[目的]探讨空心钉复合内侧支撑钢板固定Pauwels Ⅲ型股骨颈骨折的临床疗效.[方法]回顾分析2015年1月—2021年6月收治的72例Pauwels Ⅲ型股骨颈骨折患者的临床资料.依据术前医患沟通结果,33例采用3枚空心钉复合内侧支撑钢板固定(复合组),39例采用单纯3枚空心钉固定(空心钉组).比较两组围手术期、随访以及影像资料.[结果]两组患者均顺利完成手术,术中无严重并发症.复合组的手术时间、术中出血量显著大于空心钉组(P＜0.05),但是两组间切口总长度、术中透视次数、导针定位次数、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义(P＞0.05).所有患者均获随访12～24个月,复合组恢复完全负重活动显著早于空心钉(P＜0.05).复合组33例中,均未发生骨不连接、股骨头坏死;空心钉组39例中,骨不连接3例,股骨头坏死2例,复合组晚期并发症发生率明显小于空心钉组(P＜0.05),随术后时间推移,两组患者Harris评分、髋伸-屈ROM、髋内旋-外旋ROM均显著增加(P＜0.05).术后所有相应时间点,复合组的Harris评分、髋伸-屈ROM、髋内旋-外旋ROM均显著优于空心钉组(P＜0.05).影像方面,末次随访时,复合组Garden指数、颈干角和Tonnis分级均显著优于空心钉组(P＜0.05).[结论]空心钉复合内侧支撑钢板固定Pauwels Ⅲ型股骨颈骨折的临床疗效明显优于单纯空心钉固定.

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

The distal radius and the proximal row of carpal joints are important components of the carpal joint. Injury to the distal radius may result in decreased range of motion and strength of the wrist, and changes in the wrist appearance can hurt the patients. Developing microsurgical techniques, and updating orthopedic metal instruments and bone biological products provide more possible means for surgical reconstruction. Currently, reconstruction of the distal radius with autologous bone grafting is the mainstream surgical method, and the fibula and ilium are the main options for grafting. Moreover, other repair methods have also been reported, such as prosthetic repair and repair using the ulna to replace the radial function. This article reviews the main forms of surgical repair and reconstruction after distal radius injury reported in recent years, compares the clinical effects of different surgical methods, and summarizes the advantages and disadvantages of each surgical method, hoping to provide useful information for the treatment of distal radius injury.

[目的]介绍二期微创内固定开放性Schatzker Ⅵ型胫骨平台骨折的手术技术和初步临床效果.[方法]对16例开放性Schatzker Ⅵ型胫骨平台骨折一期清创和封闭负压引流(vacuum sealing drainage,VSD)处理.二期应用对抗牵引下微创经皮钢板内固定(minimally invasive plate osteosynthesis,MIPPO),于股骨髁上及胫骨远端各置入1枚斯氏针,安装对抗牵引装置.逐步增加牵引的力量,恢复骨折端对位对线.于胫骨内外侧经皮置入胫骨近端解剖锁定钢板进行内固定.[结果]16例患者均顺利完成二期手术,无严重并发症.临床骨折愈合时间为4～8个月,平均(6.14±1.35)个月.末次随访HSS膝关节功能评分86～92分,平均(89.44±2.43)分.影像检查所有患者胫骨力线恢复良好,关节面复位满意.Rasmussen胫骨平台解剖学评分12～18分,平均(14.12±1.60)分.[结论]此技术能使骨折达到良好的复位与可靠固定,大大减少手术创伤,有利于骨折愈合,避免本已严重损伤的皮肤软组织进一步坏死.

Objective:Anatomical study of the cross-donor flap pedicled with the peroneal artery and the discussion of the effect of clinical application, so as to describe a new method for the repair of large-area soft tissue defects in the foot and ankle.Methods:From June 2016 to August 2019, 12 specimens of adult lower limbs were studied. The popliteal arteries were perfused with perchloroethylene-ethyl acetate-lead oxide and red perchloroethylene-ethyl acetate. The origin, number, outer diameter, course and distribution of perforating branches of the peroneal artery were anatomically observed. The source, distribution and anastomosis of the skin nutrient vessels in the posterolateral area of the calf were also studied. Relationship of the blood supply between the peroneal arteries and veins and the nutritional vessels of the sural nerve were observed. In 9 patients, the peroneal artery and vein were designed as the pedicle of cross-donor flap in the repair of large soft tissue defects of foot and ankle. The patients were entered follow-up through outpatient visits and telephone interviews.Results:Among the 12 adult specimens of lower limbs, there were 65 perforating branches from the peroneal artery, 4-7 branches on each side, with an average of (5.41±1.00) branches. The diameter of the penetrating deep fascia was(1.07±0.36) mm. The perforator branches were mostly distributed in 3 sections of 4.0-11.0 cm, 16.0-21.0 cm and 24.0-27.0 cm away from the lateral malleolus, accounting for 48%, 24% and 17% of the total number of perforators, respectively. The outer diameters of the perforator vessels were (0.92±0.26)(0.56-1.68) mm, (1.32±0.38)(0.60-2.14) mm, and (0.98±0.28)(0.62-1.36) mm. The length of the pedicle of the perforator vessels were (3.91±0.96)(2.15-5.78) cm, (5.34±0.50)(4.01-5.85) cm, and (3.31±1.15)(2.16-5.66) cm. The perforating branches in the 3 sections appeared constantly. The diameter of the vessels was≥0.5 mm with an average length of at(4.19±1.16)(2.15-5.85) cm. The vascular network of the flap in the posterolateral area of the calf was mainly composed of subdermal vascular network and deep fascial vascular network. The deep fascia vascular network in the posterolateral area of the calf had 3 obvious longitudinal chains, including the medial sural neurotrophic vascular chain, the small saphenous vein-sural nerve communicating branch vascular chain and the lateral sural neurotrophic vascular chain, which took the nutrient blood supply from the perforating branches of the peroneal artery also formed a longitudinal and transverse anastomosis between the perforating branches of the peroneal artery. In the clinical trials performed on 9 patients, all soft tissue defects of foot and ankle were repaired. The composite tissue flap survived without infection or necrosis. The follow-up was lasted for 12 months to 3 years. The postoperative function and the donor site appearance were good and the patients walked normally. According to the American Orthopaedic Foot and Ankle Association(AOFAS) foot scoring standard, the function of affected feet were evaluated. Five patients were excellent and 4 were good.Conclusion:The cross-donor flaps pedicled with peroneal arteries and veins has sufficient blood supply and a large area. It provides a method for the repair of large-area soft tissue defects in the foot and ankle.

[目的]探讨Trimed钩钢板在Danis-Weber A型外踝骨折中的临床疗效.[方法]2019年7月-2021年1月,共收治Weber A型踝关节骨折患者20例,按医患沟通结果分为两组.10例采用Trimed钩形钢板固定外踝骨折(钩钢板组),10例采用无钩钢板固定外踝骨折(无钩钢板组).比较两组临床与影像资料.[结果]两组患者均顺利完成手术,钩钢板组外踝部手术时间显著短于无钩钢板组(P＜0.05).两组患者随访10个月以上,随术后时间推移,两组患者AOFAS和Maryland评分均显著增加(P＜0.05),相应时间点,钩钢板组的AOFAS和Maryland评分均显著优于无钩钢板组(P＜0.05).影像方面,钩钢板组术后影像显示的骨折复位质量显著优于无钩钢板组(P＜0.05),钩钢板组影像显示骨折愈合时间显著早于无钩钢板组(P＜0.05).[结论]对于Danis-Weber A型外踝骨折,钩钢板内固定的临床效果明显优于无钩钢板.

2019年7月,收治1例自残致左腕部4平面离断伤。经多学科沟通,制定相应诊疗策略,给予输液、输血、纠正休克、降低血糖等对症治疗,同时左腕部多断面离断清创再植，术后应用心里干预,应对突发情况,术后患肢恢复好。

Objective:To analyze the feasibility of applying transcutaneous electrical nerve stimulator and high-frequency ultrasound in superficial nerve positioning for detection anatomical location in the area of lateral lip of the iliac crest by lateral cutaneous branch of subcostal nerve(LCSN). The significance of using the nerve as a free sensory superficial circumflex iliac artery perforator flap was discussed.Methods:The data of patients who underwent the repair of defects on limbs with free perforator flap or composite flap of superficial iliac circumflex artery carrying sensory nerve and the volunteers who agreed to have the location of the LCSN measured between October, 2018 and October, 2020 were collected. The LCSN were located by percutaneous electrical nerve stimulation and ultrasound, and the patients were measured and located during surgery. Using Passing-Bablok regression and Bland-Altman graph to evaluated the consistency between transcutaneous electrical nerve stimulation, ultrasound and the surgical positioning.Results:A total of 43 subjects, including 22 patients and 21 volunteers, were selected for locating the LCSN. Thirty-nine males and 4 females, with an average age of 39 years old and an average BMI of 24.08. The operation time of percutaneous nerve electrical stimulation was(6±1) min, and the detection distance was(80.7±5.9) mm. The high-frequency ultrasound was(23±4) min, and the distance was(81.2± 6.6) mm. The average operation time of surgical measured distance was(80.9±8.2)(65-100) mm, the diameter of nerve was(2.3±0.8)(1.0-4.0) mm, and the operation time was(5±1) min. A 95% CI of Passing-Bablok regression intercept and slope of operation, percutaneous electrical nerve stimulation and ultrasoundincluded 0 and 1, respectively. The points on Bland-Altman plot were distributed on both sides, and 95% CI of total mean difference, total intercept and slope included 0. Therefore, it was can be considered that the application of percutaneous electrical nerve stimulation and ultrasound in LCSN localization has good consistency.Conclusion:The location point of the LCSN crossing the iliac crest which detected by transcutaneous electrical nerve stimulation and high-frequency ultrasound detection was close to the measurement taken during the operation. It was also showed that both of them can be used for preoperative locationing of the sensory branch of the sensory nerve flap, optimizing the design of the flap, shortening the operation time, and reducing the unnecessary injury in operation.

[目的]探讨Gustilo Ⅲ C型严重下肢损伤保肢方法的选择.[方法]回顾性分析本院2014年1月—2018年1月收治的30例Gustilo Ⅲ C型严重下肢毁损伤行保肢手术患者的资料.其中,胫腓骨骨折22例,股骨干骨折4例,股骨髁间骨折4例.依据患者全身与局部条件选择个性化救治.[结果]所有病例均进行急诊修复血管.9例患者一期锁定加压钢板内固定,21例患者进行外固定架固定.12例一期直接缝合创面,18例采用VSD负压吸引敷料覆盖一期创面,二期直接缝合5例,游离植皮5例,皮瓣覆盖8例,所有皮瓣均成活.所有患者均未发生肢体坏死和累及全身的严重感染.所有患者随访6～24个月,平均(11.32±1.34)个月.随着时间推移,30例患者VAS评分显著下降(P＜0.05),膝、踝关节ROM均显著增加(P＜0.05).随访期间,所有患者均无因肢体功能丧失或慢性持续感染而行截肢术.至末次随访时,所有骨折均愈合.[结论]对于Gustilo Ⅲ C型严重下肢毁损伤,若能充分的进行术前评估并个性化及时手术处理,在骨关节固定的同时,更重视软组织覆盖修复的方法选择,可大大提高保肢成功率,并获得较满意患肢功能.

目的:探讨小腿部接力穿支皮瓣修复小腿中下段软组织缺损的临床效果。方法:2014年7月至2017年5月，设计小腿内侧和外侧穿支接力皮瓣修复小腿中下部软组织缺损13例，其中，修复小腿内侧软组织缺损5例，小腿外侧软组织缺损8例。皮瓣大小4.0 cm×10.0 cm~ 6.0 cm×16.0 cm。术后通过微信视频、电话及门诊随访，内容包括小腿的整体外观、皮瓣弹性、色泽、瘢痕挛缩及色素沉着情况和皮瓣转移后供区愈合情况。结果:本组13例接力穿支皮瓣全部成活。其中1例术后第1天因血肿压迫发生静脉血管危象，血肿清除后成活。术后随访5~ 12个月，平均8个月。小腿外形饱满，皮瓣弹性、色泽、质地良好。结论:利用小腿穿支接力皮瓣修复小腿中下段软组织缺损可以达到美容修复的效果，是一种较好的修复方法。

[目的]探讨胫腓骨骨折后下肢深静脉血栓形成(DVT)的发生特点与危险因素.[方法]分析2016年7月～2018年7月178例胫腓骨骨折患者资料.患者入院及术后分别行下肢静脉彩色多普勒超声检查确定DVT的发生,对DVT发生的特点进行描述.按是否发生DVT将患者分为两组,单因素比较两组间各指标的差异.以是否发生血栓的二分变量为因变量,其他因素为自变量行多元逻辑回归分析,以确定DVT的危险因素.[结果]178例胫腓骨骨折患者中,51例发生DVT,占28.65％;127未发生DVT,占71.35％;DVT累及102条下肢静脉,其中胫后静脉29条(28.43％),腓静脉27条(26.47％),小腿肌间静脉23条(22.55％),胭静脉14条(13.73％),股浅静脉9条(8.82％).DVT组年龄显著大于非DVT组(P＜0.05),DVT组术前D-二聚体水平显著高于非DVT组(P＜0.05),DVT组受伤至手术时间显著长于非DVT组(P＜0.05),DVT组复杂骨折比率显著高于非DVT组(P＜0.05).逻辑回归分析显示:高龄(OR=21.940,95％CI 5.115,94.115,P＜0.001)、受伤至手术时间长(OR=4.040,95％CI2.010,8.119,P＜0.001)和D-二聚体水平高(OR=5.505,95％CI 2.699,11.229,P＜0.001)是发生DVT的危险因素.[结论]胫腓骨骨折患者下肢DVT的发生率在29％左右,主要累及胫后静脉、腓静脉和小腿肌间静脉.高龄、受伤至手术时间过长、D-二聚体水平增高和复杂骨折的患者易发生DVT.

[目的]观察真空封闭引流(VSD)联合富血小板血浆(PRP)治疗上肢大面积皮肤脱套伤的疗效.[方法] 2014年1月～2018年6月,共60例上肢大面积皮肤脱套伤患者纳入本研究.依据患者是否使用PRP,将患者分为两组.清创修整成中厚皮片后,28例患者采用单纯VSD,32例患者采用VSD联合PRP治疗.比较两组的临床资料.[结果]两组患者手术均顺利完成.两组患者手术时间、术中失血量的差异无统计学意义(P＞0.05).但是,VSD+PRP组术后换药次数、拆线时间、皮肤成活面积率、皮片坏死面积率和住院时间均优于VSD组(P＜0.05).随访16～42个月,平均(30.14±9.32)个月,两组患者伤肢疼痛逐渐减轻,功能逐渐恢复.末次随访时,两组患者色素沉着、皮片挛缩、瘢痕增生的发生率差异均无统计学意义(P＞0.05).[结论]真空封闭引流联合富血小板血浆治疗上肢大面积皮肤脱套伤可有效提高皮肤成活率,缩短住院时间.

目的 评估陶瓷人工骨填充成人良性骨肿瘤和瘤样病变刮除后骨缺损的疗效及潜在并发症.方法 回顾性分析2013年1月至2017年6月在本院行病灶刮除植骨的良性骨肿瘤和瘤样病变患者资料.共纳入32例,男17例,女15例,平均年龄34.2 (18～57)岁.平均病变体积25.0 (0.1～169.6) cm3.平均植入人工骨4.0 g(0.2～10g)根据X线片表现以改良Neer法评估骨愈合、材料吸收和病变复发情况.Goslings和Gouma法评估术后并发症.结果 平均随访1.8(0.5～6)年,Neer分级6例Ⅰ级,26例Ⅱ级.2年以上随访11例,7例骨皮质增厚,3例材料完全吸收.1例手部内生软骨瘤术后发生骨折,并发症分级为Ⅰ级.随访期间未发现病变复发.所有患者均恢复肢体正常功能.结论 该人工骨填充成人良性骨肿瘤和瘤样病变刮除后骨缺损效果可靠,并发症少,但材料吸收较慢.

目的 探讨距腓韧带损伤的关节镜治疗和切开修复治疗的效果,为临床更好的治疗距腓韧带损伤提供依据.方法 选取2016年1月至2018年7月我院收治的成人距腓韧带损伤的60例患者为研究对象.在条件允许的情况下,所有的调查对象都要求行关节镜治疗,在一些无法关节镜治疗的病例中进行了切开修复治疗,其中关节镜治疗26例(关节镜组),切开修复34例(切开组),对比两组患者治疗效果,术后12个月的美国足踝矫形协会踝关节功能评分(AOFAS)、Karlsson踝关节功能评分(KFAS)及患者满意度.结果 在术后的随访中,没有任何一组的患者出现踝关节不稳的情况.在接受手术之后,两组患者的AOFAS(P<0.01)和KAFAS(P<0.01)均较治疗前显著增加,然而,在两组的AOFAS和KFAS的对比中没有显著差异(P>0.05);关节镜组术后12个月踝关节功能评分82.3±8.1分,切开组术后12个月踝关节功能评分81.9±7.3分,两组比较差异无统计学意义(P>0.05);关节镜组治疗后患者满意率为86.95％,明显高于切开组75.67％,差异有统计学意义(P<0.05).结论 关节镜治疗距腓韧带损伤和切开修复距腓韧带损伤效果相近,但关节镜作为一种微创技术,创伤小,恢复快,更易被人们所接受.

目的 探讨以降支为蒂外踝上穿支皮瓣逆行转移修复中前足足背创面的临床疗效.方法 自2013-06-2018-06收治14例中前足足背软组织缺损患者,6例行一期清创急诊以降支为蒂外踝上穿支皮瓣逆行转移修复;8例行一期清创,创面稳定后二期采取以降支为蒂外踝上穿支皮瓣逆行转移法修复.结果 14例均获得随访,随访时间5个月～5年,10例皮瓣完全成活,2例出现皮瓣下瘀血,皮瓣肿胀瘀斑,间断拆线引流瘀血后皮瓣成活,2例出现皮瓣远端边缘色暗黑痂,清除坏死边缘后换药愈合.成活皮瓣质地柔软,厚薄适中,均未行皮瓣修整.皮瓣区感觉恢复S1～S3,外观满意,穿鞋无明显影响,步态无明显异常,供区皮瓣及植皮或减张切口均一期愈合.结论 采用以降支为蒂的外踝上穿支皮瓣修复中前足足背创面,手术操作安全可靠,同时减小对足部供区的损伤,值得临床推广应用.

目的 通过对手腕部血管进行灌注,研究月骨滋养动脉与月骨缺血性坏死之间的联系,为临床更好地预防、诊治月骨缺血性坏死提供依据.方法 选用成人新鲜上肢标本8例,进行以下试验:①前臂血管灌注:在前臂近端断面解剖分离出肱动脉断端,将已经磨顿圆的针头插入肱动脉断端3～4 cm,冲洗血管内淤血,过氯乙烯乙酸乙酯溶液混合氧化铅填充剂分别隔2h、4h、6h、8h各补充灌注1次,灌注结束将标本置于4℃冰柜冷存24h后,CT观察月骨滋养动脉分布情况.②尸体解剖:显微镜下解剖游离桡动脉发出的腕掌支,然后暴露尺动脉并向远侧追踪尺动脉掌深支,继续探查尺动脉末端与桡动脉掌浅支吻合成的掌浅弓,并拍照记录.解剖前臂背侧:显露掌背皮动脉及腕背浅层血管网,游离行走于其内的桡动脉,并向远端追踪其走行,显露桡动脉腕背支、尺动脉腕背支、骨间前动脉腕背支.③肉眼观察月骨血管孔的分布、数量,并测量血管孔的口径.标本主要血管解剖完成并且拍照后,根据滋养孔大小、位置分别做好记录以备数据整理及统计学分析.结果 ①月骨的血供来源于腕掌、背侧动脉网.掌侧的动脉是月骨的主要血供来源;②月骨与周围腕骨多是关节软骨相接触,缺乏骨膜和肌腱附着,其血液供应主要依靠腕前韧带的滋养血管;③月骨掌侧面血管孔数为(2.13±1.13)个,背侧面为(2.00±0.76)个.结论 ①月骨掌侧面大、中孔相对较多,背侧面小孔较多,且掌侧面血管孔多数分布于内侧区;②月骨骨折线越靠近掌侧极,其发生缺血性坏死可能性越高;③月骨骨折行切开复位内固定术时需避开月骨掌侧面内侧区.

Objective To study the correlations between the nourishing artery and the ischemic necrosis of the lunate bone in order to provide evidence for better prevention and treatment of ischemic necrosis of the lunate bone.Methods Eight adult fresh upper limb specimens were infused with perchloroethylene added oxidized lead through brachial arteries.After 24-hour cold storage at 4 ℃,the distribution of the nourishing artery of the lunate bone was observed by CT scanning.The distribution and quantity of the vascular holes of the lunate bone were also observed.The relationship between the blood vessels of the lunate bone and the surrounding structures was observed,and the caliber of the vascular holes was measured.Results The blood supply of the lunate bone comes from the carpal palmar and dorsal artery network,and the palmar artery is the main source.The lunate bone and the surrounding carpal bones are mostly contacted with articular cartilage,lack of periosteum and tendon attachment,and their blood supply mainly relies on the nourishing vessels of the anterior carpal ligament.The average number of the palmar vascular holes was 2.13,the dorsal was 2.00,the medial area of the palmar lunate was 14,the lateral area of the palmar lunate was 3,and the dorsal lunate was 16.Conclusion The large and medium holes of the palmar lunate bone are more than those of the dorsal lunate bone which has more small holes.And the vascular holes of the palmar lunate bone are mostly distributed in medial area.The closer the bone fracture line is to the palmar pole,the higher the possibility of lunate ischemic necrosis is.The medial region of the palmar lunate bone should be avoided during open reduction and internal fixation for the lunate bone fractures.

目的 探究应用游离外踝上穿支皮瓣修复手虎口区掌侧皮肤软组织缺损的方法.方法 2014年11月-2016年1月,4例患者应用外踝上穿支皮瓣修复了手虎口区掌侧皮肤软组织缺损,切取皮瓣面积约5 cm×4 cm～11 cm×6 cm.结果 术后4例皮瓣全部成活,创面一期愈合,随访6～12个月,效果满意,皮瓣外观良好,薄而富有弹性,手部功能几乎完全恢复.结论 外踝上穿支皮瓣血管恒定,皮瓣切取简单、易行,术后皮瓣效果理想,手部功能恢复满意,是一种适用于修复手部虎口区掌侧皮肤软组织缺损较理想的皮瓣.

目的 观察并比较后侧入路、前外侧入路手术治疗军事训练投掷伤致肱骨干远端三分之一骨折的临床效果,为战创伤救治提供参考.方法 笔者所在医院收治(2013年1月—2016年12月)的42例肱骨干远端三分之一骨折患者随机分成两组,研究组22例,采用侧卧位后侧入路钢板内固定治疗;对照组20例,采用前外侧手术入路前置钢板内固定治疗,分析两组患者的手术出血量、手术时间、桡神经损伤情况、骨折愈合时间及术后肘关节功能恢复情况.结果 术中出血量研究组(240.91±42.64)ml,对照组(177.50±25.52)ml;手术时间研究组平均(1.93±0.08)h,对照组平均(1.86±0.09)h;桡神经损伤情况研究组无损伤,对照组2例;术后进行1~6个月随访,研究组骨折平均愈合时间为(82.23±6.30)d;对照组患者骨折愈合时间(94.15±5.71)d;研究组无伸肘受限患者,对照组2例伸肘受限5°患者,1例伸肘受限10°患者.结论 采用后侧入路能使肱骨干远端术野暴露充分,不易并发桡神经损伤,骨折愈合时间较短,不影响伸肘装置功能,有利于早期功能锻炼,是肱骨干远端骨折最佳手术入路,值得临床推广.

小腿严重开放骨折术后较大范围骨外露或因感染导致较大创面,往往因局部皮肤条件差无法行局部皮瓣,且受区缺乏具备吻合条件的血管,覆盖创面是临床一大难题,桥式皮瓣是最适合的选择.笔者所在科室2005年-2015年共实施桥式皮瓣修复小腿严重创伤软组织缺损及创面45例,经过精心护理,皮瓣成活44例,失败1例,现将护理体会报告如下.