Objective: To explore the feasibility and clinical effects of using free thinned deep inferior epigastric artery perforator flap to repair extensive soft tissue defects in extremities. Methods: From April 2010 to January 2014, 12 patients with extensive soft tissue defect in extremities after trauma, including 10 males and 2 females, aged 21 to 48 years, 6 patients with defect in the back of wrist and 6 patients with defect in ankle were admitted to the Department of Bone Microsurgery of Xi'an Honghui hospital. After debridement, the size of soft tissue defect ranged from 15.0 cm×4.5 cm to 28.0 cm×11.0 cm. The free thinned deep inferior epigastric artery perforator flap was designed, cut and transferred for reconstruction, with size of 15.0 cm×5.0 cm to 29.0 cm×12.0 cm. The flap thickness ranged from 4.0 to 6.5 cm before defatting, and was 0.6 to 0.9 cm after defatting. All the donor sites of flaps were closed directly by suturing. The flap survival and the appearance and function of flap and donor site were observed during follow-up. Results: All the flaps survived smoothly after surgery. During follow-up of 10 to 42 months, the flaps showed no bloat in appearance, no further flap revision or defatting procedures were required, the distance of static 2-point discrimination was 11 to 17 mm (14.5 mm on average). The abdominal function of patients was not affected, and no postoperative abdomen hernia or ulceration was noted. Conclusions: The free thinned deep inferior epigastric artery perforator flap is thin and suitable for repairing extensive soft tissue defects in extremities with very good outcomes.

目的:探讨应用自制抗生素骨水泥珠链植入治疗慢性骨髓炎的临床疗效.方法:本组50例患者,先取出内固定物,清创后植入抗生素骨水泥珠链,Ⅰ期闭合伤口行外固定架固定;Ⅱ期取出抗生素骨水泥珠链,取髂骨植骨.结果:随访11～40个月(21.51±4.52月).46例伤口Ⅰ期愈合,植骨患者32例植骨全部愈合.结论:彻底清创、抗生素骨水泥珠链植入结合外固定架固定及Ⅱ期植骨是治疗感染性骨折不愈合简单而有效的方法.

目的 探讨动态监测血清血管细胞黏附因子-1(VCAM-1)、骨形态发生蛋白-2(BMP-2)对尺桡骨骨折延迟愈合的预测价值.方法 选取45例尺桡骨骨折术后延迟愈合患者为观察组,45例骨折术后正常愈合患者为对照组,对比两组患者术后4、8、12周血清VCAM-1、BMP-2水平,绘制ROC曲线分析不同时期VCAM-1、BMP-2水平对骨折术后延迟愈合的预测价值.结果 观察组患者术后4、8、12周时血清VCAM-1水平均明显高于对照组,血清BMP-2水平则显著低于对照组(P<0.05).绘制4、8、12周时血清VCAM-1、BMP-2预测骨折术后延迟愈合的ROC曲线,VCAM-1的ROC曲线下面积分别为0.821、0.747、0.642,BMP-2的ROC曲线下面积分别为0.880、0.748、0.759.结论 血清VCAM-1、BMP-2与尺桡骨骨折患者术后延迟愈合存在密切关系,早期检测血清VCAM-1、BMP-2水平有助于预测骨折延迟愈合的发生.

Objective To explore the treatment outcome and surgical techniques of free tibular flap with monitoring flap for repair of forearm ulna or radius defect.Methods From February 2005 to January 2016,free fibular flap transplantation with monitoring flap was applied to repair forearm bone defect in 11 cases.There were 2 cases with ulna defect and 9 cases with radius defect.The range of defect was 3 to 10 cm in length with an average of 5.0 cm.Results All 11 monitoring flaps survived,and no vascular crisis occurred.The monitoring flap of one case had blister and healed spontaneously.All the patients were follow-up for 6 to 36 months (average,14 months).The bone graft healing time was 3 to 10 months (average,5 months).The ranges of wrist and elbow joint motion were almost the same as those of the uninjured side,while the rotate functions were limited.The range of pronation was 0° to 70°and that of supination was 0° to 50°.Two cases of patients with tumor had no tumor recurrence.The donor site had no significantly dysfunction except two cases with toe flexor strength declining.Conclusion Despite the technical difficulty and operation risk,transplantation of free fibular flap with monitoring flap is an ideal method to repair forearm bone defect.The skin island can monitor the blood flow of bone flap and improve the soft tissue conditions to achieve reliable healing.

Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.

目的:探讨在开放性胫腓骨骨折中,使用交锁髓内钉与传统外固定架固定相比,评价局部伤口及全身感染率、骨折愈合情况及远期功能恢复的区别.方法:将本院68例胫骨干开放性骨折患者随机分为2组,A组(对照组)34例,采用常规治疗+外固定;B组(实验组)34例,采用常规治疗+交锁髓内钉固定.结果:在局部及全身感染率上,两组没有明显差异(P＜0.05);A组一期愈合率为73％,延迟愈合16％,畸形愈合11％,远期优良功能恢复75％;B组一期愈合率为89％,延迟愈合9％,畸形愈合2％,远期优良功能恢复86％.结论:与传统外固定架固定相比,交锁髓内钉治疗胫腓骨开放性骨折具有提高骨折一期愈合率、改善远期骨关节功能的明显优势.

目的:探讨经截断尺骨鹰嘴入路治疗C2～C3型肱骨髁间骨折的临床疗效.方法:采用尺骨鹰嘴截骨入路治疗C2～C3型肱骨髁间骨折18例,术后门诊或电话回访方式随访,改良Cassebaum评分系统评定肘关节术后疗效.结果:所有患者骨折均愈合,C2型患者术后优良率高于C3型患者,总体治疗效果满意.结论:经尺骨鹰嘴截骨入路治疗效果满意.

目的 探讨闭合复位空心钉固定治疗舟状骨骨折病例选择的要点.方法 C型臂X线机下闭合复位后经皮Herbert空心螺钉内固定治疗新鲜舟状骨骨折19例.按Herbert舟状骨骨折分型:A2型4例,B1型4例,B2型8例,B3型3例.术后石膏托固定2周,拆线后更换管型支具固定8周.所有患者均于术后1个月,3个月,6个月拍摄X线片并对腕关节屈曲、背伸、尺偏、桡偏进行测量.结果 19例患者术后均获随访,时间8～12个月,平均10个月.X线片示所有病例内固定均无松动,18例骨折Ⅰ期愈合,1例Ⅱ期行植骨瓣内固定术后愈合.骨愈合时间为术后12.4～25.2周,平均15.5周.本组病例无舟状骨缺血性坏死.末次随访时腕关节功能较术前显著改善.结论 Herbert A2型及B型(包括B1型、B2型和B3型)均可使用闭合复位Herbert空心螺钉固定,术后骨折愈合良好,腕关节功能恢复良好.

目的:探讨采用髂骨骨皮瓣移植治疗胫骨开放性骨折骨缺损合并软组织缺损的方法和疗效.方法:2012年3月至2015年3月,30例胫骨开放粉碎性骨折患者(Gustilo3C型)行急诊清创、外固定架固定,术后平均3次清创后,形成骨缺损合并软组织缺损,平均骨缺损7cm,骨折线处皮肤平均缺损面积约6cm×5cm,患者创面均无感染发生.以上患者均采用同侧游离髂骨皮瓣移植治疗.结果:术后30例均达到临床愈合,术后平均住院10d,无感染发生,无其他并发症发生,出院后患者经8～24个月,平均16个月的随访,骨折均在4～10个月骨愈合,功能恢复良好,无感染现象发生.结论:本组病例自体髂骨骨皮瓣治疗胫骨开放性骨折骨缺损合并软组织缺损一次性修复骨及皮肤、软组织缺损,可缩短治疗时间,减少患者二次手术的痛苦及费用,是一种治疗胫骨开放性骨折骨缺损合并软组织缺损的有效方法.