Rescue and treatment of severely injured lower extremities / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore a treatment approach for severely injured lower extremities.</p><p><b>METHODS</b>The data of 42 patients with severely traumatic lower extremities from 1989 to 1999 were retrospectively reviewed. According to MESS (mangled extremity severity score) the mean score of all the limbs was 6.24+/-1.45, 34 cases had MESS score < 7 and 8 cases had MESS score > or = 7. Treatment approaches included microvascular anastomosis technique, compound tissue flap transplantation technique and compound bone tissue flap transplantation.</p><p><b>RESULTS</b>Two patients died after operation and one patient had delayed amputation of a lower limb. The rest 39 patients were followed up for 4-13 years. All the lower extremities of the 39 patients survived and had equal length. The 39 cases were evaluated by Chen's criterion, showing that 37 had good result (29, Chen I and 8, Chen II), 1 sufficient (Chen III) and 1 poor (Chen IV).</p><p><b>CONCLUSIONS</b>Successful emergency treatment of severely injured lower extremities could be achieved by using microsurgery techniques and strict controlling of lower extremity salvagel indications.</p>

Simultaneous reconstruction of anterior cruciate ligament and posterior cruciate ligament by using allogeneic patellar tendon under arthroscopy / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate operative effects of a new method to reconstruct anterior crucial ligament (ACL) and posterior crucial ligament (PCL) simultaneously by using patellar tendon under arthroscopy.</p><p><b>METHODS</b>From November 1999 to November 2003, the injured ACL and PCL of 11 patients were fixated with compressed screws and reconstructed under arthroscopy with the bone-patellar tendon-bone treated with deep hypothermia andgamma radiation. At the same time, 2 patients were treated with medial collateral ligament (MCL) reconstruction, 3 with lateral collateral ligament (LCL) reconstruction, 1 with meniscus suture and 4 with whole or partial resection.</p><p><b>RESULTS</b>All patients were followed up for 12-26 months (average 16.5 months). The Lysholm score method was employed to evaluate the knee function. The average preoperative score was 45.3 and the postoperative score was 86.4. Anterior drawer test (ADT) was positive in 11 knees preoperatively and feeble positive in one knee postoperatively. Lachman test was positive in 11 knees preoperatively and in one postoperatively, and feebly positive in two postoperatively. Posterior drawer test was positive in 11 knees preoperatively and feebly positive in 2 postoperatively. There were 2 knees with tolerable pain and 2 with knee flexion of 5-20.</p><p><b>CONCLUSIONS</b>As for simultaneous reconstruction of ACL and PCL under arthroscopy, allogeneic bone-patellar tendon-bone can not only avoid injury and complication caused by autografting, but also help rehabilitation of the knee function.</p>

Clinical evaluation of 7 cases of elderly Kienbock's disease / 中国康复理论与实践

@#ObjectiveTo investigate the characteristics of Kienbock's disease in patients older than 60 years of age.MethodsGender, age at onset, affected side, dominant hand, occupation, and clinical results in 7 wrist of 7 elderly patients with Kienbock's disease were investigated.ResultsKienbock's disease in elderly patients commonly was observed in the dominant hand of manual works and was found more often in women than in men. The age at onset was from 60 to 70. Although radiographic examination revealed development of carpal collapse in all patients.ConclusionThe etiologic factors different from conventional ones might have played a role in aged patients with Kienbock's disease, surgical and rehabilitation treatments are good or excellent.

Monitoring island flap for fibular graft in 30 patients with long bone defects / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the effect of vascularized fibular graft on large defects of long bones and the monitoring method for the vascular status of the grafted fibula.</p><p><b>METHODS</b>From March 1988 to February 1998, 30 patients with long bone defects over 6 cm in length received vascularized fibular graft including a monitoring island flap in our department to monitor the blood circulation of the fibulae.</p><p><b>RESULTS</b>Monitoring island abnormalities were indicated in 6 flaps, which accurately gave the alarm of the circulation crisis of the fibular graft. Surgical exploration was performed timely and the blood supply was recovered instantaneously. All the bone defects were healed at 6 months postoperatively. After 4 years of follow-up, all the grafted fibulae were thickened and were just like tibiae.</p><p><b>CONCLUSIONS</b>A monitoring island flap is a satisfactory method for repairing large defects of the long bones and a reliable method for assessing the vascular status of the grafted fibulae.</p>

Clinical significance of monitoring-flap in massive compound bone grafts for repairing massive bone defects in extremities / 中华显微外科杂志

Objective To explore the significance of designing with monitoring-flap in massive com- pound bone grafts for repairing massive bone defects in extremities.Methods From January 2001 to De- cember 2004,large bone defects in 19 patients(11 men and 8 women,age:6 to 35 years,mean age:18.6 years)were repaired by vascularized free fibular transplant with a monitoring-flap combining with massive deep frozen bone allografts.Average length of the bone defects was 16.6 cm(range,12 to 25 cm).A 7 days' con- tinuously clinical examination including observing the color,turgor,temperature,capillary refill,and bleeding after a needle sticking of the monitoring-falps were used postoperatively,if any one of these were abnormal,the circulation of the compound bone grafts must be in danger and some measures such as re-operation should be taken immediately.Dynamic image analysis was used for evaluating the bone union.Results One monito- ring-flap was vascular artieulo,and the articulo was relieved after exploration and resection of vein thrombus; another one was marginal part necrosis;the remains were normal.All of monitoring-flaps healed normally after 23.2 months(range,6 to 54 months)follow-up.15 patients had the radiographic evidence of bone unions 3 months after surgery.11 patients had been removed intermal fixation,complete bone unios were found one year postoperatively.Conclusion Designing with monitoring-flap in massive compound bone grafts for repairing massive bone defects,and can clearly understand the circulatory statue of compound bone grafts and early pre- dict the final results of massive bone allografts.