[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.

目的 探讨指固有动脉皮支血管链逆行侧方皮瓣修复治疗手指软组织缺损的临床效果.方法 将30例行指固有动脉皮支血管链逆行侧方皮瓣修复治疗的患者设为观察组,30例行随意腹部皮瓣修复治疗的患者设为对照组,比较两组患者不同术后患指皮瓣存活情况、手术时间、住院时间、主动活动度、感觉恢复两点辨别觉及患者满意度的差异.结果 两组手指软组织缺损患者均随访1～2年,修复皮瓣均无感染,全部成活,Ⅰ期愈合,无明显手指瘢痕挛缩、畸形.观察组手术时间较对照组时间长,住院费用较对照组低(P＜0.05).观察组患者术后手指主动活动度优良率、感觉恢复、两点辨别觉及患者满意度均优于对照组(P＜0.05).结论 采取指固有动脉皮支血管链逆行侧方皮瓣修复治疗手指软组织缺损,不损伤指固有动脉及神经,血供可靠,重建皮瓣感觉良好,供区损伤小,并发症少,是一种理想的手术修复方式.

Objective To explore the microsurgical treatment and clinical effects of double-vane perforator flaps on the skin and soft tissue defects in the ankle.Methods These chronic wounds of 7 cases were all in the areas from the lower 1/3 of shin to malleolus and heel.Among them,4 cases were open fractures of tibiofibula and lower portion (Gustilo Ⅲb or Gustilo Ⅲc),2 cases were open fracture and dislocation of ankles,and 1 case was the postoperative wound of skin necrosis caused by closed Pilon fracture.There were multile small and irregularly shaped wounds in these 7 cases,and there were two wounds in 3 cases,in addition,there were more than 3wounds in 4 cases,and the mean area was 5.7 cm × 2.4 cm.Two pedicled perforator flaps of shins constituting double-vane shaped flaps were applied to cover wounds,and these constitutions such as posteromedial and anterolateral perforator flaps (2 cases),posterolateral and posteromedial perforator flaps (3 cases) and posterior and medial or lateral perforator flaps (2 cases) were designed.Results These 7 flaps all survived after operation,and 3 flaps swelled up to the second degree 1 week after operation and recovered to normal tension after 5 to 7 days.The distal end of two flaps blistered and skin edges appeared purple color,and these symptoms degraded after 10 to 14 days.One sinus was left over and exuded so that it delayed union after 30 days.The follow-up period ranged from 7 months to 26 months,and the average period was 11.5 months.The flaps appeared well with good texture.Six months after operation,two-point discrimination was from 7 mm to 14 mm,and the average was 12 mm.According to AOFAS standard,5 cases were excellent,and 2 cases were good.The recovery of function was satisfactory.Conclusion The blood supply of pedicled perforator flap is rich,and the operation is relatively easy.The application of assembling double-vane flaps to repair more than two small wounds or one large wound solves difficulties that multiple defects can be covered simultaneously,and its success rate is high.Moreover,it provides a promising method to restore multiple wounds in the ankle.

目的：探讨高龄不稳定性转子骨折采用半髋关节置换治疗的临床效果。方法采用双动人工股骨头置换术治疗70岁以上股骨转子间粉碎性骨折48例。骨折按Evans分型，ⅢA型l4例，ⅢB型20例，Ⅳ型8例，Ⅴ型6例。手术取外侧切口前入路，术中争取将大、小转子骨折块复位，用薇乔线和（或）钢丝捆扎和（或）捆绑固定，安放人工股骨头。结果手术时间平均85 min，平均出血量350 ml，住院时间平均l7.5 d。Harris关节功能评价：优26例，良l6例，优良率达87.50%（42/48）。无一例死亡。平均随访l8个月。合并下肢深静脉栓塞2例，泌尿系统感染42例。结论人工半髋关节置换术具有术后功能恢复快、负重活动早，可避免长期卧床并发症等优点，是治疗高龄不稳定性股骨转子间骨折较为合理的手术方法。

Pilon骨折是胫骨下端的高能量损伤［1］。这一骨折的特点：胫骨远端具有典型的不同程度的压缩粉碎性骨折的表现，累及关节面关节软骨的原发性损伤以及永久性关节面不平整导致不良的预后［2，3］。约75％～85％的Pilon骨折合并有同侧腓骨骨折。正因为Pilon骨折是高能量损伤，不仅骨折粉碎严重，关节面塌陷较重，还往往伴有软组织损伤，尤其是Rüedi-Allg?wer Ⅱ和Ⅲ型Pilon骨折。 Pilon骨折的并发症较多，其早期的并发症主要为皮肤切口的并发症，因为小腿下段前内侧软组织覆盖菲薄，且常受外物及骨折端的损害［4］。胫前内侧弧形切口为较为常用的Pilon骨折切开复位内固定的手术切口，钢板多安置在胫骨内侧皮下，切口破裂的风险较大［5，6］。因此，研究胫前内侧弧形切口愈合不良的危险因素，对于防止Pilon骨折早期并发症具有重要意义。

Objective To summarize the clinical result of the use of radial dorsal of thumb neurocutaneous fascia pedicle flap for repairing the thumb pulp defect .Methods From May 2010 to January 2012,18 digital finger pulp soft tissue of thumb were repaird in our de-partment.The dorsal cutaneous nerve of thumb was coapted with the hurt finger's inherent nerve.Results Eighteen cases of flap survived completely,only 2 cases with pale skin flap after given heat preservation ,vasodilators and symptomatic treatment were gradually restored .After skin off,donor site healed naturally ,skin graft survived completely.Fifteen cases were followed up from 4 months to 18 months with fine tex-ture,not clumsy,good shape and the sensation with 2-PD was of 5~10mm.Conclusion The radial dorsal of thumb neurocutaneous fascia pedicle flap is a ideal method for the thumb pulp defect ,with good shape,constant anatomical position ,simple operation,small injury of donor site,and postoperative sensory recovery satisfaction .

目的 探讨应用游离前臂骨间背穿支皮瓣修复手部皮肤缺损的临床效果.方法 应用游离前臂骨间背穿支皮瓣修复手指腹部皮肤缺损8例,背部3例,指侧4例,转移皮瓣面积大小(2.0~4.0)cm×(2.0~6.0)cm.结果 本组14例皮瓣全部成活,1例部分成后,随访6周~6个月,修复手部皮肤外观功能满意.结论 该皮瓣是以前臂骨间背动脉穿支为蒂,具有不损伤前臂主干血管、血管解剖恒定、皮瓣较薄、供区损伤小与受区皮肤质地颜色相近等特点,适合修复手指皮肤缺损.

<正>临床上手部皮肤缺损情况比较多见,皮瓣修复方法也较多,如临指、侧方、掌背皮瓣、腹部带蒂皮瓣、游离足拇趾腓侧皮瓣、游离小腿外侧皮瓣等,各有优缺点。而前臂穿支皮瓣是在传统皮瓣的基础上演变而来,该皮瓣是以前臂尺动脉肌间隙穿支为蒂,尺动脉肌间隙穿支发自尺动脉近中段,起始点距肱骨内上髁下方(9.2±0.2)cm,经指浅屈肌与

<正>临床上手部关节功能损伤较多见,因近指间关节与掌指关节、拇指腕掌关节活动度大,为手部重要关节,损伤后不宜行关节融合,既往多行关节成形、不吻合血管自体关节移植

目的 探讨吻合血管肋骨移植修复股骨上段转子区骨缺损的可行性和方法。 方法 根据肋骨自然弧度与股骨转子区颈干角的相近似的解剖特点，采用游离肋骨移植修复股骨上段（端）转子区骨缺损。临床应用3例，先将股骨转子部位病灶清理后选择后段弧度适宜的肋骨段并修剪成合适的长度植入缺损区，血管蒂选择肋间后动脉及其延续的肋间固有动脉，与受区旋股外侧动脉横支或降支与肋间血管吻接。其余腔隙用自体或异体松质骨条填充，并用钢板或外固定架将病灶区固定，术后石膏或支具外固定。 结果 术后随访6～ 16个月，植入骨在术后9个月达骨性愈合。患者3个月下地行走，6个月显示肋骨、骨填充物与受区生长良好，完全融合，9～11个月达骨性愈合，局部病灶未见复发。 结论 吻合血管肋骨移植修复股骨上段及转子间缺损，肋骨弧度正好符合股骨从转子部位颈干角的生理曲度，不需要塑型。移植骨血运丰富，骨生长迅速，临床效果良好。

<正>患者,女,6岁。因从2 m高处坠下致左肘部肿胀畸形入院。患者系足月顺产,父母非近亲结婚,否认家族病史。患者出生后发育迟缓,6岁智力相当于3岁儿童,语言幼稚,日常体温在38℃左右,反复发热、全身无汗、发热时烦躁不安,经吹冷风或冷水冲洗后方能安静。患者曾出现左足、右胫骨、右