应用改良跟骨外侧“L”切口入路手术治疗波及关节面的跟骨骨折疗效观察

目的探讨改良跟骨外侧"L"切口手术治疗波及关节面的跟骨骨折体会。方法分别采用跟骨外侧"L"形切口54例(59足)作为对照组。采用改良的跟骨外侧"L"形切口62例(70足)作为改良组。比较两种不同入路方法治疗效果及并发症情况。结果患者随访均获得随访,随访时间6~12个月。改良组70足中甲级愈合61足(87.14%),乙级6足(8.57%),丙级3足(4.29%);对照组59足中甲级聚合43足(72.88%)乙级9足(15.25%)、丙级7足(11.86%);甲级愈合率改良组优于对照组,两组相比差异具有统计学意义(P0.05)。改良组并发症8足(11.42%)。对照组并发症15足(25.42%),,改良组术后并发症发生率低于对照组,两组相比差异具有统计学意义(P0.05)。结论改良跟骨外侧"L"切口可降低术后切口并发症发生率。     

大鼠坐骨神经切断后相应脊髓节段中P-S473-AKT表达的变化

目的 探讨成年Wister大鼠在坐骨神经切断后P-S473-Akt于相应脊髓节段前角运动神经元内的表达变化.方法 选取健康成年雄性Wister大鼠50只,随机分为坐骨神经切断组和对照组,分别于术后1、2、4、6、8周5个时相处死后取其L4～L6脊髓,利用免疫组织化学技术检测P-S473-Akt在相应脊髓节段中的表达变化,并利用影像分析系统进行统计学分析.结果 在对照组中P-S473-Akt表达呈阴性,随着时间的变化无明显改变.坐骨神经切断组与对照组在5个时相中的变化:1周时两组比较差异无统计学意义;2周时坐骨神经切断组运动神经元胞体内P-S473-Akt有明显表达,4周时达到高峰,6～8周时逐渐下调,8周时仍可见细胞核内有少量表达.结论 坐骨神经切断可导致成年大鼠相应脊髓节段中前角运动神经元P-S473-Akt表达明显增加,可能对损伤的运动神经元发挥保护作用.     

大鼠坐骨神经移植术后BDNF在相应脊髓节段运动神经元中的表达

目的 探讨大鼠坐骨神经移植术后BDNF在相应脊髓节段前角运动神经元内的表达变化.方法 选用健康成年雄性Wister大鼠随机分为对照组(假手术组)和实验组(坐骨神经移植组),分别于术后不同时间点取材,应用RT-PCR及Western-blot方法检测相应脊髓节段前角运动神经元内的BDNF mRNA及其蛋白,所得数据进行统计学分析.结果 BDNF mRNA在对照组脊髓节段运动神经元内有一定的基础表达,实验组术后1周BDNF mRNA表达开始升高,2周时达高峰,6～8周后逐步下降,至8周时仍高于对照组基础表达量.两组中BDNF蛋白与BDNF mRNA的表达规律具有一致性.结论 坐骨神经移植术后BDNF mRNA及蛋白在相应脊髓节段前角运动神经元中的表达增强,BDNF可能参与了神经损伤后保护神经元及促进神经再生的过程.     

应用皮瓣移植治疗重度虎口挛缩的体会

Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.     

应用皮瓣移植治疗重度虎口挛缩的体会

Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.     

选择性脊神经后根切断术治疗顽固性疼痛的临床分析

目的 探讨选择性脊神经后根切断术治疗顽固性疼痛的临床效果及应用价值. 方法 应用选择性脊神经后根切断术治疗顽固性疼痛,通过将手术前后患者的疼痛表现、止痛药物应用数量、睡眠时间、疼痛视觉模拟评分(VAS)进行比较,从而分析该术式的临床效果. 结果 临床应用3例患者,其中1例随访11个月,顽固性疼痛消失,触压痛消失,止痛药物应用减少,睡眠时间及质量明显改善,VAS评分明显下降,临床止痛效果确切. 结论 对患有四肢或躯体顽固性神经性疼痛的患者,选择性脊神经后根切断术对缓解疼痛是有效的,具有一定的临床应用价值.     

上肢大面积皮肤缺损合并感染的显微外科治疗

目的 探讨上肢大面积皮肤缺损合并感染的临床特点，治疗方法及预后等相关因素。方法 对6例上肢大面积皮肤缺损合并感染的患者，采用股前外侧皮瓣游离移植3例，背阔肌皮瓣转位1例，预制骨间背动脉逆行岛状皮瓣2例（其中1例同时用腹股沟皮瓣）。结果 6例皮瓣全部存活，感染得到有效的控制。结论 对于上肢大面积皮肤缺损合并感染的患者，在控制感染的基础上，用皮瓣移植（或移位）覆盖创面是最有效的治疗方法。     

手指屈肌腱Ⅱ区断裂修复术后早期功能练习对手功能的影响

随着手工业的发展,手部肌腱的损伤越来越多,一期肌腱修复及伴有复合组织损伤修复都存在着粘连形成、再次断裂、指关节强直等问题[1]。早期活动无疑是预防粘连的方法,但早期活动存在危险性,过度肌肉收缩引起修复肌腱断裂及间隙扩大,而屈肌腱Ⅱ区损伤由于解剖结构特殊,所以此区修复术后极易发生粘连,影响手功能的恢复。本研究分析屈肌腱Ⅱ区损伤术后早期进行特殊的屈指练习预防粘连是否