發(fā)布時間：2018-04-25 21:34

  本文選題：髖臼骨折 + 外科手術�。� 參考：《鄭州大學》2016年博士論文

【摘要】：髖臼骨折屬于關節(jié)內骨折,后期髖關節(jié)功能的恢復和患者的滿意度均與關節(jié)面的復位質量密切相關。經典的髂腹股溝入路雖然可以應用于除后壁骨折、后柱骨折、后柱合并后壁骨折、橫行合并后壁骨折外的其他六種類型骨折,但由于腹股溝韌帶的限制,采用該入路時無法顯露髖關節(jié),只能通過間接復位;而在植入螺釘時因無法直視關節(jié)面,即使借助術中透視,仍有可能誤入到關節(jié)內,因此對術者的手術經驗和復位技巧要求非常高。另外,術中對髂動靜脈及其周圍淋巴組織的牽拉、剝離等易引起血管損傷、術后深靜脈血栓形成或術后淋巴漏;術中需要切開腹股溝管,如重建不佳可能導致術后腹股溝疝。針對以上不足之處,2008年Farid提出了髂腹股溝下入路,相比較傳統(tǒng)的髂腹股溝入路具有如下優(yōu)勢:(1)該入路通過髂嵴截骨的方式可以顯著擴大外側窗,通過切斷縫匠肌和股直肌可以實現(xiàn)髖臼關節(jié)面的直視下復位;(2)在腹股溝韌帶下方分離結扎腹壁下動脈和旋髂深動脈,理論上可以避免死亡冠的損傷和減少術中出血;(3)無需切開腹股溝管,可以避免腹股溝直疝和斜疝的發(fā)生;(4)無需重建腹股溝管壁,因此閉合切口時間明顯縮短。然而我們在臨床實踐中發(fā)現(xiàn)該入路存在以下問題:(1)因需要切斷股外側皮神經會引起術后灼性神經痛或其支配區(qū)的感覺障礙;(2)縫匠肌和股直肌采用直接切斷于術畢進行縫合重建,因術后制動時間較長會影響術后康復及功能鍛煉;(3)采取在腹股溝韌帶下分離髂股血管進行三窗顯露的方式并未減少對大血管的牽拉損傷;(4)對Fruchard孔下區(qū)完整性的破壞可能會誘發(fā)術后股疝的發(fā)生。因此,如何來減少或避免這些損傷以及由此導致的并發(fā)癥仍需要進一步探討。第一部分:改良髂腹股溝下入路的解剖學研究目的總結髂腹股溝下入路所涉及的解剖結構容易受損傷的原因,探討預防損傷的具體手術技巧及對該入路的改良方法。方法應用20具成人尸體標本,首先按照髂腹股溝下入路步驟切開、分離,然后針對臨床手術“三窗”顯露時涉及到的解剖結構進行上下延伸逐層解剖,觀察、測量、記錄相關解剖結構走行、厚度、長度、角度及毗鄰關系,結合臨床操作分析其易損傷的原因及預防方法。結果髂腹股溝下入路三窗顯露時涉及到的結構易受損傷的解剖特點:1.髂腹下神經和髂腹股溝神經的外側段位于髂嵴上緣及髂結節(jié)內側,如切口外側段位置偏高易損傷;2.股外側皮神經在髂前上棘內側(22.35±1.65)mm穿腹股溝韌帶出骨盆,呈(80.56±10.53)°角入股部,距髂前上棘(43.45±2.26)mm自闊筋膜淺出,因走行角度、穿出骨盆和闊筋膜部位存在較多變異,如不能直視下分離則易受損傷;3.旋髂深動脈31側(77.5%)起始于髂外動脈,因此直接在腹股溝韌帶下尋找并結扎旋髂深動脈較困難;4.縫匠肌與腹股溝韌帶下緣呈(40.23±5.35)°向內下方斜行,覆蓋于股神經和股動靜脈前方,與股神經外側邊分支交匯點到腹股溝韌帶下緣垂直距離約(20.13±6.02)mm,與股動脈交匯點到腹股溝韌帶下緣的距離約(60.03±10.12)mm。縫匠肌、腹股溝韌帶和髂恥弓三者對股神經和髂股血管起到保護和約束作用,術閉需要良好重建;5.腹壁下動脈23側(57.5%)起自于髂外動脈,發(fā)出點到腹股溝韌帶上緣的距離約為(8.81±3.02)mm,術中直接結扎該血管時易導致?lián)p傷;6.髂股血管前方與腹股溝韌帶后壁結合較緊密,在腹股溝韌帶下分離髂股血管并不能減少損傷;7.閉孔神經入小骨盆口處距離骨壁(10.18±2.44)mm,中點處距離骨壁(12.23±0.84)mm,骨折移位或顯露四邊體時易受損傷;8.Fruchard孔下區(qū)為近似四邊形結構,存在多個薄弱部位,髂腹股溝下入路對其造成的廣泛破壞因難以重建而易誘發(fā)多種股疝發(fā)生;9.腹壁下動脈與閉孔動脈的吻合支距離陷窩韌帶約(10.65±3.22)mm,直接切開陷窩韌帶顯露內側窗時易導致?lián)p傷。入路改良的解剖基礎:1.髂恥弓總長約(31.25±1.42)mm,與髂恥隆起連接處致密,不易完整剝離。與腹股溝韌帶內側半呈(22.83±5.79)°夾角,僅有疏松的結締組織充填,容易剝離分開;而夾角頂點距離股動脈外側緣約(18.66±2.35)mm,左右側比較無顯著性差異(P0.05),在此處切開不易損傷股動脈。2.整體觀髂筋膜在整個髂窩內呈一凹陷的近似四邊體結構,近側端較薄弱,向遠端則逐漸增厚。髂筋膜深面及表面有髂肌、腰大肌、股神經和股外側皮神經;生殖股神經和閉孔神經穿髂筋膜處較高,在髂窩處位于髂筋膜前方;髂血管及其周圍淋巴組織、旋髂深動脈腹股溝段位于髂筋膜前方。只要保持髂筋膜完整,在其下方分離不會傷及上述結構。3.陷窩韌帶游離緣厚度僅為(0.23±0.11)mm,結構薄弱,但其與恥骨肌筋膜一同附著于恥骨上支上方,附著點筋膜厚度為(2.23±1.35)mm,結構致密,可于此處完整剝離骨膜及筋膜后放置鋼板。結論1、采用髂腹股溝下入路治療髖臼骨折,手術切口及三窗顯露時易對髂腹下神經、髂腹股溝神經、股外側皮神經、股神經、閉孔神經、生殖股神經、旋髂深動脈、腹壁下動脈及其吻合支造成損傷;并不能減少髂股血管及周圍淋巴組織的牽拉傷;易對Fruchard孔下區(qū)造成損傷,誘發(fā)術后股疝等并發(fā)癥。2、髂筋膜與周圍解剖結構關系密切,對于髂腹股溝下入路,可以通過髂前上棘截骨,于髂筋膜下顯露外側窗,輔以內側小切口顯露恥骨上支的方法進行改良,減少或避免相關的并發(fā)癥。第二部分:應用髂腹股溝下入路與改良入路治療髖臼前部簡單骨折的療效比較目的比較應用髂腹股溝下入路與改良入路治療髖臼前部骨折的療效。方法回顧性分析13例應用改良的髂腹股溝下入路(A組)和21例應用髂腹股溝下入路(B組)治療的髖臼前部骨折(前壁、前柱和橫行骨折)的臨床資料。對兩組的手術時間、術中出血量、Matta放射學評分的優(yōu)良率及骨折的愈合時間進行比較。比較兩組最后隨訪時的改良d’Aubigné-Postel功能評分和髖關節(jié)的活動度。結果兩組患者的性別、年齡、骨折分型、自受傷到手術的間隔時間差別均無統(tǒng)計學意義,具有可比性(P0.05)。A組的手術時間平均為90min(60~160min),B組為110min(90~210min),兩組之間差異有統(tǒng)計學意義(P㩳0.05);A組的平均失血量為530m L(400~1050m L),B組平均為830m L(600~1250m L),兩組差異有統(tǒng)計學意義(P㩳0.05)。A組和B組的骨折愈合時間分別為20w(14~23w)和22w(15~25w);Matta放射學評分優(yōu)良率分別為84.61%和90.48%;改良d’Aubigné-Postel評分優(yōu)良率分別為92.30%和90.48%;關節(jié)活動度A組前屈(103.34±10.27)°后伸(10.23±5.12)°,B組前屈(106.13±12.33)°后伸(11.01±3.12)°。兩組Matta放射學評分優(yōu)良率、骨折愈合時間、改良d’Aubigné-Postel功能評分和髖關節(jié)活動度無顯著性差異(P㧐0.05)。A組1例脂肪液化、3例腿肌間靜脈血栓,無切口感染、神經損傷或麻痹、術后淋巴漏、內固定松動等并發(fā)癥,B組21例均出現(xiàn)股外側皮神經麻痹癥狀,另有2例脂肪液化、2例深靜脈血栓、3例小腿肌間靜脈血栓、3例術后淋巴漏和5例隱性股疝。結論與髂腹股溝下入路相比,應用改良髂腹股溝下入路治療髖臼前部骨折可以避免股外側皮神經損傷,減少并發(fā)癥,并在縮短手術時間,減少出血量方面具有優(yōu)勢。第三部分:應用改良髂腹股溝下入路治療髖臼復雜骨折的臨床研究目的探討應用改良髂腹股溝下入路即髂筋膜下顯露外側窗聯(lián)合內側小切口顯露恥骨上支的方法治療髖臼復雜骨折的可行性及臨床療效。方法2012年1月到2015年6月采用改良髂腹股溝下入路治療22例髖臼復雜骨折,男12例,女10例,年齡22~56歲,平均37.0歲。根據(jù)Judet-Letournel分類:T形骨折4例,前柱合并后半橫形骨折5例,雙柱骨折13例。采用單一改良髂腹股溝下入路19例,聯(lián)合Kocher-Langenbeck入路3例。應用Matta放射學標準評價術后復位情況;改良d’Aubigné-Postel評分系統(tǒng)評價髖關節(jié)功能。結果22例患者手術時間平均110min(80~210min);出血量平均770m L(650~1250m L)。術后出現(xiàn)3例脂肪液化,5例小腿肌間靜脈血栓,5例深靜脈血栓。無切口感染、坐骨神經、股神經及股外側皮神經損傷表現(xiàn)及術后淋巴漏。22例患者獲得平均18個月(8~22個月)隨訪,骨折平均愈合時間為22周(14~26周)。術后骨折復位質量根據(jù)Matta放射學標準評定:優(yōu)11例,良5例,可3例,差3例,優(yōu)良率(72.73%)。最后隨訪時間無內固定松動、斷裂及腹股溝區(qū)疝,根據(jù)改良的d’Aubigné-Postel評分系統(tǒng):優(yōu)13例,良5例,可3例,差1例,優(yōu)良率(81.82%)。評價為差的1例患者于術后9個月出現(xiàn)FicatⅣ期股骨頭壞死,行全髖關節(jié)置換術。結論改良髂腹股溝下入路廣泛的顯露不但保障了前柱及前壁的直視下復位和固定,也利于后柱螺釘?shù)臏蚀_置入,可以應用于髖臼復雜骨折的一些亞型。結合完善的術前準備,術后感染、血腫、深靜脈血栓等并發(fā)癥的預防以及正確的康復訓練可以取得理想的療效。
[Abstract]:The fracture of the acetabulum belongs to the intra-articular fracture. The recovery of the posterior hip function and the satisfaction of the patients are closely related to the quality of the articular surface reduction. The classic iliac inguinal approach can be applied to the posterior wall fracture, posterior column fracture, posterior wall fracture, and other six types of fractures outside the posterior wall fracture, but the abdomen is due to the abdomen. The limitation of the groin ligament is that the hip joint can not be exposed at the time of the approach, only by indirect reduction, but the inability to look at the articular surface when the screw is implanted, even with the help of intraoperative fluoroscopy, is still possible to enter the joint. Therefore, the operation experience and the reduction skills are not often high. In addition, the iliac vein and its peripheral lymph nodes are used in the operation. Retraction, divestiture, etc. easily cause vascular damage, deep venous thrombosis or postoperative lymphatic leakage; intraoperative incision of the groin tube, such as poor reconstruction, may lead to postoperative inguinal hernia. For the above deficiencies, the lower iliac inguinal approach was proposed by Farid in 2008 compared with the traditional iliac approach: (1) the following advantages The lateral window can be significantly expanded through the osteotomy of the iliac crest. The reduction of the articular surface of the acetabulum can be achieved by cutting the sartorius and the rectus femoris. (2) the ligation of the lower abdominal artery and the deep iliac artery under the inguinal ligament can theoretically avoid the injury of the dead crown and reduce the intraoperative bleeding; (3) no inguinal canal is not needed. It is possible to avoid direct inguinal hernia and oblique hernia; (4) there is no need to reconstruct the wall of the inguinal canal, so the closure of the incision is obviously shortened. However, we found the following problems in clinical practice: (1) the need to cut the lateral femoral cutaneous nerve to cause postoperative burning nerve pain or the sensory disturbance in its dominating area; (2) the sartorius and rectus femoris The postoperative rehabilitation and functional exercise can be affected by a long period of closure with a longer period of brakes. (3) the way to separate the iliac femoral vessels under the inguinal ligament for the three window exposure does not reduce the traction damage to the large vessels; (4) the damage to the integrity of the suborifice of the Fruchard may induce the post operative hernia. Therefore, how to reduce or avoid these injuries and the resulting complications still need to be further explored. Part 1: to improve the anatomical study of the inferior inguinal approach, to summarize the causes of the anatomical structures involved in the inferior inguinal approach, and to explore the specific surgical techniques for the prevention of injury and the approach to this approach. Methods 20 adult cadavers were used to cut and separate the specimens according to the procedure of the iliac inguinal approach. Then the anatomical structures involved in the clinical operation "three windows" were dissected, observed, measured, and recorded the related anatomical structure, thickness, length, angle and adjacent relationship, combined with clinical exercises. Results the causes and prevention methods of the injuries were analyzed. Results the anatomical features of the structures involved in the three window of the ilio inguinal approach were revealed: 1. the lateral segment of the iliac inferior nerve and the ilio inguinal nerve located at the upper iliac crest and the medial iliac nodules, such as the high location of the lateral incisional segment, and the 2. femoral lateral cutaneous nerve in the anterior superior iliac spine. The lateral (22.35 + 1.65) mm of the inguinal ligament was out of the pelvis, (80.56 + 10.53) angle into the femoral part, and from the anterior superior iliac spine (43.45 + 2.26) mm from the fascia. There were many variations in the position of the pelvis and the fascia lata because of the walking angle, for example, it was easy to be damaged in the part of the pelvis and the fascia lata; the 31 side of the 3. deep iliac artery (77.5%) started from the external iliac artery, so it was directly in the middle of the iliac artery. It is difficult to find and ligate the deep iliac artery under the inguinal ligament; the 4. sartorius muscle and the inferior inguinal ligament are (40.23 + 5.35) degrees inward, covering the femoral nerve and the femoral vein. The vertical distance from the lateral branch of the groin to the inferior edge of the inguinal ligament is about (20.13 + 6.02) mm, and the intersection of the femoral artery to the groin is toughened. The distance of the lower margin (60.03 + 10.12) mm. sartorius, inguinal ligaments and iliac iliac arches played a protective and binding role in the femoral and iliac femoral vessels, and the operation closed to a good reconstruction; the 5. abdominal inferior artery 23 (57.5%) from the external iliac artery, the distance from the point to the inguinal ligament was about (8.81 + 3.02) mm, and the blood was directly ligated during the operation. Guan Shiyi caused injury; 6. the front of the iliac ligament was closely associated with the posterior ligament of the inguinal ligament, and the separation of the iliac femoral vessels under the inguinal ligament could not reduce the damage; 7. the obturator nerve was located at the mouth of the bone (10.18 + 2.44) mm, and the middle point was distance from the bone wall (12.23 + 0.84) mm. The fracture was displaced or exposed to the quadrangular body, and the 8.Fruchard hole was easily damaged. The lower region is an approximate quadrilateral structure, and there are many weak parts. The extensive destruction caused by the inferior inguinal approach is easy to induce multiple inguinal hernia. The anastomosis branch of the inferior wall artery and the closed artery of the 9. abdomen is about (10.65 + 3.22) mm, and the direct incision of the lacunae ligament exposes the medial window to the injury. Good anatomical basis: 1. the total length of the 1. iliac arch is about (31.25 + 1.42), which is dense and not easy to peel off with the iliac hump. It is half (22.83 + 5.79) angle with the inside of the inguinal ligament, only loose connective tissue is filled and easily stripped and separated, but the angle of the apex is about (18.66 + 2.35) mm, and there is no significant difference between the left and right sides. P0.05, the incision is not easy to damage the femoral artery.2. as a whole, and the iliac fascia in the whole iliac fossa is an approximate quadrangular structure in the whole iliac fossa. The proximal end is weak, and gradually thickens to the distal end. The deep surface and surface of the iliac fascia have iliac muscle, the psoas muscle, the femoral nerve and the lateral femoral cutaneous nerve; the genital and obturator nerve and the iliac fascia are higher. The iliac fossa is located in front of the iliac fascia; the iliac vessel and its peripheral lymphatic tissue and the inguinal segment of the deep iliac artery are located in front of the iliac fascia. As long as the iliac fascia is intact, the separation below it will not hurt the thickness of the free margin of the.3. lacunar ligament (0.23 + 0.11) mm and the structure is weak, but it is attached to the suprapubic branch with the pubis myofascial membrane. Above, the thickness of the attachment point was (2.23 + 1.35) mm, and the structure was dense, and the plate could be placed after the entire periosteum and fascia. Conclusion 1, the iliac inguinal approach was used to treat the acetabular fracture. The surgical incision and the three window were easily exposed to the iliofabastric nerve, the ilio inguinal nerve, the lateral femoral cutaneous nerve, the femoral nerve, the obturator nerve and the reproduction of the femoral nerve. The deep iliac artery, inferior epigastric artery and its anastomotic branch are damaged, and it can not reduce the traction of the iliac femoral vessels and peripheral lymphatic tissue; it is easy to cause damage to the suborifice of the Fruchard and induce postoperative complications such as.2, the iliac fascia is closely related to the surrounding anatomy, and the inferior iliac inguinal approach can be used for the iliac anterior upper spine osteotomy and iliac iliac. Subfascial exposure of the lateral window with a small medial incision to expose the superior branch of the pubic symphysis to reduce or avoid related complications. Second part: comparison of the efficacy of the inferior inguinal approach and improved approach for the treatment of simple fracture of the anterior acetabulum; the application of the iliac femoral subtrench approach and improved approach for the treatment of the anterior acetabular fracture Methods the clinical data of 13 cases of the modified iliac inferior inguinal approach (group A) and 21 cases of the anterior, anterior and transverse fractures of the acetabulum treated by the inferior inguinal approach (group B) were retrospectively analyzed. The operative time, the amount of intraoperative bleeding, the good rate of Matta radiological score and the healing time of the fracture were compared between the two groups. Compared with the improved d 'Aubign e -Postel function score and the hip joint activity at the last follow-up of the two groups. Results there were no significant differences in the sex, age, fracture type and interval between the two groups of patients and the interval between the injury to the operation, and the average operation time of the.A group was 90min (60~160min), and the B group was 110min (90~210min). The difference between the two groups was statistically significant (P? 0.05); the average blood loss in the group A was 530m L (400~1050m L), the average of the B group was 830m L (600~1250m L), and the two groups were statistically significant (P? 0.05) and the fracture healing time was 84.61% and 90.48% respectively. The excellent rate of -Postel score was 92.30% and 90.48%, joint activity A (103.34 + 10.27) degrees (10.23 + 5.12) degrees, B group forward flexion (106.13 + 12.33) degrees (11.01 + 3.12) degrees. The excellent rate of Matta radiology score, fracture healing time, improved d 'Aubign e -Postel function score and hip joint activity were no significant difference (P? 0) 5) in group.A, 1 cases of fat liquefaction, 3 cases of intermuscular venous thrombosis, no incision infection, nerve injury or paralysis, postoperative lymphatic leakage, internal fixation loosening and other complications, 21 cases in group B all had lateral femoral cutaneous nerve paralysis, 2 cases of fat liquefaction, 2 cases of deep venous thrombosis, 3 cases of intermuscular venous thrombosis, 3 cases of postoperative lymphatic leakage and 5 recessive hernia. Compared with the inferior inguinal approach, the modified iliac inguinal approach in the treatment of the anterior acetabular fracture can avoid the lateral femoral cutaneous nerve injury, reduce the complications, and have advantages in shortening the operation time and reducing the amount of bleeding. The third part: the clinical study of the modified iliac inferior groin approach for the treatment of the complex fracture of the acetabulum The feasibility and clinical efficacy of the modified iliac inferior inguinal subfascia under the external iliac fascia exposed to the lateral window and the small medial incision to reveal the superior branch of the pubis in the treatment of the complex fracture of the acetabulum. Methods from January 2012 to June 2015, the modified iliac inguinal approach was used to treat 22 cases of complex fracture of the acetabulum, 12 males and 10 females, with an average age of 37. years, averaging 37.. 0 years old. According to Judet-Letournel classification: 4 cases of T shaped fracture, 5 cases of anterior column with posterior semi transverse fracture and 13 cases of double column fracture. 19 cases with single improved iliac inferior inguinal approach and 3 cases with Kocher-Langenbeck approach were used to evaluate the postoperative reduction with Matta radiology standard; the modified D 'Aubign e -Postel scoring system was used to evaluate hip function. 22 results 22 The average operation time of the patients was 110min (80~210min), the average bleeding volume was 770m L (650~1250m L). 3 cases of fat liquefaction, 5 cases of intermuscular venous thrombosis, 5 cases of deep venous thrombosis, no incision infection, sciatic nerve, femoral nerve and lateral femoral cutaneous nerve injury, and postoperative lymphatic leakage of.22 cases were followed up for 18 months (8~22 months). The average healing time of fracture was 22 weeks (14~26 weeks). The quality of fracture reduction was evaluated according to Matta radiological criteria: excellent 11 cases, good 5 cases, 3 cases, 3 poor cases, excellent rate (72.73%). The final follow-up time had no internal fixation loosening, fracture and inguinal hernia, according to improved d 'Aubign e -Postel scoring system: excellent 13 cases, good 5 cases, 3 cases, 1 cases, poor 1 case, fine 1 cases, fine 1 cases, excellent and good Rate (81.82%). 1 patients with poor evaluation appeared Ficat IV necrosis of the femoral head and total hip replacement at 9 months after operation. Conclusion the extensive exposure of the improved inferior inguinal approach not only protects the immediate reduction and fixation of the anterior and anterior walls, but also facilitates the accurate placement of the posterior column screws, which can be applied to some of the complicated acetabular fractures. Combination of comprehensive preoperative preparation, postoperative infection, hematoma, deep vein thrombosis and other complications prevention and proper rehabilitation training can achieve satisfactory results.

【學位授予單位】：鄭州大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R687.3;R322.7

【相似文獻】

相關期刊論文 前10條

1 艾合麥提·于素普,闞玉華,木和普里·穆合甫爾買合斯托夫;髂腹股溝帶蒂真皮下血管網皮瓣的解剖及臨床應用[J];新疆醫(yī)科大學學報;2002年02期

2 韓國棟，吳起寧，李長虎，王凱，沈曉鐘，王軍;髂腹股溝軸心交叉皮（骨）瓣在手外科的應用[J];青海醫(yī)藥雜志;1995年04期

3 裘法祖;;髂腹股溝綜合征[J];國外醫(yī)學參考資料.外科學分冊;1974年02期

4 韓國棟;髂腹股溝軸型交叉皮瓣在手外科的應用[J];修復重建外科雜志;1988年02期

5 徐學軍,蔡發(fā)堂,陳智,王保明;髂腹股溝骨皮瓣一期陰莖再造一例[J];中國修復重建外科雜志;1992年03期

6 郁解非;髂腹股溝淋巴清掃術切口的現(xiàn)代概況[J];國外醫(yī)學.外科學分冊;1993年01期

7 梁炳生;劉蔚民;裴連奎;張開健;;髂腹股溝軸型皮(骨)瓣在手外科應用[J];山西醫(yī)藥雜志;1990年01期

8 潘峰,陳振光,林海濱,謝昀,陶圣祥;髂腹股溝區(qū)血供的應用解剖研究及其臨床意義[J];醫(yī)學新知雜志;2004年03期

9 王偉;張志新;潘月海;;伴有神經血管外露的髂腹股溝區(qū)創(chuàng)面的修復[J];中華損傷與修復雜志(電子版);2011年03期

10 李文東;黃劍;方文沖;周丹亞;陳宏;章偉文;;髂腹股溝軸型帶蒂皮瓣修復手部2～5指脫套損傷[J];現(xiàn)代實用醫(yī)學;2008年04期

相關會議論文 前4條

1 李文東;黃劍;方文沖;周丹亞;陳宏;章偉文;;髂腹股溝軸型帶蒂皮瓣修復手部2—5指脫套損傷的療效[A];浙江省醫(yī)學會手外科學分會成立大會暨2008年學術年會論文匯編[C];2008年

2 李軍;高萍;徐堅;蘇爾瞻;連慶泉;;髂腹下、髂腹股溝神經阻滯用于小兒腹股溝手術麻醉的有效性和安全性的臨床研究[A];2007年浙江省麻醉學學術年會論文匯編[C];2007年

3 李葉揚;;應用髂腹股溝部皮瓣帶蒂移植修復燒傷早晚期皮膚缺損[A];中華醫(yī)學會第五次全國燒傷外科學術會議論文匯編[C];1997年

4 楊專;;髂腹股溝下神經周圍柵型封閉治療頑固性ⅢB型前列腺炎療效觀察(附30例臨床報告)[A];中華醫(yī)學會第八次全國男科學學術會議論文集[C];2007年

相關博士學位論文 前1條

1 徐順利;改良髂腹股溝下入路的解剖學基礎與臨床應用[D];鄭州大學;2016年

相關碩士學位論文 前1條

1 潘峰;髂腹股溝區(qū)血供的應用解剖研究及其臨床意義[D];武漢大學;2005年

，

本文編號：1803056