平行固定桥接吻合血管游离皮瓣移植

目的：探讨小腿严重软组织损伤伴骨外露、无供血血管时行吻合血管皮瓣移植的修复重建。方法：以健侧胫后动脉为供血血管，制成８～１０ｃｍ长带血管的皮管，平行桥接游离皮瓣及骨瓣，以单臂外固定器平行固定双小腿。结果：自１９９４年以来共收治４例。小腿软组织缺损平均面积１８ｃｍ×１２ｃｍ。４例皮瓣全部成活，双下肢髋、膝、踝关节功能良好。结论：此手术对小腿濒于截肢的患者，是一种有效的治疗方法。     

跨腕关节外固定器治疗不稳定性桡骨远端骨折

目的 回顾分析闭合复位、单侧外固定器跨腕关节固定治疗不稳定性桡骨远端骨折的效果。方法 2000年6月～2005年3月，利用外固定器跨腕关节固定治疗45例50侧不稳定性桡骨远端骨折，年龄15～78岁（平均44．8岁）。骨折按AO分型：A3型5例5侧，B3型4例4侧，C1型3例3侧，C2型9例9侧，C3型24例29侧。手法或外固定器协助复位，外固定器静力性固定，骨折愈合后拆除外固定器。随访8～48个月（平均20个月）。结果 骨折愈合时间6～8周，平均7．6周。4例4侧出现针道表浅感染，经口服抗生素及局部换药后好转。最后一次随访时，影像学评估（Stewan改良的Sarmiento评分）：优39例42侧，良6例8侧。腕关节功能按Garland与Werley功能评分标准：优34例37侧，良8例9侧，可3例4侧，优良率为92％。结论 闭合复位、单侧外固定器跨腕关节静力性固定桡骨远端骨折，通过选择合适的外固定针置入部位，可以避免桡神经损伤及第二掌骨医源性骨折，减少针道感染及松动等并发症的发生，并有利于术后早期行手部功能锻炼；无需辅助性植骨促进骨折愈合，是不稳定性桡骨远端骨折的有效治疗方法。     

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.     

两种股骨近端髓内钉治疗老年粗隆部骨折的比较分析

目的:比较两种股骨近端髓内钉PFNA和PFN治疗老年粗隆部骨折的疗效.方法:2005年12月-2006年9月收治的14例70岁以上粗隆部骨折患者随机分别使用PFNA(PFNA组)、PFN(PFN组)治疗,比较两组手术完成时间、术后下地负重行走时间、术后非手术区并发症情况及术后4个月X线复查情况.结果:PFNA组手术时间31～62 min,平均(46.29±10.98)min,较PFN组手术时间[67～113 min,平均(88.29±17.25)min明显缩短.PFNA组下地负重行走时间为术后3～5 d,平均(3.57±0.79)d,PFN组为5～20 d,平均(9.71±16.73)d.PFN组术后2例出现并发症,分别为患肢髂外静脉栓塞和股静脉栓塞;术后4个月1例X线片显示股骨颈切割征象.结论:对于粗隆部骨折的老年患者,PFNA内固定系统在缩短手术时间、减少卧床时间、减少术后并发症方面优于PFN,在减少股骨颈切割方面是否存在优势还需进一步观察.     

Unilateral external fixator in the treatment of lower third humeral shaft fractures

Lowerthirdhumeralshaftfracturesareoftenmanifestedbyoblique,spiralorcomminutedfractureswithahighincidenceofcomplicatingradialnerveinjury.Thispartofhumerusisirregularanatomicallyandneartheelbowjoint.Soitisdifficult toselectproperinternalfixationinstrumentswhile exploringradialnervethroughanterolateralapproach,whichaddsdifficultyinthetreatmentofthiskindof fractures.Inrecent6yearsweusedunilateralexternal fixatorstotreatsuchkindoffracturesinourdepartment andsatisfactoryresultswereachieved.METHOD…     

单侧外固定器结合植骨治疗肱骨干骨折内固定术后不愈合

自1995～2003年采用单侧外固定器结合自体髂骨植骨治疗脓骨干骨折内固定术后骨不连37倒，手术后3～7个月均获骨愈台，疗效满意。     

多发性骨与关节损伤病例回顾分析

目的：研究多发性骨与关节损伤的流行病学特点，探讨多发性骨与关节损伤的诊治经验教训。方法：对本院2000年1月1日～2004年1月1日间的318例多发性骨与关节损伤病例进行回顾分析，并进行随访。结果：符合诊断标准的多发性骨与关节损伤病例占304医院骨科创伤病区住院患者总数的16．39％，高发年龄为20～40岁之间，占总病例数的59．43％．患者中男性明显多于女性．致伤原因最多为道路交通伤，最常见损伤部位为胫腓骨干，最常见的并发症为失血性休克．治疗以早期固定及早期功能康复为好?结论：重视多发性骨与关节损伤的院前急救，强化对门诊及急诊医护人员的培训．可以提高多发性骨与关节损伤诊断的准确率，降低漏诊率，提高救治的成功率并降低死亡率。早期合理的固定是多发性骨与关节损伤的最佳治疗措施，加强早期合理的主被动综合性功能锻炼．可以明显提高患者的功能康复水平。     

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.     

负压封闭引流在Gustilo ⅢB和ⅢC型开放性骨折感染治疗中的应用

目的探讨分区应用、分层应用负压封闭引流（Vacuum-assisted closure，VAC）在GustiloⅢB和ⅢC型升放性骨折感染治疗中的应用效果。方法2006年12月～2008年1月应用VAC治疗GustiloⅢB和ⅢC型开放性骨折感染患者35例，年龄5～66岁，平均37．3岁。交通伤24例，机器损伤4例，火器伤3例，烧伤4例，ⅢB型28例（胫腓骨22例，骨盆2例，尺桡骨3例，股骨1例），ⅢC型7例（胫腓骨5例，跖趾骨2例）。骨折均已行骨折固定及血管修复，遗留创面或皮肤坏死范围为（3～50）cm×（2～35）cm。入院时骨折感染距伤后时间3～34d，平均12d。所有病例均先行清创，更换骨折固定类型或调整外固定架固定位置，在感染的肌肉间隙、关节间隙、骨折间隙等分区应用、分层应用VAC，并根据置管部位和引流情况决定拔管次序和时间，5～7d根据引流情况进行更换引流装置，应用次数为l～4次／例，平均2．2次／例。创面有新鲜肉芽组织后，12例行皮瓣移植和肌瓣移植，23例25处伤口皮片植皮或缝合修复刨面。感染性腔隙或骨髓腔可延长应用单纯负压管吸引7～14d。创面愈合后3～6个月视骨折愈合进度和骨折固定稳定情况保留原有固定或更换永久性骨折固定物。结果本组35例创面经清创后应用封闭负压吸引后，创面感染均得到控制，创面清洁时间为7～17d，平均10．5d。创面水肿减轻，出现新鲜肉芽组织，范围减小10％～15％，细菌培养阴性。游离植皮及组织瓣移植一次全部成活33例，2例游离植皮者由于面积大，术后患者搓动遗留有小创面，经再次植皮后完全消灭创面。所有患者体温血象正常，局部无窦道、无疼痛，感染均得到有效控制。结论分区应用、分层应用VAC，并根据置管部位和引流情况决定拔管次序和时间，可以有效地控制GustiloⅢB和ⅢC型开放性骨折的继发感染。