逆行内侧半比目鱼肌瓣移位修复小腿中下段胫前软组织缺损

目的探讨比目鱼肌内侧半肌瓣逆行移位修复小腿中下段胫前软组织缺损的I临床疗效。方法小腿内侧胫骨后缘纵行切口,显露比目鱼肌内侧半,结扎同时切断胫后动脉近端分支,将比目鱼肌中间纵行劈开,向远端游离足够长度,将肌瓣逆行转位引致缺损区,覆盖创面。肌瓣表面中厚皮片植皮。结果本组18例中12例获6个月～2年随访,肌瓣成活,覆盖良好,无功能障碍。结论小腿中下段胫前软组织缺损,采用比目鱼肌内侧半肌瓣逆行移位修复,是理想的方法之一,效果可靠,建议首选。     

腓肠肌肌瓣修复小腿胫前中上段感染性软组织缺损

目的总结应用腓肠肌肌瓣修复小腿胫前中上段感染性软组织缺损的疗效。方法 2007年4月-2011年7月,收治11例胫骨开放性骨折固定术后并发胫前中上段感染性软组织缺损患者。男8例,女3例;年龄12～86岁,中位年龄34岁。交通事故伤9例,重物砸伤2例。于骨折固定术后7～12 d出现创面软组织坏死、感染,细菌培养均呈阳性。伤后至此次入院时间为7～15 d,平均12 d。软组织缺损范围8 cm×6 cm～16 cm×10 cm。术中切取大小为11 cm×7 cm～19 cm×11 cm的腓肠肌肌瓣修复软组织缺损合并胫骨外露或骨髓腔,大腿中厚皮片覆盖肌瓣表面。供瓣区间断缝合。结果术后腓肠肌肌瓣及皮片均成活,供、受区创面Ⅰ期愈合。患者均获随访,随访时间6～57个月,平均21个月。受区外形饱满,皮片柔软、耐磨,无溃疡形成。X线片检查示骨折均愈合,愈合时间5～13个月。结论腓肠肌肌瓣是修复小腿胫前中上段感染性软组织缺损的有效方法之一,具有血循环可靠、肌肉组织量丰富、切取简便、供区损伤小、并发症少等优点。     

比目鱼肌胫骨骨膜瓣逆行转位术的临床应用

目的 探讨比目鱼肌胫骨骨膜瓣修复胫骨中、下段严重粉碎性骨折、骨不连、骨缺损合并软组织缺损的临床疗效. 方法 从2000年7月至2010年12月,应用比目鱼肌胫骨骨膜瓣逆行转位术修复19例胫骨开放性骨折并胫前软组织缺损骨外露、10例胫骨骨折内固定术后伤口感染组织坏死致胫骨及内固定物外露、5例胫骨创伤性骨髓炎清创后骨缺损并软组织缺损、3例胫骨骨不连合并胫前软组织缺损.结果 本组37例肌骨膜瓣均成活,其中1例术后肌瓣部分坏死,经再次清创、负压封闭吸引、植皮后愈合;1例肌骨膜瓣边缘小窦道,经换药后2个月愈合;其余创面均Ⅰ期愈合,随访0.5～7.0年,无感染复发、窦道形成,骨愈合时间6～ 10个月,所有患者均恢复负重和行走功能. 结论 比目鱼肌胫骨骨膜瓣逆行转位术,修复软组织缺损同时能促进骨的愈合,是修复胫骨中、下段严重粉碎性骨折、骨不连、骨缺损合并软组织缺损的有效方法.     

外固定架结合组织瓣技术治疗合并软组织缺损的小腿开放性骨折

目的探讨应用外固定架结合组织瓣技术治疗合并软组织缺损的下肢开放性骨折的疗效。方法对20例合并软组织缺损的下肢开放性骨折采用腓肠神经营养血管筋膜皮瓣、腓肠肌内侧头肌皮瓣、比目鱼肌肌瓣等结合外固定架的方法治疗,其中软组织缺损面积最大11.5 cm×6.8cm,最小5.2 cm×4.6 cm,其中合并软组织缺损的胫、腓骨近端骨折11例、胫、腓骨远端骨折9例。应用腓肠神经营养血管筋膜皮瓣8例、腓肠肌内侧头肌皮瓣8例、比目鱼肌肌瓣4例。结果所有组织瓣均存活,创面愈合,经3~5个月随访,骨折愈合。结论应用外固定架结合组织瓣技术是治疗合并软组织缺损的小腿开放性骨折的有效方法。     

比目鱼肌内侧半肌瓣逆行移位术的临床应用

目的　为临床上治疗胫骨中下段及踝部慢性骨髓炎合并软组织缺损提供一种一期修复的方法。方法　通过比目鱼肌内侧半血供主要由胫后动脉节段分支供应的解剖学特点 ,设计切取比目鱼肌内侧半肌瓣逆行移位术 ,其最低旋转点为内踝突出点上 10 .0 cm(9.70 cm± 2 .43cm)处。结果　经临床应用 2 4例 ,平均随访 2年 ,均取得满意疗效。结论　比目鱼肌内侧半肌瓣逆行移位术是治疗胫骨中下段及踝部慢性骨髓炎合并软组织缺损的一种简便有效的新术式     

比目鱼肌瓣移位修复小腿慢性骨髓炎软组织缺损

目的：应用比目鱼肌肌瓣移位修复伴有慢性骨髓炎的小腿和踝部软组织缺损。方法：采用结扎胫后动脉远端或近端，结扎胫后动脉远端分支或近端分支，以比目鱼肌内侧头近端或远端为蒂移位修复软组织缺损，其中面积最大为１３ｃｍ×１０ｃｍ。结果：８例中，有５例伤口Ｉ期愈合，２例植皮部分坏死，１例肌瓣远端１／３坏死，随诊１～２年，骨髓炎无复发。结论：该肌瓣对小腿功能影响小，血运丰富，转移方便，适用于小腿和踝部骨髓炎软组织缺损的修复。     

肠腓肌内侧头肌瓣植皮修复胫骨中上段骨外露

[目的]应用腓肠肌内侧头肌瓣转移及游离植皮修复小腿中上段软组织缺损骨外露的临床效果.[方法]2003年5月～2007年5月,利用腓肠肌内侧头肌移位肌瓣上Ⅰ期游离中厚皮片植皮修复小腿中上段软组织缺损、骨外露11例,修复创面最大18 cm×10 cm,最小10 cm×6 cm.[结果]随访6～36个月,肌瓣全部成活,2例游离皮片少许坏死,经换药后愈合.[结论]应用腓肠肌内侧头肌瓣转移Ⅰ期植皮修复小腿中上段软组织缺损骨外露手术操作简单,风险小,成功率高,不损伤主要血管.特别对小腿中上段皮肢软组织缺损面积大而腓肠肌完整的患者疗效显著.     

游离腹直肌瓣加植皮修复小腿及足踝部软组织缺损

目的探讨应用游离腹直肌瓣加中厚游离植皮修复小腿和足踝部软组织缺损的方法和疗效.方法 1998年5月～2002年12月,采用以腹壁下动、静脉为蒂的一侧腹直肌瓣游离移植加中厚植皮修复2例小腿、9例足踝部因外伤所致软组织缺损伴有骨、肌腱外露及骨髓炎患者.病程为1个月～10年.缺损范围3 cm×4 cm～8 cm×14 cm;切取腹直肌瓣4 cm×6 cm～8 cm×15 cm.结果术后11例移植肌瓣均成活,8例创口Ⅰ期愈合,3例移植中厚皮片坏死经再植皮后愈合.11例术后获随访6个月～4年,外形及功能良好.结论游离腹直肌瓣加中厚游离植皮修复小腿与足踝部软组织缺损具有血运好、抗感染力强和顺应性好等优点,可用于填充缺损及修复不规则创面,术后外形良好,克服了肌皮瓣肥厚臃肿的缺点.     

腓骨短肌肌瓣联合腓肠神经营养血管逆行岛状皮瓣治疗患者小腿远端及足部骨髓炎伴软组织缺损

目的 了解应用远端蒂腓骨短肌肌瓣联合腓肠神经营养血管逆行岛状皮瓣治疗患者小腿远端及足部骨髓炎伴软组织缺损的效果. 方法 2008年3月-2010年12月,笔者单位收治12例小腿远端及足部骨髓炎伴软组织缺损患者,其中7例为胫骨远端骨髓炎伴软组织缺损,1例为跟腱后侧慢性溃疡伴骨髓炎,4例为跟骨外侧软组织缺损伴骨髓炎及内固定物外露.彻底清创后,软组织缺损范围为4 cm×2 cm～13 cm×9 cm,骨缺损范围为3.0 cm ×3.0 cm ×3.0 cm～6.0 cm ×3.0 cm×4.0 cm.所有患者应用腓骨短肌肌瓣填充骨髓炎清创后形成的无效腔,腓肠神经营养血管逆行岛状皮瓣修复软组织缺损.手术切取皮瓣大小为5 cm×3 cm～14cm×10cm,肌瓣大小为11 cm ×3 cm～16 cm×4 cm.供瓣区直接缝合或植皮修复. 结果 11例皮瓣、肌瓣成活良好,创面均一次性愈合.1例皮瓣及肌瓣远端坏死,采用胫后动脉穿支肌皮瓣修复后愈合.随访6～ 24个月,皮瓣质地及外形良好,患者未复发骨髓炎. 结论 联合应用远端蒂腓骨短肌肌瓣与腓肠神经营养血管逆行岛状皮瓣移植,能有效治疗小腿远端及足部骨髓炎伴软组织缺损,操作简单、易行、安全可靠.     

肩胛骨背阔肌复合组织瓣移植一期修复小腿外伤后胫骨伴软组织缺损

目的应用肩胛骨背阔肌复合组织瓣移植一期修复小腿外伤后胫骨伴软组织缺损。方法8例小腿创伤后胫骨伴局部软组织缺损,其中胫骨完全性节段缺损6例,蝶形缺损2例;胫骨缺损长度5－8cm,平均6.3cm。局部软组织缺损面积6cmx8cm～8cmx12cm。受伤部位：小腿近段2例,中段3例,下段3例。按Gustilo分级：ⅢB型6例,ⅢC型2例。所有病例均有局限性感染,其中2例伴有胫骨断端局限性骨髓炎。应用游离胸背血管肩胛骨背阔肌复合组织瓣一期修复。结果移植组织瓣全部成活。背阔肌皮瓣面积9cmx10cm～20cmx14cm;骨瓣长7．0～9．5cm,平均8．3cm。受区血管5例为胫前动静脉,3例为胫后动静脉;动脉端端吻合6例,“T”形嵌入2例。经术后1～5年,平均2年7个月随访,骨瓣于术后3～6个月愈合。随着部分负重移植肩胛骨瓣迅速增粗,术后1年其宽度平均增加49．6％,厚度平均增加73．3％。5例恢复原工作,另3例改换工种。结论肩胛骨背阔肌复合组织瓣游离移植适合于修复小腿外伤后局部软组织伴中等长度的胫骨缺损。     

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。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.