腕管综合症( carpal tunnel syndrome,CTS) 是各种原因引起的腕管内压力升高,正中神经受到压迫而出现的神经损伤症状的一种疾病,其发病率较高,每十万人中约100人发病,在特殊职业人群中发病率更高。 腕管综合症手术疗法有常规的开放式腕横韧带切开正中神经松解术( open carpal tunnel release,OCTR)和内镜腕管松解术( endoscopic carpal tunnel release,ECTR ) 。与比较的切开手术比较,内镜微创手术由于具有创伤小、恢复快等优点,从而在临床上得到了广泛的应用。随着手术例数的增多,人们对内镜微创手术的认识也更加全面。Okutsu 等证实镜下腕管松解术后腕管压力降到了正常。Palmer 等用磁共振测量镜下手术后腕管容积与开放手术并无差别。镜下手术与开放手术患者电生理检查和客观感觉的恢复也无明显区别。但镜下手术可明显减少术后遗留症状,包括疼痛、出血、瘢痕形成、神经黏连、反射交感性营养不良和腕关节僵直等开放手术常见的并发症,而且镜下微创手术可以显著缩短患者的住院时间,使患者早日恢复社会工作。因此,在内镜下开展微创手术治疗腕管综合症目前已经成为得到广大学者共识的一种技术趋势。 目前内镜微创手术治疗腕管综合症的术式大致可分两大类: 一是以Okutsu( 奥津) 为代表的单切口法( One-portal technique) ; 二是以Chow 为代表的双切口法( Two-portal technique) 。Okutsu 法虽然视野较大,但操作在套管外进行,易发生误操作。Chow 法使用金属半开放外套管,其在腕管松解过程中视野容易受限。这两种方法都需要一些特殊的辅助器械,甚至需要使用特殊的小关节镜设备,价格昂贵,一般基层医院不易获得。另外需要较高的手术操作技巧,否则容易出现医源性误伤,初学者需要较长的学习培训才能掌握,导致目前内镜下微创手术治疗腕管综合症在基层医院尚很难开展。因此,有必要设计一种无需特殊器械、操作简便且安全有效的改良手术技术,既能很好地观察腕横韧带及腕管内容物,又能保证操作的可重复性,使内镜下微创手术治疗腕管综合症真正成为一种能被广大医务工作者接受和掌握的新技术。 作者已经初步探索出一种单切口、无需特殊器械即可完成的关节镜下治疗腕管综合症的新技术。经理论论证和初步临床检验,显示出较好的手术疗效和安全性,手术切口仅1cm,仅需住院两天,获得了良好的手术效果,克服目前内镜下微创治疗腕管综合症在基层医院的困难好技术瓶颈,极大地推动腕管综合症微创治疗的技术发展,有望使该技术在基层医院得以切实应用发展起来。
本人自2013年7月以来一直在广州市第一人民医院工作,多年来承蒙各位患者朋友厚爱支持,薄有成绩。2016年8月起,本人工作单位正式变更为南京医科大学附属逸夫医院(南京医科大学附属第三医院),地点为南京
以前腿直不了,只能套1米2腰围的裤子,现在终于能穿上正常尺码了……”“虽然强直性脊柱炎不是罕见病,但这一不死的癌症同样需要得到不亚于渐冻症的支持和关注”……26岁的湖南青年杨清梅,一名严重的强直性脊柱炎患者,从16岁发病开始,就不断用手机、电脑发布求助信息、给病友普及强直病知识。世代在湘西新晃县务农的他家庭收入微薄。日前,在热心市民和广州市第一人民医院免费提供两个人工关节后,他严重扭曲如同青蛙腿的下肢,基本恢复到了正常的姿态。“能坐上轮椅就好了”,之前因为疾病导致的全身严重扭曲,他只能躺在轮椅上。手术由覃健博士(现已调动至南京医科大学附属逸夫医院工作)主刀,手术非常成功,术后杨清梅恢复得非常好,几天就可以坐在轮椅上在医院的走廊里活动了。16岁得怪病:关节不断融合骨化发现患有全身骨骼、关节僵直的强直性脊柱炎时,杨清梅刚好16岁。“起初是腰腿疼痛,当地乡间医院是在当风湿治疗。结果病情不断恶化。”19岁那年,杨清梅的颈椎关节开始出现慢慢的融合、骨化,头部偏向左侧无法正常扭动。“到湖南的大医院看了,说这个病虽不致命,但几乎没有治愈的希望,而且随年龄渐长,身体其他部位的关节也会不断融合、骨化,全身将成为一个单一轴线的铁板,无法活动。”接着,杨清梅的膝关节、髋关节也都出现融合,双腿怪异地张开成一个扭曲的形态,整个上身向左严重扭曲,“下肢看起来就像是张开的青蛙腿。”广州市第一人民医院骨关节科覃健博士(现已调动至南京医科大学附属逸夫医院工作)表示,“强直性脊柱炎并不罕见,但强直弯曲到杨清梅这样严重的,非常罕见。”由于双腿扭曲的张开,瘦弱的杨清梅甚至无法穿上正常尺码的裤子。但他并没有放弃希望。第一处关节融合时,他开始用双手在网上发布自己的信息、图片。“科普强直性脊柱炎的同时,也希望得到社会关注和帮忙。”网上求关注:手术费得到资助“最近关注渐冻人的活动挺火的,但严重的强直性脊柱炎也同样值得关注。我并不奢望能恢复到像正常人那样活动、行走,但我希望自己能坐起来……”杨清梅不懈努力,终于得到了越来越多社会人士、病友甚至家属的热心支持。术后的杨清梅 出院前与覃健医生合影在获得网友资助的一部分医疗费,市一骨关节科又为其提供了两个人工髋关节后,杨清梅的关节置换手术顺利完成。“进行人工关节置换是最为直接的治疗方法。但人工关节比较昂贵,国产的需要3万多一个,进口的单价更高。”覃健表示。在完成手术后不久,坐下后双腿基本并拢的杨清梅终于能坐进普通的轮椅里了。“这种感觉舒服多了,至少不用再斜躺着观察这个世界、生活了。”
38岁的陕西汉中佛坪青年张健,一名严重的强直性脊柱炎患者,从9岁起开始发病,19岁彻底瘫痪,只剩手臂可以活动。在这20年的瘫痪人生中,虽然只能躺在床上,双腿扭曲,但是瘦弱的张健并没有放弃希望。在不懈努
《家庭医生在线》报道:“我以为命运里注定了我将与床为伴度过余生,现在终于坐上轮椅见到了久违的阳光……”38岁的陕西汉中佛坪青年张健,一名严重的强直性脊柱炎患者,从9岁起开始发病,19岁彻底瘫痪。人生似
中国教育新闻网讯(记者 缪志聪)6月28日,南京医科大学附属逸夫医院启用暨邵逸夫先生塑像揭幕仪式在江苏省南京市举行。香港邵逸夫基金会主席邵方逸华女士为邵逸夫先生塑像揭幕。该院由南京医科大学、南京市江宁
髋关节置换的主要人群为骨关节炎的老年患者,但因患强直性脊柱炎、类风湿关节炎的许多年轻患者往往也迫不得已需要做髋关节置换,在与患者的长期接触中,我发现这个相对特殊的年轻人群,最迷惘也最希望了解的是如何选
Getting Around After Hip Replacement Surgery 髋关节置换术后功能锻炼The following are some ways to incorporate movement after you have had hip replacement surgery. Discuss these techniques with your physicians and orthopedist before attempting them. Your physical therapist may modify some of these techniques depending upon your situation (i.e., age, weight, and procedure). Only do the techniques that are recommended by your physician and/or therapist.下床步骤1由床的患腿侧下床,理疗师会教你怎样挪动手术肢体并帮助你怎样使用助行器。Get out of the bed on the same side as your operated leg. You physician and/or physical therapist will show you how to move your operated leg properly and will assist you the first few times while you're in the hospital.步骤2Pivot on your hips using your elbows to help. Keep your body straight with your operated leg kept to the side. Do not twist your leg.以肘关节帮助支撑髋部,保持手术肢体与躯干在一条线上,禁止扭转患肢。步骤3Move your unoperated leg around and sit on the edge of the bed keeping your operated leg straight. Hold onto your walker for support and stand. Do not bend forward as you try to stand. 将非手术侧腿移动至床边并保持患腿伸直。扶住助行器支撑站立,努力站起来时不能向前倾斜。Sitting 坐下步骤1Sit in firm, straight-backed chairs with high seats and armrests. You should avoid low, overstuffed chairs. Back your walker up until you feel the chair touching the back of your legs. 坐高位直靠背带扶手的座椅,座椅避免过低,坐垫避免过厚过软。后退助行器直至感觉到腿的后方接触到座椅。步骤2Release your hands from the walker and reach down and hold onto the arm rests. Slowly lower yourself keeping your operated leg straight out in front. 将手从助行器上解放出来后抓住座椅扶手,支持慢慢降低身体,保持手术侧肢体伸直在前方。步骤3Sit then slide back in the chair bending your unoperated leg first. You use this technique when using a toilet with arm rails as well.先弯曲健侧腿向后滑动身体坐下,同样将此方法用于上卫生间。Walking 行走Once you can stand, you will use a walker to help you keep your balance. Initially you will be told to place only a small amount of weight on your operated leg as you walk. As you become stronger, your doctor will tell you when you can increase the amount of weight placed on your operated leg. 当你能够站立时,可以借助于助行器保持平衡。刚开始患肢只能部分负重行走。当肢体力量强壮时,医生会告诉你什么时候增加患肢负重量。步骤1 Place the walker a few inches in front on you and hold on to the walker firmly with both hands. Keep you hip straight and step your unoperated leg into the center of the walker. To protect your hip, avoid rotating your hip or foot. 将助行器放置在面前几英寸处,用双手握紧助行器,保持髋关节伸直,将健腿置于助行器中间。步骤2 Lean on the walker and let it support your weight. Step forward and through the walker with your operated leg. Be careful not to wrap your leg around the legs of the walker. 借助行器支持体重,术侧腿与助行器一起踏向前,注意不要碰到助行器腿。步骤3 Lift your walker straight up (if it doesn't have wheels). Be sure to place all four of its legs down before stepping forward again. 提起助行器(如果助行器没有轮子),确定放稳所有助行器四条腿后方可再次迈向前方。Crutches 拐杖Once your muscles are strong enough, your physical therapist and/or physician may recommend crutches instead of using a walker. Your therapist will give you guidelines on how far and how long you may walk. When using crutches, put your weight on your palms, not your armpits. Don't twist to turn, take small steps instead. Your physician and/or therapist will tell you how much weight you can put on your operated leg. 当肌肉力量足够强的时候,理疗师会建议使用拐杖代替助行器。理疗师会制定行走实时间和距离方案。当使用拐杖时,身体的重量负在手掌上,而不是负重于腋窝下方。不能扭转身体,而以一小步代替旋转。理疗师会告诉你患肢能够负多少重量。步骤1 With the crutches firmly in place, place pressure on your hands, not on your armpits. 正确握紧拐杖,将符合置于手上,而不是腋下。步骤2 Move the operated leg and both crutches forward at the same time. 同时向前移动患肢和双拐。步骤3 Looking up and straight ahead, first step through the crutches with the operated leg followed by your unoperated leg。 注视前方,首先拐杖和患肢迈出,紧跟着迈非手术腿。Walking Up Stairs with Crutches 扶拐杖上楼With your crutches upright on the floor and firmly planted for support, lift your unoperated leg and place it on the step. Leaning forward on the crutches, lift yourself up. Use the crutches and your unoperated leg to support your weight. Now lift your operated leg up onto the step. You may want to have someone help you the first few times until you become comfortable with stairs. 握紧拐杖直立于地面上,先健侧脚放置在楼梯台阶上,将身体倾向前,利用拐杖支撑身体向上,利用拐杖和健腿支撑支撑自己的体重,然后抬患侧脚置于台阶上。Walking Down Stairs with Crutches 扶拐杖下楼梯Place your crutches and your operated leg on the lower step. Use the crutches for balance and lower yourself carefully down onto the step moving the crutches as you move the operated leg. Again, you may wish to have someone assist you the first few times you try this. 将双拐和患侧脚放到下一级台阶上,利用拐杖保持平衡和移动身体,再次移动拐杖同时移动患脚,最初几次可以由其他人来帮助。应该的避免危险动作At first some movements will put too much strain on your new hip joint, which could cause the ball to slip from its socket. A therapist will teach you which movements to avoid. A few of the most risky ones are: 最开始活动时避免过度活动,否则会导致关节脱位,理疗师会讲述什么动作需要避免,最危险的动作是什么:坐Don't let your knee cross the midline of your body.不能使你的膝关节交叉过身体中线错误Rather, sit with both feet on the floor, with your knees six inches apart.双足置于地上,双膝关节之间保持6英寸距离。正确转身Don't plant your foot and rotate your new hip inward.避免将足固定而旋转患侧髋关节。错误Rather, turn both your feet and your body.应该同时转动躯干和患足。正确弯腰Don't bend all the way over from the waist.不能完全弯腰错误Rather, use a device, such as a long-handled grabber to reach down.正确的做法是以一种装长柄抓钩延长正确Once You Are At Home 当你在家时It is very important that you follow your surgeon's instructions. The following suggestions should be discussed with your surgeon before your hospital discharge遵循外科医师的指导是非常重要的,指导意见是主治医师在出院之前决定的。If you will be using a walker or crutches to assist with walking, ask your doctor how much weight you may put on your operated leg. 如果需要使用助行器或者拐杖,向医生问明患者可以负多少重量。Remember that you will probably tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes mid-morning and mid-afternoon. 记得你会较平时更容易疲劳,可以计划每天上午十点左右和下午3点左右休息30-60分钟。It is safer and easier to get in and out of chairs using both arms and you should avoid low or overstuffed furniture. To increase your comfort, use a cushion or pillow to raise your body while seated. 充分利用双臂起落座椅是比较安全和简单的做法,避免坐过低和厚软垫座椅。坐起的时候可以用电子或者枕头垫高垫着。An elevated toilet seat may reduce stress to your hips and knees as you sit and stand. 利用高位马桶在起来和坐下来时可以减少髋关节和膝关节的应力。A shelf placed in the shower at chest height may reduce having to bend to retrieve items while in the shower. A bathtub seat (bench) allows you to sit while bathing for increased safety and comfort.为了增加安全性和舒适度,洗浴时可以坐在浴缸座上。A long-handled bath sponge may be used to reach lower legs. Women can also purchase razor extenders to shave their legs. 使用长的搓澡巾可以到达下肢,女患者可以购买剃刀给自己的腿剃面。Avoid sweeping, mopping, and running the vacuum cleaner. Use long-handled feather dusters for dusting high and low items. Your doctor will tell you when it is okay to sweep, mop, and vacuum.避免扫地、拖地和使用吸尘器,用长把手羽毛单子打扫高位和地位置的灰尘。你的主治医师会告诉你什么时候可以扫地、拖地和使用吸尘器。You may ride in a car, but you must follow your doctor's instructions for how to get in and out of the vehicle. You can raise the height of the car seat with pillows to protect your hips and knees as well. 你可以乘坐轿车,但是必须按照医生的知道上下车,用枕头垫高车上的坐垫保护髋膝关节。Your doctor will talk with you about when you can drive, typically within four to six weeks after surgery. If you have a car with manual transmission, talk with your doctor about driving limitations. Make sure you can brake the car without discomfort before you attempt to drive in traffic. 医生会告诉你什么时候可以驾车,一般情况下在手术后4-6个星期,如果你的汽车是手动变速器,医生会告诉你驾驶注意事项,确信你在驾驶时刹车没有不舒服。Constipation is a common problem for patients following surgery. This is usually due to your limited activity and any pain medications you may be taking. Discuss your diet with your doctor. It should include fresh fruits and vegetables as well as eight full glasses of liquid each day, unless your doctor tells you otherwise.便秘是患者术后最常见的问题,便秘可限制活动和止痛药物的应用。Your doctor will probably give you a prescription for pain pills. Please follow your doctor's instructions concerning these medications.主治医生会给你止痛方案,请按遗嘱服药物。Some swelling around the incision is normal. You will find it more comfortable to wear loose clothing to avoid pressure on the incision. Ask your doctor or other qualified health professional about appropriate wound care. 伤口周围稍微隆起是正常的,穿宽松的衣物可以减少对伤口的压力,找主治医生或者有许可证的专科医生做适当的伤口护理。
OHSU(oregon health and science university)位于美国西北第二大城市波特兰的Marquam山上,山下就是市区的中心地带,OHSU有缆车、公交和班车与山下连通。山上
半月板损伤引发持续症状的必须手术,否则继发损伤会更严重,导致软骨损伤创伤性骨关节炎。休息几乎是半月板损伤保守治疗的唯一方法,理疗对深部的组织几乎是无效的,药物可以暂时缓解症状,但3个月无法彻底治愈的必须要关节镜微创手术治疗。磁共振并不是决定是否需要做手术的“尚方宝剑”,关键还是看专科医生对患者临床症状的综合评估。一般住院5-6天即可,如果一味拖延治疗,本来很简单的事情,处理不当却会要把小问题变成大漏洞。 手术多数采用部分半月板切除术:适用于桶柄状破裂、纵行破裂或横行破裂。只切除撕裂的中央部分,留下较稳定的周围半月板袖或边缘,对胫股关节起明显的稳定作用。 成功的手术后恢复很快,大部分患者术后2周左右基本恢复正常,伴随轻微肿胀,但不影响工作。一个月后可以逐步恢复运动,不会留下后遗症。