一氧化氮在神经根性疼痛中的作用

目的：探索一氧化氮(NO)在髓核突出所致的神经根性疼痛中的作用。方法：取大鼠自体尾椎髓核无压迫下放置在L4和L5神经根表面，分别在术后3d及1、2、3、4周时观察大鼠后足机械刺激和热刺激敏感性的变化，并用免疫组化方法对移植髓核中的一氧化氮合酶(NOS)进行检测．探索NO在疼痛中的作用：结果：在无明显机械压迫情况下，大鼠腰神经根上放置自体髓核可产生痛觉过敏，移植髓核组织中NOS染色阳性一结论：髓核自身是引起腰腿痛的重要原因，NO可能参与疼痛的产生.     

关节镜下同时修复重建前交叉韧带合并半月板损伤

目的　探讨关节镜下同时修复重建前交叉韧带 (ACL)合并半月板损伤的临床效果。方法　 4 8例患者全部在关节镜下完成ACL、半月板损伤的修复重建术。术前临床症状、体征包括 :膝关节行走痛 4 1例 ,膝关节不稳定感 36例 ,关节交锁史 8例 ,Lachman试验阳性 4 5例 ,前抽屉试验阳性 38例 ,外侧轴移试验阳性 2 4例。半月板损伤采用系列导管下特制长缝合针由内向外缝合法修复 ;ACL损伤修复采用半腱肌、股薄肌 ,闭合拉出微型钢板法重建 ,术后采用康复治疗。　结果　本组随访 13～ 6 5个月 ,平均 2 7个月。 1例剧烈活动后膝关节胀痛 ,2例活动受限 2 0° ,其余关节功能正常。Lyshlom膝关节评分 ,术前 5 8± 9,术后 95± 5 (P <0 .0 1)。　结论　关节镜下同时修复重建ACL、半月板损伤的疗效显著 ,值得推广。     

外固定器在前臂复合组织缺损修复中的应用

Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.     

带血管髂骨瓣游离移植修复跖骨及周围软组织缺损

目的探讨应用髂骨瓣游离移植修复跖骨及其周围软组织缺损的临床效果. 方法 1999年10月～2003年12月,采用带血管髂骨游离移植修复4例跖骨与软组织缺损.患者均为男性,年龄26～47岁,受伤至手术时间1～5个月.其中跖骨、跗骨胫侧皮肤缺损及第1跖骨感染外露3例,均为非负重区;足背瘢痕畸形愈合、跖骨跗骨缺损1例.骨缺损长度4～7 cm,皮肤缺损范围5 cm×3 cm～9 cm×5 cm.手术取髂骨瓣5.0 cm×2.5 cm～9.0 cm×2.5 cm. 结果术后1周,皮片全部成活3例,大部分成活1例,但移植骨瓣亦成活;术后1个月X线片示髂骨瓣与受区断端间有少量骨痂形成;4个月拔除克氏针.获随访5～24个月.局部无溃疡, 行走和负重良好, 外形及功能满意. 结论带血管髂骨游离移植修复术一次手术即可使跖骨及周围组织达到满意的解剖塑形及良好功能.     

AO锁骨钩钢板内固定治疗肩锁关节脱位

目的观察应用锁骨钩钢板内固定治疗肩锁关节脱位的疗效。方法采用改良Rockwood分类法时肩锁关节损伤分类，对16例Ⅲ型以上肩锁关节脱位采用AO锁骨钩钢板内固定治疗；钢板远端钩插入肩峰下端、并选择肩关节极度外展时不与肱骨头发生撞击，以减少对肩锁关节正常生理结构的干扰，术后不用外固定，利于早期功能锻炼。结果平均随访1a，按JOA肩部治疗成绩评分标准评分，90～95分13例，80～90分3例，综合评价：优良。结论该钢板具有固定确切，操作简单，疗效可靠等特点。     

白细胞介素-1α在髓核源性神经根性疼痛中的作用

目的:探讨白细胞介素-1琢(IL-1琢)是否参与髓核突出所致的坐骨神经疼痛的产生。方法:将大鼠自体尾椎的髓核无压迫下放置在L4和L5神经根表面,在术后不同时间测量大鼠后足对机械刺激敏感性的变化,同时用免疫组化方法对移植髓核中的IL-1琢进行检测。结果:在无明显机械压迫的情况下,大鼠腰神经根上放置自体髓核后,术侧后足可产生明显机械刺激痛觉过敏;实验组大鼠移植髓核组织中IL-1琢免疫组织化学染色阳性。结论:髓核组织的生物学作用是引起腰腿痛的重要因素,炎性介质IL-1琢可能参与疼痛的发生。     

外固定器在前臂复合组织缺损修复中的应用

Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.     

侧胸和背部组织在上肢毁损性损伤功能挽救中的应用

目的探讨侧胸和背部组织在上肢毁损性损伤功能挽救中的应用。方法2000年7月至2003年9月,采用一期保肢或寄养再植治疗6例机器致上肢碾挫损伤患者,缺损面积为8cm×8cm～19cm×17cm,均伴有上肢多发骨折。一期保肢病例固定骨折,修复血管、神经后,侧胸浅筋膜层包埋上臂创面,4周后行上臂取出、腋窝成形、背阔肌皮瓣转位修复创面并屈肘功能重建术;寄养再植病例二期取出上臂、再植,并行背阔肌皮瓣转位屈肘功能重建术。将背阔肌卷起缝合成长管状,重建起止点。在肘关节屈曲90°～100°位,重建屈肘功能并覆盖皮肤。术后肩关节外展90°、肘关节屈曲100°位石膏或支具固定,4周后去除固定行功能锻炼。结果6例再植肢体均顺利成活。随访6个月～2年,平均8.6个月。术后肩关节外展50°～90°、内收20°～40°、前屈50°～70°、后伸20°～30°。肘关节屈曲100°～140°、伸直-20°～0°。重建术后3个月,屈肘肌肌力达4～5级。结论充分利用侧胸和背部组织特点进行分期、分层手术,解决创面覆盖和功能重建互相干扰的矛盾,是挽救严重毁损性损伤上肢,最大程度地恢复其外形和功能的有效方法。     

骨盆骨折的手术治疗

目的 :探讨骨盆骨折各种手术方法的适应证及治疗效果。方法 :选择 3 2例骨盆骨折手术治疗病人 ,根据Tile’s分型及病人情况选择手术方法。多发伤、Tile’sB型早期 (平均 6.2h )行骨折闭合复位及外固定架固定 ,单纯骨盆骨折、Tile’sC型在伤后 5～ 7d行开放复位 ,用 3 .5～ 4.5mm重建钢板、拉力螺钉固定。结果 :本组 3 0例得到随访 ,平均随访 2 3 .4个月 ,骨折均愈合良好 ,肢体功能恢复良好。结论 :对于骨盆骨折 ,无论采取哪一种治疗方法 ,只要适应证选择得当 ,均能获得良好效果。     

单边外固定器在肱骨干下1/3骨折治疗中的应用

目的 回顾分析单边外固定器治疗肱骨干下1／3骨折的效果。方法 1997年10月～2002年10月33例肱骨干下1／3骨折，年龄18～70岁(平均31岁)，其中横形骨折3例、斜形骨折1例、螺旋形骨折9例．粉碎性骨折20例。15例行切开复位、有限内固定结合外固定器固定，10例行切开复位、外固定器固定，8例行闭合复位、外固定器固定。9例桡神经损伤者均行桡神经探查。结果 随访8～24个月(平均18个月)。骨折愈合时间11～22周，平均14周。术后有2例桡神经损伤，与术前的9例桡神经损伤在最后一次随访时均恢复功能。肘关节功能恢复正常。有7例外固定针孔感 染，经口服抗生素及针道清创后好转。结论 单边外固定器结合切开复位、有限内固定，在肱骨干下1／3骨折治疗中具有独特的价值及良好的效果。