Objective To explore the clinical effects of the treatment of humeral middle fractures by using minimally-invasive plating osteosynthesis(MIPO) techniques via the anterior humeral approach.Methods The 22 patients with humeral middle fractures were treated with MIPO via the modified anterior humeral approach.Postoperation,shoulder and elbow range of motion,Constant-Murley and Mayo scores were evaluated.Results All patients were followed-up from 10~24 months.Range of motion parameters were as final follows:active shoulder abduction range was 80°~120° and forward flexion range 120°~170°,shoulder external rotation range 10°~50° and shoulder internal rotation to range T8~L3.Elbow motion was flexion range 100°~135°,extension range 0°~20°.At the last follow-up,the Constant-Murley score was 78~96 points and the Mayo score was 74~100 points.Conclusions Sub-muscular anterior plating of the humerus by using locking screw technique is a viable and useful method for diaphyseal humeral middle fractures.

目的 观察Multiloc髓内针治疗老年肱骨近端骨折的临床疗效.方法 随机选择自2013年1月至2015年1月肱骨近端新鲜骨折的老年患者,采用Multiloc髓内针治疗12例纳入髓内钉组,采用Philos锁定钢板治疗的老年患者15例纳入钢板组(对照组),观察比较两组术中出血量、手术时间、骨折愈合情况、Constant-Murley肩关节功能评分及并发症发生情况.结果 所有患者均获得随访,时间为10~31个月,平均(25.6±6.2)个月.两组患者在术中出血量、手术时间方面差异有统计学意义.Multiloc髓内针组患者术中出血量少、手术时间短,两组差异有统计学意义(P<0.01).锁定钢板组患者并发症发生率低,但两组差异无统计学意义(P>0.05).术后3个月、6个月锁定钢板组患者的Constant-Murley肩关节功能评分高于Multiloc髓内针组,但差异无统计学意义(P>0.05).术后12个月两组的Constant-Murley肩关节功能评分接近,差异无统计学意义(P>0.05).结论 Multiloc髓内针治疗老年肱骨近端骨折有其优势,如果适应证选择合适,可取得良好的治疗效果.

目的 设计一种新型经椎弓根螺钉动力内固定系统,并测试其对失稳腰椎的稳定性效果及对相邻节段的作用.方法 1采用6具人新鲜尸体腰椎标本,测试各个节段的活动度,为新型动力内固定系统的设计提供参数支持.2以钛合金棒、钛缆和钛合金碟片弹簧为主要结构,根据正常腰椎各节段的活动度,参照文献报道的相关测试结果,设定动态连接棒屈曲范围0～10°,旋转范围0～5°,并对其进行了相关力学测试.3制作腰椎失稳模型,测试新型动力内固定系统固定后失稳腰椎固定节段及相邻节段的运动范围(ROM)和中性区(NZ),并与坚强固定对比,同时测定其上邻节段软骨终板下压力,探讨其稳定性及对相邻节段的作用.结果 与完整脊柱相比,新型动力内固定系统固定后屈伸和侧屈方向的ROM和NZ较完整脊柱减小(P＜0.05),但旋转方向的ROM和NZ与完整脊柱无显著性差异(P＞0.05).与坚强固定组相比,新型动力内固定组三个主方向的ROM和NZ均显著增加,差异有显著性意义(P＜0.01).疲劳试验后的结果表明,固定节段在三个主方向上的ROM和NZ均较疲劳前显著增加(P＜0.05),但与失稳脊柱相比,差异仍具有显著性意义,与完整脊柱相比,动力内固定屈伸方向的ROM和NZ仍较小,两组相比差异显著(P ＜0.05),侧屈与旋转方向的ROM和NZ与完整脊柱无显著性差异(P＞0.05).结论 新型动力内固定系统可控性强、可靠性好、能够提供足够的活动度.新型动力内固定系统能对失稳腰椎提供各方向上的稳定性,尤其对前屈后伸的稳定效果最好,疲劳试验后也能提供足够的稳定性.相邻节段的ROM和上邻节段终板下压力与固定方式无显著相关.

Objective To investigate the clinical effect of double-plating fixation in treatment of distal humerus fractures via an extensor mechanism-on approach. Methods From October 2008 to October 2010,16 patients with distal humerus frac-ture were treated with double-plating fixation via an extensor mechanism-on approach. There were 12 males and 4 females,aged from 17 to 61 years(36 years on average). The dominant extremity was involved in 11 patients. The mechanism of injury in-cluded 5 ground-level falls,9 falls from a height,and 2 motor-vehicle accidents. The fractures were classified according to the AO/ ASIF classification. 2 patients had a type-A fracture,14 had a type-C fracture. Of the type-C fractures,8 were C1,6 were C2. The time interval from the injury to surgery was two days to eight days. All patients were no preoperative ulnar nerve symp-toms. Results The 16 patients were followed-up from 12 to 24 months,with an average of 15 months. All 16 fractures healed primarily without infection. The average final flexionarc was 125°and the average flexion contracture of 23°and the average pro-nation-supination arc was 153°. The mean MEPI was 90 points(65 to 100 points),with six excellent,eight good,and two fair grades. The excellent and good rate was 87. 5% . Two patients had ulnar nerve dysfunction postoperatively. All elbows were sta-ble at the time of final follow-up. Conclusion Satisfactory functional outcomes can be acquired with the use of the extensor mechanism-on approach for AO-type-C1 and C2 fractures of distal humerus.

Objective To investigate the effectiveness of the terminal extensor tendon reconstrution by palmaris longus tendon graft for the treatment of old mallet finger deformity.Methods Between February 2009 and February 2011,32 patients with old mallet finger deformity were treated with palmaris longus tendon graft.There were 28 males and 4 females with an average age of 32.5 years(range,22-58 years).The injury causes included sports injury in 26 cases and punctured injury in 6 cases.The index finger was involved in 8 cases,the middle finger in 3 cases,the ring finger in 16 cases,and the little finger in 5 cases.According to the Rockwell's classification,all patients were classified as type I.The time from injury to operation was 4-16 weeks(mean,6 weeks).Results Primary healing was obtained in all incisions;no necrosis,infection,or nail bed injury occurred.All patients were followed up 12-20 months(mean,14 months).The patients had no pain or paresthesia of volar finger.According to Patel's functional assessment system,the results were excellent in 8 cases,good in 21 cases,fair in 2 cases,and poor in 1 case at last follow-up,with an excellent and good rate of 90.6%.Conclusion Reconstruction of the terminal extensor tendon by palmaris longus tendon graft is a reliable method to treat old mallet finger deformity.

Objective To investigate the effect of surgical treatment of chronic retrocalcaneal bursitis.Methods In this retrospective study,from February 2008 to February 2011,8 patients(9 heels) with retrocalcaneal bursitis were treated surgically.There were 3 male(3 heels) and 5 female(6 heels) with mean age of 50.4years(from 32years to 61 years).The surgical treatment of chronic retrocalcaneal bursitis by means of complete detachment and reattachment of the Achilles tendon,removal of the retrocalcaneal exostosis,and excision of the retrocalcaneal bursa through a lateral approach.Postoperative use of a non-weight-bearig below-the-kneel cast for up 6～8 weeks with foot positioned at a plantarflexion.Patients were identified via chart review.Results The mean duration of postoperative follow-up was 12 months(10 months to 21 months).There were no wound complications or postoperative infections.The average time to return to normal daily function was 4 months.The American Orthopaedic Foot and Ankle Society score(AOFAS) were 54befor operation and 92 after operation.Conclusion Complete detachment and reattachment of the Achilles tendon,removal of the retrocalcaneal exostosis,and excision of the retrocalcaneal bursa are effective treatment for the retrocalcaneal bursitis.

[Objective]To investigate the timing of closure for Gustilo type Ⅲ open tibial fractures.[Method]The clinical data of 31 cases were reviewed.The follow-up was 12 to 34 months(averaging 14.5 months).[Result]Eleven injuries were closed primarily,one(9.09%) resulted in superficial infection.The other twenty cases were left open for an average of four to six days before closure of the wound,resulting in two(10%) infections.There was no statistically significant difference in infection rates between patients who were treated with primary closure at initial debridement and patients treated with delayed closure.[Conclusion] Primary closures provide a lower number of operations,and decrease health care costs and hospital stays with no increase in infection.Primary closure in open fractures is appropriate in properly selected patients.Delayed closures with the negative pressure wound therapy over fractures have less complex plastic surgery procedures such as free flaps,and an increase in simpler procedures such as split skin grafts.Primary closure is acceptable based on the surgeon's discretion regarding the adequacy of debridement and low contamination of the wound.

Objective To explore the methods of replanting auricles after complete separation.Methods The clinical data of hospitalized patients since 1900 were reviewed.The methods include replantation through microsurgery,temporary ectopic implantation,and flap transfers,et al.Results The follow-up was 12 to 32 months.Satisfactory healing was found in 6 cases in the group of replantation through microsurgery.Inactivation happened in two cases after in situ replantation and temporary ectopic implantation respectively and successful survived after flap reconstruction.All patients were removed the stitches after 7～10d,operative incisions were primary healing.The replanted shapes recovered satisfactorily with normal hearing.Conclusion Replantation through microsurgery deserves to be widely used to treat auricles after complete separation.

OBJECTIVE:To investigate the method and clinical outcome of reconstructing large pulp defects of the fingertips with a homodigital neurovascular island flap.METHODS:Form June 2007 to October 2009, 16 patients with the defects of pulp were repaired by the spiral flap that was a homodigital neurovascular island flap with a unique spiral advancement and transposition design allowed pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. There were 12 males and 4 females with an average age of 37 years ranging from 18 to 49 years. The defect were caused by machine crush injury 11 cases, pressure injury by heavy objects in 2 cases, crush injury by door of car 1 case, injury by saw in 2 cases. The defect was located in the index finger in 5 cases, the middle finger in 9 cases,the ring finger in 2 cases. All injuries had large pulp defects averaging 1.6 cm (long) x 1.2 cm (wide) to 2.5 cm (long) x 1.7 cm (wide). Short-term results for all patients were reviewed. Outcome measures included static 2-point discrimination, total active motion, and hypersensitivity or cold intolerance.RESULTS:All flaps achieved primary healing with no complications. Sensory recovery was excellent with an average 2-point discrimination of 5.1 mm. All patients were followed-up for 8 to 20 months (averaged 12 months) with highly satisfactory with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance. According to the evaluation of total active motion (TAM) scales, the results were excellent in 7 cases, good in 8 cases (9 lesions) and fair in 1 case.CONCLUSION:The spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term functional and aesthetic results and high patient satisfaction.

变形综合征(Proteus综合征)是一种散发且表现复杂的罕见疾病,病因不明,特征为多种组织非对称性、不规则地过度生长,脑回状结缔组织痣,脂肪组织异常.我科于2008年10月收治1例,其形态畸形较少见,现报道如下.

目的探讨移位掌骨骨折的手术治疗效果。方法 2007-05-2008-11对采用手术治疗移位掌骨骨折并获得随访68例(76处)患者资料进行分析总结。结果随访6~12个月,骨性愈合时间为8~12周。按照手指总主动活动度(TAM)的评级标准并参考手指总主动屈曲度(TAF)的评级标准进行评定,优54例(58处),良8例(9处),中4例(6处),差2例(3处)。优良率为91.2%。结论切开复位AO微型钢板或单纯微型螺钉内固定是治疗移位掌骨骨折的一种有效方法 ,早期功能锻炼对功能恢复至关重要。

OBJECTIVE:To review the progress in the treatment of chronic Achilles tendon rupture.METHODS:Recent literature on the treatment of chronic Achilles tendon rupture was reviewed.RESULTS:The choice of operative method for the repair of chronic Achilles tendon rupture depended primarily on the length of tendon defect, the atrophic condition of triceps surae muscle, and the age and the sportive level of patient.CONCLUSION:Most chronic Achilles tendon ruptures should be treated operatively to reach good functional recovery, and tissue engineering provides a promising future for tendon defect repair.

钝性暴力所致肢体动脉闭合性损伤,因肢体远端常有侧支循环的存在,缺血症状不典型,容易漏诊从而延误治疗.自1995年3月至2009年3月我们在临床上收治肢体大动脉闭合性损伤45例,报道如下。

目的总结应用以指背动脉为蒂带神经的邻指近节指背逆行岛状皮瓣修复指腹缺损的方法及疗效。方法2005年7月-2007年1月,应用带神经的邻指近节指背逆行岛状皮瓣修复12例12指指腹缺损。男10例,女2例;年龄19～52岁,平均34岁。机器挤伤6例,电锯伤4例,绞伤2例。损伤指别:示指7指,中指2指,环指3指。缺损范围1.6cm×1.0cm～3.0cm×2.0cm。受伤至入院时间为2～9h。术中切取皮瓣范围2.0cm×1.2cm～3.5cm×2.3cm。供区游离植皮修复。结果4例术后1～2d出现皮瓣肿胀并伴张力性水疱,经对症治疗后5～7d肿胀消退;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区植皮全部成活,指蹼处遗留瘢痕。患者均获随访,随访时间8～20个月,平均13个月。手指外形良好,皮瓣质地软,无触痛,能耐受寒冷刺激。静止两点辨别觉为4～7mm,平均5.2mm。供指无明显畸形,指间关节活动正常。结论带感觉神经的邻指近节指背逆行岛状皮瓣修复指腹缺损不损伤手指重要血管及神经,切取皮瓣适中,手术操作简便,术后无指间关节僵硬,重建指腹感觉恢复满意。

Objective The aim of the present study is to discuss the replantation and repairing methods for the complex amputated injuries of the extremities and the specified tissues/organs.Methods A total of 196 cases were retrospectively analyzed,including 72 cases on the replantation and repair for the amputated extremities with tissue defects,19 cases(40 extremities)on the replantation for the multiple amputated extremities,26 cases(63 segments)on the replantation for multiple fingers and multiple segments amuputation,4 on the amputated injury of bilateral hands,59 on the replantation for the amputated injuries of composite tissues,5 on the amputated extremities in elderly more than 70 years old and 11 cases on the special amputated injury of organs.These injuries were repaired with microsurgery techniques,such as orthotopic and cross replantation,tissue transplantation and so on.Results The minimum followup was 3 months and maximum is 10 years in 162 patients.The outcome of functional recovery for the upper extremity as follows:excellent:27 cases,good:35 cases,poor:12cases,fine rate:83.8%;for the lower extremity:excellent:33 cases,good:34 cases,poor:11 cases,fine rate:85.9%.There were success in 5 cases for external ear replantation,2 for earflap reconstruction with flap,and 2 for replantation of penis and testicle,while failure in 1 case for external ear temporary ectopic implantation,1 for tongue replantation and 1 for replantation of amputated nose.Conclusions For the amputated injuries of those special tissues and organs,the shape and function of amputated tissues and organs can be well reestablished by microsurgery replantation,orthotopic and cross replantation,temporary ectopic implantation,reconstruction by flap transfer,tissue transplantation.

甲状腺功能减退(甲减)，临床上发病率有逐年增加趋势。