目的 探讨掌侧经皮Herbert螺钉治疗急性手舟骨骨折的临床效果.方法 回顾性分析2017年6月至2019年6月山东省青岛市黄岛区人民医院收治的13例急性手舟骨骨折患者的临床资料,均行掌侧经皮Herbert螺钉内固定治疗,其中骨折分型改良Herbert B1型2例、B2型11例.统计分析13例患者的骨折复位情况、骨折愈合时间及并发症发生情况,末次随访时测量腕关节活动度,并采用改良Mayo评分评估腕关节功能.结果 13例患者均顺利完成手术并随访12～18个月,骨折复位良好,均达到骨性愈合,愈合时间3～7个月,平均(4.4±1.3)个月.末次随访时腕关节掌屈70°±5°,背伸47°±6°,桡偏13°±2°,桡尺偏34°±4°;改良Mayo评分为(94.62±3.80)分,腕关节功能优12例、良1例.结论 掌侧经皮Herbert螺钉内固定治疗Herbert B1、B2型急性手舟骨骨折临床效果满意,手术操作简单、创伤小,术后功能恢复良好,值得临床应用.

[目的]介绍采用带神经股前外穿支削薄皮瓣修复足踝大面积创面的手术技术与初步临床效果.[方法]对9例足踝大面积创面患者行带神经股前外穿支削薄皮瓣修复.术前用彩超辅助血管、神经定位.先切开皮瓣内侧,解剖股外侧皮神经和穿支血管,切开外侧缘完成游离,修剪脂肪至皮瓣厚5～8 mm.将游离皮瓣覆盖足部创面,吻合血管、神经.[结果]9例患者皮瓣均存活,随访10～60个月.末次随访时,皮瓣单丝触觉辨别次数和钝锐痛觉辨别次数较健侧低(P＜0.05);但皮瓣中心部位的触觉和钝锐痛觉恢复显著优于周边区域(P＜0.05),供区温哥华瘢痕评分为(4.78±1.48)分.[结论]用带神经股前外穿支削薄皮瓣修复足踝大面积创面术后皮瓣感觉恢复较充分,大小与对侧较匹配;患足可穿普通鞋无痛行走;供区副损伤较轻.

Objective:To analyze the feasibility of applying transcutaneous electrical nerve stimulator and high-frequency ultrasound in superficial nerve positioning for detection anatomical location in the area of lateral lip of the iliac crest by lateral cutaneous branch of subcostal nerve(LCSN). The significance of using the nerve as a free sensory superficial circumflex iliac artery perforator flap was discussed.Methods:The data of patients who underwent the repair of defects on limbs with free perforator flap or composite flap of superficial iliac circumflex artery carrying sensory nerve and the volunteers who agreed to have the location of the LCSN measured between October, 2018 and October, 2020 were collected. The LCSN were located by percutaneous electrical nerve stimulation and ultrasound, and the patients were measured and located during surgery. Using Passing-Bablok regression and Bland-Altman graph to evaluated the consistency between transcutaneous electrical nerve stimulation, ultrasound and the surgical positioning.Results:A total of 43 subjects, including 22 patients and 21 volunteers, were selected for locating the LCSN. Thirty-nine males and 4 females, with an average age of 39 years old and an average BMI of 24.08. The operation time of percutaneous nerve electrical stimulation was(6±1) min, and the detection distance was(80.7±5.9) mm. The high-frequency ultrasound was(23±4) min, and the distance was(81.2± 6.6) mm. The average operation time of surgical measured distance was(80.9±8.2)(65-100) mm, the diameter of nerve was(2.3±0.8)(1.0-4.0) mm, and the operation time was(5±1) min. A 95% CI of Passing-Bablok regression intercept and slope of operation, percutaneous electrical nerve stimulation and ultrasoundincluded 0 and 1, respectively. The points on Bland-Altman plot were distributed on both sides, and 95% CI of total mean difference, total intercept and slope included 0. Therefore, it was can be considered that the application of percutaneous electrical nerve stimulation and ultrasound in LCSN localization has good consistency.Conclusion:The location point of the LCSN crossing the iliac crest which detected by transcutaneous electrical nerve stimulation and high-frequency ultrasound detection was close to the measurement taken during the operation. It was also showed that both of them can be used for preoperative locationing of the sensory branch of the sensory nerve flap, optimizing the design of the flap, shortening the operation time, and reducing the unnecessary injury in operation.

[目的]观察真空封闭引流(VSD)联合富血小板血浆(PRP)治疗上肢大面积皮肤脱套伤的疗效.[方法] 2014年1月～2018年6月,共60例上肢大面积皮肤脱套伤患者纳入本研究.依据患者是否使用PRP,将患者分为两组.清创修整成中厚皮片后,28例患者采用单纯VSD,32例患者采用VSD联合PRP治疗.比较两组的临床资料.[结果]两组患者手术均顺利完成.两组患者手术时间、术中失血量的差异无统计学意义(P＞0.05).但是,VSD+PRP组术后换药次数、拆线时间、皮肤成活面积率、皮片坏死面积率和住院时间均优于VSD组(P＜0.05).随访16～42个月,平均(30.14±9.32)个月,两组患者伤肢疼痛逐渐减轻,功能逐渐恢复.末次随访时,两组患者色素沉着、皮片挛缩、瘢痕增生的发生率差异均无统计学意义(P＞0.05).[结论]真空封闭引流联合富血小板血浆治疗上肢大面积皮肤脱套伤可有效提高皮肤成活率,缩短住院时间.