微创经皮接骨术治疗膝关节周围骨折

目的:总结微创经皮接骨术治疗膝关节周围骨折的疗效.方法:对41例采用微创经皮接骨术治疗的膝关节周围骨折患者的临床资料进行回顾性分析.结果:41例患者经6～36个月的随访,除骨延迟愈合1例、内固定取出困难2例外,无其他并发症.参照Johner-Wruhs方法进行疗效评价,优24例、良13例、中3例、差1例,总优良率为90.2%.结论:微创经皮接骨术治疗膝关节周围骨折疗效满意,熟悉局部解剖学特点和进一步掌握手术技巧有助于提高膝关节周围骨折的总体疗效.     

定量罂粟碱不同给药途径对移植皮瓣血管阻力的影响*★

目的：临床上常用罂粟碱等血管舒张药预防和解除带血管蒂游离皮瓣移植吻合口及其附近血管痉挛，减少血管阻力，提高皮瓣成活率。观察在带血管蒂皮瓣移植中，定量罂粟碱（1.5 mg/kg）的不同给药途径对皮瓣移植后血管阻力的影响。 方法：①实验于2007-03/05在广州市第一人民医院动物实验中心完成。②选用雄性新西兰兔24只，实验方法符合动物伦理学要求。采用随机区组设计，按给药途径把24只兔分成4组（n=6），即皮瓣蒂部皮下注射组、皮瓣中央皮下注射组、臀部肌肉注射组及对照组（静脉推注）。建立下腹部腹壁浅动脉皮瓣模型，术后1 h~7 d每组定量注射罂粟碱，剂量为1.5 mg/kg，1次/d。③利用彩色多普勒超声测量术前、术后1周内每天注药后1 h的皮瓣血流阻力指数。 结果：24只兔全部进入结果分析。①术后各组移植皮瓣的血流阻力指数均高于术前（P < 0.05）。②术后第1天注药后1 h皮瓣中央皮下注射组的血流阻力指数低于臀部肌肉注射组（P < 0.01），与其他两组差异无显著性意义（P > 0.05）。术后第4天注药后1 h皮瓣中央皮下注射组的血流阻力指数低于其他3 组（P < 0.05）。术后第5天注药后1 h除臀部肌肉注射组血流阻力指数略高于手术前外，其他各组的血流阻力指数均略低于手术前，3组之间差异无显著性意义（P > 0.05）。 结论：皮瓣移植术后经皮瓣中央皮下注射罂粟碱扩血管效果最好，能改善皮瓣的成活能力；静脉注射与皮瓣蒂部皮下注射效果相近；臀部肌肉注射效果最差。     

同指中节指动脉背侧皮支皮瓣修复指端缺损

目的探讨应用同指中节指动脉背侧皮支皮瓣修复指端缺损的临床疗效。方法应用同指中节指动脉背侧皮支皮瓣修复指端缺损17例,其中修复示指13例,中指3例,环指1例；切取皮瓣面积为1．4cm×1．4cm～2．7cm×2．0cm。结果术后皮瓣全部存活,随访2～21个月,平均13．4个月。皮瓣修复后指端外形满意,并渐恢复了保护性感觉；供区无明显畸形,各指间关节功能正常。结论应用同指中节指动脉背侧皮支皮瓣修复指端缺损,避免了指固有动脉的损伤,手术简便,疗效满意。     

吻合腓血管带骨骺腓骨近段移植重建小儿骨肿瘤切除后肩关节或桡腕关节

目的探讨吻合腓血管带骨骺腓骨近段移植重建小儿骨肿瘤切除后肩关节、桡腕关节的临床效果。方法采用吻合腓血管的带骨骺腓骨近段移植重建11例肱骨近端和桡、尺骨远端骨肿瘤瘤段切除后肩关节、桡腕关节,并评价其重建效果。结果术后3个月所有腓骨移植段与受区骨端愈合良好,与健侧肢体同步生长,重建后的肩关节、桡腕关节在形态和功能方面均获得较好的重建效果。结论吻合腓血管带骨骺腓骨近段移植重建小儿骨肿瘤切除后肩关节、桡腕关节,疗效满意。     

Structural bone allografts with intramedullary vascularized fibular autografts for the treatment of massive bone defects in extremities

Objective：To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods： From January 2001 to December 2005, large bone defects in 19 patients （11 men and 8 women, aged 6 to 35 years） were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm （mean 17.6 cm）, length of vascularized free fibular was 15 to 29 cm （mean 19.2 cm）, length of massive bone allografts was 11 to 24 cm （mean 17.1 cm）. Location of massive bone defects was in humerus（n=1）, in femur（n=9） and in tibia（n=9）, respectively. Results： After 9 to 69 months （mean 38.2 months） follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion： The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.     

带血管蒂腓骨移植(位)结合中药治疗胫骨骨缺损

目的:探讨带血管蒂腓骨移植(位)结合中药治疗胫骨骨缺损的临床效果。方法:2004~2007年对16例胫骨骨缺损患者分别采用带蒂腓骨移植(西医组)和带蒂腓骨移植结合中药(中西医结合组)治疗,术后随访5~36个月,对两组病例进行数据统计,对比分析。结果:所有患者均无明显排斥反应,无供区肢体功能障碍。16例供受区创口均I期愈合,监测皮岛成活并与周围组织正常愈合,X线片示移植骨与胫骨骨性愈合。西医组8例:其中一例于术后d 2出现血管危象,经及时手术探查清除血栓而转愈,手术修复次数>1者为1例,占12.5%,该组平均骨愈合时间为17周,平均住院时间为68 d,平均住院费用为3.4万元,平均病程为91 d。中西医结合组8例无血管危象发生,手术修复次数>1者为0,平均骨愈合时间为14周,平均住院时间为52 d,平均住院费用为2.8万元,平均病程为73 d。结论:带血管蒂腓骨移植(位)结合中药治疗胫骨骨缺损能更有效地防止血管危象、皮瓣坏死等手术并发症,缩短疗程,提高疗效,是治疗胫骨骨缺损的较好方法。     

股前外侧皮瓣移植修复四肢及口腔颌面软组织缺损

背景:高能量损伤所致四肢大面积软组织缺损及口腔颌面部肿瘤切除术后软组织缺损是临床常见的组织缺损,应用股前外侧皮瓣修复此类缺损不但能覆盖创面而且对供区影响小.目的:总结分析游离股前外侧皮瓣在四肢及口腔颌面软组织缺损修复中的临床效果及治疗经验.方法:收集41例四肢及口腔颌面创伤或肿瘤切除后软组织缺损应用游离股前外侧皮瓣修复的临床资料,软组织缺损面积为(12～25)cm×(5～11)cm,根据受区软组织缺损大小、形态切取股前外侧皮瓣,将皮瓣动静脉与受区动静脉吻合,覆盖创面.观察移植后股前外侧皮瓣成活、供区愈合情况,患者对手术的满意程度,受区的功能恢复情况.结果与结论:所有皮瓣均完全成活,其中2例出现血管危象,均为移植后24～36 h出现皮瓣淤黑,予及时血管探奋发现均为静脉栓塞,经手术取栓后皮瓣成活.病例随访4个月～3年,均得到覆盖创面的目的,2例患者移植后因皮瓣臃肿再次入院行削薄手术.游离股前外侧皮瓣血管恒定,血管口径大,可切取面积大,修复四肢及口腔颌面皮肤黏膜大面积软组织缺损安全可靠.     

定制旋转铰链式膝关节假体置换治疗膝关节周围侵袭性骨肿瘤的临床观察

Objective To evaluate the clinical efficacy of knee joint replacement with patienttailored rotating hinge prosthesis in patients with invasive perigenual bone tumor.Methods Between January 2000 and January 2005, clinical data of 27 patients with invasive perigenual bone tumor were retrospectively analyzed, including 13 cases of distal femoral tumor and 14 of proximal tibial tumor,comprising 16 cases of giant cell tumors, 9 of osteosarcomas, 1 of synovial sarcomas and 1 of malignant fibrous histiocytomas.All the patients received resection of the tumor, knee-joint replacement with patienttailored rotating hinge prosthesis and postoperative rehabilitation.Patients with malignant tumor also underwent routine chemotherapy after surgery.MSTS scoring was used to evaluate the knee joint function in patients during the postoperative follow-up.Results All the patients were followed up for 11 to 122 months, with median time of 64.5 months.All the patients survived 6 months of follow-up, with a mean MSTS score of 22.2±3.5 and the rate of good knee joint function being 81.5% (22/27).In a recent follow-up, 23 patients were alive and 4 patients dead.Prosthesis-related complications developed in 4 patients.The mean MSTS score was 21.0 ±2.3, and the rate of good knee joint function was 72.7% (16/22) in 22 surviving patients.The overall rate of survival in all the patients was 85.2% (23/27) at five years after treatment.Conclusion The knee-joint replacement with patient-tailored rotating hinge knee prosthesis is associated with a good efficacy in treatment of invasive perigenual bone tumor.