Search

急診拇指再造20例

STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY

ObjectiveTo explore the clinical application and effectiveness of antibiotic-loaded cement spacer combined with free fibular graft in the staged treatment of infectious long bone defect in the lower extremity. MethodsA retrospective analysis was made on the clinical data from 12 patients with infectious long bone defect in the lower extremity between June 2010 and June 2012. Of the 12 cases, there were 9 males and 3 females with an average age of 33 years (range, 19-46 years), including 3 cases of femoral shaft bone defect, 7 cases of tibial shaft bone defect, and 2 cases of metatarsal bone defect. The causes were traffic accident injury in 7 cases, crashing injury in 3 cases, and machine extrusion injury in 2 cases. The length of bone defect ranged from 6 to 14 cm (mean, 8 cm). The soft tissue defect area ranged from 5.0 cm×3.0 cm to 8.0 cm×4.0 cm companied with tibial shaft and metatarsal bone defect in 9 cases. The sinus formed in 3 femoral shaft bone defects. The time between injury and operation was 1-4 months (mean, 2 months). At first stage, antibiotic-loaded cement spacer was placed in the bone defect after debridement and the flaps were used to repair soft tissue defect in 9 cases; at second stage (6 weeks after the first stage), defect was repaired with free fibular graft (7-22 cm in length, 14 cm on average) after antibiotic-loaded cement spacer removal. The area of the cutaneous fibular flap ranged from 6.0 cm×4.0 cm to 10.0 cm×5.0 cm in 10 cases. ResultsAll wounds healed by first intention, and the healing time was 12-18 days, 14 days on average. Twelve cases were followed up 12-36 months (mean, 17 months). Bone healing time ranged from 4 to 6 months (5.5 months on average). The cutaneous fibular flap had good appearance. The function at donor site was satisfactory; no dysfunction of the ankle joint or tibial stress fracture occurred after operation. The mean Enneking score was 25 (range, 20-28) at last follow-up. ConclusionInfection can be well controlled with the antibiotic-loaded cement spacer during first stage operation, and free fibular graft can increase the bone defect healing rate at second stage. Staged treatment is an optimal choice to treat infectious long bone defect in the lower extremity.

游離腓骨皮瓣修復前足復合組織缺損

目的 總結游離腓骨皮瓣修復前足復合組織缺損的療效。 方法2000年6月－2011年11月，應用游離腓骨皮瓣修復前足復合組織缺損12例。致傷原因：交通事故傷8例，壓砸傷4例。傷后至入院時間6 h～21 d。創面范圍8 cm × 6 cm～30 cm × 18 cm。均伴跖骨缺損，缺損長度5～14 cm。切取腓骨皮瓣范圍10 cm × 8 cm～16 cm × 12 cm，腓骨長度6～16 cm。 結果術后1例發生靜脈危象，其余皮瓣全部成活。12例均獲隨訪，隨訪時間1～3年，平均2年5個月。移植骨愈合時間4～6個月。末次隨訪時采用美國足踝外科協會（AOFAS）評分，為70～92分，平均81分。 結論游離腓骨皮瓣可一期修復前足復合組織缺損，是較理想的治療方法。

EFFECTIVENESS OBSERVATION OF STAGED TREATMENT OF OPEN Pilon FRACTURE COMBINED WITH SOFT TISSUE DEFECT

Objective To explore the effectiveness of staged treatment of open Pilon fracture combined with soft tissue defect. Methods Between June 2007 and December 2012, 18 cases of open Pilon fracture combined with soft tissue defect were treated. There were 14 males and 4 females with an average age of 35 years (range, 19-55 years). The causes of injury included falling from height in 12 cases, traffic accident in 4 cases, and crushing by machine in 2 cases. According to AO classification, 1 case was classified as type B2 fracture, 3 cases as type B3 fracture, 5 cases as type C1 fracture, 5 cases as type C2 fracture, and 4 cases as type C3 fracture. Sixteen cases accompanied by fibular fracture (14 cases of simple fibular fracture and 2 cases of communicated fibular fracture). According to Gustilo classification, the soft tissue injuries were all type IIIB. In first stage, debridement and vaccum sealing drainage combined with external fixation were performed; open reduction and internal fixation of simple fibular fracture were used. In second stage, open reduction and internal fixation of Pilon fracture and communicated fibular fracture were performed, and the flaps of 6 cm × 5 cm to 18 cm × 14 cm were applied to repair soft tissue defect at the same time. The donor site was repaired by skin graft. Results Partial necrosis occurred in 2 flaps, the other 16 flaps survived completely. The incisions of donor sites healed by first intention, the skin graft survived completely. The average follow-up interval was 12 months (range, 6-24 months). The X-ray films showed that the bone healing time ranged from 5 to 8 months (mean, 6 months). No internal fixation failure was found. At last follow-up, the average range of motion of the ankle joint was 37° (range, 26-57°). According to the American Orthopedic Foot and Ankle Society (AOFAS) scale, the average score was 80.2 (range, 72-86). Traumatic arthritis occurred in 2 cases (11%). Conclusion The staged treatment has the advantages of accurate evaluation of soft tissue injury, shortened cure time, good reduction of the articular surface, and reduced incidence of infection, so it is an optimal method to treat open Pilon fracture combined with soft tissue defect.

雙Endobutton雙環套鎖內固定術治療Tossy Ⅲ型肩鎖關節脫位及Neer ⅡB型鎖骨遠端骨折

目的總結雙Endobutton雙環套鎖內固定術治療TossyⅢ型肩鎖關節脫位和NeerⅡB型鎖骨遠端骨折的療效。 方法2010年4月－2013年4月采用雙Endobutton雙環套鎖內固定術治療17例Tossy Ⅲ型肩鎖關節脫位和7例Neer ⅡB型鎖骨遠端骨折患者。男16例，女8例；年齡18～47歲，平均34歲。受傷至手術時間1～7 d，平均3.5 d。 結果術后患者切口均Ⅰ期愈合，無感染、臂叢神經及血管損傷等并發癥發生。21例獲隨訪，其中14例脫位患者隨訪時間12～20個月，7例骨折患者為12～24個月。鎖骨遠端骨折均獲骨性愈合，愈合時間4～8個月，平均6個月。隨訪期間肩鎖關節脫位無復發。術后12個月，Constant-Murley評分：脫位患者為（89.3±3.2）分，骨折患者為（87.2±2.6）分；按Karlsson標準評定：脫位患者獲A級14例，B級3例；骨折患者獲A級5例，B級2例。 結論雙Endobutton雙環套鎖內固定術治療Tossy Ⅲ型肩鎖關節脫位和Neer ⅡB型鎖骨遠端骨折創傷小，手術操作簡便，近期療效滿意。

Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger

Objective To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. MethodsBetween July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. ResultsAll flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. Conclusion The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.

近指間關節復合組織缺損的顯微外科修復

目的總結近指間關節復合組織缺損顯微外科修復的療效。 方法2005年3月－2011年3月，對12例示、中指近指間關節復合組織缺損患者采用游離帶關節的第2足趾復合組織移植修復。男9例，女3例；年齡17～38歲，平均24.6歲。致傷原因：電鋸傷3例，交通事故傷4例，機器絞傷5例。軟組織缺損范圍3.0 cm × 1.0 cm～5.5 cm × 2.5 cm。傷后至手術時間3 h～4 d，平均32 h。 結果12例均獲隨訪，隨訪時間5個月～4年，平均2.5年。術后48 h 1例發生皮瓣靜脈危象，行靜脈皮瓣移植修復成活；余11例移植復合組織均順利成活。移植骨均愈合良好，愈合時間5～12個月，平均8個月。隨訪期間無關節退行性變。11例術后14個月按照中華醫學會手外科學會上肢部分功能評定試用標準評價，獲優3例，良4例，可4例。 結論對于近指間關節復合組織缺損，通過顯微外科方法修復可以最大程度恢復手指外觀、感覺及功能。

攜帶隱神經終末支的游離足內側皮瓣在手部高壓注射傷中的應用

目的總結攜帶隱神經終末支的游離足內側皮瓣治療手部高壓注射傷的療效。方法 2014 年 3 月—2018 年 6 月，收治 16 例 16 指高壓注射傷患者。其中男 12 例，女 4 例；年齡 21～58 歲，平均 42 歲。拇指 3 例，示指 6 例，中指 5 例，環指 2 例。高壓乳膠漆注射傷 10 例，高壓油槍注射傷 6 例。受傷至入院時間為 1 h～2 d，平均 6.5 h。急診行顯微外科清創；亞急診行攜帶隱神經終末支的游離足內側皮瓣修復創面，皮瓣范圍 4.5 cm×3.0 cm～8.0 cm×5.0 cm。結果術后皮瓣全部成活，未發生指端壞死或部分壞死。患者均獲隨訪，隨訪時間 8～24 個月，平均 15 個月。末次隨訪時患指外觀滿意，皮瓣彈性、血運良好，指端指體飽滿，遠、近指間關節處橫紋初顯，無指體冷耐受差發生。皮瓣兩點辨別覺為 5～10 mm，平均 7.5 mm。手功能采用手指關節總活動度（TAM）法評定，獲優 10 指，良 4 指，可 2 指。供區無并發癥發生。結論攜帶隱神經終末支的游離足內側皮瓣是治療手部高壓注射傷的一種有效方法，術后手指外形、感覺及功能恢復良好。

橋式吻合血管組合皮瓣修復小腿大面積皮膚缺損

目的 探討橋式吻合血管組合皮瓣修復小腿大面積皮膚缺損的臨床效果。 方法 1997年2月~2003年10月，采用橋式吻合血管的組合皮瓣修復小腿大面積皮膚缺損8例，男7例，女1例；年齡10~49歲。均為車禍傷。新鮮外傷3例，陳舊外傷5例。均為脛腓骨骨折合并大面積皮膚缺損、骨外露，皮膚缺損范圍25 cm×18 cm~70 cm×12 cm，伴脛前或脛后血管長段挫滅缺損3~7 cm。 結果 術后1例發生皮瓣靜脈危象，經重新吻合靜脈后，危象緩解；1例皮瓣尖端3 cm×1 cm壞死，經換藥后創面愈合；1例傷口感染，經換藥后創面愈合，其余皮瓣均成活。術后4~6周皮瓣斷蒂，雙小腿分開；5~10個月骨折愈合。均獲隨訪2~7年，皮瓣顏色正常，彈性好，毛發生長，恢復保護性感覺，可以正常工作生活。 結論 橋式吻合血管組合皮瓣為皮瓣提供了可靠的供應血管，是治療瀕臨截肢肢體的一種較好方法。

Effectiveness of combined tissue transplantation to repair serially damaged injuries on radial side of hand

ObjectiveTo investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction. MethodsBetween May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers. ResultsAfter operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger. ConclusionFor the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.