目的评价改良法甲皮瓣移植再造拇指术后再造拇指及供足的功能改变。方法对2003年1月-2007年10月接受改良甲皮瓣移植再造拇指的65例患者进行随访。男54例,女11例;年龄15～46岁,平均33岁。术前拇指缺损程度根据三类六区分类法,皮肤脱...目的评价改良法甲皮瓣移植再造拇指术后再造拇指及供足的功能改变。方法对2003年1月-2007年10月接受改良甲皮瓣移植再造拇指的65例患者进行随访。男54例,女11例;年龄15～46岁,平均33岁。术前拇指缺损程度根据三类六区分类法,皮肤脱套伤和晚期ⅠB类缺失12例,Ⅱ类缺失44例,ⅢA类缺失9例。术后观测再造拇指及供足改变;并对最后获随访的20例患者供足进行足功能指数-5分口述评分量表(foot function index-verbal rating scales,FFI-5pt)、美国足踝外科学会(AOFAS)趾-跖趾-趾间关节评分,同时采用F-Scan动态足底测压系统测定供足步态参数及足底压力的动态分布情况。结果65例均获随访,随访时间6～60个月,平均22个月。再造拇指外形与健侧相似;两点辨别觉为(9.7±2.8)mm,与健侧(4.2±1.1)mm比较差异有统计学意义(P<0.05)。63例供趾保留了全长或大部分长度,2例自近节趾骨头水平缺失;跖侧保留皮条宽(24.5±3.7)mm,覆盖趾底负重区域,其两点辨别觉(9.0±2.6)mm,与健侧(8.1±1.9)mm比较差异无统计学意义(P>0.05)。最后获随访的20例患者供足FFI-5pt评分中,疼痛指数为5.6±4.5,行动障碍指数为1.2±2.7,足功能指数为3.2±2.9;AOFAS评分中,疼痛评分为(34.0±5.0)分,功能评分为(38.7±4.2)分,排列评分为(15.0±0)分,总评分为(87.7±7.4)分。供足与健侧足相比,步态周期内支撑相持续时间以及各时相占整个步态周期的百分比差异均无统计学意义(P>0.05),全足所承受的峰压力及压力-时间积分亦无统计学意义(P>0.05)。供足趾峰压力显著小于健侧趾(P<0.05),峰压强差异无统计学意义(P>0.05);双侧足底其他6个解剖部位的峰压力及峰压强比较差异均无统计学意义(P>0.05)。结论改良游离甲皮瓣移植再造拇指,在不降低再造拇指质量的同时,保护了供足的功能。展开更多
The advance of fluid dynamics may be divided into four stages： ancient, classical, neoteric, and contem- porary. A similar four-stage framework can be used to describe the advance of synoptic meteorology, such as the...The advance of fluid dynamics may be divided into four stages： ancient, classical, neoteric, and contem- porary. A similar four-stage framework can be used to describe the advance of synoptic meteorology, such as the conceptual models of extratropical cyclones and their attendant fronts. The first conceptual model of extratropical cyclones was proposed by Admiral FitzRoy in 1863. Based purely on Admiral FitzRoy＇s personal experience （although it does contain some scientific essentials）, this model represents the “ancient” stage of synoptic meteorology. The Norwegian cyclone model was developed based on Newtonian mechanics about 100 yr ago, and represents the classical stage of synoptic meteorology. This model was based on the idea that weather changes are primarily caused by baroclinicity, but contain some serious flaws. In particu- lar, the Norwegian model regards fronts as zeroth-order discontinuities in density, which is inconsistent with the continuity principle of fluid dynamics. The Chicago three-dimensional conceptual model of fronts and cyclones, which was developed approximately 50 yr ago by using quasi-geostrophic theory, can be thought of as representing the neoteric stage of synoptic meteorology. The Chicago model was replaced in the late 20th century by a model of extratropical cyclones characterized by back-bent and wrap-up warm fronts. This model has been developed with massive numerical calculations, and represents the contemporary stage of synoptic meteorology. In the era of large data, contemporary synoptic meteorology should be careful to maintain and make full use of the profound physical understanding generated during the neoteric stage of synoptic meteorology.展开更多
文摘目的评价改良法甲皮瓣移植再造拇指术后再造拇指及供足的功能改变。方法对2003年1月-2007年10月接受改良甲皮瓣移植再造拇指的65例患者进行随访。男54例,女11例;年龄15～46岁,平均33岁。术前拇指缺损程度根据三类六区分类法,皮肤脱套伤和晚期ⅠB类缺失12例,Ⅱ类缺失44例,ⅢA类缺失9例。术后观测再造拇指及供足改变;并对最后获随访的20例患者供足进行足功能指数-5分口述评分量表(foot function index-verbal rating scales,FFI-5pt)、美国足踝外科学会(AOFAS)趾-跖趾-趾间关节评分,同时采用F-Scan动态足底测压系统测定供足步态参数及足底压力的动态分布情况。结果65例均获随访,随访时间6～60个月,平均22个月。再造拇指外形与健侧相似;两点辨别觉为(9.7±2.8)mm,与健侧(4.2±1.1)mm比较差异有统计学意义(P<0.05)。63例供趾保留了全长或大部分长度,2例自近节趾骨头水平缺失;跖侧保留皮条宽(24.5±3.7)mm,覆盖趾底负重区域,其两点辨别觉(9.0±2.6)mm,与健侧(8.1±1.9)mm比较差异无统计学意义(P>0.05)。最后获随访的20例患者供足FFI-5pt评分中,疼痛指数为5.6±4.5,行动障碍指数为1.2±2.7,足功能指数为3.2±2.9;AOFAS评分中,疼痛评分为(34.0±5.0)分,功能评分为(38.7±4.2)分,排列评分为(15.0±0)分,总评分为(87.7±7.4)分。供足与健侧足相比,步态周期内支撑相持续时间以及各时相占整个步态周期的百分比差异均无统计学意义(P>0.05),全足所承受的峰压力及压力-时间积分亦无统计学意义(P>0.05)。供足趾峰压力显著小于健侧趾(P<0.05),峰压强差异无统计学意义(P>0.05);双侧足底其他6个解剖部位的峰压力及峰压强比较差异均无统计学意义(P>0.05)。结论改良游离甲皮瓣移植再造拇指,在不降低再造拇指质量的同时,保护了供足的功能。
基金Supported by the China Meteorological Administration Special Public Welfare Research Fund(GYHY201306023)National(Key)Basic Research and Development(973)Program of China(2013CB430106)National Natural Science Foundation of China(41375051)
文摘The advance of fluid dynamics may be divided into four stages： ancient, classical, neoteric, and contem- porary. A similar four-stage framework can be used to describe the advance of synoptic meteorology, such as the conceptual models of extratropical cyclones and their attendant fronts. The first conceptual model of extratropical cyclones was proposed by Admiral FitzRoy in 1863. Based purely on Admiral FitzRoy＇s personal experience （although it does contain some scientific essentials）, this model represents the “ancient” stage of synoptic meteorology. The Norwegian cyclone model was developed based on Newtonian mechanics about 100 yr ago, and represents the classical stage of synoptic meteorology. This model was based on the idea that weather changes are primarily caused by baroclinicity, but contain some serious flaws. In particu- lar, the Norwegian model regards fronts as zeroth-order discontinuities in density, which is inconsistent with the continuity principle of fluid dynamics. The Chicago three-dimensional conceptual model of fronts and cyclones, which was developed approximately 50 yr ago by using quasi-geostrophic theory, can be thought of as representing the neoteric stage of synoptic meteorology. The Chicago model was replaced in the late 20th century by a model of extratropical cyclones characterized by back-bent and wrap-up warm fronts. This model has been developed with massive numerical calculations, and represents the contemporary stage of synoptic meteorology. In the era of large data, contemporary synoptic meteorology should be careful to maintain and make full use of the profound physical understanding generated during the neoteric stage of synoptic meteorology.
