Cutaneous flexion

Introduction Joint skin type decompression sickness, transient skin pain and itching, also known as skin type bends. It was first discovered that decompression sickness was among the divers, so the disease was first called the diver's disease. All engaged in high-pressure operation, tunnel and caisson operations; the submarine crew of the wrecked submarine escapes quickly from the seabed; the flight personnel rise rapidly in the non-pressurized cabin; or simulate the flight lift in the low-pressure compartment; the airtightness of the high-pressure compartment fails; Decompression sickness can occur in patients treated with hyperbaric chambers due to improper decompression.

Cause

It was first discovered that decompression sickness was among the divers, so the disease was first called the diver's disease. All engaged in high-pressure operation, tunnel and caisson operations; the submarine crew of the wrecked submarine escapes quickly from the seabed; the flight personnel rise rapidly in the non-pressurized cabin; or simulate the flight lift in the low-pressure compartment; the airtightness of the high-pressure compartment fails; Decompression sickness can occur in patients treated with hyperbaric chambers due to improper decompression.

an examination

Related inspection

Coagulation factor activity assay

1. History has respiratory compression gas, high pressure operation, diving history. In the past, it is considered that the water depth is shallow at 12m, and decompression sickness is unlikely to occur in repeated operations. However, it has been reported recently that underwater operations are deep in the range of 6m to 8.5m, repeated operations, or strong physical labor, and the working time is more than 2 hours, often after water discharge. Joint pain occurred and healed by compression therapy. Therefore, any environmental pressure changes drastically, such as operating in a high-pressure environment, abrupt decompression to atmospheric pressure; or rapid decompression to a low-pressure environment under normal pressure conditions may cause acute decompression sickness.

2. Signs: The affected limbs are mostly buckling, no obvious redness and heat, and the tenderness is not obvious. Severe patients are often accompanied by other serious symptoms.

3. Therapeutic diagnosis If there is hyperbaric chamber equipment, routine pressure therapy is performed on suspicious cases. Most patients with true symptoms can quickly disappear after compression treatment; however, local patients may relapse after compression treatment, which should be Other non-barovascular osteoarthrosis was identified. The clinical diagnosis of decompressive osteonecrosis relies mainly on the history of exposure to high pressure, the history of respiratory compression gas diving, and the imaging of bones.

Must pay great attention to the history of high-pressure exposure history, it should be pointed out that the latency of decompressive osteonecrosis varies, most patients have no symptoms in the early stage, only when the lesion affects the articular surface or cortical bone and causes pain or abnormal joint function, the patient Fang came to see a doctor. Therefore, in clinical work, doctors should be vigilant against high-pressure operation doctors, and think about the possibility of this disease at any time: when cooperating with imaging examination, pay attention to its specific predilection site, which is a point that can not be ignored in early diagnosis. one.

Laboratory examination: activation of the contact factor (Hageman factor, factor XII) in the blood coagulation chain.

Other auxiliary examinations: According to the X-ray signs of decompressive osteonecrosis, the British Medical Association divides them into two categories: AB. The prognosis of type A lesions is poor, the disease is active, and it is easy to cause loss of bone and joint function and disability; It is relatively stable, far from the articular surface, and rarely deteriorates further. After many years of clinical observation, there is no statistical difference in the development and prognosis of two types of AB lesions. Chinese and Japanese scholars proposed their own classification methods for X-ray findings of decompressive osteonecrosis according to their clinical experience.

According to recent research, for the statistics of 1269 high-pressure workers and nearly 30,000 X-ray films, it is found that decompressive osteonecrosis lesions occur mostly on the inner edge of the humeral head and the medial and lateral femoral neck. A specific area of osteonecrosis occurs. Decompression osteonecrosis of long bones has a specific area of development. This finding is conducive to improving the early diagnosis of this disease and distinguishing it from other bone lesions. The reason why decompression osteonecrosis occurs in these specific parts may be related to factors such as osteoporosis, high stress, high fat content, high blood volume, and slow local blood flow. These comprehensive factors promote the formation and accumulation of air bubbles in the site, causing local embolism, affecting blood supply and causing osteonecrosis. Gregg (1981) injected 99mTc labeled bisphosphate 5C from rabbit ear vein. After bone scan and X-ray film comparison, radionuclide bone scan was found. The early diagnosis of decompressive osteonecrosis was better than X-ray film. Decompression osteonecrosis was detected by B-mode ultrasound and compared with X-ray films, the two were basically identical. Because type B ultrasound is simple and inexpensive, it is worth promoting.

Differential diagnosis

Note the identification of diseases associated with respiratory dysfunction, hypovolemic shock, intravascular coagulation, and thrombosis.

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