目的：探讨藻酸盐敷料对瘢痕皮肤为供皮区创面愈合的临床效果。方法选取2009年10月-2010年10月北京积水潭医院烧伤科收治的大面积烧伤后整形患者10例，以深度烧伤的瘢痕皮肤为供皮区取中厚皮片。将患者随机分为对照组和观察组，各5例，分别用凡士林纱布及藻酸盐敷料处理包扎供皮区，观察两组患者供皮区的愈合时间。结果两组患者供皮区均愈合。观察组、对照组取皮面积间无差异〔（138±39）cm2与（128±31）cm2，P 〉0.05〕；观察组供皮区愈合时间较对照组缩短〔（13.8±1.8）d与（17.2±1.6）d，P〈0.05〕。结论与普通的凡士林纱布作为敷料比较，藻酸盐敷料用于瘢痕皮肤供皮区可加快创面愈合，值得在临床推广应用。

Objective To investigate the clinical efficacy of alginate dressing on wound of donor sites of skin scar. Methods 10 major burn patients who admitted to the Department of Burn in Beijing Jishuitan Hospital and had plastic sur-gery procedures from October 2009 to October 2010,were selected as study subjects. Medium thickness skin graft from skin with deep burn was used for treatment. The patients were randomly divided into control group and observation group,5 cases in each group. The donor site of control group was treated by petrolatum gauze,and donor site of observation group was treated by alginate dressing,and the donor site recovery time in two groups was observed. Results All donor sites in two groups recovered. There was no significant difference in area of donor site between observation group and control group〔(138 ± 39) cm2 vs. (128 ± 31) cm2 ,P . 0. 05〕;The donor site recovery time in observation group was significantly shorter than that in control group〔(13. 8

总结微创髂骨取骨术的临床经验;方法:回顾性分析我院2005年4月~2006年8月微创髂骨取骨术26例的临床资料,评价其临床效果及安全性;结果:术后所有患者髂骨供区仅略感不适,术后第1、2日即能下床活动。髂骨供区术后第3天换药,第7天拆线。髂骨供区创口均一期愈合,供区股外侧皮肤无麻木等并发症。术后随访6~12个月,临床及X线片检查植骨区均示愈合良好。供区瘢痕较小,股外侧皮肤无麻木等并发症。结论:髂骨取骨术操作简单,容易掌握获得骨松质量充足,疼痛小,值得临床推广。

Objective:To summarize the experience of minimally invasive iliac bone graft surgery. Method:Retrospectively analyzing the clinical data of minimally invasive iliac bone graft surgery from April,2005 to August,2006,and evaluating the clinical effect and safety. Result:After operation,patients only got little discomfortable feeling in iliac bone area. They could do little activity after one or two days after operation. They got medicine changed 3 days after operation,and stitches taken out 7 days after operation. The wound of iliac bone had first step healing,and no complications,such as numbness of lateral skin. After 6~12 month follow-up,the healing was good through clinical and X-ray examination. The scar of the supply area was little,and there was no numbness. Conclusion:Iliac bone graft surgery was easy in operation and grasping, with sufficient cancellous bone and little pain. So it is worth promotion.

目的 探讨乙酰唑胺激发试验CT灌注成像在诊断慢性脑供血不足中的应用价值.方法 选择2009年8月至2011年2月于我院行健康体检的患者100例,诊断为慢性脑供血不足的患者52例作为病例组,其余健康者48例作为对照组.对两组老年人行颅脑乙酰唑胺激发试验CT灌注成像,对大脑前动脉(ACA)供血区、大脑中动脉(MCA)皮层支供血区、MCA深穿支供血区、大脑后动脉(PCA)供血区和脑桥部位(VBA)供血区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)进行分析. 结果 乙酰唑胺激发后病例组ACA供血区、MCA皮层支供血区、MCA深穿支供血区、PCA供血区和VBA的CBV和CBF值低于对照组(t=3.57、3.39、9.34、11.04、4.21、5.99、9.91、11.10、6.66、9.97,均P=0.000);而MTT和TTP值显著高于对照组(t=7.21、6.94、16.53、4.82、11.67、6.46、6.11、6.71、6.87、4.82,均P=0.000);对照组乙酰唑胺激发后的CBV和CBF值均显著高于激发前(t=6.44、6.86、9.72、10.99、7.03、6.33、12.48、14.82、8.98、12.03,均P=0.000),而MTT和TTP值均低于激发前(t=7.98、5.77、17.29、8.28、9.74、7.01、7.52、6.32、6.01、5.54,均P=0.000). 结论 CT灌注成像与乙酰唑胺激发试验相结合能提高慢性脑供血不足的检出率.

Objective To explore the CT perfusion imaging with acetazolamide (ACZ) challenge test in the diagnosis of chronic cerebral insufficiency.Methods 100 patients undergoing health examination in our hospital from Aug 2009 to Feb 2011 were chosen,52 patients diagnosed as chronic cerebral insufficiency were defined as the case group,and the remaining 48 cases of healthy elderly people were defined as the control group.The brain CT perfusion imaging with acetazolamide challenge test,and the cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) in anterior cerebral artery (ACA),middle cerebral artery (MCA)cortical branch supply area,MCA deep perforator region,posterior cerebral artery (PCA) and pons part blood supply area were examined in the elderly people of two groups.Results CBV and CBF values in ACA,MCA cortical branch supplyarea,MCA deep perforator region,PCA and pons part blood supply area after ACZ stimulation were significantly lower in c

目的 探讨第1跖背(底)动脉蒂双叶皮瓣修复相邻两手指中末节缺损的临床应用效果. 方法 自2010年11月至2013年6月,应用第1跖背(底)动脉蒂(母)趾腓侧皮瓣和第2趾胫侧皮瓣联合移植修复相邻两手指中末节缺损9例,为解决动脉跨度不足及皮瓣供区骨和(或)肌腱外露、植皮不易成活的缺陷,将血管分叉处裸露的血管蒂部及足部供区用人工真皮覆盖,3周后切断皮桥,足部供区拆除人工真皮薄膜再切取自体中厚皮片植皮修复. 结果 术后9例18块皮瓣及供区植皮全部成活.随访4～12个月,修复效果满意,皮瓣色泽、质地与受区近似,皮瓣两点辨别觉8 ～12 mm,手指关节功能恢复良好,供区植皮外观饱满,无破溃、疼痛及瘢痕增生形成. 结论 第1跖背(底)动脉蒂双叶皮瓣联合人工真皮修复相邻两手指中末节缺损伤,解决了蒂部跨度不足、不能同时修复中末节缺损的缺陷,降低了手术难度及风险,同时足部供区处理简单、提高了足部供区植皮的成活率,治疗效果满意.

Objective To explore the clinical effect that the free twin-flap with the first dorsal (bottom) metatarsa artery repair the defects of distal in adjacent two fingers.Methods The twin-flap from the big toe and the second toe based on a single vascular pedicle of the firstl dorsal (bottom) metatarsa artery was designed in this article.From November 2010 to June 2013,this twin-flap was transferred in 9 patients.In order to solve the problems:the shortage of arterial span,the bone and (or)tendon exposed in the donor site,the thickness skin graft resurfaced in the donor site was not easy to survive,the bare vascular pedicle and the donor site were covered with artificial dermis for 3 weeks.After 3 weeks,cutting skin bridge and removing the thin of artificial dermis,the donor site was resurfaced by thickness skin graft.Results All cases were followed up for 4 to 12 months.All transfering flaps and the thickness skin graft were survival.The colours and texture of the flaps matched the recipie

目的 探讨新的供皮区取皮方法,在获取较大面积全厚皮片的同时,可缩短供皮区宽度、减少缝合张力,缺损面可直接缝合闭合.方法 运用数学原理,在面积相等的条件下,设计错位供皮法,所取的皮片经拼接后即可形成较大面积皮片,满足修复大面积缺损的需要.用该方法治疗7例皮肤恶性肿瘤患者,头、面部5例,足部2例,包括基底细胞癌3例,鳞状细胞癌3例,恶性黑素瘤1例.结果 供皮宽度缩小后,供皮区缺损能够直接拉拢缝合,同时也避免供皮区皮源的浪费.7例患者,头面部5例中,3例全部成活,2例边缘少许糜烂；2例足底部约10％～20％坏死,经换药处理,1～2个月后愈合.结论 修复较大面积皮肤缺损,拼接法等面积供皮是一种较好的选择.

Objective To develop a new strategy for preparing large-area full-thickness skin grafts with donor incisions small enough to allow direct suture under low pressure.Methods A geometrical analysis was carried out to design the best strategy to obtain skin grafts with minimal donor defect.In this strategy,two semicircular donor skin grafts are subjected to a malpositioned joining to form a circle which is equal in size to the large-area skin defect.Seven patients with cutaneous malignancy were managed by this operation regimen,including three cases of basal cell carcinoma,three cases of squamous cell carcinoma,and one case of malignant melanoma.Tumors were located in the face or head in five patients,and in feet in two patients.Results The width of donor incisions was significantly reduced by this strategy,and donor defects were sutured directly with the minimal loss of donor graft.Of the five patients with malignancies of the head or face,three achieved complete survival of skin grafts,t