大隐静脉-隐神经营养血管蒂逆行岛状皮瓣的临床应用

目的 探讨大隐静脉-隐神经营养血管蒂逆行岛状皮瓣修复足踝部软组织缺损的临床应用.方法 2002年5月-2006年1月,对26例踝关节周围及足背软组织缺损患者行大隐静脉-隐神经营养血管蒂逆行岛状皮瓣转移修复术.皮瓣面积最大为14 cm×7 cm,最小为6.5 cm×5.5 cm,平均9.3 cm×6.1 cm;蒂长3～7 cm,蒂宽3～4 cm,表面均保留1.5～2 cm宽的皮桥行明道转移.结果 25例皮瓣成活,随访6～18个月,皮瓣质地满意;1例皮肤坏死,但皮下组织部分存活,经游离皮片移植后创面愈合良好.结论 大隐静脉-隐神经营养血管蒂逆行岛状皮瓣是修复下肢远端软组织缺损的一种良好方法.     

腓肠神经营养血管蒂逆行岛状皮瓣的临床应用

目的:探讨应用腓肠神经营养血管蒂逆行岛状皮瓣修复小腿下端、踝周和足部皮肤软组织缺损的可靠性.方法:对18例小腿下端、踝周和足部皮肤软组织缺损病人选择腓肠神经营养血管蒂逆行岛状皮瓣修复,皮瓣最大17cm×11cm、最小6cm×5cm.结果:皮瓣Ⅰ期愈合15例,Ⅱ期愈合3例.随访6个月～2年,皮瓣质地、颜色良好.结论:腓肠神经营养血管蒂逆行岛状皮瓣血管蒂恒定,层次清晰,操作简单,皮瓣不牺牲主干血管,对小腿功能和外形影响小,皮瓣转移幅度大,是修复小腿中下段、踝周、足跟等软组织缺损的良好修复方式.     

腓肠神经营养血管皮瓣修复小腿及足踝部软组织缺损

目的：观察腓肠神经营养血管皮瓣转位修复小腿及足踝部软组织缺损的效果。方法：设计带筋膜蒂的腓肠神经营养血管皮瓣，逆行转位修复小腿及足踝部软组织缺损15例，观察皮瓣成活情况及治疗效果。结果：本组15例中2例皮瓣部分坏死，其余全部一次成活。结论：腓肠神经营养血管皮瓣创伤小，手术简单，血供可靠，是修复小腿及足踝部软组织缺损的理想皮瓣。     

应用内踝上逆行皮瓣修复足踝部皮肤软组织缺损

目的 观察应用内踝上逆行皮瓣修复足踝部皮肤软组织缺损并骨外露或跟腱外露的效果.方法 自2000年来应用内踝上逆行皮瓣27例,转移修复由车祸外伤、肿瘤等所致的足踝部皮肤软组织缺损并骨外露或跟腱外露.修复皮肤软组织缺损最大面积6cm×14cm,跟骨外露最大面积5cm×10cm.结果 共切取内踝上逆行皮瓣27块,其中血管蒂逆行皮瓣9例,筋膜血管蒂逆行皮瓣12例,带部分皮肤的筋膜血管蒂逆行皮瓣6例.其中1例皮瓣术后坏死,行游离背阔肌肌皮瓣移植修复愈合,其余逆行皮瓣及供瓣区所植皮片均完全成活,术后随访6个月～4年,效果满意.结论 内踝上逆行皮瓣移植是修复足踝部皮肤软组织缺损并骨外露或跟腱外露的理想方法之一.     

逆行腓肠神经营养血管皮瓣修复足踝部皮肤缺损的手术配合

目的:探索足踝部皮肤软组织恶性肿瘤切除及皮肤缺损的修复方法.方法:应用逆行腓肠神经营养血管皮瓣修复外踝部11例、内踝部4例、小腿中下段10例、小腿中下部软组织肿瘤7例.结果:术后皮瓣全部成活.3例部分水泡形成,1例皮缘坏死换药后创面愈合.结论:逆行腓肠神经营养血管皮瓣修复足踝部皮肤缺损皮瓣设计、操作简便,易于切取,不吻合血管,可重建感觉,皮瓣成活率高,是足踝部皮肤缺损的理想选择.     

小腿感染性骨折伴皮肤软组织缺损的手术治疗

目的 探讨小腿感染性骨折伴皮肤软组织缺损的手术方法及其疗效.方法 采用5种带蒂的肌皮瓣和筋膜皮瓣对20例小腿感染性骨折伴皮肤软组织缺损的患者进行手术修复,皮瓣面积6cm×5cm～20cm×9cm.结果 20例皮瓣中有17例术后全部成活,创面I期愈合;3例皮瓣远端边缘少许坏死,经短期换药后愈合.均获3个月～8年随访,无1例感染复发.结论 小腿感染性骨折伴皮肤软组织缺损的治疗,选择适宜的手术时机和手术方法可获得满意的疗效.应用腓肠神经营养血管蒂逆行岛状皮瓣及隐神经营养血管逆行岛状皮瓣是较理想的修复小腿中下1/3段中等面积以下皮肤软组织缺损的方法.     

腓肠神经营养血管远端蒂皮瓣治疗足踝部软组织缺损

目的：探讨腓肠神经营养血管远端蒂皮瓣治疗足踝部软组织缺损的效果。方法：以小腿腓肠神经营养血管为蒂设计并切取皮瓣,逆行转移修复踝部、足跟部、足背及足内侧皮肤软组织缺损26例。结果：26例皮瓣中除1例修复前足内侧皮瓣远端发生脂肪液化外,余25例皮瓣全部成活。随访1~12个月,皮瓣色泽、质地、弹性良好,无破溃发生。结论：腓肠神经营养血管蒂皮瓣是修复踝部、足跟部、足背及足内侧皮肤软组织缺损的理想方法。     

腓肠神经营养血管肌皮瓣治疗小腿下段及足踝部组织感染缺损

目的 探讨腓肠神经营养血管肌皮瓣逆行转位修复小腿下段及足踝部软组织缺损的可行性.方法 对12例小腿中下段及足踝部软组织缺损或骨缺损、骨髓炎的病例,采用逆行腓肠神经营养血管肌皮瓣转移方法进行治疗.结果 12例中11例完全存活,1例皮瓣远端皮肤部分坏死,经换药瘢痕愈合.随访5～54个月,平均21个月,皮瓣质地优良,外观满意,感染治愈均尤复发.结论 腓肠神经营养血管肌皮瓣解剖简单、血供可靠,抗感染能力强,是临床上治疗小腿及足踝部软组织缺损并感染的良好选择.     

改良腓肠神经营养血管逆行皮瓣修复踝部组织缺损中的临床运用

目的探讨改良腓肠神经营养血管肌皮瓣逆行修复踝部软组织缺损并重建皮瓣感觉功能的临床效果。方法 2010年3月~2014年3月对13例足踝部软组织缺损的病例,采用改良逆行腓肠神经营养血管肌皮瓣转移方法,将皮瓣旋转点改为外踝上5cm,根据创面大小及最远端距离调整旋转点位置,筋膜蒂宽度在3~5cm,将腓肠神经与小隐静脉包含在蒂内,采用明道转移修复创面。结果 13例中11例完全存活,2例皮瓣远端皮肤部分坏死,经换药瘢痕愈合。随访6~24个月,平均15个月,皮瓣质地优良,无局限性臃肿,感染治愈均无复发。结论改良带腓肠神经营养血管逆行岛状皮瓣修复足、踝部皮肤缺损不需吻合血管,操作简便,安全可靠,是修复足踝部皮肤缺损的理想皮瓣。     

逆行腓肠神经营养血管皮瓣的临床应用体会

目的 研究逆行腓肠神经营养血管皮瓣修复小腿胫前区及足部创伤的临床效果.方法 我科2009年9月~2012年11月应用逆行腓肠神经营养血管皮瓣修复小腿胫前及足部软组织缺损19例,其中4例合并Ⅱ型糖尿病,3例合并慢性骨髓炎及窦道形成.皮肤缺损面积8 cm×5 cm～17 cm×11 cm.结果 本组17例术后皮瓣存活良好,伤口一期愈合.1例术后皮瓣因引流不充分出现积血致远端部分坏死,行二期皮片移植术后愈合;1例因皮瓣蒂部软组织挫伤致血供不良改行交腿皮瓣后愈合.结论 逆行腓肠神经营养血管皮瓣可切取范围较大,血供丰富,解剖容易,不易损伤大血管,蒂部旋转灵活,能修复的创面部位较多,皮瓣成活率高.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.