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:本文主要分析活血止痛散应用在踝部软组织运动损伤治疗中所取得的临床效果,对该药物外洗治疗在疗效中产生的影响进行评估.方法:研究对象主要选取我单位2017年02月-2019年02月期间收治的踝部软组织运动损伤患者164例,按照患者接受的治疗方案展开分组纳入,对照组(例数=82例)在治疗期间施予常规治疗,联合组(例数=82例)在治疗期间施予活血止痛散进行外洗治疗,对对照组、联合组患者疗效展开分析.结果:联合组经过治疗后有效率为96.34％,对照组经过常规治疗之后有效率为82.93％,联合组在应用外洗治疗后治疗有效率比对照组优,组别间结果数据分析和比对有显著差异(P<0.05).结论:踝部软组织运动损伤接受活血止痛散进行外洗治疗,可有效的改善其症状,可推广.

目的:本文主要对手法+康复训练配合应用在踝关节运动损伤患者(陈旧性单纯性)治疗工作中的应用价值展开探究.方法:纳入本次研究的主体为2017年02月~2019年02月期间我单位收治的踝关节运动损伤患者(陈旧性单纯性)80例,按照患者接受的治疗方案展开分组纳入,对照组(例数=40例)进行康训练治疗,干预组(例数=40例)在对照组的基础之上,患者还接受手法治疗配合,对对照组和干预组患者治疗效果展开分析.结果:干预组经治疗后其治疗有效率比对照组更优,组别间结果数据分析和对比中有明显差异(P<0.05).干预组经治疗后MBI评分比对照组高,组别间结果数据分析和对比中有明显差异(P<0.05).结论:踝关节运动损伤患者(陈旧性单纯性)在日常治疗之中接受手法+康复训练配合,保障治疗效果得以提升,可推广.

目的 探讨膝关节后外侧结构慢性损伤的MRI表现.方法 20例膝关节损伤患者均行高场MRI检查.总结膝关节后外侧结构(外侧副韧带、腘肌腱、腘腓韧带)损伤后的形态、长度、宽度及信号特点.结果 20例患者5例合并胫骨外侧平台边缘骨质增生,20例合并关节周围软组织肿胀,8例合并关节腔及髌上囊内积液,6例合并股骨远端外髁骨髓水肿,8例合并前交叉韧带慢性撕裂,5例合并后交叉韧带慢性撕裂,3例合并前后交叉韧带慢性撕裂.MRI信号特点:后外侧结构损伤呈不均匀长T1、长T2信号;组成膝关节后外侧结构的韧带及肌腱完全或部分肿胀,部分肌腱或韧带完全断裂,周围合并出血,出现不均混杂信号.外侧副韧带平均长度(68.74±4.56)mm、平均宽度(8.37±2.75)mm;腘肌腱平均长度(59.82±5.41)mm、平均宽度(12.58±1.43)mm;腘腓韧带平均长度(13.87±1.39)mm、平均宽度(6.23±1.02)mm.结论 韧带及肌腱肿胀、后期部分或完全断裂、韧带及肌腱信号增高等是膝关节后外侧结构慢性损伤的特征性表现.

Objective To evaluate curative efficacy of vancomycin calcium sulphate or vancomycin cement applied topically to treat osteomyelitis after surgery of open tibial fracture.Methods From May 2005 to August 2013,418 patients with osteomyelitis following surgery of open tibial fracture were treated in our center.They were 257 males and 161 females,with an average age of 35.6 years (from 19 to 55 years).There were 163 cases of Gustilo type Ⅰ,132 cases of Gustilo type Ⅱ,56 cases of Gustilo type ⅢA,and 67 cases of Gustilo type Ⅲ B.The initial fractures were fixated at other hospitals with plate in 334 cases,with intramedullary nails in 21 cases,and with external fixators in 63 cases.By the Cierny-Mader classification,the osteomyelitis was type Ⅰ in 21 cases,type Ⅱ in 26 cases,type Ⅲ in 366 cases,and type Ⅳ in 5 cases.We removed the internal hardware and fixated all the fractures with external fixators.For the 266 patients without bone exposure,vancomycin calcium sulfate beads (n =201) or vancomycin cement (n =65) were inset into the wounds; for the other 152 patients with bone exposure,vancomycin calcium sulfate beads were inset into the wounds which were then repaired by flap transfer.Results Follow-ups ranged from 12 to 108 months (average,37.5 months).Of the 201 patients treated with only vancomycin calcium sulfate beads,osteomyelitis was healed in 174 (86.6％) and fracture united in all (100.0％).In the 65 patients treated with only vancomycin cement,osteomyelitis was healed in 57 (87.7％) and fracture united in all (100.0％).In the 152 patients treated with vancomycin calcium sulfate beads and flap transfer,osteomyelitis was healed in 131 (86.2％) and fracture united in 147 (96.7％).Osteomyelitis was healed for the 362 patients after an average time of 3.0 months (from 2 to 14 months).Fractures united for the 413 patients after an average time of 14.0 months (from 3.5 to 20.0 months).Pin track infection was found in 23 cases.Conclusions The optimal fixation for open tibial fracture complicated with osteomyelitis is external fixators.For the wounds without soft tissue defects,vancomycin calcium sulfate beads and vancomycin cement are similar in high therapeutic efficacy.For the wounds with soft tissue defects,combination of vancomycin calcium sulfate beads and flap transfer can lead to satisfactory treatment outcomes.

Objective To evaluate vacuum sealing drainage (VSD) in limb wound care for better countermeasures against its related complications. Methods A retrospective study was done to analyze the outcome of 320 cases of VSD.The related complications,causes and countermeasures were statistically analyzed.The clinical effects Of 4 kinds of commonly used sealing membranes were cornpared. Results The block of drainage passage occurred in 309 cases(96.6%),being the commonest complication,for which the reopening technique was a good solution and precaution.Negative pressure sufficiency was found in 62 cases(19.4%)and could be resolved by alternative closing of partial drainage tubes.Of the 4 widely used sealing membranes,Tegaderm Transparent Dressing had the best clinical effect,but Surgical Adhesive Drape proved to be the most practicable in China.Of the 36 cases of serious wounds,35(97.2%)healed and their wound condition was ready for further skin graft or flap surgery after 2 times of VSD. Conclusions VSD works best in care of serious wounds,but it requires frequent observations and timely measures to minimize occurrence of complications.