Objective There are few reports on the repair of lower leg wounds with medial plantar flap. The purpose of this paper is to study the application of medial plantar flap in repairing skin and soft tissue defects in lower leg and ankle with bone and tendon exposure. Methods 19 patients with skin and soft tissue defects in the lower leg and ankle that were repaired by the medial plantar flap in the Department of Burns and Plastic Surgery, Eastern Theater Command General Hospital from January 2013 to December 2020 were included in this study. Ultrasound, CTA and/or DSA examination were given to the patients before the surgery to determine the condition of blood vessels in lower leg. The medial plantar flap was designed according to the position, shape and area of the defects in the recipient area. The flap donor area was immediately repaired by skin grafts or temporarily covered by artificial dermis and repaired secondarily. The survival of the flap, the healing of the donor site, and the recovery of sensory and motor function were followed up for evaluation of therapeutic effect. Results The flaps and skin grafts of all patients survived in stage one. Postoperative follow-up showed that the appearance of the flap was good, the color and texture of the flap were similar to those of the surrounding skin, and the patients were satisfied. The appearance of skin graft in plantar donor area was poor, and the sensation of metacarpophalangeal and second toe was lost. The plantar wear resistance is good when walking after skin grafting. Conclusion The medial plantar skin flap has reliable blood supply, concealed position and long vascular pedicle, and has little effect on the appearance and function of the foot. It is a feasible choice to repair small and medium-sized skin and soft tissue defects of the lower leg and ankle.

目的 探索DSA联合多普勒超声辅助,设计胫后动脉穿支皮瓣,修复小腿下段软组织缺损的效果.方法 自 2020 年 1 月至 2022 年 12 月,应用胫后动脉穿支皮瓣修复小腿下段软组织缺损共 5 例.术前应用DSA观察胫后动脉走行及穿支发出位置,选择优势穿支,多普勒超声确认优势穿支发出点,根据创面位置、面积设计皮瓣,并进行皮瓣移植.供瓣区植皮修复.结果 DSA检查显示,5 例患者中 2 例小腿主干血管无损伤,3 例胫前动脉损伤、远端闭塞;5例患者均可见胫后动脉穿支.5例皮瓣及移植皮片均存活.术后随访6～12个月,所有患者受区外观满意,小腿及踝关节功能恢复.结论 应用DSA观察胫后动脉穿支并选择优势穿支,联合多普勒超声定位,指导皮瓣设计,在修复小腿下段前侧和内侧创面中可取得良好效果.

目的 观察应用不同带蒂轴型皮瓣修复踝周皮肤软组织缺损的临床效果.方法 2017年1月至2020年12月,对我科收治的 22 例踝周皮肤软组织缺损患者,分别应用 4 种带蒂轴型皮瓣进行修复,其中足底内侧皮瓣 13 例、腓肠神经营养皮瓣 2例、足背皮瓣 5 例、外踝上穿支皮瓣 2例.皮瓣切取面积 3 cm×3 cm～10 cm×5 cm.供瓣区直接拉拢缝合或植皮修复.结果 所有皮瓣和供瓣区移植皮片均成活.术后随访6～24 个月,皮瓣外观满意,质地柔软,有保护性感觉.结论 根据踝周皮肤软组织缺损的具体情况,结合不同带蒂轴型皮瓣特点进行优化选择,能获得预期效果.

目的 探讨肌肉内静脉畸形(intramuscular venous malformation,IMVM)的临床特征及治疗方法.方法 回顾性分析自2012年1月至2021年12月,南京大学医学院附属金陵医院(东部战区总医院)烧伤整形科收治的66例IMVM患者的临床资料.所有患者均接受超声、X线片、MRI、CT检查,16例接受经皮穿刺造影CT扫描三维成像检查.总结患者的临床特点,影像学及病理学诊断要点.结果 7例手术切除患者,所有病灶基本清除,有效率为100％(7/7);47例硬化治疗患者,治疗有效率为82.98％(39/47);12例铜丝留置联合硬化治疗患者,所有病灶明显萎缩,有效率为100％(12/12).治疗期间及治疗后均未出现严重并发症.结论 IMVM具有不同的临床表现,影像学检查是确诊并选择治疗方法的依据.控制病程进展、保留功能是大部分IMVM的治疗目标.

目的 分析儿科应用中成药存在的不良反应.方法 采用回顾性分类统计,对我院儿科共33例中成药不良反应进行综合分析.结果 33例患儿共涉及12种药物,其中口服制剂3种,中药注射剂8例,其他1例;主要涉及皮肤系统损害14例,消化系统损害8例,神经系统损害6例,循环系统损害5例.结论 儿科应用中成药存在的不良反应比较常见,多为注射剂引起,临床主要表现为皮肤反应,要注重加强预防与管理.

目的：探讨皮耐克联合生物型封闭负压引流（VSD ）治疗四肢创面缺损的临床疗效。方法将70例四肢创面缺损患者随机均分为观察组（皮耐克联合生物型VSD治疗）和对照组（单纯VSD治疗），比较两组治疗效果。结果两组患者治疗的总有效率均为100％，但是与对照组相比，观察组患者的治愈率更高（97.14％ v s ．65.71％）（ P＜0．05）。观察组患者住院时间为（27.6±4.7）d ，少于对照组的（42.9±6.5）d（P＜0．05）。观察组患者的不良反应发生率低于对照组（11.43％ vs ．40.00％）（P＜0．05）。结论采用皮耐克联合生物型VSD治疗四肢创面缺损患者的临床疗效显著，不良反应较少，值得临床推广。

[Abstract ] Objective Pelvic radiation disease(PRD) is multiple injuries in more than one organ resulted by pelvic radio-therapy.Patients have the symptoms of frequent feces and fecal incontinence after the resection of small bowel lesion .Sugeries on PRD patients were mainly distal ileum and ilieocecal valve resections , while the most susceptible part of pelvic radiation injury is rectum . However , little research has been done concerning PRD patients′anorectal functions .This study was mainly to evaluate the anorectal function of cervical cancer patients with PRD in order to provide evidence for the therapy and prognosis of PRD . Methods Cervical cancer patients with PRD in need of small bowel resection who hospitalized in our department from January 2014 to January 2015 were collected as patient group , while people from outpatient physical exam group were selected as control group according to the exclusion criteria of hypertension , diabetes, constipation and unrelaxed pelvic floor syndrome .PDR group and control group were matched according to age.All subjects underwent colonoscopy and anorectal manometry .Rectal radiation injury was estimated on the basis of colonoscopy results.Anorectal manometry results of PRD group and control group were analysised statistically . Results PRD group and control group both included 20 women without stenosis or obstruction in rectum .Significant difference was found between PRD group and con-trol group in anal resting pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.05), anal maximum squeezing pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.01), anal distension pressure (23.30 ±12.49 mmHg vs 39.10 ±9.99 mmHg, P<0.01), rectal defecation pressure(22.85 ±16,69 mmHg vs 50.90 ±9.14 mmHg, P<0.01) and maximum tolerated rectal volume (112.85 ±51.34 mL vs 173.50 ±48.15 mL, P<0.01).There was no significant difference between the two groups as to the lenghth of functional sphincters(P=0.313),rectum initial threshold(P=0.416) and rectal defecation threshold(P=0.161). Conclusion Ionization radiation that injures PRD patients′internal anal sphincters and external anal sphincters also reduces maximum tolerated rec -tal volumes preoperatively .It′s necessary to assess the muscles and nerve functions of anorectum before intestinal surgery in order to make a proper operation plan which will improve PRD patients′life quality.

目的 探讨基质辅助激光解吸电离飞行时间质谱(matrix-assisted laser desorption ionization-time of flight mass spectrometry,MALDI-TOF MS)系统用于快速鉴定临床分离菌的可靠性和实用性.方法 收集南京军区南京总医院2013年7～10月自临床标本分离的非重复细菌1 061株,分别使用MALDI-TOF MS和Vitek 2 Compact全自动细菌鉴定仪系统进行鉴定,结果不一致的菌株采用16S rDNA测序验证.结果 1 061株临床分离菌中1 058株(99.7％)经MALDI-TOF MS系统正确鉴定到属水平,1 016株(95.8％)正确鉴定到种,其余3株(0.3％)未给出鉴定结果.5株鉴定结果不一致的菌株经16S rDNA测序确认,结果与MALDI-TOF MS和Vitek 2 Compact鉴定符合率分别为40.0％(2/5)和0(0/5).结论 MALDI-TOF MS可以作为一个快速、准确和价廉的工具应用于临床分离菌的鉴定.

BACKGROUND:For patients with lumbar spondylolisthesis combined with osteoporosis, appropriate fixation system for effective reset and good fixation stability is currently a hot issue of clinical concern. Pedicle screw screw-rod system after bone cement perfusion can achieve the effective fixation between pedicle screw system and the vertebral bone. OBJECTIVE:To observe the therapeutic effect of bone cement-augmented pedicle screw on patients with lumbar spondylolisthesis combined with osteoporosis. METHODS:17 cases of lumbar spondylolisthesis combined with osteoporosis were identified by bone density test. They received the posterior open reduction and internal fixation, and implanted with 68 bone cement-augmented pedicle screws. Their repair effects were observed by short-term fol ow-up. Patients were evaluated using low back pain Visual Analog Scale and lower limb Oswestry Disability Index before treatment, 1 week, 3 months and 1 year after treatment. Vertebral height, intervertebral height, screw loosening and bone cement leakage were observed using imaging. <br> RESULTS AND CONCLUSION:Compared with pre-treatment, low back pain Visual Analog Scale score and lower limb Oswestry Disability Index were significantly improved at 1 week, 3 months and 1 year after treatment (P<0.05). No significant difference was detected between post-treatment and fol ow-up (P>0.05), which indicated that clinical repair effect could be effectively maintained. At 3 months of fol ow-up, one screw loosening occurred in two patients. During fixation, mild bone cement leakage appeared in seven vertebral bodies with screw fixation, no symptoms or subsequent complications were observed. There were no significant differences in vertebral height and intervertebral height before and after treatment and during fol ow-up (P>0.05). These results suggest that bone cement-augmented pedicle screw for patients with lumbar spondylolisthesis combined with osteoporosis can effectively reset vertebral slippage, effectively provide good anti-pul-out force for a long term, and the effect was stable. Bone cement augmentation can perfectly strengthen fixation, shows good biocompatibility, and avoids osteoporosis around the screw-induced failure fixation.

Radiotherapy is an important method of tumor treatment .The incidence of complications caused by radiotherapy is high, which seriously effect patients′quality of life.The current terms of radiation enteritis , radiation proctitis and radiation cystitis can not reflect the changes of physiopathology after radiotherapy .Nowadays , a consensus has been gradually reached that 'pelvic radiation disease'is a more accurate description .This article mainly introduces the definition evolution , significance and current status of pelvic radiation disease to draw the attention of domestic related professionals .A new starting point is opening for the curing of radiotherapy-related complications .

Objective To explore the therapeutic effect of negative pressure drainage with double cannula in sinus tract cases. Methods Summary analysis of data for 40 sinus tract patients on limbs and sacrococcygeal region.20 cases underwent negative pressure drainage with double cannula as a treatment group,and 20 cases underwent gauze drainage and change dressing as the control group. Results Course of the treatment group compared with the control group shortened and one-time cure rate was 100%. Conclusion The treatment of negative pressure drainage with double cannula has the advantages of shorter course,and lower cost and less pain,is an ideal way to treat sinus tract.

目的：观察天舒胶囊治疗椎动脉型颈椎病疗效和对脑血管供血影响。方法选取2012年10月至20013年6月椎动脉型颈椎病患者60例，随机分为观察组和对照组，对照组采用盐酸氟桂利嗪胶囊（钙离子拮抗剂）治疗，每晚10mg，观察组在此基础上加服天舒胶囊（主要由天麻、川芎组成，每粒含生药0.34g），4粒/次，3次/d。疗程1个月后监测两组患者治疗前后临床症状改善情况。结果治疗结束后，观察组临床控制4例、显效16例、有效8例、无效2例，有效率为93.3%。对照组临床控制1例、显效10例、有效7例、无效12例，有效率为60.0%。两组比较差异有统计学意义（P<0.05），且均无严重不良反应。结论天舒胶囊联合氟桂利嗪治疗椎动脉型颈椎病安全、有效，值得临床推广。

目的 分析椎体成形手术策略选择(经皮椎体成形术PVP与椎体后凸成形术PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)的临床疗效和安全性.方法 对自2009-09-2012-09行PVP治疗的38例(45个椎体)与PKP治疗的42例(45个椎体)骨质疏松椎体压缩骨折的治疗情况进行回顾性分析.结果 2组椎体前缘高度保持度PKP组具有明显优势(P ＜0.001),各组术后较术前的临床疗效,差异有统计学意义(P ＜0.001),但2组之间的临床疗效差异无统计学意义(P＞0.05).PVP组骨水泥渗漏率显著低于PKP组,差异有统计学意义(P＜0.05).结论 对于老年骨质疏松性椎体压缩骨折的椎体成形术手术策略选择上,需按照个体的具体情况进行分析,总体上说PVP组在安全性上要优于PKP组,PVP可作为治疗骨质疏松的首选方法.

膝关节周围骨折患者以往由于创伤后组织粘连、制动时间过久等影响，膝关节僵直发生率较高［1，2］。连续被动活动机（Continuous passive motion，CPM）可帮助患者术后下肢迅速恢复关节活动功能，使得恢复后的膝关节、髋关节活动自如。骨折是重大的创伤，造成形体的变化，功能的障碍，多数人会有严重的思想负担，造成心理种种变异［3］。治疗的好坏和患者的心理状况相互作用。为了解CPM机对膝关节周围骨折后患者辅助治疗的效果对其康复心理的影响，分别对骨折患者入院后24h内和出院6个月随访时进行焦虑心理评价和CPM效果评价，现报告如下。

BACKGROUND:For distal clavicle fracture, clavicular hook plate and Kirschner wire tension band were used in the clinic, but they cannot keep the dual function of stability and functional protection. However, the application of microporous locking plate of distal clavicle makes it possible to double efficacy. OBJECTIVE:To compare and analyze the clinical outcomes of distal clavicle microporous locking plate and clavicular hook plate. METHODS:From March 2011 to March 2013, 40 patients with distal clavicle fractures were involved in this study. They were divided into two groups with the voluntary principles:distal clavicle microporous locking plate group and clavicular hook plate group. We compared and observed perioperative indicators (operation time, blood loss, and hospitalization days), clinical curative effects (University of California at Los Angeles scoring system and American Shoulder and Elbow Surgeons Scale), the score of shoulder joint function (Karlsson standard) and the overal treatment (removed the plate and functional training costs). RESULTS AND CONCLUSION:Al patients successful y underwent surgery. At 1 year after surgery, internal fixators were taken out. Necessary relevant rehabilitation training was performed for more than 3 months. There was no significant difference in perioperative indicators (P>0.05). However, clinical curative effects and the score of Karlsson shoulder joint function showed significant advantages in the microporous locking plate group (P<0.05). Although the distal clavicle microporous locking plate material cost was high, but there was no significant statistic difference in the overal treatment for better protection shoulder function (P>0.05). We draw the conclusion that distal clavicle microporous locking plate can effectively reconstruct the stability of the fracture site, and better retain the function of the joints at the same time.

BACKGROUND: Preliminary studies have found that local wound gory, tissue secretions or bacteria growth can result in tube jam after treatment with vacuum-sealing drainage based on biomaterial wound surface dressing, and we cannot get satisfied results in the repair of soft tissues below the blocked tube area. OBJECTIVE: To study the curative effect of clearance flush vacuum-sealing drainage based on biomaterial dressing in the treatment of chronic wounds. METHODS: Thirty-six patients with chronic wounds were divided into three groups which were cured by clearance flush vacuum-sealing drainage based on biomaterial dressing, vacuum-sealing drainage based on synthetic dressing and conventional dressings by their willingness. RESULTS AND CONCLUSION: The bacteria detection rate of clearance flush vacuum-sealing drainage based on biomaterial wound surface dressing group was inferior to the synthetic dressing group and conventional dressing group (P < 0.05). And the healing time was shorter in the former one group (P < 0.05). The score on the visual analogue pain in the clearance flush vacuum-sealing drainage based on biomaterial wound surface dressing group was better than that in the conventional dressing group (P < 0.05), but did not significantly differ from that in the synthetic dressing group (P > 0.05). These findings indicate that clearance flush vacuum-sealing drainage based on biomaterial wound surface dressing can promote chronic wound healing, reduce the wound infection rate, relieve the pain of patients when treatment, and have no adverse.

BACKGROUND: Theoretically, nerve conduit technology uses the biological or non-biological materials to prefabricate suitable tubular stent to bridge the nerve ends on both sides. And it can promote the nerve regeneration through neural induction and nutrition under the nerve regeneration microenvironment. OBJECTIVE: To observe the clinical effects of tissue-engineered nerve conduits for repairing peripheral nerve damage. METHODS: Twenty-four patients with old upper extremity nerve damage were selected, and divided into two groups for the treatment according to voluntary principle. The patients in the experimental group were repaired with tissue-engineered nerve conduits, and those in the control group were repaired with autologous surrounding surface sensory nerve transplantation. All the patients were followed-up for 6 months after treatment to observe the repairing functional effect of limb nerve damage.RESULTS AND CONCLUSION: After followed-up for 6 months, the limb distal sensory motor function and visual analogue scale scores of the limbs in the two groups were improved compared with those before treatment (P<0.05), and the experimental group showed better effects (P<0.05); the sensory and motor nerve conduction velocity of the damaged side in the two groups were improved compared with those before treatment (P<0.05), and there was no significant difference between the two groups. It indicates that tissue-engineered nerve conduit materials can meet the requirements of nerve repair conduit stent and the clinical application is effective.

Objective To explore the curative effect of plastic titanic plates and hollow screws in the treatment of calcaneal fractures.Methods Forty patients(52 feet) with calcaneal fractures were studied.They were divided into two groups,20 patients(26 feet) were treated with plastic titanic plates and 20 patients(26 feet) were treated with hollow screws.The operative times,blood loss,fractures healing time,and postoperative function scores were recorded in two groups.And the therapeutic effect in two groups was compared.Results All of 40 cases were followed up for 6-18 months,with an average of(10.42±1.33) months.The operative time and volume of blood loss in hollow screws group were significantly shorter or reduced than those in plastic titanic plates group.The difference was statistically significant(P 0.05).The differences in healing time,Bohler angle,Gissane angle and the range of motion in the ankle joint in two groups were not statistically significant(P 0.05).The incidence of complications was not significantly different in two groups(P 0.05).Conclusion The hollow screws in treatment of calcaneal fractures can effectively prevent the collapse of articular surface and re-displacement again.The surgery is simple with less trauma,strong advantages of minimally invasive surgery.

Objective To explore the impact of placenta polypeptide injection on fracture healing time and the incidence of infection in patients with limb fractures.Methods 138 cases with limb fractures admitted to our hospital from February 2010 to February 2012 were randomly divided into two groups,and each group had 69 patients.The control group was given conventional treatment while the observation group was given placenta polypeptide injection on the basis of the conventional treatment.The bone healing time and infection rates were observed.Results The limbs fracture healing time of observation group was significantly shorter than that of control group(P<0.05).The infection rate of observation group(1.45%) was significantly lower than that of control group(10.14%,P<0.05).Conclusion The placenta polypeptide injection for treatment of limb fractures can effectively decrease fracture healing time,and significantly reduce the rate of infection.

Objective Tibial plateau fracture(TPF) with knee dislocation is an uncommon injury and unclassifiable according to the existing classification system of TPF,and relevant reports are rare.This article introduces our experience in the management of TPF with knee dislocation by external fixation combined with limited internal fixation.Methods We treated 15 cases of TPF with knee dislocation using the external fixator supplemented with limited internal fixation.Results The postoperative X-ray images revealed 11 cases of anatomic reduction and 4 cases of nearly anatomic reduction of the articular surface.The patients were followed up for 6 to 12(mean 10) months.There were no major complications such as postoperative infection and deep venous thrombosis,nor occurrence of re-dislocation after the lifting of the external fixator.Pain in the fracture site disappeared in about 10 days.Tenderness and pain at percussion of the vertical axis vanished after 3 weeks.X-ray examinations showed that the fractures were healed in all the cases after 3 months.Based on the joint activity Rasmussen assessment criteria,10 cases achieved excellent and the other 5 cases good results.Conclusion External fixation supplemented by limited internal fixation may acheive satisfactory results in the treatment of tibial plateau fracture with knee dislocation,which contributes to anatomic reduction of the articular surface,early motion of the knee joint,and decrease of complications associated with bones and soft tissues.