患者,男,41 岁,自幼双足巨趾畸形,随生长发育足趾逐渐长大且畸形愈明显,并逐渐发生双足、双踝关节畸形伴活动受限,双趾外翻畸形,双足外侧形成胼胝,左足症状较右足严重. 因家庭贫困未进行任何诊疗. 2018 年 1 月 20日以双足巨趾畸形、双踝关节畸形伴活动受限41 年入院. 全身麻醉下行双足软组织切除+截骨矫形+植骨融合+外固定架固定术治疗.

目的 观察富血小板血浆(PRP)治疗慢性难愈性创面的临床疗效.方法 选取中国人民解放军联勤保障部队第九二〇医院2019年12月至2020年12月因创伤、压疮、糖尿病等所致慢性难愈性创面的52例患者为研究对象,根据患者是否接受PRP治疗将研究对象分为PRP组和常规组两组,其中PRP组32例,常规组20例.所有患者均给予门诊手术彻底清创,PRP组术后给予PRP凝胶覆盖创面,3 d更换1次凝胶,3次为1个疗程;常规组术后常规换药,根据创面愈合情况选择植皮或皮瓣转移加速创面愈合.1个月后观察两组创面的愈合效果.结果 PRP组32例患者创面经过2～4次PRP凝胶治疗后,均获得痂下愈合,创面愈合时间(25.25±4.93)d,平均换药(5.09±3.21)次.常规组16例经常规换药后愈合,3例植皮后愈合,1例行带蒂皮瓣转移术后愈合,创面愈合时间(42.95±7.97)d,平均换药(24.70±5.70)次.PRP组创面内表皮生长因子(EGF)、胰岛素样生长因子(IGF)、血小板衍生生长因子(PDGF)、转化生长因子β(TGF-β)、血管内皮生长因子(VEGF)的浓度明显高于常规组(P<0.05).结论 与传统的治疗方式相比,富血小板血浆能显著增加创面生长因子浓度,加速伤口愈合,缩短治疗时间,减少治疗费用,减轻患者痛苦.

目的 建立腕关节三维有限元模型研究腕关节舟月骨间韧带(Scapholunate interosseous ligament,SLIL)在腕部不同运动中的应力分布.方法 选取正常腕关节CT数据,将其导入Mimics软件构建腕关节三维有限元模型,分析腕关节不同运动方向受力时的SLIL应力分布.结果 随背伸角度增大,SLIL应力增大,背伸角度增加到90°时,SLIL受到最大应力为1.3787 MPa.背伸角度为30°时,腕关节掌届时SLIL受到的最大应力为0.1596 MPa,掌屈角度增加到90°时,SLIL的最大应力降低至0.2452 MPa.桡偏25°时,SLIL受到的最大应力为0.8145MPa,尺偏25°时,SLIL受到的最大应力为0.1356 MPa.腕关节做桡侧受力20N时,SLIL受到的最大应力为0.4465MPa,尺侧受力20N时,SLIL受到的最大应力为0.4635MPa.结论 腕关节三维有限元模型可以模拟SLIL在腕部不同运动中的受力情况.腕关节背伸角度达90°时,SLIL的应力最大.做尺偏、桡偏动作时,相同偏转角度下,SLIL桡偏时最大应力是尺偏最大应力的6倍左右.

Objective:To investigate the effect of free anterolateral thigh perforator flap in repair of forefoot injuries combined with multiple tissue defect.Methods:A retrospective case series study was conducted on 26 patients who suffered from forefoot injuries combined with multiple tissue defect admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2015 to December 2019. There were 21 males and 5 females, aged 15-61 years [(31.6±12.5)years]. The combined injuries were fracture in 10 patients, arsometatarsal joint dislocation in 3, bone defect in 9, tendon injury in 5, and ligament injury in 3. Management of multiple tissue defect of the forefeet: soft-tissue defect of the forefeet was resurfaced with free anterolateral thigh perforator flaps with the dimension of 6.0 cm×3.5 cm to 26.5 cm×10.0 cm; fracture was fixed by Kirschner wires; joint dislocation was treated by open reduction and Kirschner wires fixations; bone defect was reconstructed either by one-stage bone graft or by use of membrane-induced technique and secondary bone graft, according to the wound conditions; tendon injury of extensor digitorum longus was repaired by direct tendon suture or by tendon transfer; tarsometatarsal ligament injury was primarily sutured. The flap survival rate was observed within 2 weeks after operation. The fracture healing, bone-defect repair, foot appearance, and donor-site healing were detected at 1 month, 3 months, 6 months, 1 year post-operatively and at the last follow-up. The postoperative complications were recorded. The foot function was assessed using American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before operation and at the final follow-up.Results:All patients were followed up for 6-36 months [(20.5±4.6)months]. All flaps survived uneventfully. The fracture healing and bone defect repair were acquired. The flap showed good texture, including primary flap thinning in 11 patients and secondarily thinning in 15 patients at 3-6 months postoperatively. The donor sites showed good healing, leaving only a linear scar. The flap venous crisis developed in 1 patient and survived after emergency vascular exploring. Local infection of flap occurred in 3 patients and was cured after further debridement and the use of sensitive antibiotics. The AOFAS ankle-hindfoot score was 54-94 points [(76.6±10.4)points] at the last follow-up, compared to preoperative 11-51 points [(27.2±11.3)points] ( P<0.01). The results were excellent in 5 patients, good in 11, and fair in 10, with the excellent and good rate of 62%. Conclusions:For forefoot injuries combined with multiple tissue defect, anterolateral thigh perforator flap transplantation with additional techniques to treat fractures, bone defect, tendon and ligament injuries can achieve satisfactory results in aesthetic appearance of the flap and donor site and foot function recovery.

目的 探讨旋耕机造成下肢毁损伤的特点、探索早期预防及控制感染的策略,提高患者的治愈率及保肢率.方法 回顾性分析联勤保障部队第九二○医院2015年4月至2019年12月旋耕机损伤的病例数,统计肢体损伤的Gustilo分型、伤口细菌培养结果以及所选用的敏感抗生素.结果 结合纳入及排除标准共纳入研究98例,其中GustiloⅢ型占总患者的93.09％,98例病人中67例培养出细菌,其中阳性菌33株,阴性菌34株.敏感抗生素以头孢二、三代及氨基糖苷类为主.结论 旋耕机多造成下肢毁损伤,感染重难以控制,救治不当轻则截肢,重则危及生命.需及时反复多次清创去除感染灶,根据术中细菌培养调整敏感抗生素.定期复查感染指标,及时调整用药方案.

目的 建立掌指关节的数字化三维模型,测量相关解剖学数据并进行统计分析,为掌指关节假体的设计提供部分依据.方法 收集解放军920医院2017年1月～2019年12月行手部CT扫描的成人影像资料,排除掌指关节周围骨折、畸形等疾病50例,随机抽取10例为研究对象.利用Mimics、3-Matic等软件通过数字化技术对掌骨头及近节指骨基底弧面进行球面拟合,找到曲率半径及弧长.各组内数据比较应用SPSS统计软件的单因素方差分析.结果 各组内行同一类数据比较分析,结果为:掌骨头正中矢状面曲率半径(3)＞(2)＞(1)＞(4)＞(5),差异有统计学意义(P＜0.05);近节指骨基底正中矢状面曲率半径(1)＞(2)＞(4)＞(5)＞(3),差异无统计学意义(P＞0.05).结论 人工掌指关节假体的设计:各指掌骨头假体关节面曲率应设计不同尺寸,而近节指骨基底关节面可设计成曲率一致的假体.

目的 通过解剖观测掌指关节结构以及掌指关节关节面形态,测量掌骨及近节指骨髓腔数据,为人工掌指关节假体的形态和尺寸设计提供解剖学依据.方法 13只成人新鲜冰冻手标本,解剖各标本保留掌指关节及其周围结构,测量掌指关节、掌骨以及近节指骨髓腔的相关数据.应用SPSS软件进行统计分析.结果 各掌指关节面大小不一,各掌骨头矢状径排列为(2)＞(3)＞(4)＞(1)＞(5);各掌骨头冠状径排列为(1)＞(2)＞(3)＞(4)＞(5);各近节指骨基底矢状径排列为(3)＞(2)＞(1)＞(4)＞(5);各近节指骨基底冠状径排列为(1)＞(2)＞(3＞(4)＞(5)差异显著(P＜0.05).结论 人工关节假体的设计应符合解剖学特点,尤其拇指掌骨侧假体更需区别对待;近节指骨基底形状无明显区别,可采用形状相同型号不一的模型进行关节设计.