Surgical treatment of varicose veins of the lower limbs]

146 patients with varicosis of the lower limbs were operated upon in a method unified by the author. Consideration was given to the late results found in 132 patients followed up within the period from 1 to 9 years. 5 patients (3.8%) developed recurrence of the disease.     

Combined injuries to the lower limbs

Several patterns of severe lower limb injuries are presented. They all indicate high energy trauma and affect the immediate care of the patient. The improvement of evacuation systems and resuscitating methods in intensive care create many reconstruction challenges for the orthopaedic surgeon. Awareness of the different combinations which are presented can serve as a tool that may be helpful in these demanding injuries. Guidelines for management of combined injuries are essential to improve the outcome of these life-threatening situations.     

坐骨神经霰弹枪伤的手术治疗

目的探讨霰弹枪致坐骨神经损伤的临床特点及手术治疗方法、效果。方法19例坐骨神经霰弹枪伤中,臀部损伤2例,大腿部损伤14例,胭窝部损伤3例。枪伤射击距离在0．5—9．0m之间,按霰弹枪的Shermen分型划分,I型4例,Ⅱ型11例,Ⅲ型4例。伤后至入院手术时间除1例为4h外,其余均为2～14个月。1例行清创、神经外膜对端吻合术,7例行神经全干移值术,6例行神经电缆式移植,4例行神经松解术,1例行踝关节融合术。结果19例患者随访0．8～3．5年、平均19个月,根据英国医学研究院神经外科学会制定的MCRR标准,坐骨神经损伤恢复的优良率为52．6％。结论坐骨神经霰弹枪伤的伤情复杂,常合并开放骨折、血管损伤、软组织缺损及感染;神经损伤的性质多为Sunderland分度中的4～5度损伤;手术治疗方法以神经移植为主,但预后不佳;神经损伤后应给予正确的初始治疗,在对损伤神经恢复状况认真的连续、动态观察的基础上,正确评估神经损伤性质,采取积极、恰当的手术治疗,同时注重神经营养药物、康复理疗等综合治疗,才能获得较好的手术效果。     

广泛性下肢脱套伤的外科处理

随着工农业技术及交通事业的发展,由于意外事故造成广泛下肢脱套伤的情况临床并不少见,近二年来,我科共收治此类病人8例,由于处理及时妥当,均获得令人满意效果,现报告如下.     

外伤性面瘫的早期手术治疗

目的 探讨外伤性面瘫手术时机和手术方法的选择。强调神经外瘢痕松解切除和严格遵守显微外科无创原则,结合神经损伤的形态特点。针对性选择优选用吻合神经方法的重要性。方法 1993年12月-1997年11月,收治外伤性面瘫病人7例。于伤后3-4个月采用显微外科技术进行面神经吻合及腓肠神经眼轮匝肌植入术进行修复。结果 术后随访6个月-2年,均获得了比较满意的面肌功能恢复。结论 外伤性面瘫,争取早日手术是成功的关键。方法宜首选面神经吻合,神经移植肌肉内植入术,对整复某些外伤后面瘫有其临床应用价值和适应证。     

Sensory sequelae of injuries to the median nerve]

Median nerve wounds are frequent because of the superficial course of this nerve, especially in the wrist. The sensory sequellae of such lesions, either complete or dissociated, represent a major handicap which may be associated to a motor impairment of the external thenar muscles. The curative procedures such as neurolysis and, above all, sutures or grafts, must be very widely used, even some time after the initial injury and in spite of motor reinnervation. The role of palliative surgery is therefore limited, although it is sometimes useful. There are many procedures, which may be summed up by two techniques: use of sensitive neurovascular skin flaps, the most frequent grafts, neurotization of the median nerve with a transfer of sensory rami from the radial nerve, a less-known technique. The treatment of the sensory sequellae of median nerve lesions is primarily based on a good initial management of the nerve lesions by a good-quality emergent microsurgical suture.     

Surgical methods in the treatment of patients with sequelae of hip joint injuries]

The article analyzes results of treatment of 64 patients with sequelae of traumas of the hip joint. They showed that arthrodesis of the hip joint was indicated in treatment of young patients with severe posttraumatic coxarthrosis, destruction of the cotyloid cavity or the femur head including those after fighting injuries of the joint, purulent complications after traumas or preceding operations. Intertrochanteric osteotomy of the femur is reasonable in treatment of young patients with the initial stages of coxarthrosis and preserved amplitude of movement of the joint. Endoprosthesis of the hip joint is the operation of choice in patients older than 40-45 years with posttraumatic coxarthrosis and aseptic necrosis of the femur head, as well as in patients with the recurrent pain syndrome after intertrochanteric osteotomy.     

Surgical treatment for injuries of the middle and lower cervical spine

We reviewed the surgical treatment of 31 patients with burst fractures or teardrop dislocation fractures in the middle and lower cervical spine. Patients were treated with anterior instrumentation, posterior instrumentation, or a combination of both. Patients were evaluated radiographically and with the Frankel neurological outcomes grading scale. Anterior decompression and fusion restored the spinal canal diameter by approximately 60% whereas the posterior or combined approaches restored the canal diameter by only 6%. In addition, nine of 24 patients treated anteriorly gained improved neurological function whereas none of the patients treated posteriorly had neurological improvement. Based on the anatomical and neurological findings, the study demonstrates that anterior fusion is preferable to posterior fusion for the treatment of burst fractures and tear-drop dislocation fractures of the middle and lower cervical spine.

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Résumé Nous avons revus le résultat du traitement chirurgical de 31 malades avec une fracture comminutive ou une fracture-luxation en flexion (tear drop) du rachis cervical moyen et inférieur. Les malades ont été traités avec une instrumentation antérieure, une instrumentation postérieure, ou une combinaison des deux. Les malades ont été évalués radiographiquement et avec le score neurologique de Frankel. La décompression-fusion antérieure a restauré le diamètre du canal vertébral approximativement dans 60% des cas, alors que les abords postérieurs ou combinés ont restauré le diamètre du canal dans seulement 6% des cas. De plus, 9 des 24 malades traités par voie antérieure ont vu leur fonction neurologique améliorée, alors qu’aucun des malades traités par voie postérieure n’avait d’amélioration neurologique. Basé sur les conclusions anatomiques et neurologiques, l’étude démontre que la fusion antérieure est préférable à la fusion postérieure pour le traitement des fractures comminutives et des fracture-luxations en flexion de la colonne vertébrale cervicale moyenne et inférieure.