应用皮瓣移植修复足跟部皮肤软组织缺损

目的通过8种不同皮瓣的临床应用,总结足跟部皮肤软组织缺损的修复效果。方法采用了游离足背皮瓣、游离背阔肌皮瓣、游离肩胛皮瓣、桥式胫后动脉岛状皮瓣、桥式携带背阔肌皮瓣或桥式携带肩胛皮瓣、胫后动脉岛状皮瓣、胫后动脉皮支岛状皮瓣、跖底内侧动脉岛状皮瓣,对足跟部皮肤软组织缺损进行修复的临床应用。结果95块皮瓣修复足跟部皮肤软组织缺损,成活93块,成功率为97.9%。随访1～15年,治疗效果满意。结论应用皮瓣移植的方法,才能使足跟部皮肤软组织缺损得到有效的修复。     

Treatment of calcaneal fractures: the available evidence

Abstract Calcaneal fracture is the most common of the tarsal fractures and represents 1%–2% of all fractures. The fractures may be divided into extra-articular (not affecting the joint) and intra-articular (involving the talo-calcaneal and calcaneal cuboid joints) types. The management of heel fractures includes nonoperative and operative treatments, but no clear consensus has been reached. The choice of operative treatment is still controversial with many factors influencing the final clinical outcome. Many studies have assessed the outcome of treatment of calcaneal fractures, but there is a general disagreement on their management. The objective of this study was to collect and evaluate the scientific evidence reported in the literature supporting the different treatments for calcaneal fractures.     

Isolierte Fraktur des Sustentaculum tali: ein Fallbericht

Case reportA 32 years old male patient slipped while going downhill and injured his right foot. The next day X-rays were taken in which no bony injury was seen. Because of persistent complaints additional diagnostic by MRI and CT were performed. These showed a displaced fracture of the sustentaculum tali. The sustentaculum tali was fixed with screws. The fracture healed with a congruent articular surface and good functional outcome.ConclusionFractures of the sustentaculum tali are rare and are overseen frequently because of overlapping structures on X-rays. Even low energy trauma can cause these fractures in young patients. In patients with persistent complaints of the foot an additional cross-sectional diagnostic is strongly recommended.     

Relationship between lower limb dynamics and knee joint pain

To test the hypothesis that appropriate and timely neuromuscular control of limb motions plays an important role in the preservation of joint health, we kinematically and kinetically examined the behavior of the legs of young adult subjects at heel strike during natural walking. We compared a group of 18 volunteers, who, we presumed, were preosteoarthrotic because of mild, intermittent, activity-related knee joint pain, with 14 age-matched asymptomatic normal subjects. The two groups of subjects exhibited similar gait patterns with equivalent cadences, walking speeds, terminal stance phase knee flexion, maximum (peak) swing angular velocity, and overall shape of the vertical ground reaction. However, our instrumentation detected statistically significant differences between the two groups within a few milliseconds of heel strike. In the knee pain group, the heel hit the floor with a stronger impact in this brief interval. Just before heel strike, there was a faster downward velocity of the ankle with a larger angular velocity of the shank. The follow-through of the leg immediately after heel strike was more violent with larger peak axial and angular accelerations of the leg echoed by a more rapid rise of the ground reaction force. This sequence of events represents repetitive impulsive loading, which consistently provoked osteoarthrosis in animal experiments. We refer to this micro-incoordination of neuromuscular control not visible to the naked eye as "microklutziness."     

Treatment of painful heels with acupuncture in 32 cases

Points Fengfu (GV 16), Fengchi (GB 20) and Anmian were selected as main acupoints to treat painful heels and the total effective rate of 96.9% was got. The technique of lifting needle was the key to the therapy. Author: Ye Ming-zhu(1947-), male, associated chiefphysician Translator: Chen Han-ping     

深圳市13∽15岁正常少年超声骨密度研究

目的 :了解深圳地区 13～ 15岁少年超声骨密度状况 ;建立该年龄段少年超声骨密度正常参考值。方法 :选择13～ 15岁深圳居住的正常少年 15 8例为检测对象 ,用定量超声骨密度仪 (QU S)测定受检者足跟部骨密度 (BMD)值 ,同时测量受检者体重、身高。结果 :13～ 15岁少年 BMD值 (g/ cm2 )分别为 13岁 :男性 0 .5 2 8± 0 .0 86、女性 0 .5 4 2± 0 .117,14岁 :男性 0 .4 87± 0 .0 79、女性 0 .5 0 8± 0 .10 8,15岁 :男性 0 .5 0 1± 0 .2 2 5、女性 0 .6 0 9± 0 .2 34。身高增长速度的快与慢和BMD变化有密切关系 ,体重与 BMD呈正相关 (r=0 .82 0 ,P<0 .0 1)。 13～ 15岁女孩 BMD值高于男孩 BMD值 ;女性有月经初潮者 BMD值高于无月经初潮者。二者之间比较 ,差异均有显著性 (r=0 .978,P<0 .0 0 1;r=0 .989,P<0 .0 0 1)。结论 :13～ 15岁少年足跟部 BMD与性别有关、与身高增长快慢亦有关系 ,体重、雌激素对 BMD有明显的影响 ,在此时期应加强改善营养 ,增加补钙等干预措施。     

新生儿足跟血采集的护理体会

目的：提高新生儿疾病的筛查率,提高采血成功率和标本质量,确保筛查准确率。方法：对出生72 h的新生儿应用无菌技术采集足跟末梢血,将血吸于干净标准滤纸上,采集34个直径〉8 mm的血斑,把滤纸血卡送至新生儿疾病筛查中心,通过实验查出危害严重的先天性代谢疾病,并对健康宣教、采血前的准备、足跟血采集技巧、护理注意事项、人员培训、制度规范管理等方面进行总结。结果：20032010年共取采血标本20 327例,不合格230例,采血标本合格率为98.8%。结论：认真进行采血前准备,正确进行血标本采集,严格做好各项细节化管理,才能确保疾病筛查质量,减轻新生儿的痛苦。     

儿童足跟部开放性损伤伴踝关节脱位的治疗

目的：探讨儿童足跟部开放性损伤伴踝关节脱位的治疗方法和效果。方法10例足跟部开放性损伤伴踝关节脱位患儿急诊清创,踝关节复位后克氏针固定,行负压封闭引流（VSD）覆盖创面;2周后手术重建跟腱、腓肠神经营养血管皮瓣或隐神经营养血管皮瓣逆行转移覆盖软组织缺损创面。结果10例患者皮瓣愈合良好,按期拆线。皮瓣修复术后6周拔除固定踝关节的克氏针开始功能锻炼。所有患儿均获随访,时间6～16个月。踝关节功能按Baird-Jackson评分标准进行功能评价：优7例,良2例,可1例,差0例,优良率90．0％。所有皮瓣血运良好,色泽接近正常。结论足跟部开放性损伤伴踝关节脱位患儿急诊清创关节复位,2周后手术重建跟腱及皮瓣转移修复缺损的软组织,可以取得满意的效果。