 2015 in Meishan Hospital of Traditional Chinese Medicine. Clinical data of the patients in the two groups was comparatively analyzed. Multiple logistic regression analysis was used to explore the risk factors. Results The age, duration of diabetes, incidences of complications, count of white blood cells, level of fibrinogen, level of high-sensitivity C-reactive protein (hs-CRP) and level of glycated hemoglobin (HbA1c) in diabetic foot group were significantly higher than those in non-diabetic foot group (P<0.05), while the ankle-brachial index, level of hemoglobin and level of albumin in diabetic foot group were significantly lower than those in non-diabetic foot group (P<0.05). The independent risk factors of diabetic foot were Wanger grade, age, ankle-brachial index, hs-CRP, albumin and HbA1c (P<0.05). HbA1c and hs-CRP level were independent risk factors of disease severity in patients with diabetic foot; the difference of prognosis in patients with different Wanger grading was statistically significant (Z=–4.394, P<0.001). Conclusions The risk of diabetic foot in diabetic patients increases with older age, the more serious Wanger grade, the higher hs-CRP and HbA1c level, and the lower ankle-brachial index and albumin level. Taking precautions based on the patient’s situation is conducive to early prevention of amputation in diabetic patients with diabetic foot.
Objective To compare the effectiveness between the myo-periosteal fibular bone bridging and traditional transtibial amputation in the treatment of amputation below knee so as to provide theoretical basis for choosing transtibial amputation in clinical application. Methods Between November 2001 and November 2011, 38 patients with mangled lower extremity were treated by transtibial amputation. Among 38 patients, 17 (group A) underwent myo-periosteal fibular bone bridging (the operation techniques of an attached peroneal muscle myo-periosteal fibular strut bridge between the end of the tibia and fibula below knee amputation), and other 21 (group B) underwent traditional transtibial amputation. There was no significant difference in age, gender, injury cause, amputation cause, side, and disease duration between 2 groups (P gt; 0.05). The quality of life (QOL) was analyzed using 36-item short form health survey (SF-36), and prosthesis satisfaction by Trinity amputation and prosthesis experience scale (TAPES). Results Healing of incision by first intention was obtained in all patients of 2 groups; no necrosis, infection, or poor stumps was observed. The mean follow-up time was 22 months (range, 14-30 months) in group A, and 26 months (range, 15-30 months) in group B. The patients achieved good healing of bone bridging, no bone nonunion occurred. The healing time was (5.1 ± 1.1) months in group A and (3.3 ± 0.6) months in group B, showing significant difference between 2 groups (t=9.82, P=0.00). Spur occurred at the distal fibula in an 11-year-old boy of group B after 2 years of operation, which blocked use of prosthesis; prosthesis was well used in the other patients. After 12 months of operation, SF-36 score was 55.84 ± 14.01 in group A and 49.93 ± 12.78 in group B, showing significant difference (P lt; 0. 05); the physical functioning, social functioning, role-physical, vitality, body pain, general health scores in group A were significantly higher than those in group B (P lt; 0.05), but no significant difference was found in role-emotional and mental health scores between 2 groups (P gt; 0.05). TAPES score was 12.12 ± 2.23 in group A and 10.10 ± 2.00 in group B, showing significant difference (t=2.891, P=0.006). Conclusion It is a very effective method to treat traumatic amputation using an attached myo-periosteal fibular bone bridging between the end of the tibia and fibula below knee, which can afford better quality of life and prosthesis satisfaction.