改进的掌背动脉岛状皮瓣的临床应用

手指创面的覆盖尽管方法很多，由于手指的外形及功能要求较高，其疗效并不十分令人满意。手背皮肤质地较好，皮下脂肪少，是修复手指软组织缺损的良好供区。掌背动脉位于手背伸肌腱下，伸肌腱间隙较小，且存在腱联合，切取皮瓣时掌背动脉在近端易与皮瓣分离，有时为避免分...     

三维摄影测量在腕关节重建中的应用研究

当桡骨远端由于创伤或者疾病遭到破坏后，临床上常用带血管的游离腓骨头移植替代桡骨远端，重建腕关节［１］。为了探讨腓骨头关节面与桡骨远端关节面是否拟合，我们采用三维摄影测量技术，分别测量４０侧成人尸体膝关节与腕关节标本，为临床手术提供参考。一、材料与方法...     

应用指动脉逆行岛状皮瓣修复外伤性指端组织缺损

目的:介绍指动脉逆行岛状皮瓣治疗外伤性手指末节软组织缺损。方法:采用此方法治疗手指末节软组织缺损56例61指。结果:所有皮瓣均全部成活,术后随访3~6个月伤指的指端外形满意。结论:指动脉逆行岛状皮瓣是治疗外伤性手指末节软组织缺损的有效方法。     

超声联合微泡体外介导NT-3基因转染神经干细胞的超声占空比探讨

目的 探讨低频超声体外介导神经营养因子-3 (neurotrophin-3,NT-3)基因转染神经干细胞的适宜超声占空比条件. 方法 体外培养神经干细胞,在24孔板中加入200μl微泡(浓度20％)和20μl pEGFP-NT-3基因重组质粒(1 μg/μl)混合静置30 min.将500μl神经干细胞悬液(3×105/ml)加入到微泡和质粒混合液中,采用超声声强1.5 W/cm2,照射时间60s,占空比分别为10％、25％和50％.用1 MHz超声探头辐照上述混合液,转染后用流式细胞仪检测各组细胞基因转染率,MTT法检测神经干细胞存活率.空白对照组为未经超声辐照的质粒与神经干细胞混合物. 结果 随着超声占空比升高,细胞存活率逐渐降低.占空比为50％时,细胞存活率低于40％;占空比为25％时,细胞存活率高于60％,且基因转染率明显高于占空比10％和50％组,为(18.60±0.90)％. 结论 通过优化超声占空比条件,证明适宜的超声占空比为25％,神经干细胞转染率最高,且细胞损伤较小.     

带血管蒂腓骨头移植代替桡骨远端重建腕关节疗效观察

目的了解用带血管蒂的游离腓骨头移植治疗桡骨远端骨巨细胞瘤,重建腕关节的效果。方法１９７８年７月～１９９３年１１月,采用吻合血管的腓骨头移植代替桡骨远端重建腕关节的方法治疗桡骨远端骨巨细胞瘤５例,对其中１２例进行了腕关节功能随访,随访时间为６个月～１５年,评估患者腕关节的活动范围、握力及疼痛情况。结果１１例腕关节疼痛消失,１例有轻微疼痛不适,平均腕关节掌屈３４．０５°、背伸５２．８０°、尺偏２６．２５°、桡偏１９．７５°,握力４４．６ｋｇ,分别占对侧的４６．２％、７２．７％、７６．１％、８０．６％和７６．７％。结论带血管蒂腓骨头移植代替桡骨远端重建腕关节可较好地保留腕关节的功能,是一种安全有效的方法。     

An anterolateral thigh perforator chimeric flap combined with calcium sulfate impregnated with vancomycin for treatment of chronic fracture-related infection complicated with extensive soft-tissue defects北大核心CSCD

Objective To investigate the efficacy of an anterolateral femoral chimeric perforator flap combined with vancomycin-loaded calcium sulfate in the treatment of chronic infection after internal fixation of calf fracture with soft tissue defects. Methods Retrospectively analyzed were the data of 16 patients with chronic infection combined with extensive soft tissue defects after internal fixation of calf fracture who had been admitted to Department of Orthopedics, Shenzhen Hospital Affiliated to Peking University from September 2008 to November 2020. There were 11 males and 5 females, aged from 16 to 62 years (average, 37 years). Infection sites: the upper tibia in 4 cases, the middle and lower tibia in 10 cases, and the middle fibula in 2 cases. According to the Cierny-Mader classification, all patients were anatomical type III and by the host classification, there were 14 cases of type B and 2 cases of type C type. The areas of soft tissue defects ranged from 6 cm × 4 cm to 23 cm × 14 cm. All patients were treated by transplantation of an anterolateral thigh chimeric perforator flap combined with vancomycin-loaded calcium sulfate therapy. At the last follow-up, the curative efficacy was evaluated according to the Paley fracture union scoring. Results All patients were followed up for 8 to 24 months (mean, 16 months). Complete flap survival was achieved in 15 flaps and partial survival in one. According to the Paley fracture union scoring at the last follow-up, the curative efficacy was evaluated as excellent in 15 cases and as good in one. Both the grafted artificial bone and the tibia and fibula achieved bone union after 6 to 12 months (mean, 8.9 months). Infection with chronic sinus tract pus recurred in one case at post-operative one year. After re-debridement, the infection was controlled and the wound healed. The plate internal fixation was replaced by the unilateral or annular external fixator in 14 patients and retained in 2 patients. The lengths of the bone defects averaged 2.4 cm and the time for the external fixation 10.5 months (from 8 to 14 months). Conclusion In the treatment of chronic infection after internal fixation of calf fracture with extensive soft tissue defects, the efficacy of an anterolateral femoral chimeric perforator flap combined with vancomycin-loaded calcium sulfate is satisfactory, because the flap can fully cover the bone and soft tissue defects while the vancomycin-loaded calcium sulfate can effectively control the infection. © 2023 Chinese Journal of Orthopaedic Trauma. All rights reserved.