目的 探讨可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面的临床效果及护理要点。 方法 对2008年5月－2011年5月收治的106例皮肤缺损伴感染创面患者，采用间歇负压引流治疗3～10 d，负压值设为50～120 mm Hg（1 mm Hg=0.133 kPa），创面达到Ⅱ期植皮条件时，采用大张、网状或邮票状皮片覆盖创面，继续采用持续负压引流治疗3～12 d，负压值设为50～60 mm Hg，同时进行患者心理和可调节负压引流技术创面等护理。 结果 56例大张皮片植皮中，2例皮片出现0.5 cm×1 cm～0.8 cm×1.2 cm皮片坏死；21例邮票状植皮者，1例出现皮片移动皱缩。除5例骨外露，先通过植皮创面缩小后行皮瓣转移，101例创面愈合时间7～25 d，平均14 d，无因所植皮片未成活需再次植皮和因感染死亡或截肢。 结论 可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面，可有效控制感染，减轻患者换药痛苦，减少医务人员换药和护理工作量，加快植皮创面愈合，缩短创面治愈时间。
【Abstract】 Objective To explore the correlation between pain grading, stage of necrosis and bone marrow edema(BME) in nontraumatic osteonecrosis of femoral head (NONFH) so as to strengthen understandings about cl inical significance of BME in NONFH. Methods From October 2004 to October 2006, 97 patients (149 hips) with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years (19-62 years). The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain (grade 0), mild pain (grade 1) and moderate or severe pain (grade 2). According to Association Research Circulation Osseous staging system, NONFH were divided into I-IV stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups. Results The total incidence rate of BME was 73.15% (109/149), the incidence rateswere 84.38% in pain groups (108 /128) and 94.12% in the grade 2 (32/34). Pain grading correlated with BME rating (P lt; 0.001).The results of rank sum tests for several independent samples showed significant difference in BME among pain groups(P lt; 0.001). With the advance of pain scale, the mean rank of BME increased gradually(28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2). BME was more commonly and clearly seen in stage Ⅱ（77.05%）and stage Ⅲ（82.81%）of NONFH. Stage I-III of NONFH correlated with BME rating (P lt; 0.001). The results of rank sum tests showed significant difference in BME rating among three stages (P lt; 0.001). With the advance of disease, the rank of BME rating increased gradually (39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2 ). Conclusion BME is a sign that is accompanied with NONFH. The probabil ity and extent of BME correlated well with the pain and stage of NONFH．The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.
目的 研究盐酸氨基葡萄糖联合抗骨增生片治疗膝骨关节炎（KOA）的可行性及安全性。 方法 2011年1月－2012年8月选取90例KOA患者，按关节面改变部位归入A组（髌股关节面改变）、B组（胫股关节面改变）、C组（全关节软骨改变），每组30例。均予以盐酸氨基葡萄糖、抗骨增生片治疗，12周后观察治疗前后临床疗效、综合疗效及安全性等指标及评分。 结果 ① 3组比较，A组疗效高于B、C组（P＜0.05）；② A组与B、C两组在平地行走20 m疼痛评分、关节压痛度评分和骨关节炎指数（WOMAC）评分方面差异有统计学意义（P＜0.05）；③ A组和B、C两组在患者自我疗效评价、医生疗效评价方面差异有统计学意义（P＜0.05）；④ A组在治疗12周后血液血沉、C反应蛋白（CRP）、白细胞介素（IL）-1、IL-6、肿瘤坏死因子-α（TNF-α）较治疗前差异有统计表学意义（P＜0.05）；B组则在CRP、IL-6、TNF-α较治疗前有差异（P＜0.05）；C组仅在CRP、TNF-α较前有差异（P＜0.05）；⑤3组不良反应发生率则无明显差异（P＞0.05）。 结论 盐酸氨基葡萄糖联合抗骨增生片治疗髌股关节面改变的KOA疗效优于胫股关节改变，且治疗方案可行、安全、优效。