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find Keyword "足踝" 44 results
  • SURGICAL TREATMENT FOR HEMOPHILIA INDUCED LESIONS OF FOOT AND ANKLE

    Objective To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle. Methods Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 ± 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 ± 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot). Results The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 ± 14.7 and 75.8 ± 14.5, respectively; SF-36 scores were 76.6 ± 13.1 and 75.5 ± 13.2, respectively; and significant differences were found when compared with preoperative scores (P lt; 0.05), but no significant difference between postoperative 6 months and last follow-up (P gt; 0.05). Conclusion For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.

    Release date:2016-08-31 04:06 Export PDF Favorites Scan
  • 小腿远端皮支链血管皮瓣修复足踝部缺损的疗效观察

    目的 总结小腿远端皮支链血管皮瓣修复足踝部软组织缺损的疗效。 方法2008年5月-2011年10月,收治11例足踝部软组织缺损患者。男9例,女2例;年龄20~70岁,平均46.5岁。其中外伤致软组织缺损8例,伤后至手术时间2 h~21 d;恶性肿瘤切除后缺损3例。缺损范围为4 cm × 4 cm~7 cm × 7 cm;创面伴骨、肌腱外露。采用大小为4.5 cm × 4.5 cm~9.0 cm × 9.0 cm的小腿皮支链血管皮瓣修复缺损。供区直接拉拢缝合或游离植皮修复。 结果1例皮瓣术后发生远端皮缘坏死,经换药后二期修整缝合愈合;其余皮瓣均顺利成活,创面均Ⅰ期愈合。供区植皮均成活;切口Ⅰ期愈合10例,Ⅱ期愈合1例。术后患者均获随访,随访时间6~12个月,平均8个月。皮瓣外形不臃肿,色泽、质地优良,耐磨无破溃,穿鞋行走自如。 结论小腿远端皮支链血管皮瓣不牺牲主要血管及皮神经,手术操作简便,术后成活率高,外观较好,是修复足踝部软组织缺损的理想方法之一。

    Release date:2016-08-31 04:06 Export PDF Favorites Scan
  • 游离股前外侧动脉穿支皮瓣及腓动脉穿支皮瓣在足踝部创面中的应用

    目的总结采用游离股前外侧动脉穿支皮瓣及腓动脉穿支皮瓣修复足踝部创面的疗效。 方法2006年8月-2010年7月,收治21例足踝部开放性损伤患者。男15例,女6例;年龄21~57岁,平均37岁。致伤原因:交通事故伤12例,重物砸伤7例,高处坠落伤2例。伤后至手术时间1个月~2年。创面软组织缺损范围3.5 cm × 3.0 cm~25.0 cm × 15.0 cm,均伴足踝部骨折。创面分泌物细菌培养示11例阳性。采用游离股前外侧动脉穿支皮瓣(16例)或腓动脉穿支皮瓣(5例)修复,皮瓣切取范围3.5 cm × 3.0 cm~25.0 cm × 15.0 cm。供区游离植皮或直接拉拢缝合。 结果术后皮瓣及供区植皮均顺利成活;创面Ⅰ期愈合19例,延期愈合2例。患者均获随访,随访时间6个月~2年,平均16个月。皮瓣质地及外观满意,末次随访时皮瓣两点辨别觉为21~29 mm。下肢肢体功能评定,获优10例,良8例,可3例, 优良率为85.7%。 结论根据创面大小及部位选择游离股前外侧动脉穿支皮瓣和腓动脉穿支皮瓣修复足踝部创面可获得满意疗效。

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • 足踝部皮肤软组织缺损的修复

    【摘 要】 目的 总结足踝部皮肤软组织缺损修复方法及疗效。 方法 2005 年8 月- 2008 年8 月,收治46 例足踝部皮肤软组织缺损患者。男40 例,女6 例;年龄12 ~ 68 岁,平均35 岁。交通事故伤31 例,机器碾压伤6 例,医源性损伤2 例,电击伤1 例,糖尿病足溃疡6 例。缺损范围4 cm × 2 cm ~ 27 cm × 16 cm。病程4 h ~ 2 年。采用股前外侧游离皮瓣12 例,腓肠神经营养血管皮瓣25 例,胫后动脉逆行皮瓣1 例,隐神经皮瓣2 例,腓动脉终末穿支皮瓣2 例,交腿皮瓣1 例,足底内侧皮瓣2 例,跖背皮瓣1 例,皮瓣切取范围4 cm × 3 cm ~ 28 cm × 18 cm;供区直接缝合或中厚皮片游离移植修复。 结果 术后46 例患者均获随访,随访时间6 个月~ 3 年,平均11 个月。术后10 d 2 例腓肠神经营养血管皮瓣发生远端部分坏死;其余皮瓣均成活,创面Ⅰ期愈合。供区植皮均成活,无明显挛缩;切口Ⅰ期愈合。术后6 个月,1 例采用腓肠神经营养血管皮瓣修复的足底创面发生小面积溃疡,经对症处理后愈合;其余患者皮瓣质地、色泽正常。患者可负重行走,步态正常。 结论 合理采用局部带蒂皮瓣或游离皮瓣修复足踝部皮肤缺损,可明显缩短病程,达到保肢保足目 的。

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • 封闭式负压引流技术联合腓动脉穿支皮瓣修复足踝部皮肤软组织缺损

    目的 总结封闭式负压引流技术(vacuum sealing drainage,VSD)联合腓动脉穿支皮瓣修复皮肤软组织缺损的方法及临床疗效。 方法 2009 年2 月- 2011 年1 月,收治11 例足踝部皮肤软组织缺损患者。男7 例,女4 例;年龄18 ~ 60 岁,平均37.2 岁。交通事故伤8 例,重物砸伤2 例,爆炸伤1 例。损伤部位:足踝2 例,足跟及跟腱部3 例,足背6 例。创面范围为3.5 cm × 3.0 cm ~ 13.5 cm × 9.0 cm。受伤至手术时间为2 ~ 8 h,平均4.5 h。先行VSD 治疗,待创面肉芽组织新鲜、感染控制后,采用大小为5 cm × 4 cm ~ 15 cm × 11 cm 的腓动脉穿支皮瓣修复创面。供区直接缝合或游离植皮修复。 结果 皮瓣修复术后1 例出现皮瓣切口远端皮缘坏死,1 例出现静脉危象,经对症处理后成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。11 例均获随访,随访时间7 ~ 24 个月,平均13 个月。皮瓣色泽外形好,质地佳,局部无明显瘢痕挛缩,耐磨性良好,皮瓣受力处无破溃。末次随访时,踝关节功能采用美国矫形足踝协会(AOFAS)评分系统进行评价,获优7 例,良2 例,可1 例,差1 例,优良率为81.8%。 结论 VSD 治疗能降低创面感染几率,促进肉芽生长,为皮瓣修复提供良好条件。腓动脉穿支皮瓣是修复足踝部皮肤软组织缺损的有效方法之一。

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 股前外侧皮瓣游离移植修复足踝部大面积皮肤软组织缺损

    目的 总结股前外侧皮瓣修复足踝部大面积皮肤软组织缺损的临床应用效果。 方法 2007 年1 月-2010 年12 月,采用股前外侧皮瓣修复30 例足踝部大面积皮肤软组织缺损。男18 例,女12 例;年龄18 ~ 55 岁,平均36 岁。外伤19 例,烧伤4 例,慢性感染创面7 例。病程9 h ~ 8 个月。缺损部位:小腿下1/3 及跟腱区8 例,外踝及足背外侧区10 例,内踝及足背内侧区5 例,足跟及足底7 例。创面均伴血管、骨及肌腱外露。创面缺损范围20 cm × 14 cm ~ 23 cm ×21 cm。皮瓣切取范围为22 cm × 16 cm ~ 25 cm × 23 cm。供区游离植皮修复。 结果 术后5 ~ 7 d 3 例皮瓣边缘出现部分坏死,予以加强换药后成活;其余皮瓣及供区植皮均顺利成活,创面均Ⅰ期愈合。患者均获随访,随访时间6 ~ 36 个月,平均18 个月。皮瓣耐磨,无局部溃烂,其中27 例恢复保护性感觉。但皮瓣外形臃肿,12 例于术后1 年行二次手术皮瓣修整后,外形满意。 结论 股前外侧皮瓣具有切取范围大、血管口径粗、部位隐蔽等特点,是修复足踝部大面积皮肤软组织缺损的有效方法之一。

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 逆行隐神经皮瓣交腿移位修复难治足踝部创面

    目的 总结采用逆行隐神经皮瓣交腿移位修复难治足踝部创面的方法及疗效。 方法 2005 年9 月-2010 年11 月,采用逆行隐神经皮瓣交腿移位修复9 例难治足踝部创面。男8 例,女1 例;年龄17 ~ 47 岁,平均34.5 岁。交通事故伤5 例,重物压砸伤3 例;伤后至入院时间为2 h ~ 6 个月。脉管炎1 例,病程18 个月。缺损部位:踝部4 例,足跟部3 例,前足2 例。缺损范围为6 cm × 5 cm ~ 17 cm × 11 cm。术中皮瓣切取范围为8 cm × 6 cm ~ 16 cm × 10 cm,术后3 ~ 5 周行皮瓣断蒂。供区游离植皮修复。 结果 1 例感染创面术后4 d 发生局限感染,经换药处理后愈合,皮瓣成活;其余交腿皮瓣及供区植皮均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间6 ~ 34 个月,平均16 个月。皮瓣质地优良,无溃疡发生。术后22 个月皮瓣两点辨别觉为8 ~ 10 mm,均恢复保护性感觉。足踝均能负重行走,踝关节活动范围:背伸8 ~ 20°,跖屈10 ~ 35°。供区术后足背内侧感觉支配区麻木感范围随时间延长缩小。 结论 逆行隐神经皮瓣切取简便,厚薄适度,不损伤知名血管,术后可恢复皮瓣感觉,有效防止皮瓣再破溃,是修复足踝部创面的较好方法之 一。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • PROGRESS AND MAIN POINTS IN TREATMENT OF ACUTE FOOT AND ANKLE INJURIES

    Objective To give a review and commentary on the treatment of acute foot and ankle injuries. Methods Based on the treatment experience and recent l iterature, a commentary on acute foot and ankle injuries were given, included the basic and cl inical research results, evaluation before operation, and treatment methods of the soft tissue and bone injuries. Results The treatment of acute foot and ankle injuries is still a hot point in orthopaedic surgery. Operative and non-operative treatment of fresh Achilles tendon rupture can achieve satisfactory results, and early weight-bearing do not increase the re-rupture rate. The time delay between first debridement and injury within 24 hours does not increase the infection rate. For the treatment of severe ankle fractures, attentions should be paid to the cartilage injury, and anatomic reduction, good real ignment, and the congruity recovery are very important. The treatment determination of calcaneal fractures depends on the fully understanding injury mechanisms, classifications, and treatment method. Talus fractures should try to be treated by experienced surgeons. Operation and fixation methods of Lisfranc injury depends on different injury types. Conclusion Acute foot and ankle injuries are common in cl inical, to achieve a satisfactory result in evaluation and treatment, it is important to have a fully evaluation of the injury type, and choose the best operation time and suitable treatment methods, as well as to fully understand the biomechanical characteristics of different regions.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • 腓肠神经营养血管逆行岛状皮瓣修复足踝部大面积软组织缺损

    目的 总结采用腓肠神经营养血管逆行岛状皮瓣修复足、踝、胫前区大面积皮肤软组织缺损的临床效果。 方法 2004 年6 月- 2008 年12 月,收治12 例足、踝及胫前区大面积皮肤软组织缺损患者。男8 例,女4 例;年龄21 ~ 63 岁,平均44.8 岁。交通伤9 例,慢性溃疡、胫前区术后瘢痕、足背皮肤撕脱伤术后感染坏死创面各1 例。缺损部位:足背6 例,足跟、踝部、胫前区各2 例。软组织缺损范围6 cm × 4 cm ~ 16 cm × 9 cm。病程3 d ~ 18 个月。采用大小为8 cm × 6 cm ~ 18 cm × 10 cm 的腓肠神经营养血管逆行岛状皮瓣修复缺损,将小隐静脉近端与创面周围的回流静脉吻合,腓肠神经近端与皮瓣受区供体神经端侧缝合。供区植皮修复。 结果 术后皮瓣均顺利成活,创面Ⅰ期愈合。供区2 例植皮部分坏死,经换药后成活;其余植皮均顺利成活,切口Ⅰ期愈合。12 例均获随访,随访时间6 ~ 14 个月,平均9 个月。术后16 周根据英国医学研究会标准进行感觉功能评定,其中S2 3 例,S2+ 5 例,S3 4 例。其中9 例皮瓣两点辨别觉10 ~ 16 mm,平均14 mm。皮瓣色泽、质地、弹性良好,行走后无水疱及皮肤破溃损伤等。 结论 腓肠神经营养血管逆行岛状皮瓣修复足、踝及胫前区大面积皮肤软组织缺损时,将小隐静脉近端与受区回流静脉吻合,腓肠神经近端与皮瓣受区供体神经端侧缝合,利于皮瓣成活及感觉恢复,修复效果良好。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • REPAIR OF SMALL AND MEDIUM-SIZED SOFT TISSUE DEFECT IN ANKLE WITH SURAL NEUROCUTANEOUSVASCULAR FLAP PEDICLED ON MAIN PERFORATING BRANCH OF PERONEAL ARTERY

    Objective To investigate the operative techniques and cl inical results of sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery in repairing small and medium-sized soft tissue defects in ankle. Methods From July 2004 to February 2007, 14 patients (9 males and 5 females, aged 19-53 years) withsmall and medium-sized soft tissue defects in ankle were treated, including 4 cases of skin necrosis caused by surgery for achilles tendon rupture, 3 soft tissue defects due to car accident, 2 crush injury due to fall ing heavy objects, 2 chronical infectious ulcer, 2 skin necrosis cuased by surgery for calcaneus fracture and 1 melanoma resection in heel. Ranging from 4 cm × 2 cm to 9 cm × 5 cm and combing with exposure of either tendon or bone, the defects were in ankle areas (12 cases) and weight-bearing heel (2 cases). The time from injury to hospital ization was 12 days to 13 months, except 3 cases of emergency hospital ization. After thorough debridement, the sural neurocutaneous vascular flaps (13 cm × 5 cm - 36 cm × 6 cm ) pedicled on the perforating branch of peroneal artery was harvested to repair the defects. The donor sites were sutured directly. Results Postoperatively all the flaps survived, and all the donor sites and wounds healed by first intention. Over a 7-23 month follow-up period, the texture, appearance and color of the flaps in all cases were good, with two-point discrimination of 7-12 mm.The function of ankle obtained satisfactory recovery with normal in-shoe gait. Conclusion With a rel iable blood supply, simple operative procedure, sound repair of wound and satisfactory recovery of l imb function, the sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery is appl icable for the repair of small and medium-sized defects in the ankle and weight-bearing area of heel, especially for patients who have no satisfactory perforating branch in lower position.

    Release date:2016-09-01 09:05 Export PDF Favorites Scan
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