改良第二掌背动脉皮瓣修复示中指中末节套脱伤

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.     

改良第二掌背动脉皮瓣修复示中指中末节套脱伤

目的 探讨应用第二掌背动脉(second dorsal metacarpal artery,SDMA)逆行岛状皮瓣修复示、中指中末节皮肤套状撕脱伤的方法及疗效.方法 2004年5月至2010年1月,收治17例示指或中指中末节皮肤套状撕脱伤患者.采用SDMA岛状皮瓣进行修复,并缝合指背神经.皮瓣切取面积为2.5 cm×5.6 cm～5.0cm×6.5 cm,供区创面行游离植皮.结果 术后2例皮瓣远端出现张力性水泡,表皮结痂,经换药后愈合;其余皮瓣顺利存活.皮瓣及供区植皮切口均Ⅰ期愈合.术后17例获得4～27个月的随访,平均15.3个月.皮瓣质地柔软,外观饱满无臃肿.两点分辨觉为7～11 mm,平均8.6 mm.手功能按手指总主动活动度(total active movement,TAM)法评定:优8指,良7指,可2指;优良率为88.2%.结论 缝合指背神经的改良SDMA逆行岛状皮瓣,皮瓣切取面积足够覆盖示、中指中末节套状撕脱伤皮肤缺损创面,皮瓣血运可靠,手术安全,是一种较好的手术方法.

Abstract：

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.     

Reconstruction of finger pulp defect with reversed fasciocutaneous island flap from same finger

Objective:To investigate the clinical curative effect of reconstruction of finger pulp defect by anastomosis of reversed fasciocutaneous island flap with dorsal branch of the digital nerve of the same finger. Methods: The restoration of finger pulp defect with fasciocutaneous island flap from the same finger was conducted in 25 cases (30 fingers) from January 2002 to June 2003. Nine patients (11 fingers) whose flaps with dorsal branch of the digital nerve anastomosed with the digital inherent nerve around the surface of the wound were Group A and the others were Group B. The follow-up was carried out at 3 and 9 months after the operation to observe the shape of finger pulp and the sense restoration between two groups. Results: All flaps of 25 cases (30 fingers) survived. Three months after operation, the patients had fully grown finger pulps and recovered the superficial sensation and tactile sense of finger pulps. The two point discrimination on average was 5. 00 mm±0. 23 mm in Group A and 6.00 mm±0.30 mm in Group B. The difference between two groups was highly significant. Nine months later, their senses of finger pulps between two groups were recovered basically. Conclusions: The reversed fasciocutaneous island flap from the same finger is the first choice to reconstruct the finger pulp defect, and the anastomosis of dorsal branch of the digital nerve shall be determined according to the specific condition.     

指根部远近端蒂岛状皮瓣修复相邻两指指端缺损

Objective To introduce a new surgical procedure for repairing fingertip defects of two neighboring fingertips.Methods Seven cases of fingertip defects of two neighboring fingers were treated by transferring a proximal and a distal island flap harvested from the base of one of the involved fingers.The distal flap was transferred to repair defect of the same finger,while the proximal one was transferred to repair defect of the neighboring finger.There were defects of the index and middle fingers in 2 cases,defects of the middle and ring fingers in 4 cases,and defects of the ring and little fingers in 1 case.Finger pulp defect occurredins 8 digits,soft tissue defect distal to middle phalanx in 4 digits,and defect of ringer stump in 2 cases.Exoosure of the tendon,nerve or bone was seen in all cases.The size of the proximal flaps ranged from 1.2cm× 1.5 cm to 2.3 cm×1.5cm,while the size of distal flaps ranged from 1.0cm×1.0 cm to 1.5cm×1.0cm. Results All 14 flaps in the 7 cases survived completdy.One patient underwent secondary correction of crooked nail 6months after the fkap surgery.Postoperative follow-up rangea from 6 months to 18 months.All repaired fingers had satisfactory appearance and texture.Two-point discrimination was 8 to 12 mm.The good and excellent rate of finger function recovery was 95.7%according to the provisional functional assessment criterion for upper limbs issued by the Chinese Hand Surgery Society. Condusion The flap design of this procedure is based on the anatomical characteristics of communicating branches of the digital artery at the base of the finger.Two flaps from the base of the same finger are harvested to make full use of the harvestable area of the donor finger,and avoid damage to another finger.This procedure expands the applicable indications of finger base island flaps and is an ideal method to repair defects of neighboring fingers.     

指根部远近端蒂岛状皮瓣修复相邻两指指端缺损

Objective To introduce a new surgical procedure for repairing fingertip defects of two neighboring fingertips.Methods Seven cases of fingertip defects of two neighboring fingers were treated by transferring a proximal and a distal island flap harvested from the base of one of the involved fingers.The distal flap was transferred to repair defect of the same finger,while the proximal one was transferred to repair defect of the neighboring finger.There were defects of the index and middle fingers in 2 cases,defects of the middle and ring fingers in 4 cases,and defects of the ring and little fingers in 1 case.Finger pulp defect occurredins 8 digits,soft tissue defect distal to middle phalanx in 4 digits,and defect of ringer stump in 2 cases.Exoosure of the tendon,nerve or bone was seen in all cases.The size of the proximal flaps ranged from 1.2cm× 1.5 cm to 2.3 cm×1.5cm,while the size of distal flaps ranged from 1.0cm×1.0 cm to 1.5cm×1.0cm. Results All 14 flaps in the 7 cases survived completdy.One patient underwent secondary correction of crooked nail 6months after the fkap surgery.Postoperative follow-up rangea from 6 months to 18 months.All repaired fingers had satisfactory appearance and texture.Two-point discrimination was 8 to 12 mm.The good and excellent rate of finger function recovery was 95.7%according to the provisional functional assessment criterion for upper limbs issued by the Chinese Hand Surgery Society. Condusion The flap design of this procedure is based on the anatomical characteristics of communicating branches of the digital artery at the base of the finger.Two flaps from the base of the same finger are harvested to make full use of the harvestable area of the donor finger,and avoid damage to another finger.This procedure expands the applicable indications of finger base island flaps and is an ideal method to repair defects of neighboring fingers.     

指动脉顺行岛状皮瓣修复指端缺损

Objective To investigate the therapeutic effect of island flaps pedieled with digital artery for the defects at the end of fingers. Methods 63 eases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm× 11 mm to 21 nun × 27 ram. Results All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 ～ 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. Conclusions The technique with island flap is simple and reliable for the defects at the end of fingers.     

指动脉顺行岛状皮瓣修复指端缺损

Objective To investigate the therapeutic effect of island flaps pedieled with digital artery for the defects at the end of fingers. Methods 63 eases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm× 11 mm to 21 nun × 27 ram. Results All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 ～ 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. Conclusions The technique with island flap is simple and reliable for the defects at the end of fingers.     

指动脉顺行岛状皮瓣修复指端缺损

Objective To investigate the therapeutic effect of island flaps pedieled with digital artery for the defects at the end of fingers. Methods 63 eases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm× 11 mm to 21 nun × 27 ram. Results All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 ～ 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. Conclusions The technique with island flap is simple and reliable for the defects at the end of fingers.     

指动脉顺行岛状皮瓣修复指端缺损

Objective To investigate the therapeutic effect of island flaps pedieled with digital artery for the defects at the end of fingers. Methods 63 eases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm× 11 mm to 21 nun × 27 ram. Results All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 ～ 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. Conclusions The technique with island flap is simple and reliable for the defects at the end of fingers.     

指动脉顺行岛状皮瓣修复指端缺损

Objective To investigate the therapeutic effect of island flaps pedieled with digital artery for the defects at the end of fingers. Methods 63 eases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm× 11 mm to 21 nun × 27 ram. Results All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 ～ 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. Conclusions The technique with island flap is simple and reliable for the defects at the end of fingers.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.