Knee-ligament injuries associated with leg fractures. Prospective study.

It has been proved in 25-35% of the cases that knee-ligament injuries are associated with fracture of the femoral diaphysis. No such association has been confirmed between leg fractures and knee ligaments. In order to find out if this is a coincidence, a prospective study was conducted on 229 patients who had undergone operations for leg fractures at various locations and of variable intensity. It was established in 41 cases (17.34%) that the leg fracture was associated with knee-ligament injuries, resulting in joint instability. A significantly higher percentage of associated ligament lesions was found in open fractures as opposed to closed leg fractures. The examination was carried out with the patient under general or block anesthesia. On the basis of what was established it is recommended that the knee be examined clinically in all leg osteosynthesis cases.     

应用携带肌肉的小腿内侧皮瓣修复足部软组织缺损

目的探讨应用携带肌肉的小腿内侧皮瓣修复足部软组织缺损的临床效果。方法采用携带肌肉的小腿内侧皮瓣修复足部软组织缺损9例,缺损面积：6cm×8cm～8cm×18cm。供区均选用同侧小腿。皮瓣切取面积：7cm×9cm～10cm×20cm。结果9例皮瓣均一期成活。获随访7例,时间4～13个月,皮瓣质地柔软,供区植皮处无明显瘢痕挛缩,外观及功能均满意。结论该类皮瓣成活率高,操作简单,切取方便,血供可靠,抗感染能力强,是修复足部软组织缺损较理想皮瓣。     

胫骨皮瓣游离移植修复小腿创伤性骨和皮肤缺损

目的探讨应用胫骨皮瓣游离移植一期修复小腿严重创伤性骨与皮肤缺损，免除截肢的治疗方法。方法对12例小腿创伤性骨与皮肤缺损采用胫骨皮瓣游离移植进行治疗。一期重建患肢胫骨支架连续性及覆盖创面。皮瓣最长17cm，最宽10cm；骨瓣最长12cm。结果术后随访最短6个月，最长5年，皮瓣血运良好，术后2个月内均见骨瓣开始生长，术后3—5个月移植骨均达骨性愈合，平均愈合时间为15周，累及的炎症得到完全控制，修复的肢体功能、外形令人满意。结论胫骨皮瓣具有解剖标志清楚、骨膜较厚、血供丰富、血管蒂多、供骨量大、皮瓣面积大、位置表浅、手术操作有较大的灵活性等优点，治疗小腿严重创伤性骨皮缺损可一次完成骨架重建及创面覆盖，有利于肢体功能的尽早恢复。     

应用半环槽外固定架治疗小腿伤病

目的 回顾性评价半环槽外固定架治疗小腿伤病的疗效。方法 42例小腿伤病，其中新鲜胫腓骨骨折21例，陈旧性骨折畸形愈合、不愈合或合并骨髓炎5例，小儿麻痹症后遗单侧下肢短缩12例，骨病畸形4例．采用半环槽外固定架作固定、延长或畸形矫正。结果 随访8月～3年(平均13个月)。骨折26例均愈合，愈合时间为12～24周；儿麻12例延长4～8cm，骨病畸形4例均获矫正。并发症为针道感染8例12针，创面感染2例，早期邻近关节功能受限4例，早期拆架致骨折端轻度畸形l例。优良率95．2％。结论 半环槽外固定架适应证广泛，固定确切，操作简单、并发症少，适合在基层医院开展。     

Versatility of the distally based superficial sural flap for reconstruction of lower leg and foot in children

Twenty children are presented after undergoing a distally based superficial sural flap for coverage of defects at the lower leg and foot. The age of the patients was between 1 and 12 years. Fifteen patients had trauma to the lower leg, with eight of them having associated injuries. Three had postburn contracture and two had pressure sore. In 14 cases, the flap was used as a fasciocutaneous flap, whereas in six cases it was used as a fascial flap covered with a skin graft. The flaps were used to cover the defects from the dorsum of the foot distally up to the mid third of tibia proximally. The mean follow-up was for a period of 2 years. Even though free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children, the distally based superficial sural flap has the advantage of being easy to perform, with short operating time, minimal donor side morbidity, and preservation of major arteries of the leg.     

Calcific myonecrosis of the leg: a case report and review of the literature

Calcific myonecrosis is a rare complication of the leg after trauma. It usually develops as a late sequelae of compartment syndrome. Only approximately 21 cases have been reported in the English literature. The reported cases mostly have involved the anterior compartment of the leg. The current authors report the case of a 49-year-old man with a huge mass that involved the anterior and posterior compartments of the leg 30 years after initial trauma. Soft tissue sarcoma was suspected initially. A secondary infection developed after open incisional biopsy. After extensive debridement and closure of the wound over antibiotic-impregnated cement beads and a suction drain followed by compressive dressings, there has been no recurrence of the lesion or infection.     

三种交腿皮瓣修复小腿严重软组织缺损的临床疗效比较

目的：探讨应用三种不同的交腿皮瓣修复小腿严重软组织缺损的临床效果。方法回顾性分析2012年7月至2014年12月于我科采用交腿皮瓣修复小腿严重软组织缺损的35例患者的临床资料,10例采用健侧胫后血管束桥接的游离股前外侧皮瓣移植的患者纳入股前外侧皮瓣组,15例采用腓肠神经营养皮瓣转移的患者纳入腓肠神经营养皮瓣组,10例采用小腿内侧穿支皮瓣转移的患者纳入穿支皮瓣组,比较三组患者术后的皮瓣成活情况、供区情况等。结果34例皮瓣完全成活,1例部分成活。股前外侧皮瓣组发生1例感染;腓肠神经营养皮瓣组发生4例静脉危象、2例感染;穿支皮瓣组发生1例动脉危象。三组皮瓣成活情况差异无统计学意义（χ2=2.574,P=0.276）;而三组间供区情况（闭合/植皮情况）的差异有统计学意义（χ2=18.177,P=0.000）,股前外侧皮瓣组供区植皮率远远低于其他两种手术方式。结论三种不同交腿皮瓣修复小腿严重软组织缺损临床效果良好,可根据患者实际情况,选择合适的手术方式。     

小腿前外侧的皮瓣及筋膜瓣的临床应用

目的介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法在14侧成人下肢标本及1条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的4种术式。1988年以来,临床应用26例。结果术后皮瓣筋膜瓣全部成活,切口Ⅰ期愈合23例,Ⅱ期愈合3例,20例随访4个月到5年,情况稳定良好,无复发。结论手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部后方创面及治疗胫骨慢性骨髓炎的一种可供选用的方法。     

小腿前外侧的皮瓣及筋膜瓣的临床应用

目的介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法在１４侧成人下肢标本及１条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的４种术式。１９８８年以来,临床应用２６例。结果术后皮瓣筋膜瓣全部成活,切口Ⅰ期愈合２３例,Ⅱ期愈合３例,２０例随访４个月到５年,情况稳定良好,无复发。结论手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部后方创面及治疗胫骨慢性骨髓炎的一种可供选用的方法。     

小腿前外侧的皮瓣及筋膜瓣的临床应用

目的 介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法 在１４侧成人下肢标本及１条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的４种术式。１９９８年以来,临床应用２６例。结果 术后皮折筋膜全部成活,切口Ⅰ期愈合２３例,Ⅱ期愈合３例,２０例随访４个月到５年,情况稳定良好,无复发。结论 手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部     

腓浅动脉岛状筋膜蒂皮瓣在小腿皮肤缺损中的应用

目的探讨采用腓浅动脉岛状筋膜蒂皮瓣治疗小腿皮肤缺损的临床效果。方法对31例膝关节至足踝部皮肤缺损患者采用腓浅动脉岛状筋膜蒂皮瓣移位治疗。结果随访31例，时间3周-5年。27例皮瓣完全成活，4例皮瓣远端部分坏死。结论采用腓浅动脉岛状筋膜蒂皮瓣治疗小腿皮肤缺损，该皮瓣血供可靠，切取方便，不牺牲主干血管，基本可满足小腿前外侧创伤修复的需要。     

髓核成形术治疗腰腿痛患者的选择(附45例临床初步报告)

目的:探讨髓核成形术治疗腰腿痛患者的最佳适应证。方法:应用髓核成形术治疗45例腰腿痛患者,男26例,女19例,平均年龄32岁(18~46岁),病程平均2年(5个月~4年),其中腰痛伴有下肢放射痛40例。手术前先进行椎间盘造影,然后行髓核成形术治疗,比较手术前后疼痛症状并进行疗效评定。结果:术后随访3~20个月,平均12个月。优良率为80%(36例);腰痛伴有下肢放射痛者有效率为85%;椎间盘造影阳性者有效率为92%。无效8例,术后加重1例。结论:在下列情况下应用髓核成形术治疗腰腿痛患者将提高临床的有效率:(1)腰痛伴有下肢放射痛症状的患者;(2)影像学上表现为侧方小的椎间盘突出,以神经根刺激症状为主要症状者;(3)椎间盘造影阳性的患者。     

Malalignment of the tibia--comparative investigation of three stabilization procedures by clinical analysis and radiological measuring techniques

INTRODUCTION: Malalignment after osteosynthetic stabilization of lower leg fractures is still a common problem for trauma surgeons. The aim of the present study was to evaluate the incidence of torsional and varus- or valgus-malalignment of the lower leg subsequent to osteosynthetic stabilization techniques such as reamed nailing, unreamed nailing and tibial plating. METHODS: 70 patients with 73 fractures of the lower leg were included in the study. The fractures were treated consecutively in 37 cases with an unreamed nail (UTN), in 21 cases with a reamed nail and 15 cases were stabilized with a plate. During clinical follow-up after 5.7 years each patient was analyzed for malalignment of the lower leg with a CT-Scan and a dual-energy X-ray absorptiometry (DXA) analysis. RESULTS: Multi-level CT-scans revealed a significant rotational malalignment in 16.4 % of patients. Interestingly, all misaligned cases were treated with a nail (9.6 % UTN, 6.8 % reamed nail). Varus- or valgus-malalignment was detected in 5.4 % of cases all of whom had been treated with an intramedullary nail. CONCLUSIONS: Malalignment is still a common problem after osteosynthetic stabilization of lower leg fractures, whereby the majority of these cases can be expected after intramedullary nailing. Rotational malalignment can be detected by CT-Scans, whereas DXA analysis is a reliable procedure to diagnose varus- or valgus-malalignment after osteosynthetic stabilization of lower leg fractures.     

小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.     

小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.     

小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.     

肘部肱动脉及皮肤软组织缺损的显微外科治疗

目的探讨应用小腿内侧皮瓣修复肘部肱动脉及皮肤软组织缺损的临床疗效。方法采用吻合血管的小腿内侧皮瓣一期修复肘部肱动脉及皮肤软组织缺损8例,对伴有神经缺损者同时给予修复。结果8例肢体及皮瓣均成活,随访7~16个月,8例患者肘部无瘢痕挛缩及皮瓣臃肿现象,肘关节功能恢复正常。结论小腿内侧皮瓣移植是治疗肘部肱动脉及皮肤软组织缺损的较好方法。     

小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.     

小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.     

小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.