目的 觀察生物衍生膜在治療皮膚潰瘍及缺損創(chuàng)面的臨床效果。方法 2003年3月～2004年10月采用生物衍生膜修復(fù)皮膚潰瘍及缺損創(chuàng)面10例，觀察創(chuàng)面愈合情況，并對(duì)患者進(jìn)行隨訪。結(jié)果 10例中1例單純使用生物衍生膜治療無效，經(jīng)創(chuàng)面分泌物培養(yǎng)證實(shí)為真菌感染，加用抗真菌藥物治療后創(chuàng)面愈合；余9例創(chuàng)面在3 d分泌物減少，1周后創(chuàng)面開始縮小愈合?；颊呔@3個(gè)月~1年隨訪，7例外傷及感染創(chuàng)面均愈合，無復(fù)發(fā)；3例截癱褥瘡創(chuàng)面愈合后有反復(fù)。結(jié)論生物衍生膜具有皮膚屏障保護(hù)、抗炎、減少滲出及促進(jìn)皮膚創(chuàng)面愈合等作用，為臨床修復(fù)皮膚潰瘍?nèi)睋p創(chuàng)面提供了新的人工組織替代治療途徑。
【摘要】 目的 總結(jié)復(fù)雜脛骨平臺(tái)骨折手術(shù)治療的臨床經(jīng)驗(yàn)?！》椒ā?007年1月-2009年12月，采用切開復(fù)位內(nèi)固定治療復(fù)雜脛骨平臺(tái)骨折56例。男37例，女19例；年齡19～76歲，平均45.6歲。骨折按Schatzker分型:Ⅳ型12例，Ⅴ型26例，Ⅵ型18例。合并半月板損傷20例，膝內(nèi)側(cè)副韌帶損傷9例，外側(cè)副韌帶損傷8例，交叉韌帶損傷4例。受傷至手術(shù)時(shí)間7～14 d，平均9 d?！〗Y(jié)果 術(shù)后53例切口Ⅰ期愈合；2例術(shù)后3 d切口出現(xiàn)淺表感染，1例術(shù)后7 d外側(cè)切口出現(xiàn)皮膚壞死、鋼板外露，均對(duì)癥處理后愈合。56例均獲隨訪，隨訪時(shí)間14～49個(gè)月，平均19個(gè)月。骨折均于術(shù)后4～8周愈合，平均6周。并發(fā)膝關(guān)節(jié)僵硬1例、創(chuàng)傷性關(guān)節(jié)炎2例、異位骨化1例，相應(yīng)處理后治愈。術(shù)后12個(gè)月按美國特種外科醫(yī)院評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)療效，獲優(yōu)43例，良5例，可4例，差4例，優(yōu)良率85.7%。 結(jié)論 手術(shù)治療復(fù)雜脛骨平臺(tái)骨折需重視軟組織條件，掌握好手術(shù)時(shí)機(jī)、選擇合適內(nèi)固定、提高手術(shù)技巧、術(shù)后有效的功能鍛煉是保證療效的關(guān)鍵。【Abstract】 Objective To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures. Methods From January 2007 to December 2009, 56 patients with complex tibial plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19-76 years old (average 45.6 years old). The Schatzker type of the fractures were type Ⅳ in 12 patients, type Ⅴ in 26, and type Ⅵ in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7-14 days (average 9 days). Results After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries was healed after corresponding treatment. All of the patients were followed up with the average follow-up period of 14-49 months (average 19 months). The fractures healed 4-8 weeks (average 6 weeks) after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85.7%. Conclusion Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.