第1跖背动脉岛状皮瓣联合第1骨间背侧肌治疗足跗骨骨髓炎

我院以第1跖背动脉岛状皮瓣联合第1骨间背侧肌治疗足跗骨骨髓炎软组织及骨缺损16例,患者骨髓炎无复发,皮瓣外形良好,患足功能恢复满意。该治疗方法操作简单、损伤小,疗效理想。     

前臂骨间背侧神经的解剖学研究及临床应用

目的　为减少前臂骨间背侧神经（posterior interosseous nerve of forearm, PINOF）的损伤提供解剖学资料,并探讨手术安全性。　方法　在30具（60例）成人尸体上,通过肘关节外侧切口,在桡骨近端后外侧或外侧面,放置1块4　cm长的微型钢板。对PINOF的起点和该神经与微型钢板的关系等进行观测。　结果　PINOF起点距桡骨头上缘的距离为（1.1±1.8）　mm。桡侧腕长伸肌肌支发出点距桡骨头上缘的距离为（6.2±1.9）　mm。56例（93%）PINOF至微型钢板的距离为（5.0±1.1）　mm,4例（7%）PINOF通过微型钢板远端的上方进入旋后肌。前臂旋前位时,PINOF离开该切口,向内侧移动的距离为（10.0±1.3）　mm。应用改良式预弯微型钢板治疗桡骨头粉碎性骨折11例,伴发外伤性和术中牵拉造成PINOF损伤各1例。11例均获随访,平均随访25个月,2例PINOF损伤完全恢复,平均恢复时间2.8个月。　结论　采用肘关节外侧切口时,在桡骨近端的外侧面或后外侧面,距离桡骨头上缘3.5　cm的范围内,是放置微型钢板的安全区。     

前臂骨间背侧神经麻痹的易漏诊原因分析

近十年来 ,笔者在门诊及临床遇有前臂骨间背侧神经麻痹的病人 1 6例 ,有不少系误诊病例。此文就前臂骨间背侧神经麻痹的病因、易漏诊原因及诊断中注意点作一探讨。1　临床资料本组 1 6例患者 ,年龄均在 1 2～ 4 8岁 ,平均年龄 2 2岁。女性 3例 ,男性 1 3例。锐器伤 3例 ,前臂上段骨折脱位 6例 ,骨折脱位闭合整复继发伤 4例 ,无外伤因素自发性旋后肌腱弓卡压 1例 ,前壁后上段软组织伤继发神经症状 2例。 1 4例为不完全损伤 ,2例为完全性损伤。神经损伤时间 ,最长为 4ａ,早期就诊为 1周 ,多数病人多在 3～ 6个月后。受损 6个月内者 ,手术治疗…     

延长前臂骨间背侧逆行皮瓣的一种方法

目的：提出一种延长骨间背侧逆行皮瓣和增加其可靠性的方法。方法：保留较多的皮肤穿支,将皮瓣包埋部分去表皮以保留真皮下血管网,从而提供皮瓣远端充足的血供以及静脉回流。结果：利用本方法修复掌指关节以远和掌侧缺损12例,皮瓣血运良好,无远端坏死。结论：本方法可增加皮瓣切取的长度,提高其可靠性,也可避免出现纵行瘢痕,为骨间背侧逆行皮瓣的应用提供了一种可选方法。     

前臂背侧近1/2锐器伤中骨间背神经损伤的诊治

前臂背侧锐器伤是上肢创伤中常见的损伤 ,临床治疗中较重视前臂背侧肌肉、肌腱损伤的修复 ,而忽略近 1/ 2处的损伤常会合并骨间背神经及其肌支的损伤。笔者从 2 0 0 0年 2月～ 2 0 0 3年 2月 ,对 5例前臂背侧近 1/ 2软组织锐器伤合并骨间背神经及其肌支损伤的病人进行外科修复治疗 ,取得满意效果 ,报告如下。1　资料与方法1.1　一般资料　本组男 4例 ,女 1例。年龄 2 0～ 34岁。新鲜损伤4例(男) ,陈旧损伤 1例 (女 ) ,全部为刀伤。损伤部位 :前臂背面近1/ 2～ 1/ 4偏桡侧或近中线。陈旧损伤患者于外院诊断为“右前臂伸指、伸腕肌完全断裂” …     

自体髂骨植骨治疗距骨软骨损伤17例

目的:探讨经内踝截骨、取髂骨植骨治疗距骨骨软骨损伤的手术技巧及预后疗效。方法:回顾性分析2012年7月至2015年10月,采用取同侧髂骨松质骨植骨术治疗且获得完整随访的内侧距骨软骨损伤17例(17足)的病历资料。男10例;女7例;左足7例,右足10例;年龄16-50岁;平均年龄35岁;14例患者病灶位于内侧,3例患者病灶位于外侧,病灶平均面积为为60±52.8 mm2;按照MRI的Hepple距骨软骨损伤分型,Ⅲ型8例;Ⅳ型6例;Ⅴ型3例;所有患者术前及术后均行CT及MRI检查。采用美国足与踝协会踝与后足评分(AOFAS)及视觉疼痛量表(VAS)对术后踝关节的功能及疼痛评定治疗效果。结果:17例患者术后随访4~39个月;平均18.6个月。AOFAS评分由术前的77.32±6.67分提高到术后的93.10±8.24分,VAS评分由术前的7.80±1.38分降低到术后的1.96±1.67分,差异均具有统计学意义(P<0.001)。术后随访未见伤口感染、皮肤坏死、内固定失效、截骨端不愈合或畸形愈合等并发症。结论:对于HeppleⅢ、Ⅳ、Ⅴ型的距骨软骨损伤,经内踝截骨、髂骨植骨术治疗距骨软骨损伤是有效的治疗方式;手术治疗可以改善踝关节的功能、缓解踝关节的疼痛。     

桡神经各区损伤的诊断与治疗

本文报告了14例桡神经各区的损伤,其中2例骨间背侧神经降支的损伤罕见报道。根据解剖、临床的观察研究,将桡神经分为三区,并对各区损伤的症状、鉴别诊断和处理原则作了阐述。     

前臂背侧血管的解剖及其临床意义

为认识国人前臂血管的解剖关系,改进皮瓣设计,笔者在50例上肢标本上,对前臂背侧血管分支、吻合、骨膜支的分布进行观察,重点对骨间背侧血管、骨间掌侧血管腕背支的应用进行研究。结果表明,供区的逆行组织瓣有3种血管蒂:①以骨间掌侧动脉腕背支为蒂,切取背侧中下段皮瓣,适于向手背转移;②以尺侧骨皮     

距骨骨折脱位的手术治疗6例

距骨骨折脱位是一种较少见损伤。据统计 ,距骨骨折占踝部骨折的 1 1% ,该类骨折脱位易形成距骨缺血性坏死 ,给患者带来很大痛苦。我院自 1995年 5月～ 2 0 0 1年 10月共收治距骨骨折脱位患者 6例 ,均采取手术治疗 ,有 5例骨折愈合 ,1例出现距骨缺血性坏死 ,现报告如下。1　资料和方法1 1　一般资料　 6例中男 4例 ,女 2例 ,年龄最小者 2 0岁 ,最大者 70岁 ,受伤原因均为车祸伤。 6例均为开放性骨折并脱位。按Gillgust分型 ,6例均为Ⅲ型 (距骨颈骨折合并距骨体脱位 )。1 2　治疗方法　 4例根据骨折块向内侧脱位 ,选用踝关节前内侧切口 ,起自…     

MR imaging findings of anterior interosseous nerve lesions

OBJECTIVE: To study and characterise the MR imaging findings of lesions of the anterior interosseous nerve (AIN). MATERIALS AND METHODS: Magnetic resonance imaging (MRI) findings of the forearm of ten patients referred to our institution with suspected AIN lesions were retrospectively studied. Five healthy volunteers with normal forearm MRI findings formed a control group. Two musculoskeletal radiologists assessed the forearm musculature for oedema in the distribution of the AIN, median, posterior interosseous and radial nerves on T2-weighted (T2W) fat-saturated sequences. T1-weighted (T1W) images were assessed and graded for the presence of muscle atrophy and fatty involution. RESULTS: Six patients had undergone surgical exploration; five of these had surgically confirmed AIN compression. Four patients had diagnoses other than AIN compression made on imaging features. Of the cases of proven AIN compression, oedema within the pronator quadratus (PQ) muscle was identified in all cases. PQ atrophy and fatty involution were seen in three (43%) surgically confirmed cases. Cases 2 and 3 also demonstrated oedema in the flexor digitorum profundus (FDP)1 and FDP2 muscles. These cases also showed oedema in the flexor-carpi radialis (FCR) and FDP3/FDP4 muscles, respectively. The four cases of non-AIN compression demonstrated muscle oedema patterns that were atypical for the AIN distribution. They included a rupture of the flexor pollicis longus (FPL) tendon, brachial neuritis, amyotrophic lateral sclerosis and compression of the proximal median nerve. CONCLUSIONS: MRI is a useful investigation in the diagnostic workup of AIN syndrome. AIN syndrome is likely when there is diffuse oedema of AIN innervated muscles on T2W fat-saturated images. The most reliable sign of an AIN lesion is oedema within the PQ. Oedema in the flexor carpi radialis, FDP3 and FDP4, although not in the classical distribution of the AIN, does not preclude the diagnosis of AIN syndrome.     

前臂骨间背动脉逆行岛状皮瓣治疗手部伤残临床体会

目的：探讨前臂骨间背动脉逆行岛状皮瓣治疗手部疾病的方法。方法：从1998年7月至2000年7月有16例手部严重挤压伤或烧伤瘢痕伤残患者，在我院烧伤整形外科接受常规前臂骨间背动脉逆行岛状皮瓣治疗。结果：经短期随访治疗效果比较满意。结论：本术式对手部皮肤严重挤压伤与瘢痕伤残者治疗有效，手术操作简单，可以在基层医院开展。     

食管破裂的特征及外科治疗

目的 总结食管破裂的临床特征和治疗经验,从而提高对该病的诊断和治疗水平。方法 分析我科从1954年至今共收治食管破裂62例临床资料。62例均经上消化道碘油造影,纤维食管镜检查,胸部X线或CT检查证实。其中自发性食管破裂11例,食管异物所致15例,外伤性2例,医源性损伤34例。手术治疗48例,其中食管修补43例,食管部分切除、胃或结肠代食管5例。空肠造瘘术、胸腔闭式引流和／或纵隔引流治疗14例。结果 误诊9例(14．5％)。治愈58例,死亡4例。结论 提高对本病的认识,详细询问病史及查体,口服亚甲蓝后胸穿或胃镜检查有助诊断和减少误诊。积极手术治疗,慎重选择保守治疗。不能一期手术修补者,充分引流可使病人有好的转归。     

Clinical studies on posterior cruciate ligament tears have weak design

Very few studies in the literature focus on isolated PCL injury. Recent studies are in general more optimistic with regard to the results than previous reports. There are few randomized controlled trials and few prospective comparative studies, which may limit the value of the reported results. The goal of the present study was to evaluate the methodology of published studies according to a well-established scoring system. Studies with a high success rate have a low score on methodology design. This study was based on systematic review and level 3 evidence. We performed a literature search and included studies in which the primary aim was to report the outcome after management of isolated PCL injury. The quality of the studies was evaluated using a modified Coleman methodology score, which results in a score between 0 and 100. Studies were also assessed with use of level-of-evidence rating. We collected data on the year of publication, reported results after surgery and conservative treatment, and the outcome scales used to assess the results. Forty studies were included. The average methodology score was 52. No significant difference in outcome was detected between conservative and surgical management. Our hypothesis that a low Coleman score would yield a good clinical result was not verified. This could be caused by the fact that there were very few studies with a high Coleman score. The Coleman methodology score correlated positively with the year of publication and with the level-of-evidence rating. In the 40 reported studies, 12 different outcome scales were used. In conclusion, the generally low methodological quality shows that caution is required when interpreting results after management of injury to the PCL. Firm recommendations on what treatment to choose cannot be given at this time on the basis of these studies. More attention should be paid to methodological quality when designing, conducting and reporting trials. An erratum to this article can be found at     

老年上颈椎损伤的临床特点与治疗

目的 探讨老年上颈椎损伤的临床特点与治疗方法.方法 回顾性分析我科2003年1月-2007年12月间收治的>60岁上颈椎骨折脱位患者28例的临床资料,其中男20例,女8例;年龄60～86岁,平均68.1岁.致伤原因:跌伤16例,交通伤8例,高处坠落伤4例.寰椎骨折5例;枢椎骨折15例,其中齿状突骨折8例,C2椎弓骨折6例,C2椎体骨折1例;寰枢椎损伤伴下颈椎损伤5例;寰枢椎同时损伤2例,其中齿状突骨折伴寰椎侧块骨折1例,齿状突骨折伴寰椎前弓骨折1例;寰枢关节脱位1例.并发脊髓损伤4例.保守治疗8例,开放手术治疗8例,微创经皮手术治疗12例.结果 平均住院时间比较,保守组与传统手术组间差异无统计学意义(P>0.05),而微创经皮组短于保守组与传统手术组(P<0.05).保守治疗组2例死亡,开放手术组1例死亡,其余25例均获得随访,随访时间9～56个月,平均16.8个月.保守治疗组患者满意率为50%,开放手术组为72%,微创手术组为75%.保守治疗组中4例发生并发症,传统手术组3例,微创手术组2例.结论 老年上颈椎损伤发生率较高,其损伤特点以低能量暴力为主,损伤类型以齿状突骨折最常见,具有脊髓损伤发生率低、漏诊率高等特点.在排除手术禁忌证的情况下,手术治疗特别是微创手术可取得较好的临床疗效.     

Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique

Posterior shoulder dislocation with humeral head impression fracture is rare and its early diagnosis and treatment remain a challenge for the orthopaedic surgeon. Although literature describes several surgical options, most are based on the detachment of the subscapularis or on more complex techniques that change the humeral joint anatomy even more. This report describes a new operative technique that is only slightly invasive, where the depressed chondral surface is raised to regain a normal articular contour. The chondral surface is supported by an interference biabsorbable screw and the insertion of the subscapularis tendon is left intact. Two male patients with an acute shoulder posterior dislocation associated with anteromedial impression fracture of about 40 and 50%, respectively, of the articular humeral shape were treated in our department. The average follow-up was 26 months where plain X-ray and CT scan showed an anatomical humeral surface free from signs of arthritis or necrosis. Functional results were excellent in both cases. This new technique is easy, less invasive than others and ensures a stable cartilage and subchondral support without the use of grafts.     

预构神经的趾短伸肌皮瓣移植重建第一背侧骨间肌功能

目的 探讨采用预构神经的趾短伸肌皮瓣移植重建第一背侧骨间肌功能的效果。方法 本组5例病人,男2例,女3例;年龄17－24岁,平均21岁。将正中神经的旋前方肌肌支用腓肠神经延长预构,待神经轴突长过预构神经后,再用带神经血管的趾短伸肌皮瓣移植,治疗尺神经损伤后第一背侧骨间肌纤维化。结果 移植后4－6周,所有病例临床显示其肌力均恢复到2级以上,肌电图均出现移植肌肉动作电位。7－9周后,所有病例第一背侧骨间肌功能均恢复到4－5级。结论 预构神经的趾短伸肌皮瓣移植是重建第一背侧骨间肌功能的有效方法。     

Nerve injuries about the elbow

The ulnar, radial, median, medial antebrachial cutaneous, and lateral antebrachial cutaneous nerves are subject to traction and compression in athletes who place forceful, repetitive stresses across their elbow joint. Throwing athletes are at greatest risk, and cubital tunnel syndrome (involving the ulnar nerve) is clearly the most common neuropathy about the elbow. The anatomy and innervation pattern of the nerve involved determines the characteristic of the neuropathy syndrome. The most important parts of the work-up are the history and physical examination as electrodiagnostic testing and imaging are often not reliable. In general, active rest is the first line of treatment. Tailoring the surgery and rehabilitation protocol according to the functional requirements of that athlete's sport(s) can help optimize the operative outcomes for recalcitrant cases.