小腿外侧皮瓣修复跟骨骨折皮肤坏死疗效分析

目的 总结采用小腿外侧皮瓣修复跟骨骨折术后皮肤坏死、钢板外露的治疗效果.方法 跟骨骨折术后皮肤坏死、钢板外露采用小腿外侧皮瓣修复35例.结果 皮瓣全部成活,所有病例创面均一期愈合,术后随诊6个月～5年,皮瓣质地良好,小腿功能正常.结论 采用小腿外侧皮瓣修复跟骨骨折术后皮肤坏死、钢板外露,可获得良好的临床效果,是理想的术式之一.     

跟腱外露创面的显微外科治疗

目的 探讨应用显微外科技术,采用多种皮瓣修复跟腱外露创面的临床效果. 方法 以足底内侧皮瓣、足跟外侧皮瓣和腓肠神经营养血管皮瓣转移修复跟腱外露11例. 结果 11例皮瓣全部成活,术后随访8～ 24个月,平均14个月,皮瓣色泽,弹性良好,外形不臃肿,8例皮瓣恢复了痛觉,3例腓肠神经营养血管皮瓣恢复了保护性感觉,供区直接缝合7例,余4例供区植皮全部成活,供区无明显疼痛. 结论 对于跟腱外露创面采用局部岛状皮瓣转移修复,可获得良好的临床效果.     

小腿后侧筋膜皮瓣的临床应用

目的　总结小腿后侧筋膜皮瓣的临床应用的临床疗效。　方法　 1997年以来 ,应用由窝内 /外侧动脉供血的小腿后侧筋膜皮瓣修复膝内 /外侧骨外露、皮肤软组织缺损和窝瘢痕 12例 ,切取皮瓣面积最大为 12cm× 2 3cm ,最小为 8cm× 12cm。　结果　术后皮瓣全部成活 ,膝内 /外侧骨外露及皮肤软组织缺损得以修复 ,窝功能、外形良好。　结论　小腿后侧筋膜皮瓣部位隐蔽 ,皮肤质量较好 ,供皮面积较大 ,适合于修复膝内 /外侧骨外露及皮肤软组织缺损和窝瘢痕 ,且手术操作简便 ,血供可靠。     

胫后动脉穿支皮瓣修复胫骨外露创面

胫腓骨开放骨折术后骨与内固定物外露时有发生，随着显微外科技术的不断发展，应用皮瓣修复此类创面能获得较好临床效果。自1999年3月至2007年12月，笔者应用胫后动脉穿支皮瓣转位修复胫骨骨与钢板外露创面15例．获得较理想的治疗效果。     

胸脐皮瓣修复小腿大面积皮肤缺损并骨外露

应用胸脐皮瓣修复小腿大面积皮肤缺损并骨外露 13例 ,皮瓣面积 (3 8ｃｍ× 18ｃｍ)～ (2 0ｃｍ× 12ｃｍ) ,受区以胫前动、静脉远端为蒂 ,2例术后发生静脉危象 ,皮瓣静脉改与患肢游离出的小隐静脉近端吻合 ,13例皮瓣全部成活。随访 4～ 6个月 ,患者对皮瓣外形满意。体会 :本皮瓣切取面积较大 ,适合修复大面积皮肤缺损 ,皮瓣静脉采用生理性回流 ,有利成活胸脐皮瓣修复小腿大面积皮肤缺损并骨外露$河南省濮阳市中医院显微外科@王在斌 $河南省濮阳市中医院显微外科@陈秀民 $河南省濮阳市中医院显微外科@李百华…     

非主干血管皮瓣在小腿二次皮瓣修复中的临床应用

目的 报道采用非主干血管皮瓣移植，对小腿组织缺损皮瓣修复术后皮瓣的远端发生的部分坏死伴胫骨外露创面进行2次皮瓣修复的临床效果。方法 对外伤性小腿胫骨粉碎性骨折伴皮肤缺损，行骨折复位或异体骨移植，一次皮瓣修复术后，皮瓣的远端发生部分坏死所致的骨外露的创面，采用腓肠神经营养血管皮瓣修复6例、腓肠肌外侧头皮瓣和内侧头皮瓣修复6例。结果术后皮瓣全部成活，随访2个月～6年。植入的异体骨骨性愈合，未见明显骨吸收，没有发生感染和排斥反应等并发症。结论 应用显微外科技术，采用非主干血管皮瓣对一次皮瓣修复术后的皮瓣远端部分坏死所致的骨外露创面进行修复，是一种有效的方法。     

吻合血管折叠式腓骨皮瓣修复大段胫骨及皮肤软组织缺损

目的报道采用吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露的方法，并观察其临床疗效。方法采用吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露5例。胫骨缺损6～10cm，皮肤软组织缺损范围4cm×5cm-7cm×18cm。保持骨膜的连续性，将腓骨截骨后折叠形成双管状腓骨皮瓣，移植修复胫骨及皮肤缺损。结果术后移植组织全部成活，皮瓣弹性、色泽良好，术后3—4个月患肢开始负重，术后随访8～10个月，复查X线片示腓骨与胫骨骨性愈合良好，恢复行走功能。结论吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露及皮肤软组织缺损是可靠、有效的治疗方法，值得临床推广应用。     

四肢软组织缺损及感染创面的显微外科修复

为了总结应用显微外科技术修复四肢软组织缺损及感染创面的经验，对应用不同种类的皮瓣或肌皮瓣移位、移植修复的８３例患者进行了随访。结果表明，８３例皮瓣均成活；８２例切口Ⅰ期愈合，１例胫前溃疡骨外露，术后伤口轻度感染，经４周换药治愈。全部患者经６个月～４年随访，功能恢复满意。认为，四肢软组织缺损及时修复，皮瓣供区选择应就近避远，修复方法应就简避繁。正确处理创面，合理设计皮瓣，术后使用有效的抗生素等，有助于修复成功。     

万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面中的应用

[目的]探讨万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面及预防跟骨骨髓炎中的临床应用价值。[方法]2012年1月~2015年3月,应用万古霉素骨水泥联合胫后动脉穿支或腓动脉穿支螺旋桨皮瓣修复感染并跟骨骨折骨外露创面13例。其中10例伤口分泌物细菌培养为阳性,创面缺损范围5.0 cm×3.5 cm~8.5cm×7.0 cm。术前用手持普勒超声进行穿支点定位并完成螺旋桨皮瓣设计。术中对创面进行彻底清创,清除游离及坏死的骨质;按术前设计切取皮瓣,皮瓣旋转修复创面;在皮瓣下方跟骨缺损或感染严重的区域放置万古霉素骨水泥条1~2根,术后1个月拔出。皮瓣切取范围14.5 cm×4.0 cm~27.0 cm×7.5 cm,8例供区直接缝合,5例供区植皮修复。其中3例因跟骨缺损较多,术后二期行取髂骨植骨术。[结果]术中顺利完成皮瓣切取及创面修复,术后皮瓣均顺利成活,创面及供区切口Ⅰ期愈合。患者均获随访,随访时间12~23个月,平均17个月。随访中均未发现创面处感染复发及窦道形成,X线片未见骨髓炎病灶形成。所有皮瓣外形良好。末次随访时根据美国足踝外科协会(AOFAS)评分评价足部功能,足部功能总优良率为76.9%。[结论]万古霉素骨水泥联合螺旋桨皮瓣是修复感染性跟骨外露创面及防治跟骨骨髓炎的有效方法。     

骨外露组织缺损的显微外科修复

目的 报道游离皮瓣，带蒂岛状皮瓣移植复四肢复杂性组织缺损和骨外露的临床疗效。方法 应用显微外科方法施行皮瓣移植修复骨外露组织缺损２６例，其中游离皮瓣２０例，腓肠神经营养血和的岛状皮瓣６例。骨外露软组织缺损部位：足部４例，跟部５例，踝部４例，小腿胫，腓骨５例，手腕部８例。结果 ２６例皮瓣全部成活，仅有其中２例远端小部分坏死，经换药处理创面愈合。     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

Aneurysmal bone cyst of the occipital bone

A 13 years boy presented with a painless hard and fixed swelling in occipital region for the last three months. Plain X-ray, CT scan and MRI showed an expansile multi loculated cystic lesion in occipital bone. Histopathological examination revealed it to be an aneurysmal bone cyst. Treatment of choice is surgery. However, radiotherapy may be helpful in incompletely excised lesions.     

Genetic regulation of bone mass: from bone density to bone strength

Osteoporosis is a common disease characterized in adults by diminished bone density. Bone is an organ that evolves and grows throughout life, and establishing optimal bone density in childhood and adolescence serves to buffer bone loss later in life. Bone density, a measurable entity, is the clinical substitute for bone strength, or the ability to defend against fracture. Chronic diseases may adversely affect optimal peak bone density. Bone density is under genetic control, as revealed by three lines of investigations. These include (1) the finding of quantitative trait loci for bone density, (2) the finding that specific mutations in genes that are important in the development of osteoblast or osteoclast lineages alter bone density, and (3) the linkeage of known polymorphisms for genes involved in mineral homeostasis to bone density and/or fracture. Future therapeutics for improving peak bone density or delaying bone loss later in life may take advantage of the genetic nature of bone density development.This work was presented in part at the IPNA Seventh Symposium on Growth and Development in Children with Chronic Kidney Disease: The Molecular Basis of Skeletal Growth, 1–3 April 2004, Heidelberg, Germany     

Development of bone canaliculi during bone repair

We recently found that silver impregnation staining with protargol (silver protein), that is, a modified Bodian method, is useful for histologically identifying the details of bone canaliculi structure, using thin sections of decalcified bone tissues. With this staining method, we conducted the present study to assess the development of bone canaliculi during the process of intramembranous ossification using a fracture-like stimulation model of the rat femur. After making a drill-hole in the cortex of the rat femur, decalcified thin sections were obtained after 3, 5, 7, and 14 days by the standard paraffin-embedding procedure. Silver staining for bone canaliculi was performed using our previously reported technique. The results showed that woven bone covered the fracture surface of the cortex after 5 days, then immature lamellar bone attached to the woven bone after 7 days, and finally the lamellar bone matured and became thick with appositional growth after 14 days. The osteocytes in the woven bone appeared at an early stage of bone repair and developed a few canaliculi that were short and irregularly distributed in the osteoid matrix, while the osteocytes in the lamellar bone at a late stage formed many bone canaliculi that were long and regularly distributed in mature bone matrix. Therefore, we concluded that woven bone osteocytes may be necessary for induction of the lamellar bone osteocytes followed by active appositional growth of the lamellar bone at the early stage of bone repair, and also that both bone tissues could be clearly distinguished from one another based on the pattern of development of bone canaliculi by the osteocytes, as seen with the use of our sensitive staining method.     

重组合异种骨植骨修复骨囊肿所致骨缺损

2001年10月～2003年9月,笔者共收治28例骨囊肿患者,均采用病灶刮除,瘤腔灭活和重组合异种骨植骨治疗,获得满意疗效,体会如下。     

Transmembrane bone matrix gelatin-induced differentiation of bone

In response to chemically-defined bone matrix gelatin (BMG) inside a diffusion chamber implanted in a muscle pouch, mesenchymal cells migrate directionally, aggregate and differentiate into new bone, on theoutside of the chamber. BMG diffuses through double membranes 275 to 300 μm in thickness. The inner membrane of pore size is 0.025 μm and the outer membrane of pore size is 0.45 μm. The inner membrane is 1/20 the pore size and the combination is twice the thickness of membranes previously reported to transfer osteoinductive activity of living cells. Autoradiographs show³⁵S-cysteine-labelled BMG produces very high transmembrane grain counts while³H-proline labelled BMG produces very low transmembrane grain counts. Electron micrographs demonstrate that gelatin-derived, uranyl-acetate-stained fine granules interspersed with ruthenium red-staining coarse granules, diffuse through the membrane of 0.025 μm pore size from the inside out. Solitary pale-staining collagen fibrils, possibly formed in interstitial fluid by renaturation of BMG are found in the interior of the chamber and in the interior of the outer 0.45 μm but not the inner 0.025 μm pore size membrane. Densely-stained new bone collagen fiber bundles cover the outer membrane, fill the 0.45 μm subsurface pores for a depth of 0.20 to 30 μm, and thereby attach the new cartilage and bone deposits to the outer surface of the chamber. BMG powders solubilize rapidly in diffusion chambers and produce high yields of new bone. The relationship between denatured collagen and renatured gelatin fibrils in the process of transfer of the bone morphogen from BMG to mesenchymal cell receptors is an intriguing subject for further investigation.     

Aneurysmal bone cyst of the frontal bone

Aneurysmal bone cyst rarely affects the skull. We report two cases of aneurysmal bone cyst of the frontal bone. One of the cases is associated with pregnancy. The association of pregnancy with aneurysmal bone cyst and enlargement of the aneurysmal bone cyst during the pregnancy have been discussed.     

Aneurysmal bone cysts of the occipital bone

Two cases of aneurysmal bone cysts are reported. Each patient presented with a palpable mass in the occipital region and signs of compression of structures in the posterior fossa. One of the cases is unique, in that the aneurysmal bone cyst was associated with an epidural hematoma in the posterior fossa. The pertinent literature is reviewed.