下肢软组织缺损伴胫腓骨骨折修复16例

下肢软组织缺损伴胫腓骨骨折修复１６例傅国成罗守信傅明１９９３年～１９９６年，共收治下肢软组织缺损伴胫腓骨骨折１６例，其中粉碎性骨折８例，斜形骨折３例，螺旋形骨折５例。男１２例，女４例。年龄９～６５岁。急诊１１例，创伤术后近期感染３例，骨髓炎伴慢...     

富血小板血浆治疗下肢慢性难愈合伤口47例随访研究

目的 探讨富血小板血浆(platelet-rich plasma,PRP)对下肢慢性难愈合伤口的修复作用. 方法 2007年5月-2007年11月,采用PRP注射治疗下肢慢性难愈合伤口47例.男41例,女6例;年龄15～68岁,平均43.2岁.原发疾病:胫腓骨骨折20例,跟骨骨折4例,跖骨骨折1例,下肢多发开放性骨折3例,胫骨骨髓炎10例,股骨骨髓炎1例,足踝部软组织损伤4例,截肢术后感染2例,足部矫形术后感染及跟腱修补术后感染各1例.外院治疗后2～4个月创口未愈合转入合并骨折未愈合23例,细菌培养结果 阳性38例.患者予2次清创加自体PRP伤口内注射,每次间隔2个月. 结果 患者均于首次注射PRP后获随访,随访时间4个月.首次注射PRP2个月后,34例伤口明显缩小,坏死组织及脓苔清除,组织色泽健康,血供良好,外露骨或肌肉组织被新牛肉芽组织覆盖.4个月随访时,无肌肉和骨组织外露患者,创面覆盖率79.3%4±18.O%,总治愈率29.8%.治疗前创口体积(11.8±5.6)mL,治疗后为(2.5±2.7)mL,创口体积缩小(9.3±4.9)mL,治疗前后创口体积比较差异有统计学意义(P＜0.05).术前23例合并骨折未愈合者,随访4个月时骨折完全愈合9例,骨痂生长明显增多12例,无明显改变2例,均无骨髓炎征象加重.细菌培养阳性结果 15例. 结论 PRP能有效促进软组织缺损修复,加速下肢慢性难愈合伤口愈合.     

富血小板血浆联合中空螺钉内固定治疗股骨颈骨折

目的探讨自体富血小板血浆(PRP)联合中空螺钉内固定治疗股骨颈骨折的近期临床疗效。方法回顾性分析2012年5月至2018年5月期间漯河医学高等专科学校第二附属医院采用中空螺钉内固定治疗的160例股骨颈骨折患者资料。根据是否采用PRP配合治疗分为两组(n=80):PRP组男46例,女34例;年龄为(52.3±7.6)岁;骨折Garden分型:Ⅰ型1例,Ⅱ型5例,Ⅲ型57例,Ⅳ型17例;采用中空螺钉内固定联合PRP治疗。对照组男41例,女39例;年龄为(50.6±7.3)岁;骨折Garden分型:Ⅰ型2例,Ⅱ型7例,Ⅲ型51例,Ⅳ型20例;采用中空螺钉内固定治疗。记录并比较两组患者的骨折愈合时间、骨不连和股骨头缺血性坏死发生率及髋关节Harris评分等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。160例患者术后获12~36个月随访。PRP组患者的骨折愈合时间[(4.3±1.0)个月]显著短于对照组患者[(7.3±1.3)个月],术后骨不连发生率[0%(0/80)]、股骨头缺血性坏死发生率[3.8%(3/80)]显著低于对照组患者[7.5%(6/80)、15.0%(12/80)],差异均有统计学意义(P<0.05)。PRP组患者术后6、12个月髋关节Harris评分分别为(88.7±5.3)、(94.2±4.8)分,均显著高于对照组患者[(81.4±4.6)、(84.2±5.2)分],差异均有统计学意义(P<0.05)。结论与单纯中空螺钉内固定相比,PRP联合中空螺钉内固定治疗股骨颈骨折能明显缩短患者骨折愈合时间,降低股骨头缺血性坏死的发生率,提高髋关节功能。     

富血小板血浆治疗骨折的研究进展

富血小板血浆（platelet-rich plasma, PRP）是通过离心、血细胞单采等方式从动物或人全血中提取的富含高浓度血小板的血浆,由于来源于自体血液不产生免疫排斥,是目前应用前景优良的再生医学治疗药物之一,其临床治疗价值与干细胞相当。自Anitua于1999年发现PRP能显著促进骨组织修复以来,PRP由于其自身优良的性能,在骨科疾患中得到广泛应用。本文将分别从PRP影响骨愈合作用机制、促进骨愈合应用及研究进展、展望等方面综述应用PRP治疗骨折的研究进展。     

富血小板血浆对组织损伤修复的研究进展

<正>富血小板血浆(Platelet-rich Plasma,PRP),是自体来源的浓缩血小板血浆,人类正常血小板计数为1.5~4.5×105/μL之间,而PRP中血小板计数高出正常人血小板计数的4~5倍。自20世纪70年代以来,富血小板血浆就被用于软组织的修复。1975年,Oon和Hobbs第一次发现PRP,自从被报道后首次被Ferrari等用于心脏手术,用于阻止自体     

自体富血小板血浆-脂肪颗粒填充矫治唇部软组织缺损畸形的临床观察

目的 观察自体富血小板血浆-脂肪颗粒填充唇部软组织缺损的临床疗效.方法 经自体血液提取富血小板血浆,再应用脂肪抽取技术获得脂肪颗粒,并将自体富血小板血浆复合脂肪颗粒填充修复患者的唇部软组织缺损.结果 本组共12例患者,其唇部缺损填充后,外观自然,未见明显的脂肪吸收;获随访6～12个月,治疗效果稳定,医患双方均满意.结论 采用自体富血小板血浆-脂肪颗粒填充唇部软组织缺损畸形,能够提高移植脂肪的成活率,减少脂肪颗粒的吸收,且外观效果确切.     

自体富血小板血浆在断指再植患者术后创面愈合中的效果

目的 探究在断指再植术后患者中应用凡士林纱布+自体富血小板血浆（PRP）覆盖的效果。方法 选 取2022年3月-2023年6月于我院实施断指再植术的59例患者为研究对象,根据治疗方法不同分为对照组 （n =29）和试验组（n =30）,对照组采用凡士林纱布覆盖创面,试验组采用凡士林纱布+PRP覆盖创面, 比较两组创面愈合情况、疼痛程度、恢复效果、不良反应发生情况。结果 试验组创面完全愈合时间为 （18.73±2.90）d,短于对照组的（25.68±1.89）d（P ＜0.05）;试验组创面愈合率为（70.10±6.83）%, 高于对照组的（53.79±6.12）%（P ＜0.05）;试验组治疗后VAS评分为（3.90±0.75）分,低于对照组的 （2.90±0.80）分（P ＜0.05）;试验组恢复优良率为100.00%,高于对照组的96.55%（P ＜0.05）;试验组不 良反应发生率为0,低于对照组的3.45%,但差异无统计学意义（P ＞0.05）。结论 在断肢再植后患者中应 用PRP覆盖于凡士林纱布修复创面的效果确切,能提高创面愈合速度,改善其疼痛程度,进而降低不良反 应发生率,值得临床应用。     

自体富血小板血浆在组织缺损修复中的临床应用进展

自体富血小板血浆是一种自体血小板浓缩物,内含大量血小板和生长因子,具有来源于自身血液、制作方法简单、无免疫排斥等优点。目前,已有许多研究将其应用于创面愈合及组织缺损修复。本文对富血小板血浆的相关临床应用进展进行综述。     

多种皮瓣修复下肢软组织缺损

目的 探讨应用多种筋膜皮瓣修复下肢不同部位软组织缺损的临床疗效.方法 2007年9月-2012年3月,对下肢不同部位软组织缺损的21例患者,采用腓肠神经小隐静脉营养血管筋膜皮瓣、小腿内侧皮瓣、股前外侧皮瓣、交腿皮瓣、内踝上穿支皮瓣等修复.结果 本组21例获得随访,随访时间6～24个月.移植组织全部成活19例,2例皮瓣远端因供血不足,部分坏死,行游离植皮后愈合.未发生深部感染或创伤性骨髓炎病例,皮瓣质地优良,无继发溃疡,耐磨损.结论 对于下肢不同部位软组织缺损,要采取相应皮瓣修复,既可达到有效修复软组织缺损、恢复患肢功能的目的,又能最大程度减少不必要的副损伤.     

富血小板血浆修复半月板损伤的研究进展

半月板对膝关节具有至关重要的保护作用。在非手术情况下,半月板内部损伤常无法获得治愈。而手术治疗又存在局限性,难以发挥显著效果。近年来,随着医学不断发展,应用血小板产物已成为治疗半月板损伤的新方式。富血小板血浆(PRP)、血小板衍生生长因子等血小板产物被广泛应用于半月板损伤修复,其成效显著。目前与PRP的半月板损伤修复作用相关的临床研究较少,尤其缺乏大样本、长时间研究。该文将从半月板损伤的特点、PRP的生物学特性及作用、PRP对半月板修复作用的实验研究及临床研究和临床应用前景等方面进行综述,为后续学者深入研究提供理论依据。     

辐照猪皮覆盖创面在治疗肢体皮肤软组织缺损中的应用

2005年1月～2008年8月，我科对20例因创伤所致四肢皮肤软组织缺损患者应用浸磺胺嘧啶银的辐照猪皮覆盖并二期行皮片移植或皮瓣转移术治疗，疗效满意。     

游离、逆行岛状皮瓣修复下肢软组织缺损

目的 探讨下肢离膝关节１０ｃｍ以内小腱残端及足部残端软组织缺损的修复方法。方法 采用３种不同游离，逆行岛状皮瓣修复下肢残端软组织缺损１８例。结果 皮瓣除１例部分坏死外，其余全部成活，随访６个月￣５年，外形，功能均满意。结论 下肢离膝关节１０ｃｍ以内小腿残端及足部残端软组织缺损，尽可能采用皮瓣修复，以最大限度保留或恢复下肢行走功能。     

Free hemiback flap with surgical delay for reconstruction of extensive soft tissue defect: A case report

A delay procedure allows for reliable tissue transfer in random pattern flaps and axial pattern flaps. However, delay procedures have not been studied in free flaps. In this report, we present a case involving the use of a free extended latissimus dorsi musculocutaneous flap (hemiback flap) that included half of the total back skin and was based on thoracodorsal vessels for reconstruction of an extensive soft tissue defect of the flank and waist. The flap was tailored in combination with a delay procedure. Intraoperative indocyanine green fluorescence angiography indicated profuse perfusion except for the most inferomedial part of the flap, which was discarded. The flap survived. A free hemiback flap may offer a valuable option for reconstruction of extensive soft tissue defects. To our knowledge, this is the first report to demonstrate a free flap made in combination with a delay procedure. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

Solitary submandibular soft tissue osteochondroma: A rare case report

IntroductionSoft tissue osteochondromas are rare benign tumors containing bone and cartilage that form in mesenchymal tissues with no connection to adjacent bone, cartilage, or periosteum. They mimic endochondral ossification and are usually encased in a fibrous tissue capsule. The occurrence of the tumor is extremely rare in the maxillofacial region.Case presentationA case of soft tissue osteochondroma in the submandibular region of a 47-year-old man with a medical history of muscular dystrophy and schizophrenia is presented here. The tumor had been gradually growing for 11 years before the patient's presentation to our clinics. Radiographic and clinical examination revealed a radiopaque mass in soft tissue that extended from the left anteroinferior border of the mandible and with no connection to the mandibular periosteum. Treatment involved surgical excision. A diagnosis of soft tissue osteochondroma was established by histopathological examination.Clinical discussionPreviously, there have been only three reported cases of soft tissue osteochondroma in the maxillofacial region. The cause of this tumor is not clearly understood, with multiple hypotheses being proposed. Diagnosis usually involves radiology and histopathology, and the tumor is completely amenable to surgical excision.ConclusionExtraskeletal osteochondroma should be considered in the differential diagnosis of hard tissue lesions with no apparent connection to the underlying bone in the maxillofacial region. Although considered rare, clinical awareness about this tumor aids the practitioner in identifying, diagnosing and properly managing this tumor. There has been no report of recurrence or malignant transformation of the lesion.     

A split cord malformation with paresis of the unilateral lower limb: case report

BACKGROUND

We report a rare case of split cord malformation.

CASE DESCRIPTION

A female neonate presented with split cord malformation (SCM) manifesting as right lower limb paresis. Myelomeningocele and meningocele were found in the lumbosacral region at birth. Magnetic resonance imaging (MRI) demonstrated division of the spinal cord into two hemicords below the T5 level. The right hemicord formed a hemimyelomeningocele and the left hemicord terminated in the low-lying conus. Three-dimensional computed tomography (3D CT) showed extensive vertebral body abnormalities. The hemimyelomeningocele was repaired 1 day after birth, and septectomy and the repair of the meningocele were performed when the patient was 1 year old. The patient has been followed up as an outpatient, and has residual right lower limb paresis.

CONCLUSION

SCM can be associated with multiple spinal abnormalities. MRI and 3D-CT are useful for identifying such abnormalities and planning the surgical treatment.     

Treatment of extensive bone and soft tissue defects of the lower limb by traction and free-flap transfer

Twenty patients with extensive bone and soft tissue defects and posttraumatic osteomyelitis were treated between 1983 and 1995. In all cases an external fixator was used for bone fixation. Bone defects were managed with the Ilizarov intercalary bone transport. Two types of traction were used: the Ilizarov type and a 'new' Ljubljana type. The results of treatment were compared between the two types of traction. In all cases delayed bony union was observed. Osteomyelitis never reactivated. All patients were satisfied with treatment. They were all independent except for one amputee. The Ljubljana traction method was found to have the following advantages: no discrepancy in leg length, no orthopaedic support was needed, the aesthetic outcome was better, the traction time was reduced and there was less soft tissue damage during bone traction.     

Clinical problems related to soft tissue hemangiomas of the lower limb]

The paper presents the clinical problems related to soft tissue hemangiomas of the lower limbs basing on our material consisting of 19 patients, their age ranging from 1.5 to 53 years (average 17.4 years). Soft tissue hemangiomas were most commonly found in the thigh (7 cases) and in the foot (7 cases), less common localizations were the lower leg (4 cases) and the buttock (1 case). The most common symptoms were: local pain, a palpaple tumor cherry-sized to orange-sized, limitation of movement and joint contracture, causing limb dysfunction. Ultrasound and X-ray examination proved to be very useful in assessing the diagnosis. All patients underwent surgery with good results. The histopathologic examination showed 17 cases of cavernosous hemangioma, 1 case of papillary hemangioma and 1 case of hemangiofibroma. In the follow-up examination ranging from 1.5 to 23 years post-op proper limb function was found in all cases. In 2 cases re-operations were performed.