【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.
Objective To review the progress in amputation technique of diabetic foot. Methods Recent l iterature concerning the amputation technique of diabetic foot was reviewed and analyzed. Results According to the different levels of the amputation, the diabetic foot’s amputation can be classified as major amputation and minor amputation, and differentkinds of methods can derive from these styles. Different factors should be considered when the style and method of amputation are chosen. Conclusion To the diabetic foot amputation, the general rule is to l imit the amputation level on the premise of the good cl inical effect. The health state, the region of the diabetic foot, the tissue perfusion, the susceptibil ity to infection in local tissue, and the abil ity of wound healing are important factors in selecting the styles and methods of diabetes-related amputations. Importance should be attached to the synthesis treatments of diabetes to prevent the higher level amputation.
Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods. Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of openinjuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 l imbs) and 6 cases of acute renal failure due to crush syndrome (8 l imbs) received amputation; 32 cases of interfascial space syndrome crisis (42 l imbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT). Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospital ization time was 53 days. Twenty-two cases (26 l imbs) were fixed with artificial l imbs 3-6 months after amputation and achieved good functional outcome. Conclusion The treatment principle of crush injury is “be active to decompress and be prudent to amputate”, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earl ier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.
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.
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.
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal individuals, but the relationship between lower limb amputation and the episodes of cardiovascular disease has not been studied from the perspective of hemodynamics. In this paper, numerical simulation was used to study the effects of amputation on aortic hemodynamics by changing peripheral impedance and capacitance. The final results showed that after amputation, the aortic blood pressure increased, the time averaged wall shear stress of the infrarenal abdominal aorta decreased and the oscillatory shear index of the left and right sides was asymmetrically distributed, while the time averaged wall shear stress of the iliac artery decreased and the oscillatory shear index increased. The changes above were more significant with the increase of amputation level, which will result in a higher incidence of atherosclerosis and abdominal aortic aneurysm. These findings preliminarily revealed the influence of lower limb amputation on the occurrence of cardiovascular diseases, and provided theoretical guidance for the design of rehabilitation training and the optimization of cardiovascular diseases treatment.
