游离第二足趾或关节移植术后供足X线改变

游离第２足趾或关节移植术是最主要的拇、手指再造方法之一。但至今尚未见有关供足Ｘ线方面研究的报告。笔者采用双足标准正位及负重侧位Ｘ线摄片,对２７例术后病人平均随访５．６６年。按手术截趾平面及随访时间不同行自身对照分层分析。结果：（１）第１跖骨和其近节趾骨长轴夹角比非手术侧平均增大３．7５°，原有用外翻畸形的病人，术后供足畸形加重;（２）跖骨截骨组的远期随访病人供足外侧纵弓平均增大３°;（３）术后供足１～３趾间距平均比非手术侧小９．1３ｍｍｉ（４）术后供足最大宽度变小：（５）跖骨截骨组４１．６７％的病人出现残留跖骨密度降低。本组只有少数病人稍感供足不适，但均不需治疗。     

减压和血管束植入治疗月骨无菌性坏死

报道采用自行设计的减压和血管束植入法，治疗月骨无菌性坏死的疗效。方法：对月骨进行钻洞减压和骨间前动，静脉腕背支植入的方法，共治疗１１例。结果：平均随访３６个月，系列随访Ｘ线片显示：坏死的月骨不断地被修复，密度明显下降，骨囊性变皆完全消失。     

跟外侧血管蒂骨膜瓣移植治疗儿童距骨坏死随访

应用跟外侧血管蒂骨膜瓣植入治疗儿童距骨坏死５例，结果显示：术后３－４个月Ｘ线片距骨密度及形态明显改善，８个月距骨形态恢复正常。并经３－１０年的随访，疗效肯定。其中有以下优点；１．清除死骨彻底减压；２重建距骨血液循环系统；３．带血管的骨膜植入可为距骨带入成骨效应成分，加速骨重建。     

经皮自体骨髓移植在骨缺损瘢痕组织内成骨作用的实验研究

目的 观察经皮自体骨髓移植在骨缺损瘢痕组织内的成骨作用。方法 选健康家兔１８只，建立双侧桡骨中段骨及骨膜缺损１ｃｍ模型，两骨断端髓腔用骨蜡封闭。６周后，实验侧（右）桡骨骨缺损区经皮注射自体红骨髓２ｍｌ，对照侧（左）桡骨骨缺损区注射自身外周血２ｍｌ。于注射前及注射后不同时间内分别行Ｘ线、组织学检查及骨缺损区瘢痕组织内钙磷含量的测定。结果 注射一１周，实验侧Ｘ线显示以骨缺损为中心形成一个密度增高的弧形     

冷冻异体手指复合组织移植的临床评价

目的 评估自体拇甲皮瓣游离移植包冷冻异体手指骨－关节－肌腱－脾鞘复合组织再造拇、手术指的临床效果。方法 对再造拇、手指２７０例通过门诊复查、信访、Ｘ线睛、实验室检查、＾９９ｃＴｃＭＤＰ扫描及手术等方式进行随访,并对资料进行统计学处理与临床验证。随访时间为术后５个月～１６年,平均５年。结果 拇皮瓣携囊趾关节二块骨片包绕营养异体手指复合组织能造出外形良好的拇、手指,对掌功能优良率７１．９１％。感觉术后     

股骨颈骨折延迟及不连接的股骨头病理改变与手术疗效观察

１９８２～１９９５年间收治２５９例陈旧性股骨颈骨折，手术前采用Ｘ线片、病理组织学、电镜、四环素荧光标记和ＥＣＴ观察股骨头病理改变，发现股骨头坏死在不负重状态下有其自然的修复规律，股骨头塌陷在其修复过程中与所受的应力大小有关。２５９例中１９８例采用吻合血管腓骨移植治疗，２４例采用缝匠肌肌瓣骨移植，２２例采用带旋髂深血管蒂髂骨移植，１５例行人工关节置换处理。其中１６６例吻合血管腓骨移植病例得到了３～１２年的系统Ｘ线片和功能随访观察，优良率为８４．３％。作者认为；陈旧性股骨颈骨折在良好的复位情况下采用吻合血管的腓骨与加压螺纹钉有协同固定和支撑作用。     

亲属脾移植术后移植物抗宿主反应和移植脾亢的成功治疗经验

移植物抗宿主反应（ＧＶＨＲ）和移植脾亢是脾移植的两个棘手问题，因二者来势凶猛，控制困难，既往治疗切除移植脾脏。我们介绍一例你亲供脾移植术后天和２１天发生ＧＶＨＲ和移植脾亢，分别采用深部Ｘ线及钴６０局获得成功的治疗经验。     

胫骨干骨折后的骨质丢失

临床上注意到：胫骨干骨折后会发生松质骨的骨质丢失。表现为Ｘ线片上骨小梁变细、稀疏、整体透Ｘ线增强。但这通常是肉眼观察所得，缺乏定量测定。为此，我们以计算机辅助的Ｘ线片密度分析研究了这一问题。１材料与方法３２例胫骨干骨折。收集原始和伤后２周和６月的随访...     

冷冻保存异体椎间盘移植的实验研究

目的 观察猴冷冻保存异体椎间盘移植后的Ｘ线、组织形态学、分子生物学、生物化学少生物力学的变化,探讨移植椎间盘的长期归宿及临床应用的可能性。方法 １７只猴中的１２只随机分为０．５、１、１．５、２、６和２４个月组。移植椎间盘梯度降温至－１９６℃保存,术前复温后手术植入。结果 Ｘ线显示无脱位,２４个月极能维持正常高度的６４．９％。术后２周权在移植椎间盘终板下骨与宿主椎体骨界面区有轻度免疫排斥反应,４周时     

巨孔全髋股骨头假体的生物学固定与X线表现

为总结Ｘ线诊断无骨水泥全髋股骨头假体置换术后生物学固定的方法，作者总结了４２例４６髋的临床和初始固定、生物学固定的Ｘ线随访资料。经２～４年，平均３年随访。结果：功能优良３８髋，尚可和差８髋。Ｘ线片提示初始固定质量在前组优于后组（Ｐ值＜０．０１）；骨锚固征如巨孔区新骨形成、硬化带缺如和股矩萎缩等发生率在优良组高于功能尚可和差组（Ｐ值＜０．０１），而广泛硬化带和透射带（＞２个区）等静态不稳征以及假体下沉、内翻移位、髓腔扩大等动态不稳征的发生率在优良组低于功能尚可和差组（Ｐ值＜０．０１）。结论：（１）假体初始固定质量与临床疗效密切相关；（２）诊断假体骨性固定，巨孔区新骨形成、硬化带缺如可作为主要Ｘ线征，股矩萎缩可作为附加Ｘ线征；（３）诊断假体松动，广泛硬化带和透射带以及假体下沉、内翻移位可作为主要Ｘ线征，其它为附加Ｘ线征；（４）如无临床松动表现，但Ｘ线片有某些不稳表现，则应诊断纤维性稳定；（５）Ｘ线诊断应结合临床，可提高诊断的正确性。     

Coverage of defects over toes with distally based local flaps: A report of four cases

Reconstruction of the distal foot, especially of the toe has always been a challenging problem. Various methods have been tried with variable success rates and limitations. Presented here is a series of four cases, where distally based flaps were used. Two of them were Extensor Digitorum Brevis (EDB) muscle flaps and the other two were first dorsal metatarsal artery (FDMA) based skin flaps. One in each of the two was augmented with a plantar V-Y advancement flap. All flaps survived completely without any flap- or donor site-related complications. The patients were ambulated two weeks following the reconstruction and were symptom-free after an average follow-up of thirteen months. Distal flaps based on the dorsalis pedis system provide a reliable cover for distal foot defects.     

显微外科皮瓣修复[足母]甲瓣供区的临床应用

目的探讨应用显微外科皮瓣对[足母]甲瓣供区进行修复的临床疗效,并对皮瓣选择做出分析。方法应用5种近位足部带蒂皮瓣和2种远位游离皮瓣对57例[足母]甲瓣供区软组织缺损进行修复。其中近位带蒂皮瓣33例:带蒂足跗外侧动脉皮瓣2例,以第1跖背动脉的跖蹼穿支为蒂的足背逆行皮瓣15例,带第1跖背动脉的足背逆行皮瓣3例,顺行足第2趾胫侧皮瓣11例,逆行足底内侧皮瓣2例,足部皮瓣供区行全厚皮片游离植皮。远位游离皮瓣24例:游离腹股沟皮瓣13例,游离股前外侧皮瓣11例。皮瓣供区均直接缝合。结果57例皮瓣中53例成活良好;以第1跖背动脉的跖蹼穿支为蒂的足背逆行皮瓣3例远端部分坏死,经换药治疗后创面愈合;游离腹股沟皮瓣1例术后发生血管危象,经血管探查术后未缓解,Ⅱ期行游离植皮修复[足母]甲瓣供区创面。术后随访2~12个月,行走姿态良好。结论合适的显微皮瓣技术可以良好的修复[足母]甲瓣供区创面,保全肢体的完整性,减少医源性损伤,患者更容易接受[足母]甲瓣移植的手术方式。皮瓣选择不应只关注[足母]趾供区的修复,更应合理运用显微皮瓣技术,重视供、受区的平衡。     

游离坶甲瓣移植术后对供足功能的影响

游离甲瓣移植再造拇指已成为拇指缺损的主要治疗方法之一，但供足功能影响问题未能引起人们的重视。随访了１９８３年～１９９２年间１０７例中的６２例甲瓣移植病人。发现供足功能正常者为４２例（６７．７％）；有一般症状，如残端痛，破溃等１２例（１９．４％）；供足有较严重功能影响者为６例（９．７％）；有继发足疾患２例（３．２％）。分析了甲瓣切取对前足结构损伤的关系，前足负重点改变，以及供足继发性疾病的原因。提出重视甲瓣切取后足结构的修复，严格手术适应证选择等，将供足功能影响减少到最小程度。     

两种第二趾切取游离移植对供足足底应力影响的生物力学研究

目的 探讨第2足趾切取游离移植对供足足底应力的影响.方法 取6具正常成人新鲜尸体足标本,根据不同状态分3组:完整组(A组)、第2趾截除(保留跖骨头)组(B组)及带部分跖骨的第2趾截除(跖骨远l/3处)组(C组).应用电子万能试验机以2 mm/min的速度从胫骨远端施加轴向压载,加载载荷分别为0、600、1200 N.通过F-Scan足底压力测量系统检测足底应力变化,并对数据进行统计学分析.结果 足底应力随轴向压载的增加而增大.A组(足母)指及5个跖骨头的峰值压强以第2跖骨头最大,600 N垂直载荷时为(37.33±7.34)kPa,1200 N垂直载荷时为(112.33±10.33)kPa.同一载荷下,A组与B组的(足母)指及5个跖骨头的峰值压强差异均无统计学意义(P>0.05).同一载荷下,A组、B组分别与C组比较,(足母)指及5个跖骨头的峰值压强差异均有统计学意义(P<0.05).结论 第2跖骨的完整对足底应力正常分布及维持足弓具有重要意义.保留跖骨头的第2趾切取对供足足底应力分布影响较小,带部分跖骨的第2趾切取可导致供足足底应力的异常分配.     

Long-Term Follow-Up on the Donor Foot After Thumb Reconstruction Using Big Toe Wrap-Around Flap in Two Different Operation Methods

The function of the donor foot has been affected after using big toe wrap-around flap for thumb reconstruction. A modified operation method has been developed to reduce the adverse effect on the donor foot. The current study compared the long-term effect of the classic and the modified operation methods on the donor foot. Gait analysis was carried out, including how the patient walked, the walking speed and walking distance, and how the patient jumped and ran. Plantar pressure was measured while the patient was standing and moving. A total of 45 patients who received the 2 different operation methods were included. The follow-up time was 4–10 years with a mean of 6.5 years. Various degrees of complications occurred for the 21 patients who received the classic operation method. For these patients, plantar pressure of the donor foot was obviously different comparing with the healthy unaffected foot while the patient was standing or walking. For the 24 patients who received the modified operation method, no obvious complications were observed and the plantar pressure of the donor foot and the healthy unaffected foot was similar while the patient was standing or walking. In conclusion, both the classic and the modified operation methods have affected the function of the donor foot after using the big toe wrap-around flap for thumb reconstruction. However, the donor foot was less affected when the modified operation method was used.     

Evans跟骨外侧延长术治疗距跟联合合并后足外翻畸形

目的探讨Evans跟骨外侧延长术治疗距跟联合合并后足外翻畸形的疗效。方法2014年1月—2017年10月,采取Evans跟骨外侧延长术治疗10例(13足)距跟联合合并后足外翻畸形患者。男6例(8足),女4例(5足);年龄13~18岁,平均15.8岁。病程10~14个月,平均11.5个月。患侧跟骨外翻、前足外展、足弓低平。疼痛部位:跗骨窦4足、距跟联合5足、踝关节4足。Silverskiold试验腓肠肌腱膜紧张3例(4足),跟腱挛缩7例(9足)。术前美国矫形外科足踝协会(AOFAS)踝与后足评分为(46.54±9.08)分,行走1 km后疼痛视觉模拟评分(VAS)为(6.54±0.88)分。术后采用AOFAS踝与后足评分、VAS评分,以及X线片测量距骨-第1跖列角(talar-first metatarsal angle,T1MT)、距舟覆盖角(talonavicular coverage angle,TCA)、距骨倾斜角(talar-horizontal angle,TH)、跟骨倾斜角(calcaneal pitch angle,CP)、跟骨外翻角(heel valgus angle,HV),评价手术疗效。结果术后切口均Ⅰ期愈合。10例患者均获随访,随访时间12~30个月,平均18个月。末次随访时,AOFAS踝与后足评分为(90.70±6.75)分,VAS评分为(1.85±0.90)分,均较术前明显改善(t=-23.380,P=0.000;t=35.218,P=0.000)。X线片复查示截骨均达骨性愈合,愈合时间为2~4个月,平均3个月。末次随访时,T1MT、TCA、TH、HV均较术前明显降低,CP明显提高,差异有统计学意义(P<0.05)。随访期间1例(1足)疼痛缓解不明显,1例(1足)出现腓肠神经皮支损伤症状。结论对于距跟联合合并后足外翻畸形患者,Evans跟骨外侧延长术可以有效纠正畸形、缓解疼痛。     

足趾移植再造拇,手指400例报告

总结１９６６年２月至１９９４年２月的足趾移植术４００例，以正确评估足趾移植在拇、手指再造中的作用。     

Great toe-to-hand transfer: role of the preoperative lateral arteriogram of foot

This report correlates the results of the lateral angiogram of the foot with the operative dissection and eventual outcome in 29 patients in whom a great toe-to-hand transfer was performed to treat a traumatic loss of the thumb. Our angiographic findings were confirmed by surgical exploration and indicated that (1) in 20 (70%) of 29 patients the first dorsal metatarsal artery (FDMA) originated from the dorsalis pedis artery, dorsal to the midlongitudinal axis of the first metatarsal bone; (2) in 6 (20%) of 29 patients the FDMA originated from the dorsalis pedis artery, plantar to the midlongitudinal axis of the first metatarsal bone; (3) in the remaining 3 (10%) of 29 patients the arteriogram of the lateral foot indicated that the plantar metatarsal artery supplied the great toe in a dominant pattern, necessitating its use as the donor vessel; and (4) the measured lumenal diameters of the dorsal and plantar metatarsal arteries (mean diameter = 1.30 mm and 1.27 mm, respectively) did not significantly differ. The lateral views of the foot were helpful in permitting distinct identification of the location and size of the metatarsal arteries to the great toe.     

Isolated hexadactylia: A rare case of central polydactyly of the foot

BackgroundCentral polydactyly of foot is uncommon form of polydactyly but it usually causes intermetatarsal widening because of metatarsal bifurcation. Central polydactyly associated with T shaped bifurcation of metatarsal in vertical plane has not been reported yet.CaseWe present a 4 year male child with extra toe on the dorsal aspect of right foot with complains of difficulty in wearing footwear and poor cosmesis. The extra digit was fully developed with bifurcation of 2^nd metatarsal bone proximal to the head without any intermetatarsal widening. The angular deviation was 45° to the longitudinal axis of foot and in a plane vertical to the transverse arch of foot. The child was operated with excision of extra toe without any residual bony deformity.ConclusionThe central polydactyly is rare type of polydactyly of foot. Central polydactyly with metatarsal extension causing intermetatarsal widening has been well described entity. But the previous classifications need to be modified to include central polydactyly with vertical oriented T bifurcation of metatarsal bone without intermetatarsal widening.