游离组织瓣急诊一期修复小腿严重组织缺损

自1995年8月～2002年5月应用吻合血管的显微外科技术对严重的小腿创伤急诊一期进行组织修复和重建,效果满意.报告如下。     

小腿骨折的单侧多功能外固定支架治疗

目的 探讨临床应用单侧多功能外固定支架治疗小腿骨折的手术方法、适应证、优缺点、主要合并症的防治及术后护理。方法 自1996～2004年对39例复杂、开放性小腿骨折、邻近关节的小腿骨折、小腿骨折内固定术后合并感染行单侧多功能外固定支架治疗。结果 所有病例均达到骨性愈合。平均愈合时间为4个月，去除外固定支架时间为6个月。结论 外固定支架治疗小腿骨折具有独特的优越性。     

慢性胃炎与溃疡病怎样区别

慢性胃炎和溃疡病在我国是最常见的消化系疾病。慢性胃炎由物理性汝口过热、过粗糙）、化学性（如过酸、过辣及烈酒等）及生物性（如幽门螺旋杆菌）等有害因素造成的胃粘膜慢性炎症：溃疡病主要是指发生于胃和十二指肠球部的慢性溃疡，因它的形成与胃酸及胃蛋白酶的自身消化作用有关，故又称消化性溃疡。     

消化性溃疡病的护理体会

消化性溃疡病（PU）是临床上一种常见病，多发病，文献统计有10％的成人患有本病，是指发生在胃和十二指肠球部的慢性溃疡，亦可发生在食道下段。现将消化性溃疡的护理体会报告如下。     

比目鱼肌肌瓣转移治疗小腿软组织缺损

目的 介绍比目鱼肌肌瓣转移治疗小腿软组织缺损的方法和疗效。方法 采用比目鱼肌肌瓣顺行或逆行转移治疗各类小腿软组织缺损18例，同时在肌瓣上行游离中厚皮植皮。结果 18例病人转移酌肌瓣全部成活，仅2例病人的游离植皮有小范围坏死；有胫腓骨骨折的14例病人骨折全部愈合。结论 比目鱼肌肌瓣转移为修复小腿软组织缺损的一种有效方法。     

腓肠内外侧血管解剖特点及其在小腿创伤修复中的意义

目的：为小腿创伤皮瓣移植修复与腓肠内、外侧血管吻合提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了腓肠内、外侧血管的长度、外径、血管神经的毗邻关系及其形态特点。结果：①腓肠内、外侧动脉起于动脉，伴行静脉注入静脉；②动脉起点至入肌段的长度内、外侧分别为４．１±０．７（１．８～６．４）ｃｍ、３．７±０．５（２．０～６．５）ｃｍ；③肌门处内、外侧动脉的外径分别为２．２±０．１（１．１～３．４）ｍｍ、２．０±０．１（０．９～３．１）ｍｍ；④肌门处伴行静脉有１～２条，内、外侧静脉外径为２．５±０．３（１．８～４．５）ｍｍ，２．３±０．３（１．５～４．１）ｍｍ。结论：腓肠内、外侧血管恒定、径粗、较长，是小腿创伤皮瓣移植修复受区可供应用的吻合血管     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

吻合腓肠浅动脉的游离小腿后侧皮瓣修复手掌软组织及神经缺损

目的 探讨修复手掌软组织及神经同时缺损的新方法。方法 利用吻合腓肠浅动脉的游离小腿后侧皮瓣修复手掌软组织及神经缺损6例。结果 临床应用6例，全部成活，术后10～13个月随访，皮瓣外形近似正常手掌，两点辨别觉为5mm，感觉为S4；患指感觉恢复为S3两例，S4四例。结论 利用吻合腓肠浅动脉皮瓣修复手掌软组织及神经缺损是理想的方法。     

小腿内侧桥式复合组织瓣修复对侧皮肤软组织伴骨缺损

对胫前、胫后动脉损伤的小腿皮肤软组织伴骨缺损，常采用游离皮瓣或腓肠肌内、外侧头皮瓣移位进行修复，疗效显著。但对于下肢动脉损伤严重伴软组织及骨缺损，同时小腿后侧皮肤软组织条件欠佳，无法局部移位修复的患者，一直是骨科临床难题。我院1998年2月-2003年2月采用小腿内侧皮瓣吻合带血管的髂骨块，桥式移位修复5例此类患者，均取得一期修复的良好效果。报告如下。