RESUMO
Objective To evaluate the clinical effect of anterograde and reverse digital artery island flap in treatment of wound repairing for fingertip defects.Methods From January 2015 to December 2016,there were 35 patients with fingertip defects underwent surgical treat-ment in our hospital,including 14 cases underwent surgery with anterograde digital artery island flap(anterograde group)and 21 cases under-went surgery with reverse digital artery island flap(reverse group).The anterograde group used proper palmar digital artery and nerve as the pedicle of flap,then took forward the finger pulp flap to the injured site.The reverse flap from the dorsal of one side of finger was harvested for coverage of the distal phalanx.Results All the flaps of the 35 cases were survived.In the anterograde group,reflux obstacle of vein appeared in 1 case,and it was cured with scarification procedures.In the reverse group,there were 3 cases of vascular crisis.After dressing release and partial remove of the stitching,2 cases of them return to normal.The other 1 case suffered from flap edge necrosis,and then the wound healed after dressing change.The operation time of anterograde group was(107.5 ±18.4)min and it was(139.5 ±18.0)min in the reverse group, which showed significant difference between the two groups(P<0.05).All the 35 cases were followed up for 6 to 12 months,with an average of 8.5 months.At the last follow-up,it showed that patients in both of the two groups had ruddy color,good texture and no significant bloated flap appearance.In the anterograde group,the sensory function of 12 patients restored to S4 and 2 patients restored to S3.Meanwhile,in re-verse group,5 patients restored to S3,12 patients restored to S2, and 4 patients restored to S1.The two-points discrimination of the antero-grade group was(4.22 ±0.67)mm,and it was(7.04 ±1.25)mm in the reverse group,which was significantly different(P<0.05).The in-terphalangeal joint motion was(102.67 ±7.35)°at the distal end and(64.46 ±8.37)°at the proximal end in anterograde group.And it was (100.64 ±10.29)°and(60.81 ±10.80)°respectively in the reverse group,with no significant difference between the two groups (P>0.05).The excellent and good rate was 92.8%in the anterograde group and 80.9%in the reverse group by the criteria for functional evaluation,and there was no statistically significant difference(P>0.05).Conclusion For fingertip defects(IshikawaⅠ~Ⅲ)treated by anterograde digital artery island flap or reverse digital artery island flap both can obtained good clinical efficacy.But it has shorter operation time and better sensory recovery with anterograde digital artery island flap repairing.
RESUMO
Objective To evaluate the effectiveness and radiographic outcomes of using autologous cervical laminae as bone graft in anterior discectomy and fusion (ACDF) in patients with one-stage posteroanterior surgery for cervical spinal stenosis (cervical spondylotic myelopathy). Methods From January 2010 to June 2013, 37 patients with cervical spinal stenosis underwent surgical treatment in our hospital. Fifteen of them underwent one-stage posteroanterior cervical surgery using autologous cervical laminae as bone graft in ACDF (group A), and 22 patients underwent one-stage posteroanterior procedure using autologous iliac bone as bone graft in ACDF (group B). The operative time, intraoperative blood loss, fusion rate, VAS score, JOA score and height of intervertebral space were compared between the two groups. Results The operative time was 102.7 ± 13.9 min in group A and 128.9 ± 12.3 min in group B, showing significant difference between two groups (t=-6.031, P=0.00). The intraoperative blood loss was 170.3 ± 25.7 ml in group A and 191.1 ± 32.0 ml in group B, and also showing significant difference between them (t=-2.097, P=0.04). All the patients were followed up from 6 months to 42 months (mean, 17.4 months). At 6 months after the surgery, the fusion rate of bone graft was 94.4% (14/15) in group A and 100% (22/22) in group B, and no significant difference was found between two groups (χ2 =1.507, P=0.220). The postoperative VAS score, JOA score and intervertebral height were significantly improved compared with those before surgery in both groups (P0.05). Conclusion In anterior cervical discectomy and fusion during one-stage posteroanterior cervical surgery, the use of autologous cervical laminae as bone graft is feasible.