【作者】 林江游；

【导师】 林松庆；

【作者基本信息】 福建中医药大学 ， 中医骨伤科学， 2011， 硕士

【摘要】 目的：①通过解剖学研究,设计外侧切口同时打开小腿四个骨筋膜室的术式,证明其解剖学可行性。②制作犬小腿骨筋膜室综合征动物模型并运用外侧切口减压术治疗,检验该方法的有效性。③对采用外侧切口行小腿骨筋膜室减压术并术后配合桃红四物汤治疗的临床病例进行研究分析,探讨该治疗方法的疗效与优势。材料和方法：①本实验标本为5侧新鲜冰冻成人小腿。设计外侧切口同时打开小腿四个骨筋膜室的手术入路,并在标本上行外侧切口模拟手术,然后按手术入路逐层解剖,观察切口与四个骨筋膜室的关系及与腓总、腓浅、腓深神经及腓动脉的关系。②选取健康成年杂种犬13只(26侧)(体重在15-20kg、雌雄不限)。实验前先采用Whiteside法测量犬小腿骨筋膜室的正常压力后,根据王志刚的小腿骨筋膜室综合征动物模型的制作方法制作动物模型,在动物模型上行外侧切口骨筋膜室减压术后,再次测量其骨筋膜室压力,通过Spss16统计软件对所采集的数据进行处理,观察减压后犬小腿骨筋膜室压力是否下降至正常水平以下及术后犬小腿恢复情况。③对小腿骨筋膜室综合征的病例采用该手术方法进行减压并术后早期配合服用桃红四物汤进行治疗,术后3月根据Ewards评价系统评价该小腿功能恢复程度。结果：①从解剖学上证实了外侧切口同时打开小腿四个骨筋膜室的可行性。外侧切口从腓骨颈下2cm至外踝尖上5cm,外侧切口直达外侧骨筋膜室,切口向前牵拉在小腿前肌间隔前1-2cm纵向切开前侧骨筋膜室,切口牵向后侧可在小腿后肌间隔后1-2cm纵向切开后浅骨筋膜室,将外侧骨筋膜室及后浅骨筋膜室分别向前后牵拉可在腓骨后缘1-2cm纵向切开后深骨筋膜室,达到同时打开小腿四个骨筋膜室。手术入路距离腓总神经及腓深神经较远,不易损伤。术中仔细操作,可避免损伤腓浅神经及腓动脉。②成功制作20侧动物模型,通过外侧切口骨筋膜室减压术,使犬小腿骨筋膜室压力由术前的33.3±2.18mmHg下降至6±3.56mmHg正常水平以下,P=0.0003,P<0.001,减压前后犬小腿骨筋膜室压力具有明显统计学差异。③在临床应用的8病例中,7例术后病情得到迅速控制,1例因就诊时间超过24小时,术后发生创面感染肌肉坏死,给予清创剔除坏死组织多次换药后愈合,但愈后出现小腿缺血性肌挛缩。全部病例,3个月后,根据Edwards评价系统评分,优6例,可1例,差1例。结论：①通过解剖学及动物实验研究证实了外侧切口可同时彻底减压小腿四个骨筋膜室,并在临床应用中初步证实该方法的有效性。②外侧切口治疗小腿骨筋膜室综合征具有减压充分,损伤较小。既保护了小腿内侧皮肤深筋膜间穿支血管的完整性,为二期可能进行小腿皮瓣转移保存供区,又能避免胫骨内侧面及钢板外露。术式简单,能在临床上广泛推广应用。③桃红四物汤在小腿骨筋膜室综合征术后功能恢复方面具有其一定的辅助治疗作用,值得进一步研究。更多还原

【Abstract】 Objective:①Through the anatomy study, design the lateral incision open crus four bone fascia room proof that the surgical anatomic feasibility.②Making dogs crus osteofascial compartment syndrome of animal models and use the lateral incision decompression treatment, test the validity of this method.③Based on the lateral incision rows of curs bone fascia room decompression and postoperative cooperate with Tao Hong Si Wu soup decoction clinical cases of research and analysis, discusses this treatment efficacy and advantages.Materials and methods:①This experiment specimens for 5 side fresh frozen adult calf. Design the lateral incision open crus four bone fascia room surgical approach, and in the specimen uplink lateral incision simulation surgery, then press the surgical approaches, observing pterional incision and four bone fascia room with the relationship and the peroneal nerve, phil shallow nerve, phil deep nerve and peroneal artery relationship.②Select healthy adult hybrid dogs only (26 kidneys) 13 in 15-20kg (weight, male and female unlimited) Experiments using Whiteside method for measuring before dog of the fascia room after the normal pressure, according to Wang Zhi Gang little leg muscle film syndrome of animal models of production method of producing animal models, in animal models uplink lateral incision fascia room decompression, again measure its bone fascia chamber pressure Spss16 statistical software, through to the collected data processing, observe whether after decompression organizational pressures below levels dropped to normal and postoperative crus recovery.③The curs to collect cases of osteofascial compartment syndrome by the surgical method and postoperative cooperate with Tao Hong Si Wu soup treatment, after 3 months Ewards evaluation system based on functional recovery degree evaluation this calf.Results:①That the lateral incision from anatomy and unlock crus four bone fascia room feasibility.The peroneal neck from the lateral incision under lateral malleolus 2cm pointed to the 5cm, lateral incision direct lateral fascia room, incision longitudinal incision forward side bone muscle film room, incision to rear can hold opened longitudinally shallow bone fascia room, will the lateral bone fascia rooms and shallow bone fascia room after respectively after forward edge in (?)ibula after a longitudinal incision peroneal deep bone fascia room, to open up to four bone fascia (?)oom. Phil shallow nerve and peroneal artery with surgical approach approaching, intraoperative should avoid damage.②Successful creation 20 sides animal models, through the lateral incisioi bone fascia room decompression, make dogs of the fascia chamber pressure by preoperativ 33.3±2.18mmHg fell to 6±3.56mmHg normal levels below, P=0.0003, P<0.001, before and afte decompression of the fascia dog has significant difference chamber pressure.③In the clinica application of 8 cases,7 postoperative condition rapidly control,1 case for more than 24 hours clinical time wound infection occurred after muscle necrosis, give debridement part eliminate(?) many times the necrotic tissue healing, but appears after changeover calf ischemic muscle contracture. All cases, three months later, Edwards evaluation system according to excellent 7case medium lcase,disqualification 1 case.Conclusion:①Through the anatomy and animal studies confirm the lateral incision ma; simultaneously completely unwind crus four bone fascia room, and clinical application initiall proved that this method is effective.②The lateral incision healing curs osteofascial compartmen syndrome has reduced pressure fully, damage smaller. Protects both skin deep fascia vascula integrity between perforator, may have been for second crus inside flap transfer saved for area, and can avoid tibia lateral and steel exposed. Operation simple, can widely used in clinic.③Tao Hong Wu soup in curs osteofascial compartment syndrome postoperative function recovery has its certaii aspects of auxiliary function, deserves further study.更多还原