大鼠烫伤创面感染模型的研制

Objective To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound. Methods ( 1 ) Electrical burn producing apparatus equipped with constant temperature (80 ℃ ) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm2 ) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s) , with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes.Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partialthickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0. 1 mL of liquid containing 1 × 109, 1 × 107, 1 × 105 CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount) ,while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3,5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test. Results (1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 107 , 1 ×109 CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 109 CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 105 CFU/g of tissue, while that in B group in which 1 × 109 CFU PA was inoculated was more than 1 × 105 CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group ( with t value respectively 1.26, 0. 29, 1.07,P values all above 0.05 ). Wound healing time of wounds in B group, in which 1 × 109 CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 + 1.0) d vs. ( 19.4 + 1.6) d, t =2.73, P ＜0. 05]. Conclusions In rat, deep partial-thickness burn wound inoculated with 1 × 109 CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.     

大鼠烫伤创面感染模型的研制

目的 拟建立稳定的大鼠烫伤创面感染模型,以便于进行相关防治研究.方法 (1)取50只SD大鼠,使用恒温恒压烫伤仪,以底面积4.5 cm2、质量0.5kg的80℃圆柱形烫头垂直接触大鼠脊柱左右两侧皮肤,致伤4、6、8、10、12 s(每种致伤时间10只大鼠,左右侧烫伤时间相同)制作烫伤模型.伤后24 h,观察创面大体情况,记录左侧创面愈合时间,取右侧创面组织行组织学观察,根据结果筛选浅Ⅱ度、深Ⅱ度创面致伤时间.(2)另取36只SD大鼠,按随机数字表法分为浅Ⅱ度组、深Ⅱ度组,每组18只,按照前述方法与选定的致伤时间分别制成浅Ⅱ度、深Ⅱ度烫伤创面.伤后即刻在2组大鼠一侧创面分别接种0.1 mL含1×109、1×107、1×105CFU铜绿假单胞菌标准菌株ATCC 27853的菌液(每种菌量6只大鼠),在另一侧创面涂抹等体积生理盐水作为对照.接种细菌后24 h HE染色观察创面炎症反应情况;接种细菌后1、2、3、5、7、14 d进行革兰染色及生化反应鉴定菌种,检测并计算痂下细菌含量;记录2组大鼠创面愈合时间.对数据行t检验.结果 (1)根据大鼠创面愈合时间及组织学检查结果,筛选出烫伤6 s和8 s分别为浅Ⅱ度和深Ⅱ度创面的致伤时间.(2)浅Ⅱ度组大鼠仅接种1×109CFU细菌的创面有少许炎性细胞浸润;深Ⅱ度组接种1×109、1×107CFU细菌创面均有炎性细胞浸润,前者浸润更明显.(3)创面细菌鉴定结果为铜绿假单胞菌.浅Ⅱ度组创面接种各种菌量后14 d内,痂下细菌含量绝大多数低于1×105CFU/g;深Ⅱ度组创面接种1×109 CFU细菌后14 d内,痂下细菌含量均高于1×105CFU/g并呈持续上升趋势.(4)浅Ⅱ度组接种1×109、1×107、1×105 CFU细菌的创面与生理盐水对照创面愈合时间相近(t值分别为1.26、0.29、1.07,P值均大于0.05);深Ⅱ度组接种1×109CFU细菌创面愈合时间[(22.5±1.0)d]较生理盐水对照创面[(19.4±1.6)d]明显延长(t=2.73,P＜0.05).结论 大鼠深Ⅱ度烫伤创面接种1×109 CFU铜绿假单胞菌标准菌株ATCC 27853,可作为感染创面防治研究的实验模型,该模型稳定、重复性较高.

Abstract：

Objective To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound. Methods ( 1 ) Electrical burn producing apparatus equipped with constant temperature (80 ℃ ) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm2 ) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s) , with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes.Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partialthickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0. 1 mL of liquid containing 1 × 109, 1 × 107, 1 × 105 CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount) ,while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3,5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test. Results (1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 107 , 1 ×109 CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 109 CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 105 CFU/g of tissue, while that in B group in which 1 × 109 CFU PA was inoculated was more than 1 × 105 CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group ( with t value respectively 1.26, 0. 29, 1.07,P values all above 0.05 ). Wound healing time of wounds in B group, in which 1 × 109 CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 + 1.0) d vs. ( 19.4 + 1.6) d, t =2.73, P ＜0. 05]. Conclusions In rat, deep partial-thickness burn wound inoculated with 1 × 109 CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

膝关节后交叉韧带断裂治疗临床分析

目的 对35例膝关节后交叉韧带断裂治疗进行临床分析,重点探讨了有关交叉韧带断裂的治疗问题。方法 经明确诊断后,分析采用胫骨附着处撕脱骨折复位固定手术治疗26例、早期髌韧带中1／3移植重建3例、单纯长腿石膏固定6例。结果 本组病例全部进行随访,随访时间13个月－5年,胫骨附着处撕脱骨折复位固定及髋韧带中1／3移植重建29例为优良、单纯长腿石膏固定6例为差。结论 后交叉韧带断裂后应该及时给予手术修复;膝后外侧手术入路,操作简单,暴露充分;少于3个月的陈旧性病例仍适应手术治疗。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

胫骨干骨折的手术治疗对策

目的：明确不同固定器械在胫骨干不同骨折类型固定中的特点，以指导临床应用。方法：68例胫骨干骨折，行加压钢板螺钉、交锁髓内钉、单侧外固定架固定后，作临床疗效分析。结果：加压钢板固定组42例，感染5例，骨不连1例，平均愈合时间3．8个月；交锁髓内钉固定组13例，无感染及骨不连，平均愈合时间5．4个月；单侧外固定架组13例，骨不连1例，踝关节背伸受限3例，平均愈合时间4．5个月。结论：胫骨骨折交锁髓内钉固定并发症少，功能恢复好，适用范围广，但要注意及时进行动力加压。加压钢板及外固定架固定应选择各自的最佳适应证，以达到理想的疗效。