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小腿复杂组织缺损的修复

目的 总结小腿复杂组织缺损的特点、修复的最佳时机与方法。 方法 2000 年1 月－ 2007 年12 月，收治小腿复杂组织缺损122 例。男102 例，女20 例；年龄7 ～ 65 岁，中位年龄31.5 岁。重物砸伤57 例，交通事故伤32 例，车轮绞伤3 例，其他伤30 例。缺损位于小腿上段28 例，中段37 例，下段57 例。皮肤缺损范围为10 cm ×5 cm ～ 20 cm × 11 cm。113 例伴骨、肌腱或钢板外露。病程4 h ～ 18 个月。术中采用吻合血管皮瓣19 例，带蒂皮瓣及筋膜皮瓣103 例，切取皮瓣大小为7 cm × 5 cm ～ 20 cm × 7 cm。骨缺损分别采用肢体缩短、髂骨植骨、吻合血管的腓骨及同侧腓骨植骨，骨移植长度3 ～ 16 cm。供区均用中厚皮片修复。 结果 术后119 例皮瓣成活，3 例皮瓣坏死，经对症处理后愈合。供区植皮均成活，切口愈合良好。术后98 例获随访，随访时间4 ～ 38 个月。12 例背阔肌皮瓣外观略显臃肿，未作处理；其他皮瓣质地良好。获随访的54 例骨缺损患者于术后8 ～ 18 个月达骨性愈合。 结论 小腿复杂组织缺损应根据组织缺损的具体情况，针对性选择皮瓣、适时对骨缺损进行修复与制动是手术成功的关键。

小腿后侧逆行筋膜蒂皮瓣修复小腿软组织缺损

Comparison of the Clinical Effects of Different Rehabilitation Programs after Repair of the Extensor Tendon

ObjectiveTo compare the clinical effects of early dynamic brace passive activity program and average delay activity program after the repair of extensor tendon. MethodsSeventy-eight patients undergoing repair of the extensor tendon during the period from December 2008 to October 2011 in our hospital were randomly divided into two groups.The treatment group had 36 patients who were treated with early dynamic brace passive activity program,and the other 42 patients belonged to the control group and they accepted delay activity program.TAM and FIM were used to evaluate their clinical effects six and eight weeks after surgery,respectively. ResultsThe results of TAM and FIM of the treatment group were significantly better than those of the control group (P<0.01). ConclusionThe early dynamic brace passive activity after extensor tendon injury repair can improve the clinical effect and is worth popularizing.