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远端蒂腓动脉穿支- 踝关节血管网筋膜皮瓣修复前足背软组织缺损

目的 总结以远端蒂腓动脉穿支- 踝关节血管网为血供的逆行筋膜皮瓣修复前足背部大面积软组织创面缺损的效果。 方法 2006 年4 月－ 2008 年12 月，应用这一皮瓣修复前足背软组织缺损6 例。男4 例，女2 例；年龄16 ～ 54 岁。左侧4 例，右侧2 例。车祸伤2 例，重物压伤4 例。均伴有骨、肌腱外露。创面均在足背部，达趾蹼处。缺损范围12 cm × 6 cm ～ 16 cm × 12 cm。受伤至手术时间4 d ～ 1 个月。术中切取皮瓣14 cm × 8 cm ～ 18 cm × 13 cm。2 例行预防性结扎小隐静脉，4 例未行结扎。术中将皮瓣腓肠神经与受区皮神经吻合。供区创面植皮修复。 结果 6 例术后皮瓣均成活。5 例创面Ⅰ期愈合；1 例术后5 d 皮瓣远端约1 cm 组织坏死，经清创直接缝合后顺利愈合。供区创面愈合良好，植皮均成活，无感染及坏死情况。6 例均获随访，随访时间3 ～ 12 个月，平均7.5 个月。皮瓣外观色泽正常，两点辨别觉1.5 ～ 2.0 mm。足功能恢复良好，行走基本正常；供区愈合良好，对功能无不良影响。 结论 以远端蒂腓动脉穿支- 踝关节血管网筋膜皮瓣修复前足部软组织缺损手术操作简便，并发症少。

膀胱破裂误诊为急性肾功能衰竭一例

Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis

ObjectiveTo compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis.MethodsA retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients (flexible fixation group) and cortical screw fixation in 27 patients (rigid fixation group). There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups (P>0.05). The operation time, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) score were compared between 2 groups.ResultsThe operation time was (83.0±9.1) minutes in the flexible fixation group and was (79.6±13.1) minutes in the rigid fixation group, showing no significant difference (t=1.052, P=0.265). All patients achieved healing of incision by first intention. The patients were followed up 12-20 months (mean, 14 months). The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was (12.1±2.5) months in the flexible fixation group and was (11.3±3.2) months in the rigid fixation group, showing no significant difference between 2 groups (t=1.024, P=0.192). Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups (P>0.05).ConclusionSuture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.