Objective To investigate the application efficacy of preoperative super-selective arterial embolization for sacral tumor treatment.Methods From July 2010 to January 2022, a total of 86 patients with sacral tumors were surgically treated in Henan Provincial People’s Hospital, all of whom were newly diagnosed patients, including 47 males and 39 females. The patients were divided into two groups according to whether preoperative super-selective arterial embolization was given. The conventional group（46 cases） did not receive any hemostatic measures before surgeries. The preoperative super-selective arterial embolization group（40 cases） received preoperative super-selective arterial embolization one day before surgeries. The operative time, intraoperative bleeding, volume of blood transfusion, postoperative hospital stay, the incidence and recurrence rate of postoperative deep vein thrombosis, and the incidence of incision-related complications were compared between the two groups. And the clinical effect of preoperative super-selective arterial embolization for sacral tumor were evaluated between the two groups.Results Compared with the conventional group, the preoperative super-selective arterial embolization group had shorter operative time, less blood loss, less blood transfusion and shorter postoperative hospital stay（P＜0.05）. The incidence of postoperative deep vein thrombosis and the recurrence rate at the time of 6 and 12 months after the operations were not statistically significant between the two groups（P＞0.05）. Moreover, the incidence of postoperative incision-related complications in the preoperative super-selective arterial embolization group was lower than that in the conventional group（P＜0.05）.Conclusion The preoperative super-selective arterial embolization technique is simple, feasible, safe, reliable and effective in the treatment of sacral tumors, with the advantages of reduced the operation time, less intraoperative blood loss and transfusion, and lower incidence of complications.

目的 观察急性心肌梗死合并心力衰竭患者主动脉球囊反搏(intra-aortic balloon pump,IABP)治疗前、后左心室收缩功能变化,探讨二维斑点追踪技术评价IABP治疗效果的应用价值.方法 33例急性心肌梗死合并心力衰竭患者均采用IABP治疗.应用二维斑点追踪技术检测治疗前、后左心室整体收缩期纵向峰值应变(global longitudinal peak strain,GLS),包括四腔观GLS、三腔观GLS、两腔观GLS、平均GLS和左心室峰值纵向应变离散度;比较治疗前、后左心室舒张末期容积、左心室收缩末期容积、左心室搏出量、左室射血分数.结果 IABP治疗后,33例患者左室射血分数[(43.27±10.71)％]、四腔观GLS[(9.53±3.87)％]、三腔观GLS[(9.41±4.30)％]、两腔观GLS[(9.60±3.32)％]、平均GLS[(9.00±3.60)％]均高于治疗前[(37.03±12.95)％、(7.28±3.21)％、(6.81±2.99)％、(7.35±3.15)％、(7.15±2.77)％](P<0.05),左心室峰值纵向应变离散度[(58.12±19.89)s]低于治疗前[(75.27±26.85)s](P<0.05),左心室舒张末期容积[(114.03±30.61)mL]、左心室搏出量[(48.48±16.33)mL]和左心室收缩末期容积[(65.42±25.15)mL]与治疗前[(113.76±31.77)、(40.94±17.68)、(72.88±29.67)mL]比较差异均无统计学意义(P>0.05).结论 IABP可改善急性心肌梗死合并心力衰竭患者左心室收缩功能.左心室整体收缩期GLS及峰值应变离散度可为临床评价IABP治疗效果提供客观依据.

Objective:To explore surgical techniques and summarize surgical experience of the paraumbilical flap pedicled with deep inferior epigastric vessels for the repiration of soft tissue defects in pelvic area.Methods:Between August, 2006 and August, 2018, 8 patients with soft tissue defects and bone exposure were treated with paraumbilical flap pedicled with deep inferior epigastric vessels. There were 6 males and 2 females with the average age of 35.3 (range, 12-47) years. The defects were caused by car accident in 5 cases, by high falling injury in 1 case, by soft tissue necrosis after malignant schwannoma resection in 1 case, and by soft tissue necrosis after pelvic operation of open reduction internal fixation in 1 case. The defects located at iliac spine in 5 cases, at tuber ischii in 1 case, and at buttock and perineal region in 1 case. The size of the wounds ranged from 11.0 cm×6.0 cm to 22.0 cm×8.0 cm. The size of the flaps ranged from 13.0 cm×7.0 cm to 29.0 cm×12.0 cm. The followed-up was made by outpatinet service, telephone or WeChat.Results:All flaps survived, and the wound infection was controlled. The followed-up time ranged from 12 to 46 (mean 26) months. All flaps survived uneventfully, and the texture and elasticity of the flaps were good. There were no recurrence of infection, and no ventral hernias occurred in donor sites.Conclusion:The transfer of paraumbilical flap pedicled with deep inferior epigastric vessels is a reliable method to repair large soft tissue defects in iliac spine, perineal region, buttock and tuber ischii.

目的 研究老年开放性胫腓骨骨折术后医院感染的病原学特点及免疫细胞亚群对骨折术预后的影响.方法 分析2016年3月-2017年9月来医院治疗的154例老年开放性胫腓骨骨折患者医院感染情况以及病原菌的分布,并对出现频率较高的病原菌做耐药性分析.分析患者免疫细胞亚群分布,探究免疫细胞亚群对骨折术预后的影响.结果 154例患者中52例患者出现医院感染,主要以革兰阴性菌为主.革兰阳性菌主要是金黄色葡萄球菌,并且有一例患者发现有真菌感染.耐药性研究除利奈唑胺,其余研究药物均有不同程度的耐药;免疫细胞亚型CD3升高,CD4升高以及NK细胞升高对开放性胫腓骨骨折病人预后有积极作用,而CD8降低则是骨折术后预后情况的影响因素.结论 老年开放性胫腓骨骨折患者院内感染多为革兰阴性菌,在院内感染防控以及临床治疗中应着重注意革兰阴性菌的防治.免疫细胞亚群CD3,CD4升高以及NK细胞升高对骨折预后有积极意义,在骨折治疗和护理中应注意监测老年患者各免疫细胞亚群的水平,及时调整治疗护理策略.

目的 探讨以腓动脉穿支筋膜蒂腓肠神经营养血管皮瓣修复足踝部肿瘤切除后皮肤软组织缺损的效果.方法 选取2008年7月至2016年10月河南省人民医院收治的足踝部肿瘤切除后皮肤软组织缺损的患者共17例,肿瘤类型包括黑色素瘤11例、皮肤鳞癌5例、腱鞘巨细胞瘤1例,创面位于小腿下1／3段2例、踝关节周围4例、足跟部9例、足背部2例.均以腓动脉穿支筋膜蒂腓肠神经营养血管皮瓣修复创面,术后随访,观察皮瓣存活情况.结果 术后皮瓣完全成活16例,创面均I期愈合.术后皮瓣远端表浅坏死1例,经换药后愈合.术后随访时间16～33个月,平均24个月,皮瓣外观较满意,质地优良,随访期间肿瘤无复发.11例黑色素瘤患者中3例出现腹股沟淋巴结转移,其中1例死于肺转移,余16例患者足踝部功能恢复良好,下肢负重、行走正常.结论 采用腓动脉穿支筋膜蒂腓肠神经营养血管皮瓣修复小腿下1／3处、踝关节周围、足跟、足背处肿瘤切除后创面效果较好.

Objective To explore the influence of the fasciocutaneous pedicle on the survival of the reverse island flaps and the role of the fasciocutaneous pedicle in the venous return of the flap.Methods According to the different pedicles,12 New Zealand rabbits were divided into four groups:group A (retrograde island flap without fasciocutaneous pedicle);group B (retrograde island flap with 0.5-cm-wide fasciocutaneous pedicle);group C (retrograde island flap with 1.5-cm-wide fasciocutaneous pedicle);group D (retrograde island flap with 1.5-cm-wide fasciocutaneous pedicle but without saphenous vein).All the flaps were designed with the dimension of 7.0 cm × 3.0 cm,the pedicle length of 3.0 cm,and the pivot point locating at 2.0 cm above the medial malleolus.On the postoperative day 7 to 10 day,the survival rate of all the flaps was recorded.All the data were analyzed by SPSS 17.0.The venous drainage of various flaps was observed and recorded when the flaps were injected with methylene blue.Results Twenty-four retrograde island flaps with various pedicles were divided into four groups (6 flaps in each group).In group A,3 flaps survived uneventfully and the rest 3 flaps developed partial necrosis,and the average survival rate was 85.57％.In group B,4 flaps survived uneventfully and the rest 2 flaps developed partial necrosis,and the average survival rate was 88.10％.In group C,all the flaps survived uneventfully and no flap developed partial necrosis.In group D,4 flaps survived uneventfully,one flap developed partial necrosis,complete necrosis occurred in one flap,and the average survival rate was 73.83％.Comparison between every two groups was performed using Mann-Whitney U test,and there was no significant difference in the survival rate.Among groups A,B and C,the survival rate increased along with the increased width of the fasciocutaneous pedicle.Through the injection of methylene blue,"puzzle" anastomosis and anastomosis between perforator veins could be observed on the fasciocutaneous pedicle.Conclusion In the rabbit model,the fasciocutaneous tissue along with the main vessel can improve the reliability of the retrograde island flap.The fasciocutaneous pedicle could play partial role in drainage of the veneous blood in the flap,by means of anastomosis between perforator veins.

目的 总结胫后动脉穿支加强的隐神经营养血管皮瓣修复小腿下端及足踝部皮肤软组织缺损的临床经验. 方法 2002年8月～2014年5月应用胫后动脉穿支加强的隐神经营养血管皮瓣修复小腿下端及足踝部皮肤软组织缺损41例.男31例,女10例;平均年龄29(4 ～62)岁.车祸伤33例,机器压伤5例,慢性溃疡3例.创面均伴骨和(/或)肌腱外露.创面范围为(4.0 cm ×4.0 cm) ～(15.0 cm ×7.0 cm). 结果 皮瓣全部成活36例,创面均为Ⅰ期愈合.皮瓣远侧端部分表皮及表浅坏死5例,经换药或植皮后愈合.术后平均随访18.3(6 ～36)个月.皮瓣无明显臃肿,质软,色泽良好;3例皮瓣受区为负重区,将隐神经与受区周围皮神经缝合行感觉功能重建,随访期内均恢复保护性感觉.患者步态均正常. 结论 胫后动脉穿支加强的隐神经营养血管皮瓣适于修复小腿中下段内侧、内踝、跟后区、足跟底、足背内侧中小创面,穿支筋膜蒂形式切取皮瓣,皮瓣血运更理想,成活更可靠.

目的 总结改良骨间背侧动脉逆行岛状皮瓣修复恶性肿瘤切除后皮肤软组织缺损的临床经验.方法 2004年8月-2013年12月,应用改良骨间背侧动脉逆行岛状皮瓣修复前臂远端掌侧、掌背、虎口区恶性肿瘤切除后皮肤软组织缺损11例.结果 本组11例,术后皮瓣均完全成活,创面Ⅰ期愈合.结论 改良骨间背侧动脉逆行岛状皮瓣适于修复前臂远端掌侧、掌背、虎口区恶性肿瘤切除后皮肤软组织缺损,以较宽皮肤筋膜蒂形式切取皮瓣,皮瓣血运更理想,成活更可靠.

探讨细胞因子-骨桥蛋白(OPN)在骨关节炎(osteoarthritis,OA)患者中的表达情况及意义.选取接受膝关节置换手术治疗的骨性关节炎患者软骨标本42例,按Mankin评分分为轻度退变、中度退变、重度退变3组,取正常膝关节软骨10例作为对照组;对标本进行免疫组织化学染色,测定OPN表达情况. OA组OPN吸光度明显高于正常组,差异有统计学意义(P＜0.05);OPN在轻、中、重度退变组的表达差异有统计学意义(P＜0.05);OPN平均灰度值与Mankin病理评分呈显著负相关(r=-0.872,P＜0.01). OPN在骨关节炎软骨中高表达,且与病变程度相关,与骨关节炎发生发展也有密切关系.

目的 探讨腓动脉穿支筋膜蒂腓肠筋膜皮瓣联合腓骨短肌腱转位同期修复跟腱并皮肤缺损的疗效. 方法 回顾性分析2004年12月至2010年9月行腓动脉穿支筋膜蒂腓肠筋膜皮瓣联合腓骨短肌腱转位同期修复14例跟腱并皮肤缺损患者的患者资料,男10例,女4例;年龄5～ 59岁,平均15.0岁;跟腱缺损长2～～5 cm,平均3.6 cm.13例患者跟腱止点附近缺损,1例患者跟腱中段缺损.跟腱区皮肤缺损大小为5 cm×3 cm～10 cm×9 cm,皮瓣大小为8cm×6cm～12cm×11cm. 结果 13例皮瓣完全成活;1例皮瓣边缘坏死,二期缝合后伤口均愈合.14例患者术后获3～72个月(平均13.0个月)随访,无跟腱再断裂及感染复发者.12例患者踝关节活动范围正常,1例踝关节跖屈减少10°,另1例背伸减少10°.根据Boyden等的标准评定疗效:优13例,良1例. 结论 腓动脉穿支筋膜蒂腓肠筋膜皮瓣联合腓骨短肌腱转位同期修复跟腱缺损并皮肤缺损,具有手术一次完成、操作简便、安全可靠,患肢功能恢复好且快等优点。

Objective To summarize the exeperiences of diagnosis and surgical treatment of ossification of ligamentum flavum(OLF) in thoracic spine.Methods Totally 32 patients with the ossification of ligamentum flavum(OLF) in thoracic spine from July 2001 to July 2010 were retrospectively analyzed,24 patients were treated by en bloc laminectomy and 8 patients by traditional laminectomy(using rongeur).The Japanese orthopaedics Association(JOA) standard was used to evaluate for all the 27 patients which were followed-up.Results Totally 27 patients were followed-up in 1 to 10 years after operation,9 patients had excellent outcome,11 patients good,5 patients improved and 2 patients unchanged.The excellent and good rate was 74.1%(20/27) and the total effective rate was 92.6%(25/27).Conclusions It is a key to master clinical symptoms of rnyelopathy in thoracic spine for the diagnosis of the ossification of ligamenturn flavum and surgical decompression was a good procedure for the ossification of ligamentum flavum in thoracic spine.

桥式组织移植挽救了许多濒临截肢的肢体,文献报道较多[1-2].双下肢间桥式交叉吻合血管的腹壁下深血管皮瓣的经验值得总结.2000年8月至2009年2月,我们应用双下肢间桥式交叉吻合血管的腹壁下深血管皮瓣8例.资料与方法一、一般资料本组8例,男6例,女2例,年龄5 ～ 37岁.其中车祸6例,车祸后瘢痕形成2例.所有患者均有软组织缺损伴肌腱、骨或关节外露.手术距受伤时间22 d至18个月。

Objective To summarize the clinical experience of repairing soft tissue defect in dorsal pedis with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flap,and to explore surgery matters needing attention and measures to prevent flap necrosis.Methods Between August 2000 and April 2009,31 patients with soft tissue defects in dorsal pedis were treated with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flaps.There were 23 males and 8 females with a median age of 34 years(range,3-65 years).Defects were caused by traffic accident in 20 cases,by machine in 2 cases,and by crush in 2 cases.The time from injury to admission was 1-32 days(mean,15 days).And 6 cases had chronic ulcer or unstable scar excision with disease duration of 6 months to 10 years,and 1 case had squamous carcinoma with disease duration of 5 months.The wounds were located in medial dorsal pedis in 12 cases and lateral dorsal pedis in 19 cases;including 14 wounds near the middle metatarsal and 17 wounds beyond the middle metatarsal(up to the metatarsophalangeal joint in 10 cases).All cases accompanied with bone or tendon exposure.Five cases accompanied with long extensor muscle digits tendon rupture and defect,1 case accompanied with talus fracture,1 case accompanied with talus fracture and third metatarsal fracture.The size of the wounds ranged from 6.0 cm × 4.5 cm to 17.0 cm × 10.0 cm.The size of the flaps ranged from 8.0 cm × 5.5 cm to 20.0 cm × 12.0 cm.The donor sites were resurfaced by skin graft.Results Seventeen flaps survived uneventfully,wounds healed by first intention.Distal epidermal or superficial necrosis occurred in 6 flaps at 5-12 days after operation,wounds healed by dressing change or skin graft.Distal partial necrosis occurred in 8 flaps(7 in medial dorsal pedis and 1 in lateral dorsal pedis) at 7-14 days after operation,wounds healed by skin graft in 3 cases,by secondary suture in 3 cases,by local flap rotation in 1 case,and by cross leg flap in 1 case.All skin grafts at donor sites survived uneventfully,wounds healed by first intention.Twenty-nine patients were followed up 6-29 months(mean,19 months).The appearance was slightly overstaffed,but wearing shoe function and gait were normal.The texture and color of the flaps in all cases were good.There was no pigmentation and suppuration relapse.There was neither ankle plantar flexion deformity nor hammer toe deformity in 5 cases accompanied with long extensor muscle digits tendon rupture and defect.All fractures healed at 3 months after operation in 2 cases.Conclusion The reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flaps are suitable to repair most soft tissue defects in lateral dorsal pedis.When the flaps are used to repair soft tissue defects in medial dorsal pedis,avoiding tension in flaps and fascia pedicles should be noted so as to improve flap survival.

目的 总结带血管蒂腹壁下深血管皮瓣移位修复大面积软组织缺损的手术方法及临床效果.方法 2000年8月-2008年3月,收治大面积软组织缺损5例.男3例,女2例;年龄12～44岁.致伤原因:车祸伤4例,肿瘤切除术后1例.缺损位于髂前上嵴周围3例,臀部及会阴部1例、坐骨结节1例.软组织缺损范围11 cm×6 cm～22 cm×8 cm.均为感染创面.病程14～36 d.术中采用13 cm×7 cm～25 cm×9 cm带血管蒂腹壁下深血管皮瓣移位修复缺损.供区直接缝合.结果 5例皮瓣均顺利成活,供、受区切口均Ⅰ期愈合.患者均获随访,随访时间3～24个月.皮瓣质地、色泽、弹性均较好.供区无腹壁疝形成,受区感染无复发.结论 带血管蒂腹壁下深血管皮瓣移位是修复髂前上嵴周围、臀部、会阴部及坐骨结节处大面积软组织缺损的有效方法之一.

[目的] 探讨远端蒂腓肠神经营养血管皮瓣修复足跟区的特点.[方法] 2002年6月～2008年7月行远端蒂腓肠神经营养血管皮瓣修复足跟区皮肤软组织缺损58例,其中创面合并有足跟部空洞形成者10例,创面位于跟底行皮神经吻合13例,皮瓣面积8 cm×4 cm～20 cm×15 cm,皮瓣的切取采用先显露穿支血管后游离皮瓣的方法.[结果] 本组58例皮瓣中,46例完全存活,12例远端浅表或部分坏死,经换药、Ⅱ期缝合或植皮后创面愈合.经术后1～34个月随访,皮瓣均外观较满意,感染控制且无复发,无慢性溃疡及压疮形成,行走功能好.[结论] 远端蒂腓肠神经营养血管皮瓣修复足跟区创面具有血运丰富,成活面积大,手术简单,成功率高,可重建保护性感觉的优点,大部分足跟区皮肤软组织缺损可用该皮瓣修复.

本文探讨了儿童腓肠神经筋膜皮瓣临床应用的特点及影响皮瓣成活的因素.