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.     

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.     

腓肠神经营养血管皮肤筋膜蒂逆行岛状皮瓣的应用及静脉并发症的预防处理

目的探讨腓肠神经营养血管皮肤筋膜蒂逆行岛状皮瓣修复足踝部创面的效果及静脉并发症的预防和处理。方法切取腓肠神经营养血管皮肤筋膜蒂逆行岛状皮瓣时筋膜皮肤蒂保留3cm宽皮肤,其宽度尽量与皮瓣宽度一致;选择性在旋转轴点附近结扎小隐静脉远心端;明道转移;术后弹性绷带适当加压包扎。结果本组23例皮瓣全部成活,无严重静脉并发症发生。结论腓肠神经营养血管皮肤筋膜蒂逆行岛状皮瓣是修复足踝部创面的理想术式,静脉并发症完全可预防或处理。     

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。     

远端蒂腓骨短肌肌瓣加逆行隐神经皮瓣治疗小腿远端、足骨髓炎伴软组织缺损

目的探讨远端蒂腓骨短肌肌瓣加逆行隐神经皮瓣治疗小腿远端、足骨髓炎伴软组织缺损的方法及疗效。方法回顾性分析2014年3月至2016年3月住院治疗的小腿远端、足骨髓炎伴软组织缺损21例患者的临床资料。其中,创伤后急性骨髓炎7例,慢性骨髓炎14例。所有患者均应用腓骨短肌肌瓣填充骨髓炎清创后死腔,应用逆行隐神经皮瓣修复软组织缺损。结果彻底清创后,平均软组织缺损为2 cm×2 cm～8 cm×6 cm(长×宽),胫骨缺损范围为3 cm×2 cm×2 cm～6 cm×3 cm×6 cm(长×宽×深)。采用腓骨短肌肌瓣+逆行隐神经皮瓣治疗骨髓炎伴软组织缺损。逆行隐神经皮瓣全部成活,创面均Ⅰ期愈合,未见皮瓣下腓骨短肌肌瓣坏死、液化现象。随访6～24个月,皮瓣质地及外形良好,患者骨髓炎未见复发。结论应用远端蒂的腓骨短肌肌皮瓣加逆行隐神经皮瓣移植,可消除小腿远端及足部骨髓炎清创术后死腔,控制骨感染,同时可修复此区域范围更大的软组织缺损。手术方法简单、易行、安全可靠,能Ⅰ期治疗骨髓炎并修复软组织缺损。     

腓肠神经营养血管蒂逆行岛状皮瓣的解剖研究和临床应用

目的：研究腓肠神经营养血管蒂逆行岛状皮瓣的血供和临床应用。方法：依据10侧下肢标本的解剖结果，采用腓肠神经营养血管蒂逆行岛状皮瓣修复软组织缺损11例。结果：腓肠神经营养血管与腓动脉穿支之间形成广泛的链式血管网，临床应用的皮瓣全部成活，效果满意。结论：该皮瓣是修复足踝部软组织缺损的理想的皮瓣。     

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.     

指背逆行岛状皮瓣修复指端软组织缺损

目的探讨指背逆行岛状皮瓣修复指端软组织缺损的手术方法及疗效。方法 2010年1月~2015年4月,应用指背逆行岛状皮瓣修复指端软组织缺损41例45指,其中男性32例,女性9例;年龄17~57岁,平均37岁。41例患者45指均有指骨外露,缺损面积1.8cm×1.5cm~3.0cm×2.5cm。皮瓣切取范围2.0cm×1.8cm~3.2cm×2.8cm。皮瓣旋转点于远指间关节以近,逆行旋转覆盖指端缺损区。结果 45指皮瓣均成活。39指随访5~20个月,平均12.5个月,皮瓣颜色、皮肤质地及弹性良好,外形佳,皮瓣两点辨别觉为8~10mm,皮瓣供区外观满意,手指运动功能满意。结论指背逆行岛状皮瓣手术操作简单,不伤及指间动脉及神经,血管蒂长,皮瓣蒂携带皮条,旋转弧度大,成功率高,疗效满意,是修复指端软组织缺损的有效方法之一。     

改良同指根部逆行皮瓣修复远端软组织缺损358例体会

目的观察改良同指根部逆行岛状皮瓣修复远端软组织缺损的临床效果。方法应用带一侧指固有动脉,吻合指神经背侧支和浅静脉的改良同指根部逆行岛状皮瓣修复远端软组织缺损358例,手指皮肤缺损面积最大2.5 cm×2.5 cm,最小1.0 cm×0.8 cm。结果 358例全部成活。住院时间2～3 w,平均2.5 w。术后随访3～12个月,修复的皮瓣颜色红润,质地柔软,皮瓣感觉良好,患指功能良好。结论改良同指根部逆行岛状皮瓣修复远端皮肤软组织缺损可最大限度保留指体长度,缩短住院时间,皮瓣感觉恢复快,患指功能恢复良好,效果满意。     

隐神经营养血管逆行交腿皮瓣修复小腿远段与足部皮肤缺损

目的：总结采用隐神经营养血管逆行交腿皮瓣修复小腿远段与足部皮肤软组织缺损的临床经验。方法：1999—10～2006—05，采用隐神经营养血管逆行交腿皮瓣修复小腿中下段及足部皮肤软组织缺损6例。结果：6例皮瓣均100％成活，术区外形与功能良好。结论：在特定的条件下，隐神经营养血管逆行交腿皮瓣可以做为修复小腿中下段及足部皮肤软组织缺损的备选方法。     

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.     

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.     

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).     

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.