Comparison of single-stage and delayed gastrocnemius flap procedures for soft-tissue defects of the knee and proximal tibia

European Journal of Orthopaedic Surgery & Traumatology - Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and proximal tibia following orthopedic...     

骨外固定器结合股前外侧皮瓣急诊修复胫腓骨骨折软组织缺损

自1998年以来采用外固定器结合股前外侧皮瓣急诊修复小腿严重创伤所致胫腓骨开放性骨折并软组织缺损患者21例,效果较好,报告如下。1临床资料本组男17例,女4例;平均年龄30岁。车祸伤14例,砸伤6例,炸伤1例右侧12例,左侧9例。软组织缺损创面最大20 cm×15 cm,最小12 cm×7 cm。2手     

逆行股前外侧皮瓣移位修复胫骨外露创面

目的探讨逆行股前外侧皮瓣、肌皮瓣修复小腿中上段胫骨外露创面的方法及疗效。方法 2005年10月-2010年4月,应用逆行股前外侧皮瓣、肌皮瓣移位修复小腿中上段胫骨外露创面16例。男10例,女6例;年龄16～52岁。交通事故伤11例,重物压伤5例。10例为伤后1～6 h入院,平均3 h;6例伤后于外院行胫骨骨折钢板内固定术后创面严重感染,伤后至该次入院时间为6～14 d,平均10 d。创面范围13 cm×7 cm～20 cm×13 cm。皮瓣切取范围16 cm×10 cm～23 cm×15 cm。供区取中厚皮游离移植修复。结果术后5～7 d 2例皮瓣发生感染,经换药1周后愈合;其余皮瓣成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮成活。患者均获随访,随访时间10～23个月,平均18个月。患肢皮瓣外形稍臃肿,色泽、质地满意。骨折均于术后8～10个月愈合。结论采用逆行股前外侧皮瓣、肌皮瓣可有效修复小腿中上段胫骨外露创面。     

经三角肌前外侧入路人工肱骨头置换治疗老年Neer三、四部分肱骨近端骨折

目的探讨经三角肌前外侧入路人工肱骨头置换治疗老年Neer三、四部分骨折的可行性、方法及临床治疗效果。方法对12例60岁以上Neer三、四部分肱骨近端骨折患者采用经三角肌前外侧入路人工肱骨头置换术治疗。结果 12例均获随访,时间12～25(17±6.2)个月。ASES评分为77～91(87.1±5.8)分。肩关节活动度为:主动前屈上举95°～148°(130°±22.1°),主动体侧内旋角度T8～L5水平,主动体侧外旋角度25°～42°(35.2°±5.5°)。无神经损伤、异位骨化、大结节再次移位。1例伴肩关节前脱位者(Neer四部分骨折)游离脱位肱骨头取出困难,延长了手术时间并增加了术中出血。结论人工肱骨头置换是治疗老年Neer三、四部分肱骨近端骨折有效方法,经三角肌前外侧入路具有暴露直接、组织损伤小、术中出血少等优点,但对于伴有肩关节脱位的骨折,利用此切口有一定局限性,不建议使用。     

Triplane fracture of the proximal tibia

We report a case of successful treatment of a very rare triplane fracture of the proximal tibia in an adolescent boy. The fracture was internally fixed using cannulated Herbert screws. The final result was excellent.     

骨外固定架结合锁定钢板治疗胫骨开放骨折

2006年7月~2012年7月,我们对28例小腿软组织条件较差的胫骨开放骨折患者早期采用外固定支架固定,待皮肤软组织条件稳定后,采用微创锁定钢板固定治疗,获得良好疗效.1 材料与方法1.1 病例资料本组28例,男18例,女10例,年龄18~65岁.均为Ⅱ~Ⅲ度开放骨折,中上1/3段6例,中1/3段10例,中下1/3段12例.     

Treatment of an open distal tibia fracture with segmental bone loss in combination with a closed proximal tibia fracture: a case report

The treatment of open distal tibia fractures remains challenging, particularly when the fracture is infected and involves segmental bone loss. We report the case of a 38-year-old man who sustained an open distal tibiofibular fracture with segmental bone loss and a closed proximal tibial fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture was infected, and the skin was covered after the wound became culture negative. The tibia was then internally transported with a ring external fixator; the closed fracture of the proximal tibia served as the corticotomy for internal transport without conventional corticotomy. After 5?cm internal transport, the docking site of the distal tibia was fixed with a locking plate and autogenous cancellous bone graft. Bone graft was also used to the distal tibiofibular space to achieve distal tibiofibular synostosis. We describe one treatment option for an infected open fracture of the distal tibia with segmental bone loss that is accompanied by a closed fracture of the proximal tibia. This method can treat two fractures simultaneously.     

前外侧入路人工关节置换治疗股骨转子下骨折并股骨颈陈旧性骨折

目的:探讨股骨转子下骨折并股骨颈陈旧性骨折经一次性关节置换术的临床疗效。方法:自2003年10月至2013年10月,对7例外伤性股骨转子下新鲜骨折伴股骨颈陈旧性骨折患者行一次性人工髋关节置换术,其中男5例,女2例;年龄 69～80岁,平均74.5岁。股骨颈骨折按照Garden分型:Ⅳ型2例,Ⅴ型5例。股骨骨折类型按照 AO分类均为 A1型长斜形股骨转子下骨折,均采用生物涂层长柄股骨假体。术后观察其并发症并采用Charnley评分系统评价髋关节功能。结果:7例患者均获随访,时间 12～24个月,平均18个月。术后泌尿系统感染1例,深静脉栓塞1例。5例患者在术后 6个月恢复步行能力,2例在 1年后仍需扶拐步行。按Charnley髋关节功能评分标准,总分(15.0±2.5)分,其中优4例,良2 例,中1例。结论:前外侧入路人工髋关节置换治疗股骨转子下骨折并股骨颈陈旧性骨折,具有关节稳定性好、并发症少、恢复快、疼痛轻、可早期下地活动的优点。     

二期经小腿后内侧入路植骨治疗胫骨下段开放骨折术后骨缺损

目的探讨二期经小腿后内侧入路植骨治疗胫骨下段开放骨折术后骨缺损的临床疗效。方法采用二期小腿后内侧入路取髂骨植骨对24例胫骨下段开放粉碎性骨折术后骨缺损的患者进行手术治疗。结果 24例均获随访,时间12～18个月。伤口均一期愈合,无皮肤坏死、伤口感染、骨外露等严重并发症;植骨融合时间距植骨后12～18(16±2)周。踝关节功能根据Mazur评分系统评定:优20例,良2例,可2例。结论小腿后内侧入路因其具有显露充分、术后软组织并发症少等优点,二期经小腿后内侧入路植骨是治疗胫骨下段开放骨折术后骨缺损有效且可靠的方法 。     

The proximal pedicled anterolateral thigh flap for lower limb coverage

Although primarily considered as a versatile free-flap donor site, the anterolateral thigh can also be a source of a local muscle perforator flap. This attribute has previously been rarely considered for lower limb coverage. This small series of 3 additional cases demonstrates the usefulness of a proximal pedicled anterolateral thigh flap for medial and lateral thigh wounds. This flap can also be part of a combined flap, in particular when transferred with the vastus lateralis muscle as a local chimeric flap. The peninsular version of the anterolateral thigh local flap avoids venous congestion and is very reliable. The orthograde pedicled anterolateral thigh muscle perforator flap should be considered as another useful alternative for any upper thigh wound if a flap is essential.     

胫骨远端前外侧锁定钢板内固定治疗胫骨远端骨折

2008年10月-2010年1月,我科对18例胫骨远端骨折患者采用切开复位胫骨远端外侧锁定钢板内固定治疗,疗效满意。     

部分开放式组织瓣移植术治疗开放性胫骨骨感染

目的 探讨应用部分开放式组织瓣移植的方法治疗胫骨骨感染骨坏死的临床治疗价值.方法 伴不同感染程度的开放性胫骨缺损、骨坏死28例,于伤后3～8周行部分开放式的组织瓣移植修复术,并对其病程转归及治疗结果进行临床总结.胫骨上段6例,胫骨中下段21例,胫骨全长1例;单纯骨外露坏死5例,开放性骨感染骨缺损23例.应用局部带蒂岛状皮瓣2例,26例应用吻合血管的游离组织瓣移植.其中游离股前外侧(肌)皮瓣21例,髂骨皮瓣5例,腓骨瓣组合股前外侧(肌)皮瓣2例.结果 组织瓣全部成活,成活率达100%.移植骨瓣于术后3～6个月有骨痂形成包裹,坏死骨在6个月左右被大部分吸收替代,2例发生深部组织感染,经反复清创并开放创面后愈合.残留创面在术后3～6周闭合22例,术后3～6个月闭合6例.术后21例获得随访3个月到1.5年,疗效满意.与闭合式组织瓣移植术比较,其组织瓣切取面积小、深部组织感染几率小、有利于患者心理及体质恢复、缩短治疗周期.结论 部分开放式组织瓣移植术是治疗胫骨开放性骨坏死骨感染的理想方法.     

肩峰下前外侧小切口入路在肱骨近端骨折治疗中的临床应用

[目的]评价应用肩峰下前外侧小切口入路治疗肱骨近端骨折的方法和临床疗效。[方法]2006年12月-2008年12月运用肩峰下前外侧小切口入路使用锁定钢板治疗42例肱骨近端骨折,其中男25例,女17例,根据AO/OTA分型,A2型5例,A3型11例,B1型7例,B2型12例,C1型3例,C2型4例。经肩前外侧小切口入路,在肱骨大结节顶端下1.5 cm左右,做一3 cm左右横切口,纵行分离三角肌,探及骨折,直视下间接和直接复位。经骨表面肌肉下隧道向骨折远端插入锁定钢板,于钢板远端做纵行切口,远近端用锁定螺钉固定。比较不同时期病例的切口长度、手术时间、出血量、骨折复位及术后1年Neer评分。[结果]42例均在小切口中完成手术,初期和后期病例切口长度分别为(4.5±1.0)cm和(4.0±0.7)cm;手术时间为(60±14.1)min和(45.4±8.7)min;出血量为(100±20.6)ml和(70.2±16.8)ml;Neer评分为(80.2±5.4)分和(86.0±6.0)分,达到影像学的解剖复位分别为6、16例。统计学分析显示以上几项指标不同时期比较,差异有统计学意义(P0.05)。[结论]严格把握适应证和规范的手术技巧,肩峰下前外侧小切口入路可以很好的完成肱骨近端骨折的手术治疗,可以获得满意的临床效果,在大多数的肱骨近端骨折的手术治疗中可以作为首选的手术入路。     

The anterolateral acromial approach for fractures of the proximal humerus

Displaced and unstable fractures of the proximal humerus are notoriously difficult to manage. Successful surgical treatment requires finding the appropriate balance between adequate exposure for reduction and rigid fixation and minimizing soft tissue dissection. The anterolateral acromial approach was developed to allow less invasive treatment of proximal humerus fractures. The plane of the avascular anterior deltoid raphe is utilized, and the axillary nerve is identified and protected. Anterior dissection near the critical blood supply is avoided, substantial muscle retraction is minimized, and the lateral plating zone is directly accessed. Over a 4-year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. Twenty-three patients were evaluated clinically at a minimum follow-up of 1 year (average, 28 months) by clinical examination for range of motion and nerve function and a QuickDASH score. There were no axillary nerve deficits postoperatively related to the approach, and the average QuickDASH score was 25.2 (0, best; 100, worst). This approach allowed direct access to the lateral fracture planes for fracture reduction and plate placement or safe nail and interlocking screw placement.     

Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects

BACKGROUND: Reconstruction of defects involving the knee and proximal one third of the lower leg presents a challenging problem in plastic surgery. AIM: To evaluate the reversed anterolateral thigh adipofascial flap for covering such defects. METHODS: Between September 2006 and May 2007, one man and four women with defects around the knee and upper calf underwent reconstruction with reversed anterolateral thigh adipofascial flaps. The patients' average age was 45 years (25-72 years). The size of the transferred flap ranged from 6cmx8cm to 12cmx13cm. RESULTS: Four flaps with overlying skin grafts healed uneventfully; one skin graft showed minor necrosis due to haematoma, but the adipofascial flap survived well. Postoperatively the appearance of the reconstructive flap was acceptable. CONCLUSIONS: The reversed anterolateral thigh adipofascial flap is an effective option for covering defects of the knee and proximal calf.     

应用肱骨近端锁定型髓内针治疗肱骨近端骨折的临床疗效分析

目的探讨应用肱骨近端髓内针治疗肱骨近端两部分外科颈骨折的疗效。方法回顾性分析22例应用锁定型肱骨近端髓内针治疗两部分外科颈新鲜骨折患者的临床资料,患者平均年龄57岁。最终随访时拍摄肩关节X线片以评价愈合情况,并应用可视模拟评分法（VAS）评分,美国肩肘外科医师评分（ASES）,Constant-Murley评分,UCLA评分以及简易肩关节测验（SST）问卷评估。结果所有患者均获随访,平均随访时间为13个月,22例患者骨折均在术后8周内初步愈合。随访过程中未出现感染、肱骨头坏死以及任何与内固定物有关的并发症。术后患肢主动前屈上举平均为147．8°,主动体侧外旋平均为45．5°,主动内旋平均达T10水平。术后患者疼痛VAS评分平均为1．5。平均ASES评分为81．2,Constant-Murley评分为85．4,UCLA评分为29．9,SST评分为9．5。18例患者的肩关节功能评估为优或良,4例患者肩关节功能评估为差。结论闭合复位、锁定型肱骨近端髓内针固定术是治疗肱骨近端两部分外科颈骨折的一种有效的手术方式。