目的:探讨应用分叶股前外侧穿支皮瓣（ALTPF）游离移植修复四肢软组织缺损创面的手术方法。方法:2010年1月-2021年5月，根据四肢软组织缺损、形态不规则、不连续的特点，海南中德骨科医院手足外科设计切取分叶ALTPF游离移植修复四肢软组织缺损创面26例，其中10例大面积缺损面积为13 cm×12 cm~22 cm×19 cm，13例为邻近不相连的创面，3例为贯通型创面。供区创面均直接缝合。出院后主要通过门诊、电话、微信等方式进行定期复查随访，观察皮瓣的血运、肤色、外观、出汗、质地、温度、痛觉、触觉、TPD、有无破溃及供区恢复情况。结果:术后26例患者移植皮瓣均成活。其中2例皮瓣边缘小面积坏死，反复换药后愈合；1例术后48 h内发生静脉危象，积极探查处理，重新吻合血管后皮瓣成活；1例24 h内发生血肿压迫出现血管危象，给予拆除部分缝线充分引流后皮瓣成活。24例患者获得随访，随访时间6~18个月，平均14个月，皮瓣外形良好、无臃肿，质地柔软，色泽正常，感觉功能恢复良好。供区仅留线形瘢痕，外观、功能无明显影响。参照《手外科手术学》的皮瓣综合评定标准，结果优18例、良6例。结论:分叶ALTPF疗效满意，是修复四肢创面的一种较好的手术方法。

Objective:To explore the surgical procedure and clinical effect of a free transverse carpal flap based on the superficial palmar branch of radial artery in reconstruction of soft tissue defect of digits.Methods:From February 2014 to May 2022, 17 cases of soft tissue defects with tendon or phalanges in digits were treated in the Department of Hand and Foot Surgery, Hainan Zhongde Orthopaedic Hospital. All 17 cases were treated by the free transverse carpal flap based on the superficial palmar branch of radial artery. The flap size was 2.0 cm×2.0 cm-4.5 cm×2.0 cm. The anastomosed artery was digital artery or common digital artery, and the vein was the accompanying vein or superficial subcutaneous vein. All donor sites were directly sutured. Preventive measures of anti-infection, anticoagulation, anti-vasospasm and symptomatic treatment were given after surgery. After discharge of patients, scheduled follow-ups were conducted through outpatient clinic, telephone or WeChat interviews to observe the clinical effects. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, hand functional recovery was good in 14 cases and good in 1 case.Results:All 17 flaps had survived with 16 completed the postoperative follow-up. Follow-ups ranged from 6 to 18 months, with a mean of 14 months. At the last follow-up, the flaps were good in shape, soft texture, in normal flexion and extension and with good protective sensation. Two-point discrimination (TPD) was 8-12 mm, with an average of 8 mm. There was no other adverse effect in the donor sites except a linear scar.Conclusion:Application of transverse carpal flap based on the superficial palmar branch of radial artery from same limb to restore the digit function is feasible. It is an ideal surgical procedure of flap transfer.

目的 探讨跗骨窦切口治疗跟骨关节内骨折患者的临床疗效.方法 选取2017年9月至2020年9月本院收治的30例跟骨关节内骨折患者作为研究对象,按照随机数字表法分为常规组(传统外侧L型切口治疗)与研究组(跗骨窦切口治疗),各15例.比较两组手术治疗优良率、手术时间、骨折愈合时间、切口大小、手术失血量、术后24 h疼痛评分、并发症发生情况、Gissane角、Bohler角以及Maryland评分、Kofoed评分.结果 研究组手术治疗优良率为93.33％,略高于常规组的80.00％,但组间比较差异无统计学意义;研究组手术时间、骨折愈合时间均短于常规组,切口大小小于常规组,手术失血量少于常规组,术后24h疼痛评分及并发症发生率均低于常规组(P＜0.05);术后12个月,两组影像学技术评价Gissane角、Bohler角及Maryland评分、Kofoed评分均高于术前(P＜0.05),但两组比较差异无统计学意义.结论 跗骨窦切口与传统外侧L型切口治疗跟骨关节内骨折患者均具有一定疗效,但前者具有疼痛轻、微创、术后并发症少、骨折愈合速度快等优势,值得临床推广应用.

目的:比较掌背动脉岛状皮瓣与游离尺动脉腕上穿支皮瓣修复手指软组织缺损的疗效及安全性.方法:回顾性纳入2018年1月-2019年12月笔者医院收治的95例(95指)手指软组织缺损患者,按照治疗方案的不同分为A组(n=46)与B组(n=49),A组采用游离尺动脉腕上穿支皮瓣进行修复,B组采用掌背动脉岛状皮瓣进行修复.比较两组皮瓣存活及供区愈合情况、治疗效果、手功能情况及不良反应情况.结果:两组均获得随访,皮瓣均成活.A组40例供区一级愈合,6例供区再处理后愈合;B组47例供区一级愈合,2例供区再处理后愈合.B组治疗优良率明显高于A组[87.76％(43/49)vs 78.26％(36/46)],B组手功能效果优良率明显高于A组[89.80％(44/49)vs 73.91％(34/46)],差异均有统计学意义(P<0.05).两组均没有发生明显不良反应.结论:掌背动脉岛状皮瓣对手指软组织缺损的修复效果优于游离尺动脉腕上穿支皮瓣.

目的:探讨游离 甲瓣联合髂骨移植在I~II度拇指缺损全形再造术中临床应用的选择和治疗效果。 方法:2018年5月至2021年3月,收治拇指缺损患者18例,I度缺损10例,II度缺损8例。根据拇指缺损长度设计切取同侧 甲瓣联合髂骨移植再造拇指,将 甲瓣趾腹做改良"V"字形切口,改善拇指指腹外观, 甲瓣切取游离皮瓣修复或人工真皮覆盖修复,定期随访。 结果:I~II度拇指缺损应用改良 甲瓣联合髂骨移植再造拇指,术后供、受区切口一期愈合。术后随访6~24个月,再造手指外形美观,接近健侧拇指,功能良好。指腹感觉恢复S 3~S 4,TPD为6~10 mm。按中华医学会手外科学会上肢部分功能评定试用标准进行评定:优12例,良6例。足部供区保留全部足趾,外形满意,不影响走路跑步,无疼痛等不适感。 结论:甲瓣联合髂骨移植在I~II度拇指缺损全形再造术中临床较为实用,再造拇指外形逼真,感觉、运动功能恢复满意。

目的 探讨微创经皮钢板固定术(MIPPO)和交锁髓内钉(IMN)治疗胫骨远端关节外骨折的疗效及美国足外科协会(AOFAS)踝-后足评分比较.方法 选取2019年6月-2020年6月收治的胫骨远端关节外骨折患者92例,根据随机数字表分为对照组(46例)与研究组(46例),对照组患者予IMN手术治疗,研究组患者予MIPPO手术治疗,比较两组患者临床疗效指标,治疗前后AOFAS踝-后足评分与炎症因子[白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)]与术后并发症.结果 较对照组,研究组患者手术时间与骨折闭合时间均更短(P＜0.05),但两组患者术中出血量与住院时间比较(P＞0.05);治疗前两组AOFAS踝-后足评分、IL-1、TNF-α比较(P＞0.05),治疗后,两组患者AOFAS踝-后足评分、IL-1、TNF-α均明显提高,其中较对照组,研究组IL-1、TNF-α明显更低(P＜0.05),但两组AOFAS踝-后足评分比较(P＞0.05);较对照组,研究组患者并发症更少(26.09％ vs10.87％,P＜0.05).结论 MIPPO与IMN手术用于胫骨远端关节外骨折的治疗均可有效改善患者足踝功能,但较IMN治疗,MIPPO治疗引发炎症反应更小,其患者恢复更快,且并发症更少,更具优势.

目的:比较小腿岛状穿支蒂螺旋桨皮瓣与股前外侧皮瓣修复足踝部复合组织缺损的疗效.方法:按照随机数字表法将2019年1月-12月笔者医院收治的40例足踝部复合组织缺损患者分为A组与B组,每组20例.A组患者采用小腿岛状穿支蒂螺旋桨皮瓣进行修复,B组患者采用股前外侧皮瓣进行修复,术后随访12个月.比较两组的手术时间、皮瓣愈合时间、皮瓣成活率、术后并发症发生率、AOFAS踝-后足评分及皮瓣感觉评分.结果:两组的皮瓣成活率均为100.00％,B组的手术时间、皮瓣愈合时间均明显短于A组,差异具有统计学意义(P<0.05).A组与B组的术后并发症发生率分别为15.00％、10.00％,两组之间比较差异无统计学意义(P>0.05).随访结束时,两组的AOFAS踝-后足评分、皮瓣感觉评分均较术前明显增高(P<0.05),B组的增加幅度更加明显(P<0.05).结论:股前外侧皮瓣对足踝部复合组织缺损的修复效果优于小腿岛状穿支蒂螺旋桨皮瓣.

目的:探讨应用足底皮肤异位寄养原位回植治疗足部脱套伤的临床治疗效果。方法:2014年3月至2020年1月,应用足底皮肤异位寄养原位回植治疗足部脱套伤5例。足部创面从踝关节以远完全撕脱,创面污染。将全足部撕脱的皮肤分为足背和足底两部分,足背皮肤急诊削薄后一期回植,撕脱足底皮肤修剪成全厚皮移植到大腿前外侧,足底移植皮肤面积18 cm×10 cm~24 cm×13 cm。术后定期门诊随访,观察足部回植皮肤成活情况并定期随访。结果:术后随访5~18个月,术后4例足部回植皮肤全部成活,1例边缘出现部分坏死,术后经清创植皮后痊愈；患肢皮肤回植成活后下地走路足底皮肤耐磨,无破溃,足底感觉麻木,半年后逐渐减轻。结论:足底皮肤异位寄养原位回植治疗足部脱套伤效果满意,临床较实用。

目的 比较老年背侧移位桡骨远端骨折患者的非手术治疗与掌侧锁定钢板内固定的临床效果.方法 将患者随机分配到石膏夹板非手术治疗组(n=55)和掌侧锁定板固定手术治疗组(n=55).结果 指标为患者腕部评估(PRWE)评分、手臂、肩膀和手部残疾(DASH)问卷评分、EuroQol-5维度(EQ-5D)评分、活动范围、握力、影像学结果和并发症发病率.以上指标在治疗后3个月和6个月时由研究人员进行评估.结果 治疗后3、6个月,两组PRWE中位数评分、DASH评分、握力差异有统计学意义(P<0.05).治疗后3个月和6个月时,X线测量结果证明掌侧锁定钢板固定效果更优.两组6个月后术后并发症发生率相似,非手术组主要并发症为11％,掌侧锁定钢板组主要并发症为14％,两组比较差异无统计学意义(P=0.505),非手术组次要并发症为13％,掌侧锁定钢板组次要并发症为20％,两组比较差异无统计学意义(P=0.214).结论 对于患有不稳定背侧移位的桡骨远端骨折的老年患者,较非手术治疗,使用掌侧锁定钢板治疗具有更多的临床获益.

Objective:To compare two different methods for the harvest of the costal cartilage cortical slice with perichondrium preserved for rhinoplasty patients, and to explore a simple and less invasive method for the costal cartilage cortical slice.Methods:From September 2019 to December 2020, the rhinoplasty patients using the techniques of nasal tip "double arch" stent combined with prosthesis were selected in Shanghai Time Plastic Surgery Hospital, they were randomly divided into observation group and control group. In the observation group, only the cortical slice of costal cartilage with perichondrium was cut and the continuity of costal cartilage was preserved. While in the control group, with the superficial perichondrium preserved, the whole costal cartilage was dissected first, and then pruned it and harvested the cortical slice of costal cartilage with perichondrium. The operation were performed by the same clinicians in both groups. Different variables were compared between the two groups, including the operation time, intraoperative blood loss, length of incision, the degree of chest pain after postoperative 6, 24, 72 h, 1 week, the incidence of intraoperative complications and so on. The severity of chest pain was assessed by visual analogue scale (VAS). The measurement data of the two groups were analyzed by t-test, and the enumeration data were analyzed by χ2 test. Results:For both observation group and the control group, 61 patients were included. In the observation group, there were 3 males (4.9%) and 58 females (95.1%), aged (28.6±5.4) years old, and BMI (21.76±1.65) kg/m 2. In the control group, there were 2 males (3.3%) and 59 females (96.7%), aged (45.8±5.7) years old, and BMI (22.25±1.47) kg/m 2. There were no significant differences in gender composition, age and BMI between the two groups ( P>0.05). The double arch stent of nasal tip could be made by the costal cartilage cortical slices obtained in the two groups. In the control group, two cases of pleural rupture occurred and their prognosis was good after effective treatment, with no complications such as hematoma, infection or pleural injury. In the observation group, there were no complications such as hematoma, infection or pleural injury. The operation time, incision length and intraoperative blood loss in the observation group were significantly lower than those in the control group [(18.54±3.62) min vs. (25.75±3.75) min; (1.68±0.26) cm vs. (2.16±0.32) cm; (16.79±7.86) ml vs. (25.46±8.49) ml; P<0.05]. The VAS score in the observation group was lower than that in the control group after postoperative 6, 24, 72 h, 1 week [(2.76±0.62) vs. (3.87±0.68)scores; (2.37±0.45) vs. (3.12±0.55) scores; (1.76±0.45) vs. (2.57±0.53) scores; (1.17±0.44) vs. (1.85±0.51) scores; P<0.05]. Conclusions:Compared with the conventional method of whole costal cartilage harvest, the method of harvesting the costal cartilaginous cortical slice with the costal perichondrium preserved and preserving the continuity of the costal cartilage can reduce the trauma and bleeding, shorten the operation time, simplify the operation process, and significantly reduce the postoperative chest pain.

报道1例2019年8月收治的23个月幼儿足远段并 趾完全离断再植病例。患儿右前足断端创面组织碾挫严重,彻底清创后应用逆行再植法行断足及断趾再植术,再植足趾全部成活。术后17个月随访,患足外观及形态恢复满意,感觉及功能恢复良好。

目的:探讨应用带感觉神经的股前外侧穿支皮瓣（ALTPF）修复足底软组织缺损创面的治疗效果。方法:2013年4月至2019年7月,对9例足底伴骨和肌腱外露的软组织缺损的患者,一期予以清创、VSD敷料覆盖创面,待创面稳定后,二期应用带感觉神经的ALTPF进行修复。皮瓣切取面积为10.0 cm×7.0 cm~25.0 cm×14.0 cm,均与受区皮神经缝接重建感觉。术后定期随访,评估临床效果。结果:本组术后皮瓣无血管危象发生,9例皮瓣全部顺利成活,1例皮瓣远端边缘出现少量坏死,创面经换药、植皮处理后完全愈合。术后随访6~23个月,平均13.6个月,皮瓣质地耐磨无破溃,恢复保护性感觉,无站立疼痛,无色素沉着,外形不臃肿,不影响穿鞋,无需再次修薄处理。皮瓣供区愈合良好,皮肤感觉无明显异常。至末次随访时,皮瓣感觉恢复情况为：S 2级1例,S 3级3例,S 3+级5例。 结论:应用带感觉神经的ALTPF修复足底软组织缺损,效果确切,外形美观,质地耐磨,部分感觉功能得到恢复。

目的:探讨游离腓骨骨皮瓣联合Masquelet膜诱导技术治疗创伤性跖骨缺损的临床效果。方法:2015年8月至2020年6月,应用游离腓骨骨皮瓣联合Masquelet膜诱导技术治疗创伤性跖骨缺损12例。跖骨缺损长度3.2~9.5 cm,截取的腓骨瓣长度4.8~9.5 cm。其中单独第1跖骨缺损5例,同时合并有第2~4跖骨缺损7例。急诊清创后按照Masquelet膜诱导技术操作要求将人工骨水泥填充骨缺损及覆盖肌腱裸露创面,等待约2周后创面分泌物减少、感染初步控制后再行骨与软组织缺损的修复。其中所有第1跖骨骨缺损采取腓骨骨皮瓣移植,将腓动脉与足背动脉吻合4例,2条腓静脉与足背静脉吻合,腓动脉与胫前动脉吻合8例。第2~4跖骨缺损切取自体髂骨植骨术。骨皮瓣供区切取皮瓣宽度不超过5.0 cm直接缝合,宽度大于5.0 cm的、切取全厚皮片游离移植修复。结果:术后门诊随访6~24个月,所有腓骨皮瓣成活,皮瓣外观、色泽正常,质地柔软,无慢性溃疡,术后12周左右骨愈合良好,顺利拆除内固定,步态正常。结论:吻合血管的腓骨皮瓣游离移植修复跖骨缺损,血运丰富、骨愈合速度快,结合Masquelet膜诱导技术抗感染能力更强,有一定的应用价值。

目的:探讨顺行克氏针髓内固定在第五掌骨颈骨折中的临床应用及效果.方法:选取我院2016年1月至2019年7月之间收治的第五掌骨颈骨折患者10例,在C臂下机透视下对10例患者进行第五掌骨颈新鲜骨折采用手法复位,顺行髓内钉固定.结果:术后对10例患者进行7～12个月的随访,10例骨折患者均获得解剖复位,达到骨性愈合,第五掌指关节活动正常,无僵硬.结论:新鲜第五掌骨颈采用顺行髓内针固定治疗,操作简便、手术时间短、固定可靠、对肌腱激惹小,临床效果满意.

目的 探讨应用游离髂腹股沟骨皮瓣修复足部复合组织缺损的临床疗效.方法 2014年9月-2018年6月,应用游离髂腹股沟骨皮瓣修复足部开放性跖骨缺损9例,术后观察皮瓣成活情况及影像学检查骨愈合情况.结果 9例皮瓣全部成活,术后随访6～20个月,平均12个月,皮瓣外形不臃肿,质地与周围皮肤接近,骨愈合良好,患肢行走步态正常,功能恢复满意.结论 游离髂腹股沟骨皮瓣修复足部复合组织缺损可取得满意的治疗效果,值得临床推广应用.

Objective To investigate the operation method and clinical value of peroneal artery perforating fascia flap combined with reconstruction of achilles tendon insertion point to repair heel radial injury in children. Methods From Sep. 2014 to Feb. 2019, 9 cases of children heel radial injury was repaired by peroneal artery perforating fascia flap transplantation, and the achilles tendon insertion point was reconstructed simultaneously. Results All 9 cases of flaps survived, in 1 case, the skin margin at the end of the flap had congestion, but healed after changing dressing and disassembling thread. 9 cases were followed up for 6-18 months, with an average of 10 months, the skin flap had the similar color and texture as the surrounding skin, no obvious bloated appearance, normal ankle active metatarsal flexion and dorsiflexion and normal walking gait. Conclusion Peroneal artery perforating flap combined with reconstruction of achilles tendon insertion point is a better method to repair severe heel radial injury in children.