Treatment of tibiofibular fractures of Gustilo type Ⅲ by vacuum, sealing drainage and external fixation

Objective To report clinical efficacy of vacuum sealing drainage(VSD)and external fixation in the treatment of tibiofibular fractures of Gustilo type Ⅲ. Methods From October 2006 to November 2009,19 cases of Gustilo type Ⅲ tibiofibular fracture were treated in our department.They were 14men and 5 women,with an average age of 30.1 years(from 17 to 62 years).There were 9 cases of type ⅢA,8 cases of Type ⅢB 2 cases of typeⅢC.After emergency debridement,all the fractures were fixed with an extemal fixator following indirect reduction.The wounds were sealed with VSD.When the wounds were clean and granulation appeared,they were repaired by direct suture(5 cases),split-thickness skin graft(9 cases)and flap transposition(5 cases). Results The 19 cases were followed up for 12 to 24 months,with an average of 16.3 months.A11 the wounds were closed'after VSD for 5 to 17 days.Wound infection occurred in 2 cases and was finally repaired by flap transposition following repeated debridement and VSD.The fractures healed after 4 to 10 months(average,5.6 months). Conclusion External fixation combined with VSD is a simple and effective treatment for tibiofibular fractures of Gustilo type Ⅲ.because it can provide not only rapid fixation but also early wound sealing to facilitate fracture healing and reduce incidence of complications.     

5·12汶川地震绵竹灾区幻肢痛发生情况调查

目的 观察汶川地震伤员截肢后幻肢痛的流行病学特征,分析创伤性截肢术后幻肢痛发生的相关危险因素.方法 2008年8月～2010年5月期间,对四川省绵竹市5·12地震截肢伤员进行针对幻肢痛发生情况的现况调查,此后每3月一次电话随访直至术后2年.结果 本文调查了绵竹市147例截肢伤员,获得连续完整资料108例,幻肢痛的2年患病率是86例（79.6%）,22例（20.4%）在截肢后2年内从未发生过幻肢痛.取截肢术后8个时间点（每3个月一次,共2年）,计算幻肢痛发病率依次为：61.1%、62.9%、68.5%、70.4%、69.4%、66.7%、62.0%、62.0%.女性幻肢痛发病率（88.7%）,明显高于男性（67.4%,P〈0.05）.结论 幻肢痛在四川地震截肢伤员当中有较高的发病率,女性比男性更容易发生幻肢痛.     

外固定支架结合负压封闭引流技术治疗Gustilo Ⅲ型胫腓骨开放性骨折

目的 探讨外固定支架结合负压封闭引流(VSD)技术治疗Gustilo Ⅲ型胫腓骨开放性骨折的疗效.方法 2006年10月至2009年11月采用外崮定支架结合VSD技术治疗19例Gustilo Ⅲ型胫腓骨开放性骨折患者,男14例,女5例;年龄17～62岁,平均30.1岁.开放性损伤按Gustilo分型:ⅢA型9例,ⅢB型8例,ⅢC型2例.所有患者均行急诊清创、骨折复位后外固定支架固定,采用VSD技术关闭创面,待创面洁净、肉芽生长后通过直接缝合(5例)、游离植皮(9例)或转移皮瓣(5例)等方法修复软组织创面.结果 19例患者术后获12～24个月(平均16.3个月)随访.所有患者经VSD治疗5～17 d(平均9.3 d)后关闭创面.2例因创面感染、组织坏死渗出,经多7欠清创并更换VSD敷料后,创面最终通过转移皮瓣得以修复.骨折愈合时间为4～10个月(平均5.6个月).结论外固定支架结合VSD技术治疗Gustilo Ⅲ型胫腓骨开放性骨折能在迅速有效地稳定骨折的同时,早期闭合创面,促进骨折愈合,减少并发症的发生.

Abstract：

Objective To report clinical efficacy of vacuum sealing drainage(VSD)and external fixation in the treatment of tibiofibular fractures of Gustilo type Ⅲ. Methods From October 2006 to November 2009,19 cases of Gustilo type Ⅲ tibiofibular fracture were treated in our department.They were 14men and 5 women,with an average age of 30.1 years(from 17 to 62 years).There were 9 cases of type ⅢA,8 cases of Type ⅢB 2 cases of typeⅢC.After emergency debridement,all the fractures were fixed with an extemal fixator following indirect reduction.The wounds were sealed with VSD.When the wounds were clean and granulation appeared,they were repaired by direct suture(5 cases),split-thickness skin graft(9 cases)and flap transposition(5 cases). Results The 19 cases were followed up for 12 to 24 months,with an average of 16.3 months.A11 the wounds were closed'after VSD for 5 to 17 days.Wound infection occurred in 2 cases and was finally repaired by flap transposition following repeated debridement and VSD.The fractures healed after 4 to 10 months(average,5.6 months). Conclusion External fixation combined with VSD is a simple and effective treatment for tibiofibular fractures of Gustilo type Ⅲ.because it can provide not only rapid fixation but also early wound sealing to facilitate fracture healing and reduce incidence of complications.     

部队夏季野外驻训皮肤病调查分析

国内外调查资料显示,军事训练后皮肤病发生率比训练前增高,为进一步探讨这一问题,我们对某部2009、2010年连续两个夏季（6～8月）野外驻训官兵皮肤病患病情况进行调查。现报告如下。1对象和方法1.1对象某部夏季野外驻训官兵2 949名。均为男性,年龄17～47岁,平均20.8岁。     

72例新兵下肢应力性骨折原因分析

目的探讨新兵基础训练致下肢应力性骨折（SF）的原因,为预防应力性骨折提供参考。方法查询基础训练期间就诊登记,回顾分析某部2008-2010年72例入伍新兵下肢应力性骨折,了解其发生部位和危险因素。结果应力性骨折发病率6.07%。股骨应力性骨折2例占2.78%,胫骨应力性骨折67例,占93.05%,足第二跖骨骨折3例占4.17%。入伍前缺乏运动、带伤训练、循环训练是应力性骨折的高危因素。结论新兵基础训练致下肢应力性骨折以胫骨多见,与胫骨解剖结构以及训练方法等有关,应积极采取应对措施区别对待和科学训练。     

后入路内固定治疗肩胛骨骨折疗效分析

目的探讨经后入路内固定治疗肩胛骨骨折的疗效。方法回顾性分析2007年12月至2009年12月收治的经手术治疗的17例肩胛骨骨折的临床资料。根据Miller的分型方法,ⅠA型1例,ⅡA型2例,ⅡB型1例,Ⅲ型10例,Ⅳ型3例。采用后入路对肩胛骨骨折使用重建钢板、拉力螺钉等进行治疗。结果 17例患者全部获得随访,随访时间12~30个月,平均18个月。根据Hardegger的疗效评价标准,优13例,良2例,可2例,优良率为88.24%。结论采用后入路重建钢板及拉力螺钉治疗肩胛骨骨折效果确切,利于早期进行康复功能锻炼,疗效满意。     

神经断端肌肉内埋入法治疗汶川地震截肢伤员痛性神经瘤

目的：探讨神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤的临床疗效.方法：应用神经断端肌肉内埋入法治疗汶川地震伤截肢伤员痛性神经瘤12例27处,观察术后症状、体征及患肢功能改变情况.结果：12例全部获随访12～26个月,平均16个月.随访时患者主诉肢体残端疼痛和触电感消失;局部无压痛、叩击痛和Tinel征,残端软组织内未触及硬性结节或包块;患肢功能较术前明显改善.结论：采用神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤,可减轻痛苦,疗效确切.     

庆大霉素静滴致全身过敏性皮疹一例

1病例资料患者,男,25岁,65 kg,171 cm,战士。因腹痛腹泻伴发热1 d来门诊治疗。患者于1 d前食用不洁水果后出现腹痛症状,随后出现腹泻,大便呈稀水样,每日数次,无里急后重感。查体：体温37.7℃,脉搏85次/min,呼吸17次/min,血压120/80 mmHg（1 mmHg=0.133 kPa）,痛苦面容,步入病室,意识清楚,言语流利,心肺听诊无异常。详细询问患者病史,仔细体格检查,下腹部压痛,无反跳痛,听诊肠鸣音。     

甲钴胺致手背虎口区皮疹一例

1病例报告患者,男,19岁。因注射破伤风疫苗后出现左腕不能抬起,左手虎口区感觉明显减退。既往体健,无食物、药物过敏史,无烟、酒不良嗜好。查体：左侧上臂中下段外侧见一包块隆起约3 cm×2 cm大小,无充血,触压痛（＋）,Tinel征（＋）,左手伸腕伸指肌力2级,左手背虎口区感觉明显减退,感觉2级。伸、屈肘关节正常,左桡动脉搏动良好。X线片示：左肱骨无骨折,行EMG检查示桡神经损伤。     

部队夏季野外驻训皮肤病调查分析

<正>国内外调查资料显示,军事训练后皮肤病发生率比训练前增高,为进一步探讨这一问题,我们对某部2009、2010年连续两个夏季(6～8月)野外驻训官兵皮肤病患病情况进行调查。现报告如下。1对象和方法1.1对象某部夏季野外驻训官兵2 949名。均为男性,年龄17～47岁,平均20.8岁。1.2方法由卫生队医师参照《临床皮肤病学》统一诊断标准,对皮肤病患者进行登记、诊断、治疗。2结果共发现皮肤病1 152例,患病率39.06%。其中,2009