小腿外侧皮瓣顺行及逆行转位的经验与教训

1984年以来,我院应用腓动脉为血管蒂的小腿外侧皮瓣顺行或逆行转位修复小腿及足部皮肤缺损共8例,成功7例,失败1例。现将经验教训介绍如下。     

复杂中足损伤的临床治疗

Objective To evaluate the features and key points of clinical treatment of the complex midfoot injury retrospectively.Methods Twenty-two cases of complex midfoot injury were admitted to our hospital from June 2003 to June 2008, including 8 cases of open fracture and 5 cases of complicated soft tissue defects.Thirteen were emergency cases and the other 9 chronic ones were referred from other hospitals.In the emergency cases, only 1 underwent arthrodesis of the navicular and middle and lateral cuneiform and the others had reduction and internal fixation.In the referred cases, 2 received talar-navicular arthrodesis, 3 Lisfranc arthrndesis (accompanied by distal hallux amputation in 1), 1 navicular-cuneiform arthrudesis and 1 Chopart arthrndesis, 1 medial column amputation and 1 lateral column reconstruction.In the cases of soft tissue defects, 4 underwent free serratus anterior transfer, and 1 had transfer of distally-based sural fas-eio-cutaneous flap.The American Orthopaedic Foot & Ankle Society (AOFAS) scoring was used to evaluate the results.Results All the patients were followed up for 5 to 44 (average, 17.5) months.The main sequelae of the emergency cases were pain after long time waking, which was relieved following local injection of steroid and NIADs in 2 cases.Of the referred cases, pain and fatigue after walking were reported in 2, callus and pain under the 4th and 5th metatarsal heads in 2, and the whole foot rigidity and atrophy of the intrinsic muscle with severe pain while walking in 1.The case of medial column amputation developed medial arch collapse and valgus of hind foot.The mean AOFAS score for the emergency cases was 80.3± 8.7 and for the chronic ones was 60.1±16.3.Conclusion For complex midfoot injury, good results can only be obtained by early operation, anatomic reduction and stable fixation on the basis of enough understanding of the functional anatomy and traumatic pathology.     

吃药您喝足水了吗

张大爷患有多种慢性病，经常需要服用药物进行治疗，有时，他图省事，将药片放在口中后，不喝水或仅喝一口水，用力一咽，算是服完了药。其实，这种服药方式是不可取的。     

小腿后部巨大腓动脉逆行皮瓣修复足部皮肤软组织缺损

目的 探讨小腿后部巨大腓动脉逆行皮瓣在修复足部、足远侧半大面积皮肤缺损的应用效果.方法 应用小腿后部巨大腓动脉逆行皮瓣修复11例含一个或多个跖趾关节外露的、足部大面积皮肤缺损.皮瓣设计:上界超过腓骨头平面.外侧界达腓骨前缘前2 cm,内侧界达腓肠肌内侧缘,下界达内外踝连线,以外踝上1 cm为旋转点.手术要点:解剖皮瓣时应将腓动脉在外踝上11～13 cm和5～7 cm两个肌皮支和(或)皮支带入,并包含腓肠神经、小隐静脉在内的3 cm宽筋膜蒂.结果 本组11例中10例皮瓣全部成活,1例皮瓣边缘1 cm宽区域坏死,经换药处理后愈合.结论 应用小腿后部巨大腓动脉逆行皮瓣修复足部大面积皮肤缺损,尤其是含足远侧半的皮肤缺损,皮瓣成活率高,对肢体供血影响小,血管蒂恒定,解剖容易,易于推广.     

足细胞骨架相关蛋白研究进展

近年来的研究表明足细胞在多种肾小球疾病的发生和发展过程中起着关键作用.在人类及动物模型的肾小球疾病如微小病变、局灶节段硬化、膜性肾病、糖尿病肾病和狼疮肾炎中都发现有足细胞损伤,主要表现为裂孔膜和细胞骨架的异常.     

中国护足周专访朱铁君教授

尊敬的医生朋友: 由中华医学会皮肤性病学分会开展的“中国护足周”已进入了第五个年头。在过去几年里.全国各地的皮肤科工作者积极参与“中国护足周”活动,为数百万患者检查足病或讲解足病有关知识,为中国的皮肤医学事业做出了贡献。 “中国护足周”是皮肤科医生将医疗服     

眼科手术患者不同病人自控镇静镇痛术效应的比较

近年来，病人自控镇静镇痛术(PCSA)在术中的应用不断增多。眼科玻璃体视网膜手术精细复杂、历时长、手术刺激大，局麻下应用PCSA比传统的医生管理用药能更好地满足病人个体化的需求；同时与全身麻醉比较，术后并发症少，费用低，恢复快，术后即刻病人能按要求保持内眼注气或注油后的特殊体位。本研究通过选择不同的镇静、镇痛药物及配伍组合，探讨PCSA在此类手术中应用的安全性和有效性。     

130例国人正常胎儿手足长的测量

本文130例国人胎儿的手、足长测量结果表明:手、足长与胎龄线性相关(手∶r=0.9498;足∶r=0.963)。从而可据手或足长预测胎龄。结果还表明:左、右手长度无显著性差异(P<0.01)。     

经络学说指导诊治三叉神经痛及鼻渊体会

目的:由于三叉神经痛及上颌窦、筛窦、额窦、喋窦的解剖部位与经络学说中的少阳、阳明经脉循行部位有密切关系,故以该理论指导临床诊治.方法:以针刺少阳、阳明经脉穴位及口服和解少阳、清泻阳明之中药治疗三叉神经痛及鼻渊观察疗效.结果:均获得满意疗效.结论:少阳、阳明经脉循行与三叉神经及上颌窦等的解剖部位相似,可指导临床诊治.