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腓骨皮瓣修复胫骨开放性粉碎性骨折及皮肤缺损

目的 应用吻合血管腓骨皮瓣重建胫骨粉碎性骨折段骨的连续性及修复胫前皮肤软组织缺损的疗效分析。方法 2002年2月～2004年12月，收治22例胫骨粉碎性骨折。Gustilo ⅢB型8例，ⅢC型14例。合并血管损伤14例，神经损伤5例。缺损范围12 cm×6 cm～20 cm×6 cm。于伤后1～22 d，在彻底清创基础上，采用吻合血管腓骨皮瓣修复。随访观察骨愈合情况及患肢功能。 结果 22例获8～42个月随访，移植的腓骨皮瓣全部成活，胫骨粉碎性骨折均获骨性愈合，无截肢和慢性骨髓炎发生，下肢外形及功能恢复满意。 结论 应用吻合血管腓骨皮瓣，重建胫骨严重粉碎性骨折段骨的连续性及修复其皮肤软组织缺损，有助于加速骨折愈合、减少慢性骨髓炎的发生、缩短病程和降低致残率。

HIDDEN BLOOD LOSS AFTER LUMBAR SPINAL STENOSIS OPERATION

Objective To determine the total blood loss and hidden blood loss associated with surgery for lumbar spinal stenosis and to identify risk factors for blood loss. Methods From September 2002 to July 2006, the cl inical data from 138 patients with lumbar spinal stenosis undergoing initial operation were analysed prospectively. There were 44 males and 94 females, aging 56-78 years (mean 66.7 years). A simple posterior lumbar spinal decompression was used in 26 cases;posterior spinal canal decompression, interbody distraction Cage, and bone graft between transverse process was used in 54 cases; pedicle screw fixation, posterior decompression and bone graft between transverse process was used in 32 cases; posterior decompression, pedicle screw fixation, interbody Cage, and graft between transverse process was used in 26 cases . Before operation, 23 patients took aspirin, and after operation 15 patients had gastrointestinal bleeding. Intraoperative blood loss was calculated by the aspirator and observed blood loss intraoperation. The whole estimated blood loss was calculated according to the level of hemoglobin, blood volume and blood transfusion at the time of admission and after 3 and 4 days of operation. Results The blood loss intraoperation was (485.51 ± 143.75) mL. The estimated blood loss was (1 218.60 ± 306.86) mL, which was significantly higher than the intraoperational blood loss (P lt; 0.001). There was significant difference between the estimated blood loss and observed blood loss during surgeries (P lt; 0.001). There were significant differences in the estimated blood loss and observed blood loss during surgery between patients treated with aspirin and without aspirin (P lt; 0.001), between patients with gastrointestinal bleeding and whiout gastrointestinal bleeding (P lt; 0.001). Conclusion The total blood loss after surgery for lumbar spinal stenosis is much greater than that of observed intra-operation. The type of surgery, treatment with aspirin and gastrointestinal bleeding or ulceration can all independently increase blood loss.

监测皮岛在多种深部移植组织瓣血供监测中的应用