应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损

自1999年1月-2005年3月,应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损13例,同时辅以中药治疗,获得较满意的效果,现报告如下。1临床资料本组13例,男9例,女4例;年龄18⁶7岁,平均32岁。致伤原因:车祸伤6例,挤压伤4例,烧伤1例,坠落伤2例。胫骨上1/3段1例,中1/3段2例,下1/3段5例,中下2/3段5例。病程12d³0个月,外露骨有干燥、硬化、发白、变黑,周围有肉芽、瘢痕组织、脓性分泌物等。外露骨纵形长0·6⁸·0cm,皮肤缺损面积最大为4cm×10cm。2治疗方法2·1手术方法在硬膜外麻醉下,股部上止血带,术区常规消毒。首先切除溃疡及外露胫骨周围瘢痕,清除髓腔内分泌物及     

阴囊皮瓣转移修复阴茎皮肤缺损

目的探讨一种操作简便而有效地修复阴茎皮肤缺损的手术方法.方法自1995年1月以来,应用阴囊皮瓣转移修复阴茎皮肤感染坏死所致皮肤缺损8例.其中6例为阴茎全周皮肤缺损,2例为2/3周皮肤缺损.手术切除创面肉芽组织,显露正常的阴茎海绵体或尿道海绵体筋膜,使阴茎充分伸展,设计、解剖、形成阴囊皮瓣,旋转转移至阴茎皮肤缺损区,边缘缝合固定.对阴囊皮肤缺损较大者,同期应用股内侧局部皮瓣转移修复阴囊皮肤缺损.结果本组8例手术全部成功,术后3～12个月随访,阴茎外形良好,生理功能恢复正常.结论阴囊皮瓣转移是一种较好的修复阴茎皮肤缺损的手术方法,具有操作简便、手术Ⅰ期完成、术后阴茎外形和生理功能恢复均佳的优点,值得推广应用.     

pcD2/hVEGF对缺血皮瓣存活的影响

目的 观察并探讨pcD2/hVEGF对缺血皮瓣血循环重建和皮瓣存活率的影响.方法 SD大鼠24只,分2组,每组12只.在鼠背部制作蒂位于尾侧的缺血皮瓣(7cm×1cm).实验组皮下注射pcD2/hVEGF,对照组皮下注射生理盐水,术后7天观察皮瓣存活面积比、单位面积微血管计数和及VEGF基因表达水平.结果 2组中pcD2VEGF组皮瓣存活面积比、单位面积微血管密度与对照组有显著性差异.结论 pcD2VEGF能促进缺血皮瓣存活.     

椎弓根螺钉联合椎间植骨融合器治疗腰椎滑脱症的远期疗效分析

[目的]探讨椎弓根螺钉系统联合椎间植骨融合器治疗峡部不连性腰椎滑脱症的远期疗效。[方法]自1996年10月~2002年10月本组收治峡部不连性腰椎滑脱症105例,随访资料齐全者86例。所有患者均行椎弓根螺钉系统复位滑脱,椎间植骨融合器行椎间融合固定。62例患者中1枚融合器从后斜向前呈45°植入,24例为2枚融合器从后向前垂直植入。随访测定固定节段的椎体间有无移位、滑脱有无复发,比较术前、术后2周及随访时固定椎间隙高度与近端第2椎间隙高度比值的变化。[结果]随访2~8年,平均35个月。根据NaKai评分标准,本组优56例,良13例,可17例,优良率为80.23%。Ⅰ度腰椎滑脱19例术后全部解剖复位;Ⅱ度腰椎滑脱51例中5例遗留Ⅰ度滑脱;Ⅲ度腰椎滑脱16例中4例留有Ⅰ度滑脱。末次随访时使用1枚融合器或2枚融合器所固定的椎间隙高度与近端第2椎间隙高度的比值与术后2周时的比值相比有所减低,滑脱无复发。[结论]椎弓根螺钉加椎间植骨融合器治疗腰椎滑脱症手术疗效满意,显著提高融合率,预防神经根管狭窄、神经卡压的发生,减少术后断钉和滑脱复发等问题。     

"风筝"皮瓣在眼睑前层缺损修复中的应用

目的探讨“风筝”皮瓣(亦称皮下蒂推进皮瓣)在修复眼睑前层(包括皮肤和眼轮匝肌)缺损的应用。方法于缺损邻接部位沿皮纹方向设计“风筝”皮瓣，按设计线切开皮肤，在眼轮匝肌下剥离形成以眼轮匝肌为皮下蒂的“风筝”皮瓣，推进转移修复皮肤缺损，用70无损伤缝线缝合。自1994年以来已用于14例，年龄15～64岁，缺损最大直径为上睑长度的1／3。结果皮瓣全部成活，切口Ⅰ期愈合，随访时间3个月至1年，眼睑形态满意，切口瘢痕不明显。结论对于眼睑前层范围较大不宜直接缝合，但尚有条件用局部皮瓣修复的中等大的缺损，用“风筝”皮瓣进行修复简单易行，效果可靠。其优点是，皮瓣通过推进转移的方式覆盖创面，没有旋转和变形，转移后局部平整，无“猫耳”等畸形产生，皮瓣蒂部宽广，血运良好，愈合后肤色与四周一致。     

股前外侧区穿支动脉的形态学研究及皮瓣设计

目的探讨以旋股外侧动脉降支为蒂的皮瓣设计方法，以便增加术前多普勒定位的准确性。方法6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本，解剖观测股前外侧区穿支，通过血管造影术和拍摄X线片测量其直径、行程、分支和定位。用3D—doctor和Scion Image软件分别测量穿支供血的趋向性、三维重建和单穿支供血面积。结果股前外侧区共有外径大于0．5mm穿支16支，平均外径0．8mm，平均供血面积45．61cm^2，其中20％为肌间隙穿支，80％为肌皮穿支。平均蒂长为（3．15±1．43）cm。自旋股外侧动脉降支发出的穿支在浅筋膜中的平均长度为2．63cm。结论改良的氧化铅-明胶灌注技术可以为皮动脉和穿支皮瓣的研究提供高质量的血管造影图像。本研究发现股前外侧单穿支皮瓣的最大供血面积是30cm×20cm。以股前外侧区穿支设计的穿支皮瓣可以移植到下肢或身体其他部位。     

Pterygium excision with free conjunctival autograft (FCG) versus postoperative strontium 90 (90Sr) beta-irradiation. A prospective study

In a prospective study the results of a pterygium excision in 54 patients (57 eyes) who underwent a superficial free conjunctival autograft (FCG) were compared to those of patients who were treated with postoperative90Sr-irradiation. In 51 cases the minimum follow-up was six months, the maximum follow-up seven years. We divided the study up into a randomized part and an open part. In the randomized part, surgery of a primary pterygium was performed in 25 eyes, of which 16 were treated with a FCG and compared with 9 eyes with primary pterygium surgery and postoperative90Sr beta-irradiation. In the same period 16eyes were treated because of a recurrent pterygium: 8 with FCG and 8 with90Sr-irradiation. In the open part of the study16 eyes with primary pterygium were successively treated with FCG alone. The results showed in the randomized, as well as in the open study on primary surgery with a minimum follow-up of six month, one recurrence in each of the FCG-groups (2 out of 31 eyes =6.4%), and no recurrences in the 90Sr-group(0%). In the randomized group of patients treated for a recurrent pterygium one recurrence developed in the FCG group (1 out of 8 eyes =12.5%) and one in the 90Sr-group (1 out of 7 =14.6%). Analysis of other clinical parameters showed that postoperative treatment with corticosteroids, nonsteroidal anti-inflammatory drugs, and artificial tears was necessary for a longer period in the FCG group than in the90Sr-group. This revised version was published online in August 2006 with corrections to the Cover Date.     

Clinical and therapeutical considerations on a case of conjunctival melanoma

The authors report a case of limbal conjunctival melanoma treated in a conservative manner. The choice of such a therapy was based not only on clinical examinations and review of literature, but also and mainly on the intraoperative histological examination that showed no involvement of the conjunctival deeper layers.     

“Chain-link” combined tissue transfer for the reconstruction of the mandible

We describe a procedure for “chain-link” combined tissue transfer connecting the vascular pedicle of a deep circumflex iliac flap with that of a forearm flap after wide resection of the mandible. Combination of these flaps facilitated the reconstruction of the defect in both intra- and extraoral soft tissue and the mandibular bone. This method is useful when cervical recipient blood vessels are limited due to the wide resection of the primary tumor and radical neck dissection.     

带旋髂深血管蒂髂骨瓣移植与加压螺钉治疗青壮年股骨颈骨折

本文报告了自１９８５年￣１９９５年间采用带旋髂深血管蒂髂骨瓣移植与加压螺纹钉内固定治疗青壮年囊内型股骨颈骨折２６例。随访时间平均５年５个月。结果，２６例骨折痊愈，骨折愈合率为１００％。骨折愈合时间平均４个月。仅１例骨折愈后后股骨头发生缺血坏死。股骨头缺血坏死率为４％。