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Injury:胫骨远端骨折MIPO手术如何防止大隐静脉/隐神经损伤

2012-08-09 zhanghaisen 丁香园

目前在胫骨远端骨折的手术治疗中,微创钢板接骨术(Minimally invasive plate osteosynthesis , MIPO)的应用越来越普遍。该技术通过在胫骨远端内侧经皮插入锁定钢板(Locking plates, LP)可实现骨折的相对稳定固定,其对骨折断端血供的保护有利于骨折的早期愈合。 大隐静脉(great saphenous vein, GSV)和隐神经(sapheno

目前在胫骨远端骨折的手术治疗中,微创钢板接骨术(Minimally invasive plate osteosynthesis , MIPO)的应用越来越普遍。该技术通过在胫骨远端内侧经皮插入锁定钢板(Locking plates, LP)可实现骨折的相对稳定固定,其对骨折断端血供的保护有利于骨折的早期愈合。

大隐静脉(great saphenous vein, GSV)和隐神经(saphenous nerve, SN)在小腿处位于胫骨远端的内侧面,因此,采用MIPO技术实施胫骨远端骨折固定的手术过程中,存在GSV和SN的损伤风险。尽管目前多数临床学者很少注意这一问题,且相关研究也鲜有报道,但其重要性却不容忽视。近日发表于Injury杂志的一篇临床研究对此问题进行了关注,并介绍了一种简单的方法用以减少胫骨远端骨折MIPO手术过程中GSV和SN损伤的发生机率。

作者在2008年至2011年间共征募了两组因胫骨远端骨折采用MIPO手术治疗的患者。1组31例,平均年龄为35岁,所有病例均为闭合性骨折,术前无病例存在患足内侧感觉障碍。在胫骨内侧面并平行其长轴做切口,采用传统胫骨远端骨折经皮钢板固定技术实施手术。术后对患足SN支配区的皮肤感觉进行问卷评估。

2组15例,平均年龄为37岁,所有病例也均为闭合性骨折,术前亦无病例存在患足内侧感觉障碍。除了大隐静脉的处理之外,采取的MIPO技术与1组相同。骨折复位、固定前,将一根用于中央静脉置管的0.81 mm直径弹性导针沿着内踝前面从远端插入GSV,直向近端。当软组织肿胀较重时,经皮插入GSV存在困难,此时在内踝远端做一切口,细致的分离出GSV远端,直视下将导针插入GSV。手术过程中,导针的一端置于静脉中,另一端留于体外(1)。骨折复位后,经皮插入LP,导针留于皮下,C臂透视下可见导针走行(2)。导针的位置即为GSV的走行方向。术后立即取出导针。同样,术后对患足SN支配区的皮肤感觉进行问卷评估。术后4周对GSV行彩色Doppler检查。


1.软组织肿胀较重者,在内踝末端做一切口,解剖分离GSV远端,直视下插入弹性导针。骨折复位后,在内踝内侧面经皮插入LP。


2.透视下可见插入导针(实线箭头)后GSV的走行位置,此时对存在损伤风险的螺钉孔进行定位(空心箭头)。

两组术后的SN支配区皮肤感觉问卷调查结果见1。2组病例术后GSV均未发生穿刺点异常出血,彩色Doppler检查显示,GSV血流畅通。根据其研究结果,作者认为,对于胫骨远端骨折的MIPO手术而言,该技术可安全、准确地对GSV走行进行术中定位。

1.两组病例术后的感觉障碍评估结果

原文链接:

Wang X, Chang SM, Yu GR, Ma Z. A simple method to protect the great saphenous vein and saphenous nerve in percutaneous plate fixation of distal tibial fractures.Injury. 2012 Jul;43(7):1216-8.

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    2012-11-01 fusion
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    2012-10-24 xuqianhua
  4. [GetPortalCommentsPageByObjectIdResponse(id=1662709, encodeId=d8e61662e0933, content=<a href='/topic/show?id=a3d644038c3' target=_blank style='color:#2F92EE;'>#大隐静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44038, encryptionId=a3d644038c3, topicName=大隐静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98ce25462322, createdName=ms306040998833292, createdTime=Tue Oct 16 06:48:00 CST 2012, time=2012-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697142, encodeId=add9169e142f2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Nov 01 15:48:00 CST 2012, time=2012-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877858, encodeId=056a18e785862, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Wed Oct 24 03:48:00 CST 2012, time=2012-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1818898, encodeId=6f0a181889833, content=<a href='/topic/show?id=cd90985457e' target=_blank style='color:#2F92EE;'>#隐神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98545, encryptionId=cd90985457e, topicName=隐神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Tue Jan 15 02:48:00 CST 2013, time=2013-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396710, encodeId=4e031396e1079, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412124, encodeId=828f1412124a4, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510808, encodeId=eb4b1510808fd, content=<a href='/topic/show?id=f98210002a8' target=_blank style='color:#2F92EE;'>#IPO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10002, encryptionId=f98210002a8, topicName=IPO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a1910256881, createdName=dzx0922892, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1584260, encodeId=8d031584260f6, content=<a href='/topic/show?id=ee6de4320c6' target=_blank style='color:#2F92EE;'>#神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74320, encryptionId=ee6de4320c6, topicName=神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=771e17042997, createdName=LShY0906_98743849, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1662709, encodeId=d8e61662e0933, content=<a href='/topic/show?id=a3d644038c3' target=_blank style='color:#2F92EE;'>#大隐静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44038, encryptionId=a3d644038c3, topicName=大隐静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98ce25462322, createdName=ms306040998833292, createdTime=Tue Oct 16 06:48:00 CST 2012, time=2012-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697142, encodeId=add9169e142f2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Nov 01 15:48:00 CST 2012, time=2012-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877858, encodeId=056a18e785862, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Wed Oct 24 03:48:00 CST 2012, time=2012-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1818898, encodeId=6f0a181889833, content=<a href='/topic/show?id=cd90985457e' target=_blank style='color:#2F92EE;'>#隐神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98545, encryptionId=cd90985457e, topicName=隐神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Tue Jan 15 02:48:00 CST 2013, time=2013-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396710, encodeId=4e031396e1079, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412124, encodeId=828f1412124a4, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510808, encodeId=eb4b1510808fd, content=<a href='/topic/show?id=f98210002a8' target=_blank style='color:#2F92EE;'>#IPO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10002, encryptionId=f98210002a8, topicName=IPO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a1910256881, createdName=dzx0922892, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1584260, encodeId=8d031584260f6, content=<a href='/topic/show?id=ee6de4320c6' target=_blank style='color:#2F92EE;'>#神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74320, encryptionId=ee6de4320c6, topicName=神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=771e17042997, createdName=LShY0906_98743849, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1662709, encodeId=d8e61662e0933, content=<a href='/topic/show?id=a3d644038c3' target=_blank style='color:#2F92EE;'>#大隐静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44038, encryptionId=a3d644038c3, topicName=大隐静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98ce25462322, createdName=ms306040998833292, createdTime=Tue Oct 16 06:48:00 CST 2012, time=2012-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697142, encodeId=add9169e142f2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Nov 01 15:48:00 CST 2012, time=2012-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877858, encodeId=056a18e785862, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Wed Oct 24 03:48:00 CST 2012, time=2012-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1818898, encodeId=6f0a181889833, content=<a href='/topic/show?id=cd90985457e' target=_blank style='color:#2F92EE;'>#隐神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98545, encryptionId=cd90985457e, topicName=隐神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Tue Jan 15 02:48:00 CST 2013, time=2013-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396710, encodeId=4e031396e1079, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412124, encodeId=828f1412124a4, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510808, encodeId=eb4b1510808fd, content=<a href='/topic/show?id=f98210002a8' target=_blank style='color:#2F92EE;'>#IPO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10002, encryptionId=f98210002a8, topicName=IPO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a1910256881, createdName=dzx0922892, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1584260, encodeId=8d031584260f6, content=<a href='/topic/show?id=ee6de4320c6' target=_blank style='color:#2F92EE;'>#神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74320, encryptionId=ee6de4320c6, topicName=神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=771e17042997, createdName=LShY0906_98743849, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=)]
    2012-08-11 yb6561
  7. [GetPortalCommentsPageByObjectIdResponse(id=1662709, encodeId=d8e61662e0933, content=<a href='/topic/show?id=a3d644038c3' target=_blank style='color:#2F92EE;'>#大隐静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44038, encryptionId=a3d644038c3, topicName=大隐静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98ce25462322, createdName=ms306040998833292, createdTime=Tue Oct 16 06:48:00 CST 2012, time=2012-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697142, encodeId=add9169e142f2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Nov 01 15:48:00 CST 2012, time=2012-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877858, encodeId=056a18e785862, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Wed Oct 24 03:48:00 CST 2012, time=2012-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1818898, encodeId=6f0a181889833, content=<a href='/topic/show?id=cd90985457e' target=_blank style='color:#2F92EE;'>#隐神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98545, encryptionId=cd90985457e, topicName=隐神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Tue Jan 15 02:48:00 CST 2013, time=2013-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396710, encodeId=4e031396e1079, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412124, encodeId=828f1412124a4, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510808, encodeId=eb4b1510808fd, content=<a href='/topic/show?id=f98210002a8' target=_blank style='color:#2F92EE;'>#IPO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10002, encryptionId=f98210002a8, topicName=IPO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a1910256881, createdName=dzx0922892, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1584260, encodeId=8d031584260f6, content=<a href='/topic/show?id=ee6de4320c6' target=_blank style='color:#2F92EE;'>#神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74320, encryptionId=ee6de4320c6, topicName=神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=771e17042997, createdName=LShY0906_98743849, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=)]
    2012-08-11 dzx0922892
  8. [GetPortalCommentsPageByObjectIdResponse(id=1662709, encodeId=d8e61662e0933, content=<a href='/topic/show?id=a3d644038c3' target=_blank style='color:#2F92EE;'>#大隐静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44038, encryptionId=a3d644038c3, topicName=大隐静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=98ce25462322, createdName=ms306040998833292, createdTime=Tue Oct 16 06:48:00 CST 2012, time=2012-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697142, encodeId=add9169e142f2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Nov 01 15:48:00 CST 2012, time=2012-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877858, encodeId=056a18e785862, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Wed Oct 24 03:48:00 CST 2012, time=2012-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1818898, encodeId=6f0a181889833, content=<a href='/topic/show?id=cd90985457e' target=_blank style='color:#2F92EE;'>#隐神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98545, encryptionId=cd90985457e, topicName=隐神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Tue Jan 15 02:48:00 CST 2013, time=2013-01-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396710, encodeId=4e031396e1079, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412124, encodeId=828f1412124a4, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510808, encodeId=eb4b1510808fd, content=<a href='/topic/show?id=f98210002a8' target=_blank style='color:#2F92EE;'>#IPO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10002, encryptionId=f98210002a8, topicName=IPO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a1910256881, createdName=dzx0922892, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1584260, encodeId=8d031584260f6, content=<a href='/topic/show?id=ee6de4320c6' target=_blank style='color:#2F92EE;'>#神经损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74320, encryptionId=ee6de4320c6, topicName=神经损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=771e17042997, createdName=LShY0906_98743849, createdTime=Sat Aug 11 02:48:00 CST 2012, time=2012-08-11, status=1, ipAttribution=)]
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