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陳舊性跖跗關節脫位的足弓重建

目的 總結陳舊性跖跗關節脫位足弓重建的治療方法及效果。 方法 2004 年9 月－ 2008 年1 月，收治陳舊性跖跗關節骨折脫位26 例。男19 例，女7 例；年齡18 ～ 56 歲，平均38.4 歲。交通傷8 例，重物砸傷10 例，高處墜落傷8 例。根據Myerson 分類法的X 線分型：A 型6 例，B 型5 例，C 型2 例，D 型6 例，E 型3 例，F 型4 例。受傷至手術時間4 周～ 9 個月，平均9 周。采取切開復位、內固定術9 例，足弓重建跖跗關節原位融合術 17 例。 結果 術后切口均Ⅰ期愈合。26 例均獲隨訪，隨訪時間12 ～ 48 個月，平均22 個月。4 例術后5 個月發生足部轉移性疼痛，應用足弓墊治療，2 例1 年后疼痛緩解，2 例擴大關節融合后疼痛緩解。按Maryland 足部評分標準測定：優 5 例，良17 例，可4 例；優良率84.6%。關節融合全部愈合。 結論 傷后4 ～ 6 周的陳舊性跖跗關節脫位可行切開復位內固定術，療效滿意；6 周以上陳舊性跖跗關節脫位，宜行足弓重建跖跗關節原位融合術。

DIFFERENT TYPES OF TISSUE TRANSPLANTATION IN REPAIRING TISSUE DEFECTS AND FUNCTIONRECONSTRUCTION

Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.

頦下島狀瓣重建硬腭缺損一例

Multi-Slice Spiral CT Angiography of Liver with Three-Dimensional Reconstruction Technique and Its Clinical Applications

BIOMECHANICAL STUDY OF QUADRICEPSPLASTY

One hundred and fifty cases were followed up after quadricepsplasty. Hamstring M. were used in 112 cases. M. rectus femoris or obliquis abdominis was used in 38 cases. The validity and force analysis of such two kinds of operation were analyzed and compared. It was confirmed that the power of the transferred muscle depended on the angle between the force line and the neutral axis of the joint, provided the arm of the force and the area of transection of the muscle were constant. The bigger the angle was, the longer the arm of the force was, and the smaller was the labour. If this angle was negative or the knee joint was in a position of flexion deformity, the smaller the negative angle was, the smaller the componend force of the joint was, and the larger was the component force of extension.

Experimental Study of Repairing of Esophagus Defect with Lung Tissue Flap and an Inner Chitosan Tube Stent

ObjectiveTo investigate the feasibility of lung tissue flap repairing esophagus defect with an inner chitosan tube stentin in order to complete repairing and reconsruction of the esophagus defect.MethodsFifteen Japanese white rabbits were randomly divided into two groups， experiment group(n=10): esophagus defect was repaired with lung tissue flap having inner chitosan tube stent; control group(n=5): esophagus defect was repaired with lung tissue flap without inner chitosan tube stent; and then the gross and histological apearance in both groups were observed at 2, 4,8 weeks after operation, barium sulphate X-ray screen were observed at 10 weeks after operation.ResultsSix rabbits survived for over two weeks in experiment group, lung tissue flap healed with esophageal defect, squamous metaplasia were found on the surface of lung tissue flap in experiment group. At 10 weeks after operation, barium sulphate examination found that barium was fluent through the esophageal and no narrow or reversed peristalsis, the peristalsis was good in experiment group.Four rabbits survived for two weeks and the lung tissue flap healed with esophageal defect, fibrous tissue hyperplasy on the surface of the lung tissue flap in control group. At 10 weeks after operation, barium sulphate examination found that barium was fluent through the esophageal and slight narrow or reversed peristalsis, the peristalsis was not good in control group, otherwise.ConclusionIt is a feasible method to repair the esophageal defect with lung tissue flap with the inner chitosan stent.

THE FACTORS INFLUENCING THE DEFECT ON RESTORATION OF APPOSTI

The clinical experience of rest-oration of apposition function in 75cases of 83 hands, since 1960, wasreported. Thirty-eight cases had beenfollowed-up with an averege time 8. 5years. The excellent recovery ratewas 65. 5% . The indication of vari-ous restoration methods. choose ofthe acting muscle, reconstructionof the trochlea. the supplementaryoperation and the rehabitation methodswere discussed. The author notedthat the most applicable muscleswere flexor digitorum superficialis,extensor carpi ulnaris and flexor carpi ulnaris, with the musele power ber than 4 degree. The trochlea must be stble and a distance from the tendon inserticn.

不穩定骨盆骨折合并雙柱髖臼骨折的修復重建

目的 總結不穩定骨盆骨折合并雙柱髖臼骨折手術方法及效果。 方法 2002 年5 月－ 2007 年6 月，收治12 例不穩定骨盆骨折合并雙柱髖臼骨折患者。其中男9 例，女3 例；年齡16 ～ 59 歲，平均32 歲。骨折類型結合Marvin Tile 及Judet-Letoumel 分類：B2 型骨盆骨折合并髖臼骨折C2 型1 例、C3 型2 例；C1 型骨盆骨折合并髖臼骨折C1 型3 例、C2 型1 例；C2 型骨盆骨折合并髖臼骨折C2 型2 例、C3 型1 例；C3 型骨盆骨折合并C1 型髖臼骨折2 例。受傷至手術時間5 ～ 14 d，平均7 d。分別采用髂腹股溝入路2 例，Kocher-Langenbeck 入路4 例，前后聯合入路6 例修復重建手術。 結果 術后1 例切口脂肪液化經換藥愈合，其余切口均Ⅰ期愈合。12 例均獲隨訪，隨訪時間10 ～ 72 個月，平均30 個月。骨盆骨折均獲復位；髖臼骨折復位采用Matta X 線評估標準，優8 例，良2 例，一般2 例，優良率83.33%。術后3 個月X 線片示骨折均愈合，骨盆環無畸形，無深靜脈血栓及肺栓塞等并發癥。臨床效果采用改良的Merled Aubigne和Postel 評分系統評估，優2 例，良7 例，一般2 例，差1 例，優良率75.00%。 結論 不穩定骨盆骨折合并雙柱髖臼骨折早期手術修復重建可獲得較滿意的療效。

LIMB SALVAGE SURGERY FOR WRIST IN BONE TUMOR BY USING FREE VASCULARISED FIBULAR GRAFT WITH FIBULAR HEAD OR SIMPLE FIBULAR GRAFT

Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.

單切口自體骨- 髕腱中1/3- 骨復合體重建前交叉韌帶

目的 總結采用單切口自體骨- 髕腱中1/3- 骨復合體重建前交叉韌帶的臨床效果。 方法 2006 年4 月－ 2008 年7 月，采用單切口自體骨- 髕腱中1/3- 骨復合體重建32 例前交叉韌帶損傷。男23 例，女9 例；年齡19 ～ 43 歲，平均26.4 歲。損傷原因：交通傷12 例，運動傷16 例，摔傷2 例，其他傷2 例。采用國際膝關節評分委員會（International Knee Documentation Committee，IKDC）標準評分：B 級5 例，C 級22 例，D 級5 例；Lysholm 評分為（43.6 ± 3.1）分。急性損傷27 例，陳舊性損傷5 例；受傷至手術時間3 d ～ 2 年，平均2.5 個月。 結果 術后切口均Ⅰ期愈合，膝關節均無感染發生。32 例均獲隨訪，隨訪時間1 ～ 2 年，平均15.6 個月。術后7 個月1 例膝關節伸直受限10°；術后2 年2 例膝關節關節屈曲≤ 120°。術后18 個月3 例前抽屜試驗弱陽性。術后IKDC 評分：A 級28 例，B 級3 例，C 級1 例；Lysholm評分為（91.3 ± 4.6）分，與術前比較差異有統計學意義（P lt; 0.01）。 結 論 采用單切口自體骨- 髕腱中1/3- 骨復合體重建前交叉韌帶臨床療效好，且手術創傷小，外形美觀。