指背逆行筋膜岛状皮瓣的临床应用

目的探讨I期修复同指中、末节掌、背侧及指端缺损的方法。方法自1997年6月～2006年10月,对59例(63指)手指皮肤缺损的患者,采用指背逆行筋膜岛状皮瓣旋转30°～180°移转修复。结果除2例皮瓣远端部分坏死外,余均成活,经3～6个月随访,功能及外观良好。按TAM法评定,优41指,良18指,可4指,优良率达94%。结论该术式操作简单、疗程短、成功率高,皮瓣血运可靠,柔软耐磨。多指远端同时缺损的修复其优越性尤为明显。     

应用腹直肌前鞘-腹外斜肌腱膜瓣修复先天性膀胱外翻

目的总结先天性膀胱外翻的修复,探讨腹直肌前鞘—腹外斜肌腱膜瓣及肌蒂阔筋膜张肌肌皮瓣在修复膀胱外翻中的应用。方法应用腹直肌前鞘—腹外斜肌腱膜形成的前鞘—腱膜瓣加局部皮瓣或同侧肌蒂阔筋膜张肌肌皮瓣修复先天性膀胱外翻及腹壁缺损,局部皮瓣修复尿道上裂,肌皮瓣的应用面积最大为10cm×8cm。结果临床应用12例,膀胱外翻及腹壁的修复均达到了良好效果,膀胱括约肌功能基本恢复,二次尿道紧缩后12例均能控制排尿。肌蒂阔筋膜张肌肌皮瓣部分坏死2例,游离植皮后痊愈。结论选择性地应用腹直肌前鞘及腹外斜肌腱膜形成前鞘—腱膜瓣加强腹壁,局部皮瓣转移或应用同侧肌蒂阔筋膜张肌肌皮瓣转移修复腹壁缺损能有效地修复先天性膀胱外翻,恢复膀胱颈部括约肌的连续性及尿道紧缩,能达到自主控制排尿的目的。     

Recurrent and Chronic Complete Ruptures of the Proximal Origin of the Hamstring Muscles Repaired With Fascia Lata Autograft Augmentation

Hamstring injuries are common, especially among athletes. A complete rupture of the proximal hamstring muscles requires surgical intervention. In this report we describe a reconstruction method for a complete proximal hamstring rupture using fascia lata autograft augmentation in addition to suture anchors. This method can be advocated in cases in which the primary repair has failed or in chronic injuries where a large defect between the distally retracted tendons and the ischial tuberosity prevents anatomic reinsertion. In our technique, a muscle-tendon flap is first created from the retracted tendon stump, turned proximally, and fixed to the ischial tuberosity by suture anchors. The fascia lata graft is then fixed from the midpart to the ischial tuberosity via the same sutures. The other sleeve of the graft is folded on the ventral side of the ruptured tendon stump and fixed by use of absorbable sutures. Then the other sleeve is folded on the dorsal side and fixed in the same manner. Finally, the fixation can still be reinforced with additional absorbable sutures passing through both sleeves of the graft, as well as the muscle-tendon bridge and the tendon stump.     

阔筋膜皮瓣移植修复手前臂巨大创面

报道采用吻合血管的阔筋膜皮瓣移植，修复手、前臂巨大创面１１例，均获成功，其优点：①阔筋膜长而坚韧，内面光滑，覆盖关节、骨、肌腱粘连轻，尤其利于肌腱滑动，是修复手、前臂的最佳皮瓣。②皮肤与肌腱同时缺损时，利用阔筋膜修复肌腰，一期完成肌腱及皮肤的修复。③股外侧皮神经长而粗，分支多，适合手部感觉修复。④供区隐蔽，皮下组织簿，血运丰富，供皮及阔筋膜面积大。     

带血管蒂岛状筋膜瓣移植治疗晚期类风湿性髋关节炎

目的：阐明带血管蒂岛状筋膜瓣移植治疗晚期类风湿性髋关节炎的疗效。材料和方法：对４２例４８髋晚期类风湿性髋关节炎病人采用以旋股外侧血管降支为蒂的股前外侧筋膜瓣移植行患髋成形术。结果：术后随访４～１０．５年，平均４．５年，髋关节活动范围术前平均１６．５°，术后２２８．６°，按照Ｃｈａｒｎｌｅｙ和吴之康人工髋关节置换术后的疗效评定标准，优良２９髋、很好１３髋、好６髋，尚可、差、很差无。结论：患者年龄在１５～４０岁之间为合适的治疗年龄。与人工髋关节置换术相比，本方法对髋关节正常结构破坏小；一旦手术失败仍可选用其它治疗方法弥补；且并发症少、费用低、远期效果好。     

踢伤至臀筋膜室综合征1例报告

骨筋膜室综合征是骨科创伤常见的并发症 ,如治疗不及时、处理不当会造成神经肌肉缺血变性、坏死甚至危急生命 ,给患者带来伤残和严重的后遗症。现将 1例踢伤致右侧臀筋膜室综合征的病例报道如下 :患儿 ,男 ,12岁 ,以踢伤右臀部伴右下肢活动障碍 10ｄ为主诉。患儿 10ｄ前被足踢伤右臀部 ,当时自觉疼痛 ,走路跛行 ,没有重视 ,也未作任何治疗。伤后 7ｄ ,又被踢伤右臀部 ,当时自觉疼难忍 ,逐渐发现右臀部肿胀加重、皮肤发亮 ,在当地县医院就诊住院对症治疗 ,未能缓解症状 ,故来我院就诊 ,门诊以右侧臀筋膜室综合征收住院。入院检查 :Ｔ 38 5℃…     

Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study

The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 × 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.     

Septal innervation of mossy cells in the hilus of the rat dentate gyrus: an anterograde tracing and intracellular labeling study

 Mossy cells in the hilus of the rat dentate gyrus are the main cells of origin of the dentate commissural and associational projections. They project along the septotemporal axis of the dentate gyrus and may thus influence the hippocampal signal flow in a longitudinal direction. To analyze the septal innervation of these hilar neurons, anterograde tracing with Phaseolus vulgaris leucoagglutinin (PHAL) was used in combination with intracellular labeling of mossy cells (Lucifer yellow). Anterogradely labeled septal fibers impinge on proximal and distal dendrites of hilar mossy cells but spare the cell body. In contrast, numerous aspiny hilar neurons, presumably GABAergic interneurons, receive a septal innervation on their somata and proximal primary dendrites. These data demonstrate that septal fibers show a specificity for the dendritic segments of hilar mossy cells. Since mossy cells project predominantly to adjacent hippocampal lamellae, the activity of adjacent portions of the dentate gyrus may be influenced by the septal input onto these neurons. Received: 22 July 1996 / Accepted: 24 October 1996     

晚期喉癌扩大喉次全切除胸骨舌骨肌及筋膜喉成形的研究（附19例报告）

目的：探讨治疗晚期喉癌（T4）并能重建喉功能的手术方法。方法：对19例晚期喉癌患者行扩大喉次全切除术,并用胸骨舌骨肌及筋膜行喉成形术。结果：术后13例恢复全部喉功能,6例恢复部分喉功能,1、3、5年生存率为89.47%,68.42%,47.37%。结论：部分T4患者是可以施行喉次全切除术的,用胸骨舌骨肌及筋膜行喉成形术效果好,成功率高。