Objective:To investigate the clinical efficacy of skin flap combined with antibiotic bone cement beads in bone and soft tissue infectious wounds of hand.Methods:From February 2016 to November 2019, 16 cases of hand infectious wounds were repaired with dorsal fasciocutaneous flap of adjacent finger, lateral vascular chain flap of finger, radial artery snuff box perforator flap, local transfer flap, etc. combined with vancomycin antibiotic bone cement beads. Antibiotic beads were taken out in 16 cases 3 months after flap operation, of which 8 cases underwent bone graft and internal fixation.Results:All the cases were follow-up for 3 to 38 months with an average of 22 months. The flaps were well supplied and survived uneventfully. All the wounds achieved primary healing. X-ray films showed that all the 8 cases of bone defect achieved bony union, and the fracture healing time was 6 to 10 weeks. According to the evaluation standard of upper limb function issued by Hand Surgery Society of Chinese Medical Association, 7 cases were excellent and 9 cases were good.Conclusion:The application of skin flap combined with vancomycin antibiotic bone cement beads can effectively control infection and create a good condition for the second stage treatment of bone defects.

目的:探讨应用吻合血管的腓骨（皮）瓣移植修复上肢软组织及大段骨骼、肌腱等复合组织缺损的临床治疗效果。方法:自2015年4月至2019年6月,共收治上肢大段骨缺损患者7例,男5例,女2例；年龄14~52岁,平均31.5岁；均伴有不同程度的皮肤、血管、神经、肌腱等组织缺损。根据软组织缺损种类、部位和大小（长短）情况做好术前设计,修复骨、软组织缺损的同时,自小腿供区取材修复血管、神经、肌腱组织缺损。术后定期随访。结果:7例患者腓骨（皮）瓣均成活良好,经平均15（8~36）个月随访,患者肢体功能均有不同程度恢复,供区无任何并发症发生,治疗效果满意。按Enneking系统进行评分，平均为25.9分：优4例，良3例。结论:吻合血管的腓骨（皮）瓣游离移植特别适合上肢的大段骨（皮）缺损修复,并且可一个供区同时解决皮肤、血管、神经、肌腱等组织缺损问题,修复效果好。

Objective To investigate the therapeutic effect and feasibility of proximate clavicle fracture treated by anatomic locking plate.Methods Seven patients with of proximate clavicle fracture who were admitted in orthopedics department of Xinhua hospital(Chongming) affiliated to medical college of Shanghai Jiao Tong University from May 2012 to May 2016 were all treated by open reduction and internal fixation with locking plate,included 1 case with floating clavicle.The therapeutic effect was observed after surgey.Results Seven patients were followed up for 12 to 24 months (with average 15.6 months).All patients had normal shoulder joint range except 1 case with discomfort feel after hard work.Postoperative imaging showed that the clavicles had all achieved good reset,the fractures got good healing,the average healing time was 3.5 months.Curative effect according to Rockwood score,excellent in 4 cases,good in 3 cases,the excellent and good rate was 100％.Conclusion The anatomic locking plate is safe and reliable for proximate clavicle fracture,which can provide good reduction and fixation,early function exercise,meanwhile it should be make appropriate adjustment according to different situation of individual patients so as to achieve the best curative effect.

目的 探讨导丝技术在预防经内镜逆行性胰胆管造影术后高淀粉酶血症及胰腺炎的临床效果.方法 选取2014年5月至2016年5月在医院进行治疗的260例内镜逆行性胰胆管造影手术患者作为此次研究对象,并将其随机分为观察组与对照组,每组患者130例,对照组患者采用静脉滴注乌司他丁和内镜逆行性胰胆管造影术进行治疗,观察组患者采用导丝技术和内镜逆行性胰胆管造影术进行治疗,观察两组患者症状变化情况,分析比较两组患者手术时间、住院时间、治疗费用、腹痛评分、腹胀评分情况.结果 观察组患者手术时间、住院时间、治疗费用、腹痛评分、腹胀评分情况明显低于对照组,组间比较差异明显,具有统计学意义(P＜ 0.05).结论 导丝技术在预防经内镜逆行性胰胆管造影术后高淀粉酶血症及胰腺炎的临床效果显著,改善了临床症状和预后,缩短了治疗时间,降低了治疗费用,提高了治愈率,临床上值得推广应用.

目的:总结应用腓骨(皮)瓣修复前臂复合组织缺损的护理经验.方法:应用身心社灵护理模式,采取皮瓣分区SpO2监测观察法,使用统一的观察指标及术后护理记录单,积极做好疼痛护理管理,并进行视频、系统化的功能锻炼,延续家庭护理.结果:本组8例,皮瓣均成活良好,未出现并发症,平均随访13个月,骨瓣远近端全部愈合,按照Enneking系统评分,8例患者平均功能评分24分,恢复肢体功能的80％,供区无任何自觉症状及功能障碍.结论:设计精细的手术方式和精心的护理,可避免血管危象的发生,科学的康复期指导,有助患者肢体各种功能的康复.

坠积性肺炎是指因长时间的卧床使得呼吸道分泌物不易排出,而随重力流向肺底部并淤积于此,此病症的出现为细菌提供了良好的培养基,极易诱发肺部感染[1]. 老年髋部骨折患者是坠积性肺炎的高发人群,特别是年老体弱、有长期吸烟史、慢性支气管炎病史、肺功能不良者,发病率高,且危险性极大,可直接导致患者死亡[2] ,研究证实,患者积极主动配合肺部物理性护理干预,同时加强护理是降低坠积性肺炎发生的关键[3]. 本文对老年髋部骨折患者坠积性肺炎的预防及护理综述如下.

目的 观察局部植入脂肪干细胞对兔背部跨区供血轴型皮瓣Choke区血管新生效应的影响.方法 在无菌条件下分离、培养脂肪干细胞(ADSCs),并扩增至第3代,用免疫荧光对其鉴定.将24只新西兰大白兔随机分成实验组和对照组,每组12只 在两组大白兔背部皮肤设计长10cm,宽4cm,包含胸背动脉及肋下动脉两个穿支血管区的轴型皮瓣,制作皮瓣模型;实验组在Choke区注射重悬ADSCs 1 ml于皮瓣中央部(每相隔2cm注射1点,共5个点),对照组大白兔同法注射等容积的完全培养液,两组大白兔于术后14d切取中央皮瓣组织标本行HE染色、Masson染色、CD31免疫组织化学染色以及VEGF的Elisa检测 结果 实验组(5.68mm±0.17mm)皮瓣厚度明显厚于对照组(4.56mm±0.23mm) (P ＜0.05);Masson染色结果显示:实验组[(33.37±6.92)个/视野]真皮中纤维细胞密度较对照组[(21.29±4.06)个/视野]明显增高(P＜0.05);实验组移植ADSCs术后14d免疫组织化学结果显示:实验组[(12.90±1.53)个/视野]微血管密度＞对照组[(6.20±1.69)个/视野](P＜0.05).VEGF表达量(320.86ng/L±20.61 ng/L)明显高于对照组(224.96ng/L±25.08ng/L)(P＜0.05).结论 ADSCs能促进VEGF表达以及血管内皮细胞增生,从而促进皮瓣Choke区血管新生

目的 探讨应用改良双叶式腹壁下动脉穿支皮瓣移植修复巨积辉Ⅱ、Ⅴ型全手套状撕脱伤的方法和治疗效果.方法 2012年1月～2014年1月,对单侧手部大面积皮肤脱套伤10例患者,依据腹壁皮肤血供研究新进展,设计包含腹壁下动脉、腹壁上动脉、肋间后动脉的外侧支的轴型血管链式腹部双叶皮瓣,修复部分全手套状撕脱伤.结果 皮瓣主叶25cm×8cm ～35cm×11cm,副叶8cm×7cm,10例皮瓣完全成活,腹部创面直接拉拢缝合,胸、腹无严重并发症.术后随访6个月～2年,患肢拇指外形、功能满意.结论 该皮瓣供区设计合理,可切取面积大,利于手部活动度、力量及功能的早期恢复,是一种修复部分全手皮肤脱套伤的较好方法.

[目的]介绍超大面积胸脐皮瓣游离移植修复前臂和小腿皮肤软组织缺损的护理方法。[方法]选择2011年8月—2013年12月我科收治超大面积游离胸脐皮瓣修复前臂和小腿大面积软组织缺损病人37例，根据病人不同的病情，给予显微外科的护理观察及心理指导，实施住院全程健康指导。[结果]术后除1例超“长”皮瓣远端边缘部分坏死，余36例顺行及逆行供血皮瓣成活良好。皮瓣颜色正常，质地柔软，外观好。[结论]超大面积胸脐皮瓣修复四肢大面积软组织缺损后，全身情况和局部观察同样重要，综合护理干预很重要，术后的病房环境、心理指导、疼痛护理、皮瓣血运的观察及血管危象的及时处理是皮瓣成活的关键。

Objective To investigate the surgical method and clinical effect of repairing the complex soft tissue defects of the first carpometacarpal joint by transplanting the second metatarsophalangeal joint and the forearm perforator flap.Methods Patients suffering from joint destruction and severe complex soft tissue defects were treated with transplanting the second metatarsophalangeal joint composite flaps with tendon,nerve,and simultaneous transplanting distal radial forearm flap based on perforators around the radial styloid process and dorso-ulnar flap based on supracarpal perforator to repair the remaining defect.Results Composite flaps and transferred pedicle flaps in 6 cases all survived.After 1 to 4 years follow-up,function of carpometacarpal joint was nearly normal.X-ray showed quick healing osseous tissue after 9 to 13 weeks postoperatively.Flaps were soft,wearable and in normal shape.Sensory function in the transplant area reached S2 to S3.Conclusion Transplanting the second metatarsophalangeal joint and the forearm perforator flap for severe complex soft tissue defects could achieve a satisfactory effect.

目的 总结双足(足母)甲皮瓣组合移植再造拇指末节的护理经验. 方法 给予充分的术前供受区准备,积极有效的心理护理,及时发现和解除术后双足(足母)甲皮瓣血循环危象诱因,采取"支点 "观察法,使用统一的观察指标判定标准,积极做好"三抗"和疼痛护理,并有计划、有步骤地对再造拇指进行功能、感觉康复训练.结果 本组15例15指全部成活,术后随访3~6个月,再造拇指指腹饱满,指甲生长良好,两点分辨觉5~8 mm,外形逼真,功能满意,未出现并发症.结论 设计精细的手术方式和精心的护理,可避免血管危象的发生,科学的康复期指导,有助患者再造拇指各种功能康复.

[ ABSTRACT] Objective To explore the operative technique and clinical results of using sural neurofasciocuta-neous chain perforator flaps to repair skin and soft tissue defects in lower extremities .Methods Twenty-three patients with skin and soft tissue defects of leg and foot from 2006 to 2013 were repaired with sural neurofasciocutaneous chain perforator flaps.The preoperative location of perforator vessel was made by Duplex ,and the nearest perforator to wound was selected as the rotation point to design flaps .Results Twenty-three flaps survived completely .Patients were followed up for 6 months to 2 years,the appearance of flaps were satisfactory .Conclusion It is a suitable method to repair soft-tissue defects of lower leg ankle and foot with sural neurofasciocutaneous chain perforator flaps .

>外伤引起的四肢复杂性皮肤软组织缺损临床常见,刨面散在、不连续,多个创面的存在增加了修复难度。股前外侧皮瓣自1984年报道以来已成为整形、显微修复领域应用最为广泛的皮瓣之一,其解剖特点为旋股外侧动脉降支发出多条穿支动脉供养皮瓣区域 [1] 。笔者利用其特点,自2009年5月至2012年4月收治四肢复杂性皮肤软组织缺损患者15例,术前应用超声多普勒对旋股外侧血管皮穿支点探测定位,设计分叶式股前外侧皮瓣修复创面,取得良好的手术效果。现报告如下。

患者,女,33岁.右手拇 指指甲畸形并疼痛不适10年余,加重1年余入院.体检:右手拇指指甲桡侧凸起畸形,甲体不规则,欠光滑,甲下见粉红色椭圆形包块,大小约0.5 cm×0.3 cm,局部温度正常,触痛质软,边界不清,无波动感.X线提示:右手拇指末节指骨远端桡侧见圆形压迹.B超显示:右手拇指甲下可见一类圆形低回声肿物,大小约0.8 cm×0.6 cm×0.4 cm,边界清,回声尚可,邻近远节指骨受压,内可见丰富的血流信号,提示血管球瘤可能大.术中见拇指远端桡侧瘤样组织,约0.8 cm×0.5 cm×0.3 cm,呈紫色,包膜完整.

目的探讨采用Herbert螺钉内固定治疗尺骨冠状突骨折Ⅱ、Ⅲ型的疗效。方法采用切开复位Herbert加压螺钉内固定治疗11例尺骨冠状突骨折。结果本组获随访14~20个月,患者均达到骨性愈合。根据HSS肘关节功能评分:优4例,良5例,可2例。结论尺骨冠状突骨折采用Herbert螺钉固定牢靠,能够早期功能锻炼,效果良好。

Objective To introduce the surgical procedure of reconstructing the distal segment of the thumb using combined bilateral big toe wrap-around flap.Methods A partial fibular side wrap-around flap was harvested from both big toes.The flaps were tailored and designed based on measurements taken from the thumb of the intact side.These two flaps were combined like "mirror image" to reconstruct the distal segment of the thumb.Results This technique was used in 6 thumbs of 6 cases.All the transplants survived.The patients were follow-up for 3 to 9 months.All reconstructed thumbs had full pulp.Two-point discrimination was 5.0 to 8.0 mm.The appearance of the thumb looked real with normal growing nail.There was no impairment of joint movement and thumb function.Donor sites could be directly closed and healed uneventfully.No walking problems were encountered.Conclusion Reconstruction of the distal segment of the thumb using combined bilateral partial big toe wrap-around flap causes less trauma to the donor sites by preserving the shape and nail of the big toes.The appearance of the reconstructed thumb looks near normal.This surgical procedure is an ideal method for finger reconstruction.

2003年6月-2010年12月笔者应用足背皮瓣修复创面,皮瓣内动静脉桥接再植断指,Ⅰ期完成大面积皮肤软组织缺损及长段血管神经缺损的修复9例(12指),全部成活,再植后的手指外形及功能满意.现报告如下.1临床资料1.1一般资料本组男7例,女2例;年龄19 ～41岁,平均27岁.致伤原因:机器压榨伤6例,绞压伤3例,均为掌指关节及附近部位离断,伴手背皮肤软组织缺损.缺血时间1～8h,皮肤缺损面积6.0 cm×4.5 cm～11 cm×7 cm。

<正>儿童桡骨颈骨折是临床上一种常见的骨折,在所有儿童骨折中约占1%,在儿童肘关节骨折中占第3位。骨折按文献[2]分型分4型,Ⅰ型:桡骨头轻度倾斜;Ⅱ型:成角<30°;Ⅲ型:成角30～60°;Ⅳ型:a成角<80°,b成角80～90°。X线片所示患者桡骨头或骨骺呈"歪戴帽"状。Ⅲ、Ⅳ型桡骨颈骨折并发症发生率较高,包括:肘关节活动度丧失、桡骨头过度生长、骺板早闭、肘外翻、缺血性坏死及尺桡骨骨性连接。传统

<正>近年来,我院采用经十二指肠镜结合X线监视下行支架置入术治疗胃出口恶性梗阻9例,并取得满意近期疗效,现总结报告如下。1资料与方法1.1临床资料2011年10月至2012年7月中国人民解放

<正>桡骨远端骨折是全身最常见的骨折之一,其发生率约占急诊骨折患者的17%。桡骨远端骨折后经常发生移位、畸形愈合,对腕关节功能产生影响,并出现疼痛、旋转受限、握力减低等并发症,影响生活质量。目前,国内外锁定加压钢板广泛运用于桡骨远端关节内与不稳定性骨折治疗,并取得满意的疗效。笔者所在科自2008年运用锁定加压钢板治疗桡骨