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交鎖髓內釘聯合帶血管骨瓣骨膜瓣治療四肢骨不連及骨缺損

Decompressive Craniectomy for the Treatment of Severe Traumatic Brain Injury: A Systematic Review

Objectives　To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods　We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results　Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion　The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.

帶肌蒂髂骨瓣植骨融合治療腰椎滑脫癥

報道5例腰椎Ⅰ～Ⅱ°滑脫,伴有腰痛患者,釆用帶腰髂肋肌蒂的髂骨瓣移位作脊柱融合手術。經隨訪,全部達到骨性融合,腰痛癥狀解除。介紹了手術方法。

脛骨上段大型骨化性纖維瘤切除后修復一例

THE APPLIED ANATOMY OF TRANSPOSITION OF THE DISTAL DORSAL ULNA BONE FLAP PEDICLED WITH DORSAL METACARPAL ARTERY

OBJECTIVE: To investigate the anatomic basis for transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery to repair the defect of the 3rd or 4th and 5th metacarpal bone head. METHODS: In 30 adult cadaveric upper limbs, the branches and constitutions of the dorsal carpal arterial networks were observed. RESULTS: The dorsal carpal arterial networks were consisted of the dorsal carpal branches of ulnar and radial arteries, the terminal branches of posterior interosseous artery and the dorsal carpal branch of anterior interosseous artery, and then the 2nd, 3rd, 4th dorsal metacarpal branches were originated from the networks. The dorsal metacarpal branches were anastomosed with the deep branches of deep palmar arch to constitute the dorsal metacarpal artery. CONCLUSION: Transposition of the distal dorsal ulna bone flap pedicled with the 3rd, 4th dorsal metacarpal arteries can be used in repairing the defect of 3rd, 4th and 5th metacarpal bone head.

空心釘內固定加股直肌骨瓣移植治療青壯年股骨頸骨折23 例

探討一種治療青壯年股骨頸骨折的方法。 方法 2000 年5 月－ 2005 年10 月，采用空心釘內固定加股直肌骨瓣治療青壯年股骨頸骨折23 例。男16 例，女7 例；年齡21 ～ 45 歲，平均31.3 歲。車禍傷18 例，高處墜落傷5 例。左側10 例，右側13 例。骨折部位：頭下型10 例，頭下經頸型13 例。Garden 分型：Ⅲ型15 例，Ⅳ型8 例。 結 果 23 例患者術后獲隨訪16 ～ 52 個月，平均26 個月。術后無感染、退釘、骨瓣松動等發生。22 例術后4 ～ 6 個月X 線片示骨折愈合；1 例術后8 個月X 線片示骨折未愈合，術后16 個月CT 及ECT 示股骨頭壞死。髖關節功能按Harris 評分標準：優13 例，良8 例，差2 例，優良率91%。 結論 空心釘內固定加股直肌骨瓣移植能有效減少青壯年股骨頸骨折的骨折不愈合和股骨頭壞死的幾率。

雙蒂腓骨瓣與比目魚肌骨膜瓣移位修復小腿感染性骨皮缺損

臨床應用帶腓動脈及(足母)長屈肌的腓骨與逆行比目魚肌骨膜骨瓣移位,治療6例小腿感染性復合組織缺損。術后3～8個月達到骨性愈合。隨訪14～32個月,感染無復發。討論了手術方式,雙蒂腓骨瓣與比目魚肌骨膜瓣移位的作用及該術式的優點和注意事項。

ILIAC FLAP COMBINED WITH ANTEROLATERAL THIGH FLAP FOR REPAIR OF FIRST METATARSAL BONE AND LARGE SKIN DEFECT

ObjectiveTo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect. MethodsBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft. ResultsAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up. ConclusionThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.

TREATING AVASCULAR NECROSIS OF FEMORAL HEAD IN YOUNG ADULT BY GRAFTING SARTORIUSMUSCLE ILIAC BONE FLAP

Objective To explore an improved method of treating avascular necrosis of the femoral head in young adults by grafting the sartorius muscle iliac bone flap. Methods From September 1994 to August 2003, 68 patients (57 males, 11 females; age, 16-58 years) underwent of the transplant the sartorius muscle oliac bone flap into the femoral head after decompression of the femoral head medullary core and removal of the dead bone and the fibrous tissue in the femoral head. The transplantation was performed on 31 patients left-unilaterally, on 37 patients rightunilaterally, and on 7 patients bilaterally. The pathological causeswere as follows: alcoholism in 52 patients, prolonged use of hormones in 6, traumain the hip in 6, and undetermined cause in 4. Their illness course ranged from 8 months to 4 years. According the Ficat staging, 10 patients belonged to Stage I (11 sides), 27 patients to Stage Ⅱ (31 sides), and31 patients to Stage Ⅲ (33 sides). Results The follow-up of the 68 patientsfor 2.5-11 years averaged 5.2 years revealed that based on the Harris evaluation for the hip function, 23 patients had an excellent result, 33 had a good result, 10 had a fair result, and 2 had a poor result. The excellent and good resultsaccounted for 82.3%. There was no recurrence after operation. Conclusion Thismethod has the following advantages: the lesion focus can be eradicated; enoughdecompression can be achieved, and the blood circulation for the femoral head can be rebuilt. The grafting of the sartorius muscle iliac bone flap can bring the osteogenesis components to the femoral head, promoting the reconstruction of the bones. This method is suitable and effective for the patients with avascular necrosis of the femoral head (Ficat Grades Ⅰ, Ⅱ and Ⅲ) in young adults. 

帶旋髂深血管蒂髂骨瓣聯合空心加壓螺釘內固定治療青壯年股骨頸骨折的療效分析

目的 總結帶旋髂深血管蒂髂骨瓣聯合松質骨空心加壓螺釘內固定治療青壯年股骨頸骨折的療效。 方法 2006 年1 月－ 2008 年12 月，采用帶旋髂深血管蒂髂骨瓣聯合松質骨空心加壓螺釘內固定治療23 例外傷致股骨頸骨折患者。其中男17 例，女6 例；年齡19 ～ 47 歲，平均31.4 歲。骨折按Garden 分型：Ⅱ型3 例，Ⅲ型14 例，Ⅳ型6 例。受傷至手術時間1 ～ 9 d，平均5 d。 結果 術后患者切口均Ⅰ期愈合。23 例均獲隨訪，隨訪時間13 ～ 36個月，平均15.3 個月。骨折愈合時間9 ～ 15 個月。術后15 個月Harris 評分為73 ～ 92 分，其中優5 例，良16 例，中2 例，優良率91.3%。1 例術后33 個月發現股骨頭缺血性壞死（avascular necrosis of femoral head，ANFH），其余患者無ANFH及股骨頭晚期塌陷等并發癥發生。所有患者無神經損害并發癥，無術區感染；1 例術后伴供骨區疼痛，12 個月后疼痛自行消失。 結論 帶旋髂深血管蒂髂骨瓣聯合松質骨空心加壓螺釘內固定治療青壯年股骨頸骨折手術操作簡便、安全，可獲得較好療效。