Objective To investigate the treatment of outcomes of repairing soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects.Methods From January,2014 to June,2016,7 patients(4 males and 3 females.Patients'age ranged from 18 to 45 years,with an average of 28.5 years) with soft tissue defects on the palmar side of the proximal and middle phalanx of the fingers accompanied by proper digital artery and nerve defects were treated by first dorsal metatarsal artery Flow-through flap,application of color Doppler ultrasound was used in the detection of vascular type before operation.The flap area was from 2.0 cm×2.5 cm to 3.5 cm×5.5 cm.All the donor site of the flap were sutured directly.The patients were followed-up in 1 month,3 months,6 months,12 months,24 months after the surgery,and the results were evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived.These cases were followed-up for 6 to 24 months,average 12 months.All the flaps got satisfactory appearance and good sense function,and 2-PD of the flap averaged 7 mm,ranging from 6 mm to 12 mm.All injured fingers got satisfactory appearance and good sense function,2-PD of the injured fingers averaged 8 mm,ranging from 6 to 15 mm.The donor site incision healed well no obvious scar hyperplasia,good function.Conclusion Application of the first dorsal metatarsal artery Flow-through flap to reconstruct soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects,can achieve good clinical effects.This method can restore the appearance,blood supply and sensation of the injured finger.

Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur.Methods From January 2012 to December 2015,23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma,Changhai Hospital.They were 15 males and 8 females,aged from 19 to 77 years (average,48.3 years).According to the Seinsheimer classification,there were 6 cases of type ⅡB,8 cases of type ⅡC,6 cases of type Ⅲ A,and 3 cases of type ⅢB.Their injuries were caused by traffic accident in 10 cases,falling from a height in 5 cases,and sprain in 8 cases.All patients were treated by closed reduction and anterograde intrarnedullary nailing at lateral decubitus.Their operative time,bleeding volume,fluoroscopic frequency,fracture healing time,functional recovery and complications were recorded and analyzed.Results Their operative time ranged from 55 to 80 min,averaging 65.7 min;their bleeding volumes ranged from 240 to 420 mL,averaging 304.3 mL;their fluoroscopic frequency ranged from 30 to 60 times,averaging 42.7 times.This cohort was followed up for 12 to 28 months (average,17.9 months).Their fracture healing time ranged from 4 to 10 months,averaging 5.5 months.Nonunion occurred in one patient but was cured by secondary operation.The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones,yielding an excellent to good rate of 100％.All the wounds healed by the first intention.No infection,deep vein thrombosis or implant failure was observed.Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur,the body position of lateral decubitus may be a good alternative.

Objective To evaluate the effect of family doctor contracted service system in Shenzhen and explore the influencing factors for families to contract their family doctors. Methods A total of 480 residents were selected from 12 first-class community medical rehabilitation centers in Luohu, Futian and Nanshan districts of Shenzhen. The contents of the survey included the contracting status between the contracted and non-contracted residents, the utilization of four basic public health services, and the difference of satisfaction with community medical rehabilitation centers.Meanwhile, logistic regression was used to explore the important influencing factors of the contracted family doctors. Results The overall contracting rate of residents was 51.9% (248/478), and the lowest contracting rate was 23.1% (27/117) (P<0.05), found among patients under 40 years old.The utilization rate of contracted residents for growth and development examination, maternal health care as well as guidance of chronic disease prevention and treatment was higher than that of non-contracted residents ( P <0.05 ). fees and medical environment, service attitude,medical fees was higher than that of non-contracted residents(P<0.05).The satisfaction for convenience in medical environment, service attitude,medical fees and access to medical service was higher than that of non-contracted residents(P<0.05).The results of binary logistic regression analysis showed that age, education level, occupation ( retirement ) and chronic diseases were important factors affecting the signing of contracts.Conclusions The family doctors tend to be embraced by residents better than before. Family doctors contracted service system is conducive to improving the utilization rate of basic health services, acceptance rate of health services and satisfaction of residents. At the same time, the young population at large requires greater efforts before they can embrace the family doctor system.