目的：探讨空心钉联合克氏针内固定治疗第5跖骨基底部 I 区骨折的临床疗效。方法选取2008年6月至2014年5月采用切开复位空心钉联合克氏针内固定治疗第5跖骨基底部 I 区骨折36例，观察临床疗效。结果：随访时间6～18个月，切口均一期缝合且一期愈合。骨折愈合时间8～14周，平均9．6周。末次随访时 X 线片显示骨折均愈合，未出现骨折不愈合或延迟愈合、再骨折、内固定材料松动及断裂等情况。疗效评定根据美国矫形足踝协会（AOFAS）评分系统评定：本组优24例，良9例，可3例，优良率91．7％。结论：空心钉联合克氏针内固定治疗第5跖骨基底部 I 区骨折，内固定性能良好，无明显应力遮挡作用，康复时间短，疗效可靠，是一种较为理想的内固定方式。

Objetive To report the clinical application of pediatric toe with toe antegrade arterial nerve pedicle flap. Methods January 2008-2013 June 8 cases of patients with toe-side (belly)application to re-pair the same defect toe toe antegrade arterial nerve pedicle flap flap.Defects in three cases in which the toe,toe abdominal defect five cases,the area of skin defect size 1.0 cm ×1.5 cm~1.2 cm ×1.8 cm.Age 3~12 years (mean age 5 years old). Results All flaps survived,no vein crisis occurred.After January-six months of fol-low-up,full flap shape,color,line-like scar just for the subject area,toe feels normal,all cold and sore toe ca-ses,children with normal gait. Conclusion Toe with toe antegrade arterial nerve pedicle flap is a good method to repair pediatric toe toe (abdomen)defect.

Objective To compare the repairment effect of digit tip injury and pulp loss by three kinds of pedicle skin flap in long-term. Then the result will provide the best choice for digit tip injury and pulp loss. Methods The cases which had the digit tip injury and pulp loss repaired by two types of digital artery flapwere divided into 3 group, group 1 was anterograde digital artery flaps. Group 2 was pedicle of dorsal digital artery flaps of middle segment, group 3 was pedicel of dorsal digital artery flap of Proximal finger. 30 cases of each group were followed up for 4.5 years. A contrastive analysis of 9 index were made. This comparison consists of the satisfaction of the flaps. Results All patients were satisfactory with the effect, There was difference between group 1 and group 2 andgroup 3. The difference consist of stereognosis, two point discrim-pination, cases of chills, sweat, appearance of the donor sites. Group 2 and group 3 had difference in cases of chills. No significant difference between the three groups in other aspects. Conclusion These are good methods for using 3 different flaps to repair digit injury and pulp loss in long period. Good results coverd all the groups. Comparison of comprehensive indexes, anterograde digital artery flaps is the first choice of treatment then the pedicel of dorsal digital artery flaps of middle segment, at last pedicel of dorsal digital artery flap of Proximal finger.

Objetive To report the effect and clinical applications of using antegrade digital artery flaps from the same finger to repair digit injury and pulp loss. Methods From January 2009 to December 201 2.46 cases of the digit fingertip injury and finger pulp defect were treated with anterograde digital artery flaps transfer form the same finger,there were 25 cases of them which preserve nail bed.there were 24 cases of finger tip in-gury and 31 cases of pulp defect.The defect scopes were 0.5 cm ×1 .0 cm to 0.8 cm ×1 .0 cm the age ranged from 2 to 1 1 years,the average age was 5 .8 years. Results All flaps survived after operation,there was no vascular crisis.1 0 cases with nail bed and 1 0cases without nail bed which were followed up from 1 to 3 years. The flaps had good appearance and texture and sweat,here were just few string sign on the donor and receient sites.The nails of 1 6 cases which preserve nail bed grew normally without nail bed partial andnail deformity,4 cases of they have longitudinal ridge or nail stripes.Two point discrimination were normal.fine touch and func-tion of finger motion were obtained. Conclusion When the indication under control it is a better method for repair of finger tip defect and finger pulp loss by the digital neurovascular antegrade flaps from the same finger.

手是人类重要的劳动和感觉器官，兼有美学功能，指端感觉灵敏。指端（腹）缺损在手外伤中占有较大比例［1］，处理不当不仅会影响手的功能和美观，也给患者的生活造成心理压力。作者对2006年1月-2012年12月收治的64例（其中小儿18例）末节皮肤缺损的患者应用重建感觉的中节指动脉终末背侧支筋膜蒂皮瓣进行修复，取得了满意的效果，现报告如下。

目的：总结小儿指背侧指动脉逆行皮瓣修复同指中、末节皮肤缺损的临床应用。方法2009年1月至2013年1月对20例手指中、末节皮肤缺损的小儿患者应用重建感觉的指背侧指动脉逆行皮瓣修复。中节皮肤缺损8例，末节皮肤缺损12例，皮肤缺损面积0.6 cm×1.2 cm~1.0 cm×1.5 cm。结果皮瓣全部成活，术后出现静脉危象3例。其中14例经6个月~1年的随访，8例大于6岁的患者两点辨别觉平均为5.5 mm。皮瓣外观饱满，深感觉恢复，手指无活动障碍，供区无明显瘢痕。结论重建感觉的指背侧指动脉逆行皮瓣是修复小儿手指中、末节皮肤较大面积缺损的好方法。

Objective To study the curative effect on comminuted patella fracture using vertical incision by internal fixation of fine Kirchner wires plus improved tensile band with steel wires.Methods 65 cases of comminuted patella fracture using vertical incision were treated by internal fixation of fine kirchner wires plus modified tensile band with steel wires,followed by the observation of postoperative time of fracture union,smoothness digree of joint surface on X-rays and restoration of knee joint function.Results The average time of fracture union was 85.5 days,and smoothness digree of joint surface on X-rays was fine.The excellent rate of joint function accounted for 93.8%.Conclusions It is an effective method in the treatment of comminuted patella fracture because of its wide indications,minimal invasion,firm fixation and satisfactory results.

<正>Lisfranc关节广义上为跗跖关节,是一个相对稳定的关节复合体,作为中足的复杂结构,它在步行时起着将重力从前足传导至中足的作用,并在步态各期支持体重,因此Lisfranc关节有着重要的临床意义。近年来随着高能量损伤的增多,Lisfranc关节

患者,女,68岁,因"右膝关节疼痛伴活动受限3年,加重10d"入院.既往无外伤史.查体:右膝后无红肿,局部皮温正常,右胫骨近端后内侧可及包块,大小3.0cm×3.0cm,质硬,表面光滑,边界清楚,不可推动,局部压痛,右小腿无放射痛,无搏动感,听诊无血管杂音.右膝关节活动度屈20°～100°,右腘窝及右侧腹股沟淋巴结未及肿大,右下肢血运、感觉及足趾活动正常.实验室检查:血常规及血碱性磷酸酶正常,血沉、抗O、类风湿因子偏高,超敏C反应蛋白升高126mg/L.

Objective: To discuss the operative procedures and results of treatment of complicated tibial avulsion fracture of the posterior cruciate ligament via the medial gastrocnemius approach. Methods: From July 2007 to October 2010, 9 patients of complicated tibial avulsion fracture of the posterior cruciate ligament were treated by open reduction and fixated by cannulated screw via the medial gastrocnemius approach. All 9 cases of tibial avulsion fracture of the posterior cruciate ligament were retrospectively analyzed. Results: Surgical operation was achieved in all cases, without infection, vessel and nerve injuries, and deep venous thrombosis of lower limbs. The follow-up period ranged from 6 to 18 months(average 9.2 months) in all cases. All fractures healed in period I, and Lysholm scores reached 96 from the preoperative 58.4. Conclusion: Treatment of tibial avulsion fracture of the posterior cruciate ligament via the medial gastrocnemius approach is simple and safe, and has many advantages such as sufficient exposure of the fracture area and effective reduction and fixation. Most patients could acquire excellent clinical outcomes after proper physical therapy.

锤状指即手指末节伸肌腱止点断裂,为伸肌腱Ⅰ区,指伸屈肌腱牵拉末节指骨屈曲成锤状,多为戳伤致远侧指间关节突然屈曲而撕脱伸肌腱附力点,常伴有末节指骨基底部撕脱性骨折,大骨块撕脱和关节囊、韧带损伤可致指间关节脱位[1]。患者虽然不能主动伸指,但被动活动正常。我们对新鲜闭合伴末节指骨基底部背侧撕脱性骨折的锤状指患者,经甲下克氏针固定法的疗效进行观察,现报告如下。

1995年2月～2002年8月,我院行指尖再植49例,收到满意的效果,现报道如下.

1990年～2002年,我们再植手指末节离体复合组织块11例,全部成活,效果满意. 临床资料 本组男6例,女5例.年龄15～40岁.均为单指断离;手指末节复合组织块近端断离平面,按Yamano分区,Ⅲ区6例,Ⅱ区5例.组织块大小在0.5 em×1.1 cm×1.2 em～1.0 cm×1.0 cm×1.6em.切刀伤3例,机床伤6例,电锯伤2例.拇指2例,食指5例,中指2例,环指2例.腱骨皮甲型5例,骨皮甲型3例,皮肤筋膜型3例.

指尖冠状面离断是甲根部以远,指体主要在解剖冠状面方向的斜形离断,其再植属于指尖再植的范畴.我院自1998年3月～2001年6月采用顺行和逆行相结合的方法,再植完全性指尖冠状面离断16例16指,效果满意.

我院从1995年2月～2001年6月再植66例71指完全性指尖断离,效果满意,现报道如下.

目的研究拇指套状撕脱伤的急诊一期修复的最佳方法.方法运用显微外科技术,进行足趾游离组织移植,提供了拇手指复杂软组织套状损伤的早期覆盖方法(附1例报告).结果应用游离拇甲瓣移植急诊一期拇指再造,术后伤口一期愈合,再造拇指成活,经术后10个月随访,再造拇指外形美现,功能良好.结论游离拇甲瓣移植是急诊一期修复拇指套状撕脱伤再造拇指的最佳方法.