胫腓钩与螺钉治疗下胫腓联合损伤的疗效比较

目的比较分析螺钉固定与胫腓骨钩固定治疗下胫腓联合损伤的临床疗效。方法回顾性分析我院2000年7月—2009年7月手术治疗并获得随访的38例下胫腓联合损伤患者的临床资料。其中螺钉内固定26例,胫腓钩内固定12例,根据美国足与踝关节外科协会踝与后足功能评分（AOFAS Ankle-Hindfoot Scale）标准对其术后疗效进行评定。结果所有患者随访6个月,拉力螺钉固定组取出螺钉时间为术后8周～12周,优10例,良7例,可6例,差3例,其中有2例患者术后11周发现螺钉断裂,优良率为65.4%;胫腓骨钩固定组取出胫腓骨钩时间为8周～12周,优8例,良3例,可1例,优良率为91.7%.结论下胫腓联合损伤时采用胫腓钩固定的效果要好于螺钉固定。     

外固定器治疗胫腓骨骨折体会

目的评价外固定架手术方法在胫腓骨骨折患者治疗中的作用及地位。方法回顾2003年2月—2008年2月运用外支架固定治疗22例胫腓骨骨折患者,其中男17例,女5例,平均年龄42岁。开放性骨折18例,闭合性骨折4例;粉碎性骨折16例,其中复合伤13例。结果22例患者均获8个月～16个月的随访,骨折均恢复良好,膝踝关节功能良好。结论外支架治疗胫腓骨骨折作为手术和保守治疗间的补充,尤其对于体弱及伴有软组织损伤的患者是一种有效且安全的治疗方法。     

Vascular basis of free transfer of proximal epiphysis and diaphysis of fibula: an anatomical study

Introduction  Transfer of proximal epiphysis and diaphysis of fibula is a treatment of bony defects in children. Although there are few reports of this procedure, different arteries or combination of arteries have been used as supplying pedicle and the reported success rates are different. This is an anatomical study to clarify the vascular anatomy of this region. Materials and methods  A total of 16 fresh cadavers were enrolled. An incision was made in the popliteal fossa to find the popliteal artery, which was dissected distally and the lateral inferior genicular artery, anterior tibial artery, tibioperoneal trunk and its bifurcation were located. In eight subjects popliteal artery was cannulated above the level of femoral condyles and injected by latex. In the next eight cases the same material was injected in the anterior tibial artery. The next steps of dissection were done by 4.3-loupe magnification. Lateral inferior genicular artery was dissected from its origin to the fibular head and branches of anterior tibial artery were also dissected. In three specimens, the fibula and its supplying arteries were removed after dissection and put in diluted hydrochloric acid to be opened for studying the medullary vasculature. Results  This study confirms the existence of not only periosteal but also intramedullary anastomosis between artery of the neck and peroneal artery. Artery of the neck was usually a branch of anterior tibial artery and in 24% of the subjects a branch of popliteal artery. In the latter condition the pedicle would be too short to permit the surgeon to do this surgery. Therefore preoperative angiography is mandatory to identify the origin of the artery of the neck. Conclusion  According to these dissections, a classification system of arterial supply of proximal fibular epiphysis is introduced in this article.     

小腿严重开放性骨折伴软组织缺损的治疗

目的 探讨小腿严重开放性骨折伴软组织缺损(Gustilo ⅢB型或ⅢC型)的治疗方法.方法 1990年1月至2008年12月,收治开放性胫腓骨骨折53例,其中Gustilo ⅢB型45例,ⅢC型8例.软组织缺损面积为6 cm×4 cm～18 cm×8 cm,8例伴骨缺损.急诊行骨折复位同定和血管修复,二期对软组织或骨缺损采用13种53块组织瓣移位或移植修复.骨折外固定支架固定35例,内固定16例,骨牵引及石膏固定2例.皮瓣或肌皮瓣47例,骨皮瓣6例.结果 51例获得随访,时间8个月～9年(平均18个月).骨折顺利愈合44例,愈合时间3.5～9.5个月,平均6.5个月.骨延迟愈合4例,骨不愈合3例,经手术植骨(5例)或骨外固定支架加压同定治疗(2例)均治愈.组织瓣移植53块,成活51块,坏死2块,成活率为96.2%.无截肢病例.结论 Gustilo ⅢB型或ⅢC型小腿严重开放性骨折,初期清创并采用以骨外支架为主的方法固定骨折,二期采用适当组织瓣移植修复软组织或骨缺损,是安全有效的治疗策略.     

改良游离腓骨移植联合红骨髓骨泥填充治疗青壮年股骨头坏死

目的探索青壮年股骨头缺血性坏死的治疗方法并进行疗效评价。方法2003年10月-2009年2月,采用改良式吻合血管的游离腓骨移植联合自体红骨髓骨泥填充治疗青壮年股骨头缺血性坏死32例（38髋）。结果术后对32例患者经6个月～5年随访,根据症状改善情况及影像学变化,采用Harris评分进行评价,优28例,良7例,可3例,优良率92.1％．结论改良式吻合血管的腓骨移植联合自体红骨髓骨泥填充治疗青壮年股骨头缺血性坏死具有创伤小、手术时间短、股骨头修复效果可靠,关节功能恢复好等优点,能够阻止或延缓病情发展,是治疗青壮年股骨头缺血性坏死的有效方法。     

Stress Fracture of the Proximal Fibula in Military Recruits

Background

We wanted to report on stress fracture of the proximal fibula and to suggest the pathomechanism of this fracture.

Methods

Between April 2004 through April 2005, the military recruits who complained of leg pain during the 6 weeks basic training in the Republic of Korea Marine Corps education and training group were evaluated according to their clinical manifestations and plain radiographs.

Results

Twelve recruits of 635 recruits who complained leg pain were diagnosed as having fibular stress fracture. Eleven cases (10 recruits) appeared at the junction of the proximal and middle 1/3 of the fibula and 2 cases (2 recruits) were in the middle 1/3 of the fibula, as assessed radiologically. Tenderness was the most reliable clinical manifestation. All the fractures occurred after repetitive walking or jumping in a squatting position. Conservative treatments that included bed rest, immobilization and non-steroidal anti-inflammatory drugs administration according to the symptom severity were satisfactory.

Conclusions

Proximal fibular stress fracture is not rare in military recruits. The shearing force on the proximal fibula and the repetitive stress by walking or jumping in a squatting position contribute to the stress fracture of the proximal fibula.     

腓骨皮瓣移植修复股骨长段骨骨缺损的临床应用研究

目的探讨腓骨（皮）瓣移植修复股骨长段骨骨缺损的临床疗效。方法应用腓骨（皮）瓣修复大腿皮肤软组织或骨缺损及重建患肢股骨骨支架的连续性23例。结果术后23例骨（皮）瓣全部成活,术后随访6～60个月,移植腓骨与受区断端均达骨性愈合,肢体功能均得到良好恢复。结论腓骨（皮）瓣具有解剖标志清楚、骨膜较厚、血供丰富、血管蒂多、供骨量大、皮瓣面积大、位置表浅、成功率高（或）手术操作有较大的灵活性等优点,治疗大腿严重创伤性骨皮缺损可一次完成骨架重建及创面覆盖,有利于肢体功能的尽早恢复。     

Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application

The purpose of this study was to investigate the feasibility of microvascular transplantation, based on the anterior tibial artery, of the epiphysis and the proximal half of the diaphysis of the fibula. India ink injections into the anterior tibial artery were performed in 13 unembalmed adult cadavers, following which transverse frozen sections were taken. Dye was observed in the fibula, both within the intramedullary cavity and at the level of the periosteum, in all specimens. The average distal limit reached by the dye, measured from the tip of the epiphysis, was 10.4cm in the intramedullary cavity and 11.8cm in the periosteum. Based on these anatomical findings one case of humeral reconstruction has been performed with a fibular transplant, including both the epiphysis and a segment of diaphysis, vascularized solely by the anterior tibial artery.     

四种不同类型带血供腓骨移植的临床应用

作者分别采用膝下外血管、腓血管为蒂的游离腓骨移植和以腓动脉为蒂的腓骨顺行或逆行转位移植,治疗13例炎症、肿瘤、先天性畸型造成的尺桡骨(包括骨骺)缺损。结果:以膝下外血管为蒂的腓骨上段骨(骨骺)移植,修复桡骨远端缺损,重建桡腕关节疗效满意,1例骨骺移植,获较好的继续生长,随访3年,与对侧等长,以腓动脉为蒂的腓骨干移植,无论是游离或转位移植,用于修复长度〉6cm的长骨缺损疗效满意。     

多发伤合并胫腓骨骨折的急诊外固定器治疗

目的:探讨多发伤合并胫腓骨骨折急诊外固定器治疗对多发伤的影响。方法:多发伤合并胫腓骨骨折(ISS≥15分)患者113例,其中男76例,女37例;年龄11~65岁,平均32.6岁。合并颅脑损伤62例,血气胸36例,腹腔脏器损伤23例,泌尿系损伤6例,合并其他部位骨折21例。急诊外固定器手术58例,择期外固定器手术34例,保守治疗21例。通过死亡率、急性呼吸窘迫综合征(ARDS)和脂肪栓塞综合征(FES)发病率、平均ICU监护时间等4项近期指标及骨折情况等远期指标对比3种不同治疗方法对骨折本身和多发伤治疗的疗效。结果:113例患者除4例死亡外,109例全部获得5个月~1年随访,急诊手术ICU监护时间为(9.0±1.5)d,ARDS、FES发病率为0和3.2%,明显低于另外2种方法(P(0.05)。急诊外固定器手术死亡率及其他并发症与其他2种方法相比差异无显著性意义。结论:多发伤合并胫腓骨骨折急诊外固定器治疗,具有手术简单、创伤小等优点,可显著减少多发伤患者ICU监护时间及部分并发症发病率,具有较高的临床意义和社会意义。