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带蒂皮瓣移位修复手指创面

推进腓肠肌皮瓣修复跟腱开放性缺损

目的 探讨跟腱开放性缺损的治疗方法及临床效果。 方法 2001 年5 月－ 2008 年8 月，采用推进内外侧腓肠肌联合肌皮瓣治疗8 例外伤致跟腱开放性缺损。男5 例，女3 例；年龄15 ～ 36 岁，平均25 岁。左足3 例，右足5 例。伤后至手术时间为7 ～ 65 d。创面范围6.0 cm × 4.5 cm ～ 8.0 cm × 6.5 cm。跟腱缺损长度为5.0 ～ 7.5 cm，平均6.0 cm。术中肌皮瓣切取范围为22.5 cm × 7.8 cm ～ 28.0 cm × 11.5 cm，供区皮肤行V-Y 推进缝合。 结果 术后第2 天3 例肌皮瓣出现张力性水疱，经对症处理后成活；其余肌皮瓣均顺利成活，创面Ⅰ期愈合。供区切口Ⅰ期愈合。术后患者均获随访，随访时间6 个月～ 7 年，中位时间2 年3 个月。术后肌皮瓣质地、外观满意。末次随访时，按Arner-Lindholm跟腱损伤疗效评定标准，获优6 例，良2 例。 结论 内外侧腓肠肌联合肌皮瓣具有感觉、耐磨、对供区影响较小，是修复跟腱开放性缺损较理想的组织瓣。

Short-term effectiveness of lateral raft plate combined with Jail screw fixation in treatment of tibial plateau collapse fractures involved posterior-lateral column

Objective To investigate the short-term effectiveness of proximal tibial lateral raft plate combined combined with or without Jail screw fixation in the treatment of tibial plateau collapse fractures involved posterior-lateral column. MethodsA retrospective analysis was performed on 106 patients (106 knees) with tibial plateau collapse fracture involved posterior-lateral column admitted between January 2016 and January 2021. According to the combination with Jail screw fixation or not, patients were divided into control group (treated by lateral raft plate without Jail screw fixation, 52 cases) and study group (treated by lateral raft plate with Jail screw fixation, 54 cases). There was no significant difference between the two groups in terms of gender, age, affected knee side, cause of injury, Schatzker classification, Tscherne-Gotzen classification, time from injury to operation, and preoperative lateral tibial plateau posterior slope angle (PSA), tibial plateau varus angle (TPVA), Rasmussen anatomical score (P>0.05). The operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, fracture healing time, complications, and lateral tibial plateau PSA, TPVA, Rasmussen anatomical score detected by X-ray films and CT before operation and at 1 year after operation of the two groups were recorded and compared. The number of cases of articular surface collapse in the two groups was recorded at 1 year after operation, and the effectiveness was evaluated by American Special Surgery Hospital (HSS) score. ResultsAll patients were followed up 12-32 months (mean, 19.5 months). There was no significant difference between the two groups in operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, and fracture healing time (P>0.05). There were 2 patients (3.7%) in the study group and 3 patients (5.8%) in the control group with superficial wound infection, which were cured after debridement and dressing change. There was no significant difference in the incidence between the two groups (χ2=0.252, P=0.616). There was no complication such as vascular and nerve injury, internal fixation failure, nonunion or malunion of fracture, and deep vein thrombosis of lower limbs in both groups. At 1 year after operation, 9 cases (17.3%) in the control group had joint collapse of 2-3 mm, while only 2 cases (3.7%) in the study group had joint collapse, showing significant difference (χ2=5.271, P=0.022). At 1 year after operation, the PSA, TPVA, and Rasmussen anatomical scores of the two groups were significantly improved when compared with preoperative ones (P<0.05); the differences of pre- and post-operative PSA, TPVA, Rasmussen anatomical score, and postoperative HSS score in the study group were significantly better than those in the control group (P<0.05). ConclusionThe lateral raft plate combined with or without Jail screw fixation can achieve satisfactory short-term effectiveness in the treatment of tibial plateau collapse fractures involved posterior-lateral column. Combined with Jail screw, it can enhance the fixation and avoid the occurrence of secondary articular surface collapse, which can be used as a better choice.