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中华解剖与临床杂志
中华解剖与临床杂志

苗华 周建生（执行）

双月刊

2095-7041

jpylc@byyfy.com.cn；3062505@163.com

0552-3062505

233004

安徽省蚌埠市长淮路287号

中华解剖与临床杂志/Journal Chinese Journal of Anatomy and ClinicsCSTPCD
查看更多>>本刊是由解剖学专家临床医学专家共同创办的跨学科学术期刊，以广大解剖与临床工作者为主要读者对象，以促进解剖与临床两大学科间的信息交流为宗旨，坚持基础与临床、理论与实践、普及与提高相结合的工作方针，面向临床，服务于临床。
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    18F-FDG PET/CT显像对肺癌骨转移、前列腺癌骨转移与多发性骨髓瘤的鉴别诊断

    高俊刚尚宇刘翔梁宇霞...
    1-8页
    查看更多>>摘要：目的 探讨18F-脱氧葡萄糖（18F-FDG）正电子发射体层摄影（PET）/CT在肺癌骨转移、前列腺癌骨转移与多发性骨髓瘤（MM）鉴别诊断中的应用价值。 方法 横断面研究。纳入2020年11月—2022年11月西安交通大学第一附属医院均行18F-FDG PET/CT检查的42例肺癌骨转移患者、30例前列腺癌骨转移患者和36例MM患者的临床资料，其中男78例、女30例，年龄33~87岁，分别纳入肺癌组、前列腺癌组和MM组。分析3组患者骨骼病灶的位置分布、骨质破坏类型和最大标准摄取值（SUVmax）的差异。 结果 3组患者年龄、性别比较，差异均有统计学意义（F=9.63、χ2=17.17，P值均<0.001）。3组患者骨骼病灶部位70%以上累及肋骨、脊柱及骨盆，其次好发于四肢；3组患者骨骼病灶位于肋骨、骨盆、四肢、颅骨的差异均有统计学意义（P值均<0.05），位于脊柱和胸骨的差异均无统计学意义（P值均>0.05）。病灶分布位置组间比较显示：前列腺癌组骨转移灶分布于骨盆、四肢者分别为96.7%（29/30）、53.3%（16/30），均多于肺癌组的71.4%（30/42）、19.0%（8/42），差异均有统计学意义（P值均<0.05）；MM组病灶位于肋骨者［100%（36/36）］多于前列腺癌组［70%（21/30）］，位于骨盆者［72.2%（26/36）］少于前列腺癌组［96.7%（29/30）］、位于颅骨者［55.6%（20/36）］多于前列腺癌组和肺癌组［6.7%（2/30）和4.8%（2/42）］，差异均有统计学意义（P值均<0.05）。3组患者骨质破坏类型总体比较的差异有统计学意义（χ2=82.94，P<0.001）：肺癌组和MM组患者骨骼病灶的骨质破坏均以溶骨性病变为主［81.0%（34/42）和94.4%（34/36）］，成骨性病变较少［7.1%（3/42）和2.8%（1/36）］，还有部分混合性病变［11.9%（5/42）和2.8%（1/36）］；前列腺癌组患者则以成骨性病变为主［90.0%（27/30）］。在代谢特征方面，肺癌组、前列腺癌组和MM组的SUVmax水平依次由高到低（F=54.66，P<0.001）。 结论 18F-FDG PET/CT有助于综合评价肺癌骨转移、前列腺癌骨转移和MM病灶的骨质结构和代谢特征，对它们具有较高的鉴别诊断价值。 Objective This study aims to explore the application value of 18F-fluorodeoxyglucose (18F-FDG) positron emission computed tomography (PET)/CT in the differential diagnosis of bone metastasis of lung cancer, bone metastasis of prostate cancer, and multiple myeloma (MM). Methods The study was cross-sectional. The clinical data of 42 patients with bone metastasis of lung cancer, 30 patients with bone metastasis of prostate cancer, and 36 patients with MM treated in the First Affiliated Hospital of Xi'an Jiaotong University from November 2020 to November 2022 were analyzed retrospectively, including 78 males and 30 females, aged 33 to 87 years. All patients underwent 18F-FDG PET/CT examination. They were divided into the lung cancer group, prostate cancer group, and MM group. Differences in 18F-FDG PET/CT examination results of lesion distribution, bone destruction, and maximum standardized uptake value (SUVmax) were analyzed. Results Significant differences in age and gender were observed among the three groups (F=9.63, χ2=17.17,all P values <0.001). More than 70% of the bone lesions in the three groups involved the ribs, spine, and pelvis, followed by the limbs. There were significant differences in ribs, pelvis, limbs and skull among the three groups (all P values <0.05). There were no significant differences in spine and sternum (all P values >0.05). Comparison of lesion distribution between groups showed that: 96.7%(29/30) and 53.3%(16/30) lesions occurred in the pelvis and limbs in the prostate cancer group, respectively, which were higher than those in the lung cancer group(71.4%[30/42] and 19.0%[8/42], respectively), with statistical significance(all P values <0.05). More lesions occurred in the ribs of MM group than in the prostate cancer group [100%(36/36) and 70%(21/30)], less lesions occurred in the pelvis(72.2%[26/30]) than in the prostate cancer group(96.7%[29/30]), and more lesions occurred in the skull than in the prostate cancer group and lung cancer group(55.6%[20/36], 6.7% [2/30], 4.8%[2/42], respectively). All the differences were statistically significant (all P values <0.05). A significant difference in the type of bone destruction was observed among the three groups ( χ2=82.94, P<0.001). Bone destruction in the lung cancer group and MM group was primarily due to osteolytic lesions (81.0%[34/42] and 94.4%[34/36], respectively), and bone destruction caused by osteoblastic lesions was less observed (7.1%[3/42] and 2.8%[1/36], respectively). Some mixed lesions were also observed (11.9%[5/42] and 2.8%[1/36]). In the prostate cancer group, osteoblastic lesions were predominant (90.0%[27/30]). With regard to metabolic characteristics, SUVmax in the lung cancer group, prostate cancer group, and MM group showed a high-to-low order (F=54.66, P < 0.001). Conclusion 18F-FDG PET/CT can be used to evaluate the bone structure and metabolic characteristics in lung cancer, prostate cancer, and MM, and has a high value in the differential diagnosis.

    肺肿瘤前列腺肿瘤骨转移瘤多发性骨髓瘤正电子发射体层摄影/计算机体层成像18F-脱氧葡萄糖

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    18F-PSMA-1007 PET/CT与 18F-FDG PET/CT在脑胶质瘤分级评估中的对比研究

    尚宇刘军李瑞春梁华...
    9-14页
    查看更多>>摘要：目的 对比18F-前列腺特异性膜抗原（18F-PSMA）-1007 正电子发射体层摄影（PET）/CT与18F-脱氧葡萄糖（18F-FDG）PET/CT在脑胶质瘤分级诊断中的应用价值。 方法 回顾性队列研究。纳入2022年8月—2023年3月西安交通大学第一附属医院脑胶质瘤患者32例，其中男16例、女16例，年龄19~79（50.3±13.2）岁。患者术前均行头颅18F-PSMA-1007 PET/CT和18F-FDG PET/CT检查，2次扫描间隔时间均<1周；均接受颅内占位切除术治疗，术后病理WHO分级Ⅱ级14例、Ⅲ6例、Ⅳ级12例。根据WHO分级将患者分为2组：Ⅲ~Ⅳ级18例为高级别胶质瘤（HGG）组，Ⅱ级14例为低级别胶质瘤（LGG）组。观察指标：（1）比较HGG组和LGG组在18F-PSMA-1007 PET/CT和18F-FDG PET/CT图像中病灶最大标准摄取值（SUVmax）、肿瘤/背景比值（TBR）的差异，统计2种不同示踪剂PET/CT显像在诊断HGG和LGG时的灵敏度、特异度和准确度。绘制受试者操作特征曲线并计算曲线下面积（AUC），评估2种示踪剂在胶质瘤分级中的诊断效能。（2）统计HGG组和LGG组中18F-PSMA-1007 PET/CT和18F-FDG PET/CT能够清晰显示病灶边界的病例数，比较2种显像方法在显示病灶边界清晰度上的差异。 结果 LGG组18F-PSMA-1007 PET/CT和18F-FDG PET/CT的SUVmax分别为0.69±0.32、8.87±3.20，TBR分别为1.05±0.45、0.89±0.30；HGG组18F-PSMA-1007 PET/CT和18F-FDG PET/CT的SUVmax分别为5.39±3.88、11.85±3.54，TBR分别为12.99±10.60、1.25±0.54。LGG组18F-PSMA-1007 PET/CT和18F-FDG PET/CT的SUVmax、TBR均小于HGG组，差异均有统计学意义（P值均<0.05）。18F-PSMA-1007 PET/CT的SUVmax和TBR对HGG和LGG分级诊断的灵敏度、特异度、准确度和AUC均高于18F-FDG PET/CT。18F-PSMA-1007 PET/CT中TBR的AUC最高，为0.988（95%可信区间 0.960~1.000），相应的阈值为2.15；18F-FDG PET/CT TBR的AUC最低，为0.694（95%可信区间 0.512~0.877），相应的阈值为0.97。18F-PSMA-1007 PET/CT图像上HGG组和LGG组清晰显示病灶边界的病例均高于18F-FDG PET/CT图像，差异均有统计学意义（P=0.039、0.016）。 结论 18F-PSMA-1007 PET/CT在胶质瘤分级诊断中具有潜在的诊断价值。与18F-FDG PET/CT相比，18F-PSMA-1007 PET/CT在区分高级别和低级别脑胶质瘤时，具有更高的灵敏度、特异度、准确度和诊断效能，可更清晰地描绘病变边界。 Objective This work aims to compare the application value of 18F-prostate specific membrane antigen (PSMA)-1007 positron emission tomography/computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT in the grading of gliomas. Methods A retrospective cohort study was conducted on the data of 32 patients with gliomas who underwent head 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT examinations at the PET Center of the First Affiliated Hospital of Xi'an Jiaotong University from August 2022 to March 2023. The data included 16 males and 16 females, with an age range of 19-79 years (50.3±13.2). All patients underwent intracranial mass resection surgery, and postoperative pathological grading were as follows: 14 patients were classified as WHO grade Ⅱ, 6 patients were classified as grade Ⅲ, and 12 patients were classified as grade Ⅳ. According to the WHO grading, the patients were divided into two groups: 18 patients with grades Ⅲ to Ⅳ were categorized as the high-grade glioma (HGG) group, and 14 patients with grade Ⅱ were categorized as the low-grade glioma (LGG) group. The observation indicators were as follows: (1) Observe the differences in the maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of lesions in 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT images between the HGG group and the LGG group statistically analyze the sensitivity, specificity, and accuracy of the two different tracer PET/CT imaging methods in differentiating between HGG and LGG and utilize the receiver operating characteristic curve and calculate the area under the curve (AUC) to assess the diagnostic performance of two tracers in the grading of gliomas. (2) Count the number of cases in which the lesion boundaries were clearly delineated by 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT in the HGG group and the LGG group, and compare the differences in the clarity of lesion boundary delineation between the two imaging methods. Results In the LGG group, the SUVmax values for 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were 0.69±0.32 and 8.87±3.20, respectively, whereas the TBR values were 1.05±0.45 and 0.89±0.30, respectively. In the HGG group, the SUVmax values for 18F-PSMA-1007 PET/CT and 18F-FDG PET/CT were 5.39±3.88 and 11.85±3.54, respectively, whereas the TBR values were 12.99±10.60 and 1.25±0.54, respectively. In the LGG group, the SUVmax and TBR values for 18F-FDG PET/CT and 18F-PSMA-1007 PET/CT were significantly lower than those of the HGG group (all P values <0.05). SUVmax and TBR of 18F-PSMA-1007 PET/CT showed higher sensitivity, specificity, accuracy, and AUC for distinguishing HGG and LGG compared with those of 18F-FDG PET/CT. In 18F-PSMA-1007 PET/CT, the TBR had the highest AUC of 0.988 (with a 95% confidence interval ranging from 0.960 to 1.000), and the corresponding threshold value was 2.15. By contrast, the TBR's AUC in 18F-FDG PET/CT was the lowest at 0.694 (with a 95% confidence interval ranging from 0.512 to 0.877), with the corresponding threshold value of 0.97. 18F-PSMA-1007 imaging showed a higher number of cases with clearly delineated lesion borders in the HGG and LGG groups compared with 18F-FDG imaging, with statistically significant differences (P=0.039 and 0.016, respectively). Conclusion 18F-PSMA-1007 PET/CT imaging demonstrates potential value in the diagnostic grading of gliomas. Compared with 18F-FDG PET/CT, 18F-PSMA-1007 PET/CT has higher sensitivity, specificity, accuracy and diagnostic effectiveness in distinguishing high-grade and low-grade gliomas, and can more clearly delineate the lesion boundaries.

    神经胶质瘤正电子发射体层摄影/计算机体层成像18F‐脱氧葡萄糖前列腺特异性膜抗原

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    18F-FDG PET/MRI与PET/CT在肾细胞癌原发灶与转移灶诊断中的对比研究

    刘烜利姜双士么雨彤周莹...
    15-23页
    查看更多>>摘要：目的 探讨18F-脱氧葡萄糖（FDG）正电子发射体层摄影（PET）/MRI在诊断肾细胞癌原发灶及转移灶中的应用价值。 方法 横断面研究。纳入2018年3月—2023年4月于武汉大学人民医院经组织学病理确诊的68例肾细胞癌患者临床资料。患者均于同一天先后行全身18F-FDG PET/CT及MRI检查。由2名阅片者观察PET检出的肾细胞癌阳性病灶，包括原发灶及转移灶，在相应的18F-FDG PET/CT和PET/MRI图像上评价清晰度并比较PET阳性病灶的清晰度评分，通过病灶诊断信心评分结果来评价18F-FDG PET/CT或18F-FDG PET/MRI对肾细胞癌的诊断信心评分。 结果 68例肾癌患者中，结合早期及延迟显像，58例患者18F-FDG PET/CT和18F-FDG PET/MRI检出相同数量阳性病灶150个，其中原发灶共58个、淋巴结转移灶44个、肝转移灶28个及骨转移灶20个，PET阳性病灶检出率为85.29%（58/68）。18F-FDG PET/CT原发灶清晰度评分为［3.00（2.00，3.25）分］，低于18F-FDG PET/MRI T1加权像（T1WI）的［4.00（3.00，4.00）分］、T2加权像（T2WI）的［4.00（4.00，4.00）分］及弥散加权成像（DWI）的［4.00（4.00，4.00）分］，差异均有统计学意义（Z=4.91、5.78、5.97，P值均<0.001）。18F-FDG PET/MRI T1WI、T2WI、DWI对肝转移灶的清晰度评分为［3.00（3.00，4.00）］、［4.00（3.00，4.00）］、［4.00（4.00，4.00）］，均优于18F-FDG PET/CT清晰度评分［2.50（1.00，3.00）］，差异均有统计学意义（Z=3.86、3.76、3.96，P值均<0.001）。18F-FDG PET/MRI T1WI、T2WI、DWI对骨转移灶的清晰度评分分别为［3.00（3.00，4.00）］、［4.00（3.00，4.00）］、［4.00（4.00，4.00）］，均优于18F-FDG PET/CT［2.00（1.00，3.00）］，差异均有统计学意义（Z=3.37、3.32、3.55，P值均<0.001）。对于淋巴结转移灶，18F-FDG PET/MRI DWI清晰度评分［3.50（3.00，4.00）］高于18F-FDG PET/CT［3.00（3.00，4.00）］，差异有统计学意义（Z=2.44，P=0.014）。68例患者中阅片人对18F-FDG PET/MRI的诊断信心评分［2.00（2.00，2.00）分］高于18F-FDG PET/CT［1.00（1.00，1.00）分］，差异有统计学意义（Z=4.47，P<0.001）。 结论 18F-FDG PET/CT和18F-FDG PET/MRI对PET阳性病灶的检出率无差异，但后者可提供更好的病灶清晰度和更高的诊断信心评分，且对淋巴结、肝脏及骨转移的显示优于18F-FDG PET/CT。 Objective This study aims to investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) in primary lesions and metastases of renal carcinoma by comparing the overall detection rate, lesion conspicuity, and reader confidence of 18F-FDG PET and computed tomography (CT) with hetero-computer fused 18F-FDG PET/MRI. Methods A cross-sectional study was conducted by retrospectively analyzing 68 patients with renal carcinoma diagnosed by histological pathology at the People's Hospital of Wuhan University from March 2018 to April 2023. All patients underwent whole-body 18F-FDG PET/CT and all-machine fusion 18F-FDG PET/MR examinations on the same day. Two readers observed PET-positive lesions, including primary and metastatic lesions, and evaluated and compared the clarity of PET-positive lesions on corresponding 18F-FDG PET/CT and PET/MRI images. The diagnostic confidence score was used to evaluate the diagnostic rate of 18F-FDG PET/CT or 18F-FDG PET/MRI in renal cell carcinoma. Results Sixty-eight patients with renal carcinoma, by combining early and delayed imaging, 18F-FDG PET/CT and 18F-FDG PET/MRI detected the same number of positive lesions, including 58 primary lesions, 44 lymph node metastasis, 28 liver metastases, and 20 bone metastases. The 18F-FDG PET/CT primary focal clarity score was [3.00 (2.00, 3.25) points], which was lower than those of 18F-FDG PET/MRI T1 weighted image (T1WI) [4.00 (3.00, 4.00) points], T2 weighted image (T2WI) [4.00 (4.00, 4.00) points] and diffusion weighted image (DWI) [4.00 (4.00, 4.00) points], and the differences were statistically significant (Z=4.91, 5.78, 5.97 all P values <0.001). The resolution scores of 18F-FDG PET/MRI T1WI, T2WI, and DWI for hepatic metastasis were [3.00 (3.00, 4.00)], [4.00 (3.00, 4.00)], and [4.00 (4.00, 4.00)], respectively. All of them were better than the18F-FDG PET/CT resolution score of [2.50 (1.00, 3.00)], and the difference was statistically significant (Z=3.86, 3.76, 3.96 all P values < 0.05). For bone metastases, the articulation scores of 18F-FDG PET/MRI T1WI, T2WI and DWI were [3.00 (3.00, 4.00)], [4.00 (3.00, 4.00)], and [4.00 (4.00, 4.00)], which were better than that of18F-FDG PET/CT [2.00 (1.00, 3.00)], and the difference was statistically significant (Z = 3.37, 3.32, 3.55 all P values < 0.05). For lymph node metastasis, the resolution score of 18F-FDG PET/MRI DWI [3.50 (3.00, 4.00)] was higher than that of 18F-FDG PET/CT[3.00 (3.00, 4.00)], and the difference was statistically significant (Z=2.44, P=0.014). Among the 68 patients, the diagnostic confidence score of 18F-FDG PET/MRI [2.00 (2.00, 2.00)] was significantly higher than that of 18F-FDG PET/CT [1.00 (1.00, 1.00)], and the difference was statistically significant (Z=4.47, P<0.001). Conclusion No difference was found in the detection rate of PET-positive lesions between 18F-FDG PET/CT and 18F-FDG PET/MRI, but the latter provided better focal clarity and higher diagnostic confidence scores. 18F-FDG PET/MRI is better than 18F-FDG PET/CT in displaying lymph node, liver, and bone metastases.

    肾肿瘤肾细胞癌18F-脱氧葡萄糖图像融合正电子发射体层摄影磁共振成像

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    18F-FDG PET/CT对早期活动性大动脉炎的诊断价值分析

    刘翔尚宇刘军梁宇霞...
    24-28页
    查看更多>>摘要：目的 探讨18F-脱氧葡萄糖（18F-FDG）正电子发射体层摄影（PET）/CT对早期活动性大动脉炎（TA）患者的诊断价值。 方法 病例对照研究。纳入西安交通大学第一附属医院2020年1月—2022年12月行PET/CT检查的10例早期活动性TA患者的临床资料，其中男2例、女8例，年龄20~72（44.9±17.7）岁，为TA组；选择同期年龄、性别匹配的10例非TA的受检者作为对照组，均行18F-FDG PET/CT显像检查。观察研究对象的显像结果，由2位有经验的影像科医师分别勾画血管病变，测量TA组病变段血管壁与对照组主动脉段血管壁对18F-FDG的最大标准摄取值（SUVmax），比较2组SUVmax的差异。采用Spearman相关性分析方法，探讨TA组病变动脉段血管壁局部对18F-FDG的SUVmax值与红细胞沉降率（ESR）、C反应蛋白（CRP）的关系。 结果 10例早期活动性TA患者18F-FDG PET/CT显像中均可看到主动脉及其主要分支血管壁葡萄糖代谢轻至中度增高。TA组的18F-FDG SUVmax值为3.38±0.85，明显高于对照组的1.68±0.24，差异有统计学意义（t=6.12，P<0.001）。TA组的18F-FDG SUVmax值与ESR无相关性（rs=0.489，P=0.151），与CRP呈正相关（rs=0.758，P=0.011），ESR与CRP间无相关性（rs=0.479，P=0.162）。 结论 18F-FDG PET/CT可准确显示TA的病变范围，并通过血管壁的SUVmax反映TA的活动性，是诊断早期活动性TA的一种可靠的影像学手段。 Objective This paper investigates the diagnostic value of 18F-fluorodeoxyglucose(FDG) positron emission tomography (PET)/computed tomography(CT) in patients with early active takayasu arteritis (TA). Methods A case-control study was conducted. The clinical data of 10 patients with TA who underwent PET/CT examination in the First Affiliated Hospital of Xi 'an Jiaotong University from January 2020 to December 2022, 2 males and 8 females, aged 20-72 (44.9±17.7) years, were included in the TA group, and 10 age- and gender-matched patients without TA were part of the control group. The 18F-FDG PET/CT imaging results of the two groups were observed, and the vascular lesions were delineated by two experienced radiologists. The maximum standardized uptake value (SUVmax) of the vessel wall was measured in the TA group and the control group, and the differences of the SUVmax between the two groups were compared. Spearman correlation analysis was used to explore the relationship between the SUVmax of the diseased artery wall and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the TA group. Results 18F-FDG PET/CT imaging showed mild to moderate increase in glucose metabolism of aorta and its branch vessel walls in the 10 patients with TA. The SUVmax of large arteries in the TA group was 3.38±0.85, which was significantly higher than that in the control group 1.68±0.24 (t=6.12, P<0.001). In the TA group, the SUVmax of large arteries was not correlated with ESR (rs=0.489, P=0.151) but was positively correlated with CRP (rs=0.758, P=0.011), and no correlation existed between ESR and CRP (rs=0.479, P=0.162). Conclusion 18F-FDG PET/CT can accurately reflect the extent of TA lesions and the activity of TA through the SUVmax of the vessel wall, which is a reliable imaging method for the diagnosis of early active TA.

    大动脉炎早期诊断正电子发射体层摄影/计算机体层成像18F-脱氧葡萄糖红细胞沉降率C反应蛋白

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    经椎弓根截骨术联合卫星棒治疗强直性脊柱炎胸腰椎后凸畸形的疗效观察

    陆景顺钱邦平邱勇王斌...
    29-35页
    查看更多>>摘要：目的 探讨经椎弓根椎体截骨术（PSO）联合卫星棒技术治疗强直性脊柱炎（AS）胸腰椎后凸畸形的临床疗效。 方法 回顾性队列研究。纳入2016年9月—2021年6月南京大学医学院附属鼓楼医院29例AS胸腰椎后凸畸形患者，其中男26例、女3例，年龄18~55（35.5±9.9）岁。本组患者均采用单节段PSO联合卫星棒技术治疗。根据围截骨区单侧或双侧使用卫星棒固定，将患者分为2组：单侧组13例，双侧组16例。观察指标：（1）基于患者站立位全脊柱X线侧位片测量和观察患者的矫正效果，比较2组术前、术后即刻及末次随访时矢状面平衡（SVA）、腰椎前凸角（LL）、全脊柱后凸角（GK），以及术后即刻与末次随访时的截骨角（OVA）、融合节段角（AFS）。（2）比较患者并发症发生率，重点观察力学并发症断棒的发生情况。 结果 2组患者的年龄、性别、随访时间、截骨水平等基线资料比较，差异均无统计学意义（P值均>0.05）。29例患者手术均顺利，术后均获得随访，随访时间12~72（26.4±10.7）个月。（1）组内比较：单侧组术前SVA、GK、LL分别为（162.1±53.3）mm、79.7°±16.8°、-9.5°±20.4°，术后即刻分别为（64.1±42.5）mm、34.4°±20°、-44.0°±10.8°，末次随访时分别为（64.2±51.6）mm、34.7°±18.4°、-39.3°±11.9°；双侧组术前分别为（155.4±66.7）mm、68.3°±15.3°、0.6°±18.1°，术后即刻分别为（53.9±45.9）mm、24.9°±14.0°、-40.7°±9.2°，末次随访时分别为（48.6±48.5）mm、25.6°±15.7°、-39.8°±8.5°。2组患者SVA、GK、LL术后均较术前改善明显，差异均有统计学意义（P值均<0.05）；而末次随访与术后即刻比较，各项指标差异均无统计学意义（P值均>0.05）。2组间比较：除双侧组术后即刻的OVA（28.6°±8.8°）明显大于单侧组（19.9°±10.4°），差异有统计学意义（t=-2.42，P=0.023）外，其余影像学参数（SVA、GK、LL、AFS）组间比较差异均无统计学意义（P值均>0.05）。（2）29例患者中有4例出现并发症：单侧组2例（1例术后体位性臂丛神经麻痹、1例术后6年截骨椎水平卫星棒未固定侧断棒），双侧组2例均为术中截骨椎脱位，2组差异无统计学意义（P=1.000）。 结论 PSO联合卫星棒技术治疗AS胸腰椎后凸畸形可获得满意的矫正效果，并有效预防术后矫正丢失和断棒现象。 Objective This study aims to investigate the clinical outcomes of pedicle subtraction osteotomy (PSO) combined with satellite rod technique in the treatment of thoracolumbar kyphosis in ankylosing spondylitis (AS). Methods This study adopted a retrospective cohort. Twenty-nine patients with AS (26 males and 3 females) who underwent single-level PSO combined with satellite rod technique in the Drum Tower Hospital of Nanjing University Medical School from September 2016 to June 2021 were retrospectively reviewed. The patients had an average age of 18 to 55 (35.5±9.9) years and divided into two groups according to the use of satellite rod unilaterally or bilaterally around the osteotomy area: 13 patients were in the unilateral group and 16 patients were in the bilateral group. Observation indicators included the following. (1) The corrective effect of patients was measured based on lateral full-spine X-ray. Radiographic parameters including sagittal vertical axis (SVA), lumbar lordosis (LL), and global kyphosis (GK) were compared between the two groups preoperatively, postoperatively, and at the last follow-up. Osteotomized vertebral angle (OVA) and angle of fused segments (AFS) were compared postoperatively and at the final follow-up. (2) The incidence of complications between the two groups was compared and the mechanical complication of rod breakage were observed. Results No statistical difference was observed in age, gender, and follow-up period between the two groups (all P values>0.05). Twenty-nine patients with AS received surgical treatment successfully and were followed up for 12-72 (26.4±10.7)months. (1) Based on comparison of data within the group, the postoperative SVA, GK, and LL were (64.1±42.5) mm, 34.4°±20°, and -44.0°±10.8°, respectively, and at the last follow-up values were (64.2±51.6) mm, 34.7°±18.4°, and -39.3°±11.9°, respectively, and before surgery, they were (162.1±53.3) mm, 79.7°±16.8°, -9.5°±20.4°, respectively in the unilateral group. In the bilateral group, the postoperative SVA, GK, and LL were (53.9±45.9) mm, 24.9°±14.0°, and -40.7°±9.2°, and the values at the last follow-up were (48.6±48.5) mm, 25.6°±15.7°, and -39.8°±8.5°, respectively, and before surgery they were (155.4±66.7) mm, 68.3°±15.3°, 0.6°±18.1°, respectively. All of above-mentioned parameters were significantly improved compared with the preoperative values, and the differences were statistically significant (allP values<0.05). However, no significant difference was observed between the final follow-up and immediate postoperative parameters (allP values>0.05). Based on comparison of data between two groups (SVA, GK, LL, AFS), no statistically significant difference was detected in the radiographic parameters, except that the postoperative OVA was significantly greater in the bilateral group (28.6°±8.8°vs. 19.9°±10.4°, t=-2.42, P=0.023). (2) Surgical complications occurred in four of the 29 patients. The complications in the unilateral group included 1 case of rod fracture on the side without satellite rod at the level of the osteotomized vertebra that occurred in 6 years after operation and 1 case of postoperative positional brachial palsy. The bilateral group included 2 cases of osteotomized vertebral subluxation. The incidence of complications was not significantly different between the two groups (P=1.000). Conclusion The application of PSO combined with satellite rod technique in the treatment of AS-related thoracolumbar kyphosis could achieve satisfactory correction and effectively prevent mechanical complications and correction loss.

    脊柱炎,强直性脊柱后凸胸腰椎后凸畸形矫形外科手术卫星棒经椎弓根椎体截骨术力学并发症

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    创伤性颈脊髓损伤5年死亡率的危险因素分析及预测模型的构建

    蒋帅吴舜杰吴晓东霍维玲...
    36-42页
    查看更多>>摘要：目的 分析创伤性颈脊髓损伤（TCSCI）5年死亡率的危险因素，探讨据此构建的预测模型对TCSCI 5年死亡率的预测效能。 方法 回顾性队列研究。纳入2010年1月—2017年12月美国脊髓损伤数据库（NSCID）中TCSCI患者2 540例，其中男2 030例、女510例，年龄15~89岁。2 540例患者以3∶1比例按照随机抽样法分为开发队列1 927例和验证队列613例，其中开发队列用于分析危险因素、建立5年死亡率预测模型，验证队列用于预测模型的内部验证。根据开发队列患者伤后5年生存与否分为存活组1 554例和死亡组373例。观察指标：（1）对比开发队列和验证队列TCSCI患者的临床病理特征。（2）对开发队列中2组TCSCI患者临床病理特征、出院后是否因呼吸或泌尿系统疾病再入院、出院后是否需转医疗机构继续治疗等观察指标进行单因素分析和多因素logistic回归分析，分析TCSCI后5年死亡率的独立危险因素。根据危险因素构建预测TCSCI 5年死亡率的列线图模型。（3）对验证队列采用受试者操作特征（ROC）曲线、校准曲线、决策曲线评估列线图模型的性能。 结果 （1）开发队列和验证队列TCSCI患者性别、年龄、合并伤、治疗方式、脊髓损伤程度等临床病理特征比较，差异均无统计学意义（P值均>0.05）。（2）开发队列单因素分析显示：年龄、损伤节段、美国脊髓损伤委员会（ASIA）脊髓损伤分级、椎体骨折、手术、住院期间机械通气、出院后因呼吸/泌尿系统疾病再入院、出院后是否需转医疗机构继续治疗是TCSCI 5年死亡率的影响因素（P值均<0.05）。多因素logistic回归分析显示：年龄、ASIA脊髓损伤分级、住院期间机械通气、出院后因呼吸或泌尿系统疾病再入院、出院后是否需转医疗机构继续治疗是TCSCI 5年死亡率的独立危险因素（P值均<0.05）。根据危险因素构建列线图预测模型，验证队列对列线图预测模型进行内部验证：ROC曲线分析显示，曲线下面积为0.841，95%可信区间 0.817~0.864，阈值为0.219，灵敏度为82.5%，特异度为70.0%，列线图预测模型诊断性能较好；校准曲线分析显示，列线图预测模型预测死亡率和实际死亡率有良好的一致性；决策曲线分析显示，列线图预测模型有较高的临床应用价值。 结论 高龄、入院时高ASIA脊髓损伤分级、住院期间机械通气、出院后因呼吸或泌尿系统疾病再入院、出院后需要去医疗机构继续治疗是TCSCI 5年死亡率的独立危险因素。根据危险因素构建的列线图预测模型对TCSCI患者的5年死亡率具有较好的预测效能。 Objective This study aims to explore the clinical risk factors of the five-year mortality of traumatic cervical spinal cord injury (TCSCI) and the predictive efficacy of the prediction model. Methods In this retrospective cohort study, 2 540 patients were selected from the National Spinal Cord Injury Database from January 2010 to December 2017, including 2 030 males and 510 females with age in the range of 15-89 years. The 2 540 patients were randomly divided into the development cohort (1 927 patients) and the validation cohort (613 patients) in a 3∶1 ratio. The development cohort was used for analyzing of risk factors and establishing a five-year mortality prediction model. The validation cohort was used for the internal validation of the model. According to whether the patients in the development cohort died five years after TCSCI, they were divided into death group (373 patients) and survival group (1 554 patients). Outcome measures: (1) The clinicopathological features of patients with TCSCI in the development cohort and the validation cohort were compared. (2) The clinical baseline data of the two groups of patients with TCSCI in the development cohort, as well as observation indicators such as whether they were readmitted to hospital due to respiratory or urinary diseases after discharge and whether patients should go to a medical institution for further treatment after discharge, were analyzed by univariate analysis and multivariate logistic regression analysis to determine the independent risk factors for the five-year mortality of TCSCI. A nomogram model was constructed to predict the five-year mortality according to the risk factors. (3) In the validation cohort, the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve were used to evaluate the predictive performance of the nomogram model. Results (1) No significant difference existed between the clinicopathological features of patients with TCSCI in the development cohort and the validation cohort in gender, age, combined injury and degree of spinal cord injury (all P values >0.05). (2) Univariate analysis of the development cohort showed age, injury segment, American Spinal Injury Association (ASIA) spinal cord injury grade, vertebral fracture, surgery, mechanical ventilation during hospitalization, readmission to hospital for respiratory or urinary diseases after discharge, and patients should go to a medical institution for further treatment after discharge were the influencing factors for the five-year mortality of TCSCI (all P values <0.05). Multivariate logistic regression analysis showed age, ASIA spinal cord injury grade, mechanical ventilation during hospitalization, readmission for respiratory or urinary diseases after discharge, and patients should go to a medical institution for further treatment after discharge were independent risk factors for the five-year mortality of TCSCI (all P values <0.05). A nomogram prediction model was constructed according to the risk factors, and an internal verification of the nomogram model was conducted on the validation cohort. The ROC curve showed the area under the curve was 0.841, the 95% confidence interval was 0.817-0.864, the threshold was 0.219, the sensitivity was 82.5%, the specificity was 70.0%, and the diagnostic performance of the nomogram model was satisfactory. The calibration curves revealed the predicted and actual five-year mortality probabilities were fitted well. The decision curve analysis demonstrated the clinical value of this nomogram. The calibration curve showed the nomogram prediction model exhibited good consistency between the predicted mortality rate and the actual mortality rate. The analysis of decision curve showed the nomogram prediction model had a high clinical application value. Conclusion The results show advanced age, high ASIA spinal cord injury grade, mechanical ventilation during hospitalization, readmission due to respiratory or urinary system diseases, and patients should go to a medical institution for further treatment after discharge are independent risk factors for the five-year mortality of TCSCI. The nomogram prediction model constructed according to the risk factors displays good prediction performance and which can provide a reference for predicting the five-year mortality of TCSCI.

    脊髓损伤死亡率危险因素列线图模型

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    对等设计微型 甲瓣整形性修复指尖毁损伤的疗效分析

    李秀忠于大志张华刚范筱...
    43-47页
    查看更多>>摘要：目的 探讨对等设计微型甲瓣整形性修复手指尖毁损伤的临床疗效。 方法 病例系列报告。纳入2015年5月—2020年5月海军第971医院及青岛市市立医院收治的应用对等设计微型甲瓣进行整形性修复的手指尖毁损伤患者56例（56指）。56例患者中，男36例，女20例，年龄30~50（40.2±5.4）岁；拇指指尖毁损20例，示指指尖毁损17例，中指指尖毁损10例，环指指尖毁损9例；门挤压伤36例、机器挤压伤20例。指尖软组织缺损范围为0.60 cm×1.00 cm~0.80 cm×1.50 cm，甲床缺损0.40 cm×0.70 cm~0.60 cm×0.80 cm。受伤至手术时间为2~7（4.8±1.4）h。对等设计微型甲瓣的大小为0.71 cm×1.22 cm~0.88 cm×1.71 cm。记录手术情况及术后并发症，计算甲瓣成活率。术后定期随访，记录指甲生长时间，观察手指外观及质地；按照Zook甲床修复评定标准评价指甲修复情况，记录Semmes-Weinstein触压觉、两点分辨觉；应用中华医学会手外科学会上肢部分功能评定试用标准评价手术疗效。 结果 所有患者手术顺利，手术时间2~5（3.5±0.6）h，术中出血量13~27（20.7±4.9）mL；56指移植瓣全部成活，成活率100%。1例患者于术后48 h发生静脉危象，2例患者分别于术后13、17 h发生动脉危象，经手术处理后均成活。所有患者随访20~45（30.8±11.2）个月，指甲生长总时间为6~13（9.7±2.1）个月。末次随访时，56例患者指甲生长正常、指腹螺纹及精细感觉均恢复，指甲无畸形、外形美观逼真，皮瓣外形质地良好，保护性感觉恢复；Zook甲床修复评定标准优38例、良18例，优良率100%；Semmes-Weinstein触压觉0.1~0.2（0.32±0.14）g，两点分辨觉5~9（7.33±1.02）mm；根据中华医学会手外科学会上肢部分功能评定试用标准评定疗效，优秀46例、良好10例，优良率100%。 结论 对等设计微型甲瓣整形性修复手指尖毁损伤手术供区损伤小、毁损手指尖外形美观且功能恢复良好，是治疗指尖毁损伤的有效手术方法。 Objective This study aims to explore the clinical effect of plastic repair of fingertip injury with equivalent mini toenail flap. Methods This case series report with retrospective analysis was conducted on 56 patients (56 fingers) with fingertip injuries treated with equivalent design mini toenail flaps for plastic repair at the No. 971 Hospital of the People's Liberation Arm and Qingdao Municipal Hospital from May 2015 to May 2020. The patients included 36 males and 20 females, aged 30-50 (40.2±5.4) years. Twenty patients had thumb fingertip damage, 17 patients had index fingertip damage, 10 patients had middle fingertip damage, and 9 patients had ring fingertip damage. Moreover, 36 patients had door crush injury and 20 patients had machine crush injury. Fingertip soft tissue defects ranged from 0.60 cm×1.00 cm to 0.80 cm×1.50 cm, and nail bed defects ranged from 0.40 cm×0.70 cm to 0.60 cm × 0.80 cm. The time from injury to operation was 2-7 (4.8±1.4) h. The size of the equivalently designed mini toenail flap was 0.71 cm×1.22 cm to 0.88 cm×1.71 cm. The operative conditions and postoperative complications were recorded and the survival rate of great nail flap was calculated. At the last follow-up, the appearance and texture of fingers were observed. Nail repair was evaluated according to Zook nail-bed repair evaluation criteria. Semmes-Weinstein touch pressure sense and two-point resolution sense were recorded. The trial criteria of upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association were used to evaluate the surgical effect. Results All patients underwent surgery smoothly, with a duration of 2-5 (3.5±0.6) h and intraoperative bleeding of 13-27 (20.7±4.9) mL. All 56 fingers survived, with a survival rate of 100%. One patient developed venous crisis 48 h after surgery, and two patients developed arterial crisis 13 h and 17 h after surgery. All patients survived after surgery. The postoperative follow-up was 20-45 (30.82±11.21) months, and the total nail growth time was 6-13 (9.68±2.11) months. At the last follow-up, 56 patients recovered nail growth, finger thread and fine sensation, no nail malformation, beautiful and realistic appearance, good skin flap shape and texture, and protective sensation. According to the Zook nail bed repair evaluation standard, 38 patients were excellent, 18 patients were good, and the excellent and good rate was 100%. The Semmes Weinstein tactile sense was 0.1-0.2 (0.32±0.14) g, and the two-point resolution angle was 5-9 (7.33±1.02) mm. According to the trial criteria of upper limb function evaluation of the Hand Surgery Society of the Chinese Medical Association, 46 patients were excellent, 10 patients were good, and the excellent and good rate was 100%. Conclusion The plastic repair of fingertip injury with equivalent mini toenail flap has little damage in the donor area, beautiful appearance, and good functional recovery hence, it is an effective surgical method for the treatment of fingertip damages.

    指损伤游离移植整形创面修复

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    老年人股骨粗隆间骨折Inter Tan术后隐性失血影响因素分析及其与预后的相关性

    杨怀阔薛磊商晓迪杨公博...
    48-54页
    查看更多>>摘要：目的 探讨老年股骨粗隆间骨折患者Inter Tan术后隐性失血的危险因素，以及隐性失血与患者预后的相关性。 方法 。 回顾性病例对照研究纳入2018年12月—2022年1月中国中医科学院西苑医院创伤骨科股骨粗隆间骨折患者65例，其中男34例、女31例，年龄60~87（69±5）岁，均采用Inter Tan手术治疗。采集患者临床病理资料，计算患者术后隐性、显性及实际失血量，并采用单因素分析和多元线性回归分析隐性失血的危险因素。以全组患者隐性失血量的均值为界，将患者分为2组，≥均值28例入高隐组，<均值37例入低隐组。比较两组患者骨折愈合时间和术后Harris髋关节功能评分。采用Pearson相关分析隐性失血量与骨折愈合时间和术后Harris髋关节功能评分的相关性。 结果 65例老年股骨粗隆间骨折患者Inter Tan术后实际失血量为（803.5±126.9）mL，其中显性失血量为（104.8±23.8）mL、占13%，隐性失血量为（698.3±113.6）mL、占87%。多元线性回归分析显示，年龄≥75岁、饮酒史、骨折至手术时间≥3 d和手术时间≥60 min为老年股骨粗隆间骨折患者Inter Tan术后隐性失血独立影响因素（标准化回归系数分别为0.128、0.167、0.113和0.109，P值均<0.05）。28例高隐组骨折愈合时间为（12.5±2.3）周，长于37例低隐组的（10.3±2.7）周，差异有统计学意义（t=3.16，P=0.003）。高隐组和低隐组患者术后3、6、12个月Harris评分均较术前升高，差异均有统计学意义（F=112.35、160.72，P值均<0.001）；患者术前Harris评分2组间比较差异无统计学意义（t=0.68，P=0.502），高隐组术后3、6和12个月Harris评分均低于低隐组、差异均有统计学意义（t=2.13、2.16、2.31，P值均<0.05）。Pearson相关分析结果显示，隐性失血量与骨折愈合时间呈正相关性，与术后12个月髋关节功能Harris评分呈负相关性，差异均有统计学意义（r=0.412、-0.301，P值均<0.05）。 结论 隐性失血是老年股骨粗隆间骨折患者Inter Tan围术期失血的主要原因，其影响因素包括患者年龄、饮酒史、骨折至手术时间和手术时间，且与术后骨折愈合时间和Harris髋关节功能评分相关。 Objective This study aims to explore the risk factors of hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery and influence of hidden blood loss on the prognosis of patients. Methods In this retrospective case-control study, 65 patients with femoral intertrochanteric fractures were enrolled from the Department of Orthopedic Trauma of Xiyuan Hospital, China Academy of Chinese Medical Sciences from December 2018 to January 2022. The study participants consisted of 34 males and 31 females, with age of 60-87 (69±5) years old. All patients were treated with Inter Tan surgery. The clinicopathological data were collected, and the hidden, dominant, and actual blood loss volumes after surgery were calculated. The risk factors of the hidden blood loss were analyzed by univariate analysis and multivariate linear regression analysis. The patients were grouped according to the hidden blood loss volume. The cases with hidden blood loss volume greater than or equal to the mean value were included in the high-hidden group (28 cases). Meanwhile, the cases with less than the mean value were enrolled as the low-hidden group (37 cases). The fracture healing time and postoperative Harris hip function score were compared between the two groups. The correlation of hidden blood loss volume with fracture healing time and postoperative Harris hip function score was analyzed by Pearson product-moment coefficient. Results The actual blood loss volume of 65 elderly patients with femoral intertrochanteric fractures after Inter Tan surgery was (803.5±126.9) mL, the dominant blood loss volume was (104.8±23.8) mL (13%), and the hidden blood loss volume was (698.3±113.6) mL (87%). Multivariate linear regression analysis revealed that age ≥75 years old, drinking history, time from fracture to surgery ≥3 d, and surgical time ≥60 min were the independent influencing factors of the hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery (standardized regression coefficient β=0.128, 0.167, 0.113, and 0.109, all P values<0.05). The fracture healing time in the high-hidden group (n=28) was (12.5±2.3) weeks, which was longer than (10.3±2.7) weeks of the low-hidden group (n=37), and the difference was statistically significant (t=3.16, P=0.003). The Harris scores in the high-hidden and low-hidden groups after surgery were significantly enhanced compared with that before surgery, and the differences were statistically significant (F=112.35 and 160.72, all P values <0.001). No statistically significant difference in the preoperative Harris score was observed between the two groups ( t=0.68, P=0.502). The Harris scores in the high-hidden group at 3, 6, and 12 months after surgery were lower than those in the low-hidden group (t=2.13, 2.16, and 2.31, all P values =0.502). The hidden blood loss volume was positively correlated with fracture healing time and negatively correlated with Harris hip function score at 12 months after surgery (t=0.412 and -0.301, all P values <0.05). Conclusion Hidden blood loss is the main cause of perioperative blood loss in elderly patients with femoral intertrochanteric fractures undergoing Inter Tan surgery. The influencing factors of this condition include age, drinking history, time from fracture to surgery, and surgical time. Hidden blood loss is also associated with postoperative fracture healing time and Harris hip function score.

    股骨骨折股骨粗隆间骨折手术后出血老年医学隐性失血危险因素Harris评分

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    肌电图在低位L 4~S 1腰椎间盘突出症定位诊断中的应用价值

    王丹丹蒋玉宝康亮刘玉红...
    55-57页
    查看更多>>摘要：目的 探讨肌电图检查对低位（L4~S1）腰椎间盘突出症患者病变节段的定位诊断价值。 方法 横断面研究。选取2020年10月—2022年9月安徽医科大学第一附属医院脊椎外科108例L4~S1腰椎间盘突出症患者，其中男56例、女52例，年龄30～65岁。108例患者均行腰椎MR和肌电图检查，其中90例患者进行了腰椎手术。分析肌电图对L4~S1腰椎间盘突出症受累神经节段的显示结果，并与患者的腰椎MRI和术中观察结果进行对比分析。 结果 108例L4~S1腰椎间盘突出症患者的肌电图提示102例（94.4%）异常，其中102例针电极肌电图结果异常，43例合并神经传导异常，15例合并F波（胫神经）异常。90例手术患者中有80例（88.9%）肌电图定位的神经根受累节段与术中观察结果一致，差异无统计学意义（χ2=0.46，P=0.988）。108例患者肌电图与腰椎MRI对L4~S1腰椎间盘突出症受累节段的定位诊断和检出受累节段数目的比较，差异均无统计学意义（P值均>0.05）。 结论 在L4~S1腰椎间盘突出症的定位诊断中，肌电图与术中观察及腰椎MRI检出的结果基本一致，且肌电图能反映神经根功能受损情况，弥补腰椎MRI在评估神经功能方面的不足。

    椎间盘退行性变腰椎间盘突出症肌电图定位诊断

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    带部分末节趾骨的足拇甲瓣联合第2趾近趾间关节重塑再造三度缺损拇指

    李建美郑晓飞周明伟刘国印...
    58-61页
    查看更多>>摘要：目的 探讨应用带部分末节趾骨的足拇甲瓣联合第2趾近趾间关节重塑再造三度缺损拇指的临床疗效。 方法 病例系列报告。纳入2016年2月—2022年5月东部战区总医院秦淮医疗区骨科拇指三度缺损的患者35例，其中男23例、女12例，年龄20~50（35.2±11.2）岁，受伤至手术时间2~5 d。患者均为外力所致新鲜开放伤，掌指关节均存在；均采用带部分末节趾骨足拇甲瓣联合第2趾近趾间关节重塑再造三度缺损拇指术治疗，手术分足部供区组、手部受区组2组医师同时进行。观察指标：（1）观察术后早期再造拇指成活及伤口愈合情况。（2）随访观察再造拇指吻合处骨愈合情况，外观、感觉及功能恢复情况；足部供区残端骨愈合情况，外观及功能恢复情况。（3）末次随访时根据中华医学会手外科学会拇指再造功能试用标准评价再造拇指。 结果 35例患者再造拇指全部成活，伤口均一期愈合。其中1例患者术后24 h内发生血管危象，及时处理后完全成活。所有患者随访6~24（15.1±7.1）个月。术后6~12个月，复查再造拇指、足部供区X线片，再造拇指吻合处骨愈合良好，足部供区残端骨愈合良好。术后12~24个月，再造拇指外形大小与正常拇指接近，指甲生长未见明显畸形，指间关节活动可，拇对捏功能、对掌功能良好，再造拇指捏持有力，指腹两点分辨觉5~7 mm，感觉恢复良好，日常生活中手使用情况良好。末次随访时根据中华医学会手外科学会拇指再造功能试用标准评定拇指功能，优33例、良2例，再造拇指外观、感觉及功能均满意。患足负重行走等功能未见受影响，足负重区无皮肤磨破及溃疡形成，无跛行、疼痛等不良并发症，未见明显拇趾外翻畸形。 结论 应用带部分末节趾骨足拇甲瓣联合第2趾近趾间关节重塑再造三度缺损拇指，再造拇指外形、指甲生长、指间关节活动均较好，拇指功能基本恢复，供区影响小，是一种理想的手术方法。

    指损伤拇指三度缺损足拇甲瓣再造

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