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距骨下重建治疗先天性马蹄内翻足

交锁髓内钉治疗股骨干骨折

目的 总结交锁髓内钉治疗股骨干骨折的临床经验。方法 2000年6月~2004年6月，收治股骨干骨折35例，男21例，女14例；年龄16～69岁，平均31.5岁。其中车祸伤19例，摔伤6例，工地外伤3例，坠落伤7例。开放性骨折13例，Anderson分型Ⅰ型8例，Ⅱ型5例；闭合性骨折22例。新鲜骨折于伤后4 h~5 d、陈旧性骨折于伤后25~56 d入院。35例均采用交锁髓内钉治疗。结果 35例获随访6~49个月。术后达骨性愈合25例(71.4%)，平均愈合时间5.4个月，12~16个月取出内固定；4~8个月临床愈合9例(25.7%)；5个月骨折延迟愈合1例，经取出上端横行锁钉，改为动力型髓内钉固定4个月后骨性愈合。随访期内无感染，髓内钉无折弯和折断，无畸形愈合；锁钉折断与退出各1例。35例功能锻炼后，髋、膝关节功能均基本恢复正常。结论 交锁髓内钉能防止肢体短缩和旋转，骨折固定牢靠，愈合率高，是治疗股骨干骨折的首选内固定方法。

生物衍生膜修复皮肤溃疡及缺损十例

目的 观察生物衍生膜在治疗皮肤溃疡及缺损创面的临床效果。方法 2003年3月～2004年10月采用生物衍生膜修复皮肤溃疡及缺损创面10例，观察创面愈合情况，并对患者进行随访。结果 10例中1例单纯使用生物衍生膜治疗无效，经创面分泌物培养证实为真菌感染，加用抗真菌药物治疗后创面愈合；余9例创面在3 d分泌物减少，1周后创面开始缩小愈合。患者均获3个月~1年随访，7例外伤及感染创面均愈合，无复发；3例截瘫褥疮创面愈合后有反复。结论生物衍生膜具有皮肤屏障保护、抗炎、减少渗出及促进皮肤创面愈合等作用，为临床修复皮肤溃疡缺损创面提供了新的人工组织替代治疗途径。

Surgical Treatment for Complex Tibial Plateau Fractures

【摘要】　目的　总结复杂胫骨平台骨折手术治疗的临床经验。　方法　2007年1月-2009年12月，采用切开复位内固定治疗复杂胫骨平台骨折56例。男37例，女19例；年龄19～76岁，平均45.6岁。骨折按Schatzker分型:Ⅳ型12例，Ⅴ型26例，Ⅵ型18例。合并半月板损伤20例，膝内侧副韧带损伤9例，外侧副韧带损伤8例，交叉韧带损伤4例。受伤至手术时间7～14 d，平均9 d。　结果　术后53例切口Ⅰ期愈合；2例术后3 d切口出现浅表感染，1例术后7 d外侧切口出现皮肤坏死、钢板外露，均对症处理后愈合。56例均获随访，随访时间14～49个月，平均19个月。骨折均于术后4～8周愈合，平均6周。并发膝关节僵硬1例、创伤性关节炎2例、异位骨化1例，相应处理后治愈。术后12个月按美国特种外科医院评分标准评价疗效，获优43例，良5例，可4例，差4例，优良率85.7%。　结论　手术治疗复杂胫骨平台骨折需重视软组织条件，掌握好手术时机、选择合适内固定、提高手术技巧、术后有效的功能锻炼是保证疗效的关键。【Abstract】　Objective　To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures.　Methods　From January 2007 to December 2009, 56 patients with complex tibial plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19-76 years old (average 45.6 years old). The Schatzker type of the fractures were type Ⅳ in 12 patients, type Ⅴ in 26, and type Ⅵ in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7-14 days (average 9 days).　Results　After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries was healed after corresponding treatment. All of the patients were followed up with the average follow-up period of 14-49 months (average 19 months). The fractures healed 4-8 weeks (average 6 weeks) after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85.7%.　Conclusion　Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.

前路减压与植骨内固定治疗胸腰椎骨折

腓肠肌内侧头肌皮瓣移位术治疗胫骨慢性骨髓炎伴胫前皮肤缺损

胫骨前面及内侧因皆位于皮下,慢性胫骨骨髓炎伴胫前皮肤溃疡、骨外露、贴骨瘢痕以及有较大骨腔存在时,其治疗十分困难。我们从1983年以来选用带血管、神经蒂的腓肠肌内侧头肌皮瓣移位治疗胫骨慢性骨髓炎伴胫前皮肤缺损15例,经过6月～2年随访,结果全部一期愈合,无一例失败。10例19月以上者行X线照片检查,骨质有明显修复。3例硬化性骨髓炎经两年后硬化骨转变为正常骨,髋腔也再通。