臂外侧穿支皮瓣修复手指皮肤缺损的临床应用

目的 探讨臂外侧穿支皮瓣治疗手指皮肤缺损的临床效果. 方法 收集新鲜尸体10具(20侧),使用动脉显影技术进行灌注.CT扫描,数据导入Mimics图形工作站,对臂外侧穿支血管三维重建,并模拟皮瓣设计,所有标本CT扫描后统一进行尸体解剖;从2007年4月-2011年7月,对18例手指皮肤缺损的患者,缺损面积3 cm ×4 cm～6 cm ×9cm,采用游离臂外侧皮瓣修复皮肤缺损,术后随访其疗效. 结果 尸体解剖结果显示,肱深动脉穿支管径为(0.71±0.15)mm,肌穿支(Mc)蒂长与肌间隙穿支(Sc)蒂长之比为(2.74 ±0.42) cm:(2.96 ±0.37) cm;桡侧副动脉后支的穿支管径为(0.94±0.22) mm,肌穿支(Mc)蒂长与肌间隙穿支(Sc)蒂长之比为(4.78±0.63)cm:(4.86 ±0.51)cm.三维重建的结果显示,上臂外侧穿支血管主要来源于肱深动脉和桡侧副动脉后支的穿支.皮瓣一期全部成活,供区伤口直接缝合或植皮,一期愈合,所有18例病例均得到随访,随访时间6个月～3年,平均11个月,皮瓣外观稍臃肿,质地和感觉恢复较好. 结论 臂外侧穿支皮瓣营养血管解剖恒定,皮瓣质地和感觉恢复好,是修复手指外伤后中、小面积皮肤缺损的一种有效可行的方法.     

关节镜辅助治疗桡骨远端关节内骨折

Objective To investigate the role of arthroscopy in the treatment of intra-articular distal radius fractures. Methods Twelve cases of intra-articular distal radius fractures treated from 2004 to 2007 were reviewed. In these cases, open reduction and internal fixation were performed with the assistance of wrist arthroscopy to observe the alignment of the articular surface. CT scan was obtained postoperatively to evaluate joint alignment, radial height, volar tilting and radial inclination. Recovery of the wrist function was also followed. Results The average postoperative follow up period was 24 months. None of the 12 cases was found to have any "step" appearance of the articular surface of the wrist. X-ray measurement showed radial height averaged 12 mm (7 to 15 mm), volar tilting averaged 5° (1° to9°) and radial inclination averaged 20 °(14° to28°). Range of motion of the wrist joint achieved 33° of flexion on average ( 18° to 42°) and 38° of extension on average (21° to 42°). Six cases had mild pain during motion. According to Gartland / Werley' s criteria, the result was excellent in 5 eases and good in 7. Conclusion Arthroscope-assisted treatment of intra-articular distal radius fractures can avoid "step" appearance of the articular surface of the wrist, thus achieve maximal functional recovery of the wrist.     

关节镜辅助治疗桡骨远端关节内骨折

Objective To investigate the role of arthroscopy in the treatment of intra-articular distal radius fractures. Methods Twelve cases of intra-articular distal radius fractures treated from 2004 to 2007 were reviewed. In these cases, open reduction and internal fixation were performed with the assistance of wrist arthroscopy to observe the alignment of the articular surface. CT scan was obtained postoperatively to evaluate joint alignment, radial height, volar tilting and radial inclination. Recovery of the wrist function was also followed. Results The average postoperative follow up period was 24 months. None of the 12 cases was found to have any "step" appearance of the articular surface of the wrist. X-ray measurement showed radial height averaged 12 mm (7 to 15 mm), volar tilting averaged 5° (1° to9°) and radial inclination averaged 20 °(14° to28°). Range of motion of the wrist joint achieved 33° of flexion on average ( 18° to 42°) and 38° of extension on average (21° to 42°). Six cases had mild pain during motion. According to Gartland / Werley' s criteria, the result was excellent in 5 eases and good in 7. Conclusion Arthroscope-assisted treatment of intra-articular distal radius fractures can avoid "step" appearance of the articular surface of the wrist, thus achieve maximal functional recovery of the wrist.     

关节镜辅助治疗桡骨远端关节内骨折

Objective To investigate the role of arthroscopy in the treatment of intra-articular distal radius fractures. Methods Twelve cases of intra-articular distal radius fractures treated from 2004 to 2007 were reviewed. In these cases, open reduction and internal fixation were performed with the assistance of wrist arthroscopy to observe the alignment of the articular surface. CT scan was obtained postoperatively to evaluate joint alignment, radial height, volar tilting and radial inclination. Recovery of the wrist function was also followed. Results The average postoperative follow up period was 24 months. None of the 12 cases was found to have any "step" appearance of the articular surface of the wrist. X-ray measurement showed radial height averaged 12 mm (7 to 15 mm), volar tilting averaged 5° (1° to9°) and radial inclination averaged 20 °(14° to28°). Range of motion of the wrist joint achieved 33° of flexion on average ( 18° to 42°) and 38° of extension on average (21° to 42°). Six cases had mild pain during motion. According to Gartland / Werley' s criteria, the result was excellent in 5 eases and good in 7. Conclusion Arthroscope-assisted treatment of intra-articular distal radius fractures can avoid "step" appearance of the articular surface of the wrist, thus achieve maximal functional recovery of the wrist.     

关节镜辅助治疗桡骨远端关节内骨折

Objective To investigate the role of arthroscopy in the treatment of intra-articular distal radius fractures. Methods Twelve cases of intra-articular distal radius fractures treated from 2004 to 2007 were reviewed. In these cases, open reduction and internal fixation were performed with the assistance of wrist arthroscopy to observe the alignment of the articular surface. CT scan was obtained postoperatively to evaluate joint alignment, radial height, volar tilting and radial inclination. Recovery of the wrist function was also followed. Results The average postoperative follow up period was 24 months. None of the 12 cases was found to have any "step" appearance of the articular surface of the wrist. X-ray measurement showed radial height averaged 12 mm (7 to 15 mm), volar tilting averaged 5° (1° to9°) and radial inclination averaged 20 °(14° to28°). Range of motion of the wrist joint achieved 33° of flexion on average ( 18° to 42°) and 38° of extension on average (21° to 42°). Six cases had mild pain during motion. According to Gartland / Werley' s criteria, the result was excellent in 5 eases and good in 7. Conclusion Arthroscope-assisted treatment of intra-articular distal radius fractures can avoid "step" appearance of the articular surface of the wrist, thus achieve maximal functional recovery of the wrist.     

关节镜辅助治疗桡骨远端关节内骨折

Objective To investigate the role of arthroscopy in the treatment of intra-articular distal radius fractures. Methods Twelve cases of intra-articular distal radius fractures treated from 2004 to 2007 were reviewed. In these cases, open reduction and internal fixation were performed with the assistance of wrist arthroscopy to observe the alignment of the articular surface. CT scan was obtained postoperatively to evaluate joint alignment, radial height, volar tilting and radial inclination. Recovery of the wrist function was also followed. Results The average postoperative follow up period was 24 months. None of the 12 cases was found to have any "step" appearance of the articular surface of the wrist. X-ray measurement showed radial height averaged 12 mm (7 to 15 mm), volar tilting averaged 5° (1° to9°) and radial inclination averaged 20 °(14° to28°). Range of motion of the wrist joint achieved 33° of flexion on average ( 18° to 42°) and 38° of extension on average (21° to 42°). Six cases had mild pain during motion. According to Gartland / Werley' s criteria, the result was excellent in 5 eases and good in 7. Conclusion Arthroscope-assisted treatment of intra-articular distal radius fractures can avoid "step" appearance of the articular surface of the wrist, thus achieve maximal functional recovery of the wrist.     

166例上肢皮肤脱套伤显微外科治疗的临床疗效分析

由于手工业经济的发展，出现了大量的上肢外伤的病人，而在此类外伤中，皮肤脱套伤是一种比较难治疗的疾病，按传统的经验治疗，患者留下了比较大的残疾。本次研究对166例上肢皮肤脱套伤进行了临床显微技术修复，能取得比较满意的疗效。现报道如下。     

两种皮瓣修复末节指腹缺损的临床研究

末节指腹是手部重要的功能区,其缺损的治疗原则是尽可能保留患指功能并改善外形[1].临床修复方法很多,既往常用指根逆行岛状皮瓣转移修复,但其切口跨越近指间关节,皮瓣转移距离长,术后易产生瘢痕挛缩导致近指间关节活动受限、皮瓣供区疼痛等并发症.近年来我们采用中节指动脉逆行岛状皮瓣修复末节指腹缺损,现将两组疗效进行比较,报告如下.     

前臂再植术后动静脉瘘一例

患者 男,26岁.因右臂再植术后出现前臂肿块1年收住入院.1年前,因外伤致前臂完全离断在我院行断臂再植术,术后再植成活.     

腕关节镜辅助Wristore外固定架治疗桡骨远端粉碎性关节内骨折的临床疗效

目的 探讨腕关节镜辅助Wristore外固定架治疗桡骨远端粉碎性关节内骨折（桡骨远端C3型骨折）的疗效.方法 将20例桡骨远端C3型骨折患者分采用腕关节镜辅助Wristore外固定架治疗,观察疗效.结果 20例患者均获得随访,随访时间为12～36个月,平均随访20.3个月,所有患者均达到了骨性愈合,术后12个月对患肢腕部进行疼痛评分,疼痛不明显者10例,轻度疼痛者9例,中度疼痛者1例;腕关节功能评定优7例,良9例,一般4例,优良率80.0％.结论 腕关节镜辅助Wristore外固定架治疗桡骨远端C3型骨折,是一种简单有效,尤其对于桡骨远端关节内严重骨折的治疗有优势.