Heel ulcer is one of the severe complications of patients with diabetes mellitus, which poses a high risk for foot infection and amputation, especially in patients with peripheral arterial disease and neuropathy. Researchers have searched for new treatments for treating diabetic foot ulcers in recent years. In this case report, we demonstrated the treatment of large ischemic ulcers for the first time in a diabetic patient. The overall treatment goal of this patient was designed to improve blood supply to her diseased lower extremities and close the ulcer. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at postoperative follow-up.

目的 观察自制持续皮肤牵伸器在修复四肢皮肤软组织缺损的可行性和临床效果.方法 回顾性分析2014年6月至2016年12月采用自制持续皮肤牵伸器治疗的20例小腿皮肤缺损骨外露患者资料,男15例,女5例;年龄19～54岁,平均34岁.皮肤缺损部位:上臂2例,前臂3例,小腿下段15例(中段5例,中下段6例,踝部4例).皮肤缺损程度:骨外露4例,肌腱外露7例,单纯皮肤缺损13例.缺损面积平均为14.1 cm×4.3 cm,均为创伤后皮肤软组织缺损.结果 全部患者获6 ～12个月(平均10.6个月)随访,术后20例患者创面均愈合,愈合时间为3～7周,平均3.6周.16例患者1次牵张成功后直接间断缝合,4例患者因皮肤缺损面积较大或伴有感染出现牵拉针切割皮肤后脱落,再次穿针牵张成功后间断缝合.牵张后的皮肤色泽与正常皮肤接近、毛发生长正常、弹性良好、无臃肿且触痛觉正常.结论 自制持续型皮肤牵伸器在修复四肢皮肤软组织缺损是一种可行方便的手术方法.

目的 应用彩色多普勒超声技术检测腓动脉穿支的分布规律和内径等参数并对其进行研究,进而探讨腓动脉穿支皮瓣的临床应用效果.方法 应用彩色多普勒超声技术对15例健康志愿者双侧小腿30侧腓动脉的穿支数目、分布、类型及直径进行检测研究;术前对25例患者行腓动脉穿支精确定位并设计皮瓣修复缺损部位,术后观察不同类型腓动脉穿支皮瓣的临床效果.结果 15例志愿者双侧小腿30侧腓动脉的穿支总数为110支,其中肌皮穿支45支(占40.9％),肌间隙穿支65支(占59.1％);穿支起始处内径平均为(1.06±0.31) mm.25例患者应用腓动脉穿支皮瓣修复缺损,术后随访3～18个月,20例皮瓣完全成活,5例皮瓣出现局部坏死,其中3例采用皮肤移植修复后愈合,2例经换药后创面自愈.结论 腓动脉穿支皮瓣具有稳定可靠的血管蒂,是重建软组织损伤的良好方法.

目的:探讨海桐皮汤在踝关节骨折术后康复中的临床效果.方法:选择2014年3月-2017年3月我院收治的64例踝关节骨折术后完成康复的患者,随机分成两组,每组32例,对照组采用关节主被动活动度训练理疗方法,实验组在采用对照组方法基础上加用海桐皮汤熏洗治疗,每日2次,1周为一个疗程,其中6天治疗,1天休息;总共4个疗程,随访6个月.结果:根据Olerud-Molander踝关节骨折功能评分,实验组的优良率在治疗4周、8周、12周后均明显高于对照组,两组比较差异具有统计学意义(P<0.05).结论:海桐皮汤在踝关节骨折术后康复中疗效确切,可以有效减少创伤性关节炎等并发症的发生.

目的:建立符合中国糖尿病足住院特点的治疗方法,以指导糖尿病足的临床治疗工作.方法:将糖尿病足溃疡患者的治疗流程分成手术前准备、手术及术后促生长、防止溃疡复发3个阶段,每个阶段对患者的主要矛盾进行动态评估并制定相应的诊疗计划的糖尿病足治疗流程——SIANM疗法.结果:按照此治疗流程治疗的糖尿病足患者创面均得到较好的愈合.结论:SIANM治疗法是安全、有效的糖尿病足诊治方法.

Objective To explore the feasibility and effect of self-developed skincontinual-stretching device in the treatment of skin defect.Methods The skin defect models were made by rectangular resection of skin and soft tissue in the backs(both sides) of 7 white pigs with 14 wound surface.The mean wound areas of two sides were 10 cm × 5 cm,10 cm × 10 cm.The pigs were divided into experimental group (n =5,10 wounds) and control group (n =2,4 wounds).The selfdeveloped skincontinual-stretching device was used for skin traction treatment in experimental group,and wound cleansing and dressing change was used for self healing in control group.Results The skin defects were closed directly by two-stage sutures at 3-5 days after skin traction treatment in experimental group and healed after 2 weeks.However,there were still large skin defects which could not be sutured and closed after 1 weeks in control group.The daily traction distance,shrinking area and drafting speed of the wound in experimental group were obviously better than those in control group (P ＜ 0.01).Conclusions Skin traction treatment with self-developed skincontinual-stretching device can rapidly close skin defects in early stage,and the speed and frequency of drafting can be controlled.It is easy to use with reliable effect and fewer complications.

Objective To analysis the evaluation value of blood coagulation and fibrinolytic indexes of lower limb venous thrombosis in patients with orthopaedic trauma. Methods We evaluated 230 patients with traumatic surgery in our hospital from January 2014 to June 2016. Color Doppler ultrasonography was used to detect DVT before and after operation. Plasma prothrombin time(PT),fibrinogen enzymes(Fbg),fibrinogen degradation products(FDP),activated partial prothrombin time(aPTT) and D-dimmer(DD) were tested.At the same time, we analyzed the relationship among blood glucose,blood pressure,gender,age and thrombosis. Results There were 37 patients with deep vein thrombosis of lower extremity in 230 cases and the incidence of DVT was 16.0%. The incidence of lower extremity venous thrombosis in patients with diabetes and high blood pressure were significantly higher than the control group(27.6% vs 12.2%;30.3% vs10.3 %). Preoperative and postoperative DD,FDP and Fbg in the thrombus group were significantly higher than that non-thrombosis group. The differences of PT and aPTT between the thrombosis group and the control group were not statistically. Conclusion Coagulation and fibrinolysis indicators help to screen and diagnose DVT.

目的:探讨海桐伸筋汤在膝关节周围骨折术后康复中的临床效果.方法:72例膝关节周围骨折术后康复患者,随机分成对照组和实验组,每组36例.对照组采用主被动关节功能训练、超声波方法,实验组在对照组方法基础上加用海桐伸筋汤熏洗治疗,比较两组的临床效果.结果:实验组在治疗4周、8周、3个月后的优良率均高于对照组,差异具有统计学意义(P＜0.05).结论:海桐伸筋汤在膝关节周围骨折术后康复中疗效确切,能够有效减少膝关节炎的发生,帮助膝关节功能的恢复,值得推广.

目的：比较微型铆钉和抽出钢丝法治疗锤状指的临床疗效。方法选取单纯伸肌腱止点撕脱导致的锤状指患者23例，11例采用微型铆钉修复，12例采用抽出钢丝法修复。23例患者术后均固定于近节指间关节屈曲、远节指间关节过伸位6周，6周后行手指功能锻炼。观察患者远节指间关节活动度。结果23例患者获7.2～12.3个月随访，微型铆钉修复患者远节指间关节活动度优6例，良4例，可1例；抽出钢丝法修复患者远节指间关节活动度优5例，良6例，差1例（由于功能锻炼过程中肌腱再撕脱）；两组比较差异无统计学意义（P＞0．05）。结论微型铆钉和抽出钢丝法治疗锤状指临床疗效均较好，但微型铆钉可有效防止肌腱再撕脱。

目的:研究比较股骨近端髓内钉(PFNA)和动力髋螺钉(DHS)治疗股骨转子间骨折的临床疗效.方法:选择2012年1月至2013年12月间因单侧股骨转子间骨折于我院住院行PFNA及DHS手术治疗的患者312例,其中192例采用PFNA内固定,120例采用DHS内固定,记录手术时间、术中出血量、术后3 d VAS评分、住院时间、Harris评分,并将所记录的结果进行统计分析.结果:PFNA和DHS两组的手术时间之间差异有统计学意义,而术后3d的VAS评分、住院时间及术后1年的Harris评分差异均无统计学意义,术中出血量的差异性仍需要进行进一步求证.结论:PFNA和DHS两种内固定方法治疗股骨转子间骨折时,手术时间PFNA优于DHS,而临床疗效两者无明显差异.

Objective To observe the effect of three types skin graftings in repairing diabetic foot ulcers. Methods 143 pa?tients of diabetic foot ulcer ( wagner class 3) were divided into three groups randomly, all patients carried out three types skin graftings. The follow?up period was 4 times after surgery to evaluate the effect. Results In 143 cases with skin graftings, 85 cases were cured, 40 cases were survived well, and 18 cases were survived poor, which was almost in perforator flap and nutrition and free skin flap. Conclusion Skin grafting is an effective method in treating diabetic foot ulcer, and local flap may be the best choice for diabetic foot ulcer.

目的：探讨常规冲洗与脉冲冲洗在治疗GUSTILO-III型胫骨开放性骨折时的效果差异。方法：2013年1月-2015年5月本科收治的GUSTILO-III型胫骨开放性骨折的患者49例，23例采用常规冲洗，26例采用脉冲冲洗，对于受伤至冲洗的时间差、冲洗时间、冲洗量、伤口愈合时间、伤口愈合情况、感染率数据进行统计分析，并对冲洗前后的创面组织进行细菌培养。结果：两种冲洗方法在冲洗时间、冲洗量、伤口愈合时间、伤口愈合情况及感染率方面无明显统计学差异，与受伤至冲洗的时间差无统计学相关性。结论：常规冲洗与脉冲冲洗在治疗GUSTILO-III型胫骨开放性骨折均效果良好，而且两种方法效果无差异。

目的:分析在高能量胫骨平台骨折治疗中应用双钢板的临床效果.方法:随机选择2012年7月-2015年1月在本院接受治疗的高能量胫骨平台骨折患者70例参与研究,随机平均分成2组,对照组选择单钢板治疗,观察组选择双钢板治疗,比较两组治疗效果.结果:观察组治疗优良率为88.6％,对照组为65.7％;观察组并发症发生率为2.9％,对照组为17.1％.结论:双钢板治疗高能量胫骨平台骨折的效果明显优于单钢板,能够有效提升膝关节功能,值得推广.

目的:观察延迟拉拢法在皮肤软组织缺损创面中的应用效果.方法:2009年1月至2013年1月选择65例皮肤软组织缺损创面的患者,采用预先缝合,术后分次拉拢收紧闭合创面的方法处理.术后通过门诊复查随访3个月.结果:48例患者获得完整随访,在经过2～5次(平均2.8次)延期收紧后,8～21 d内均一期愈合,随访检查创面遗留瘢痕不明显或只有线形瘢痕,患者运动及感觉功能未受明显影响.结论:延迟拉拢法对皮肤软组织缺损创面的疗效肯定,简便易行,外观满意且费用低廉,值得推广.

目的 总结股骨近端解剖型锁定钢板内固定治疗殷骨粗隆下粉碎性骨折的临床疗效.方法 采用切开复位殷骨近端解剖型锁定钢板内固定治疗股骨粗隆下粉碎性骨折43例,根据患者手术前后影像学比较及术后功能恢复情况评价治疗效果.结果 Russell-Taylor Ⅰ型骨折手术时间(=2.117,P=0.046)与术中出血量(=6.376,P＜0.001)少于Ⅱ型骨折,且不伴有小粗隆断裂的A型骨折手术时间(t =2332,P=0.010)与术中出血量(t=2.395,P=0.022)少于伴有小粗隆断裂的B型骨折,差异均有统计学意义(P＜0.05).43例均获平均16.8(5～23)个月随访,髋关节功能Harris评分:优22例,良17例,可4例,优良率90.7％.结论 股骨近端解剖型锁定钢板内固定治疗股骨粗隆下骨折具有技术容易掌握、骨折高愈合率和低并发症发生率的优点.