鼻内镜下鼻整形术同期鼻中隔偏曲畸形矫正

目的探讨鼻内镜下同期矫治鼻畸形及鼻中隔偏曲的手术方法与效果。方法鼻内镜下采用Killian切口和与其相连的大翼软骨间切口,显露畸形鼻骨结构及鼻中隔偏曲部位,松解牵拉力量,鼻中隔成形术消除鼻中隔畸形,截骨及复位鼻骨,使其解剖复位,重塑鼻支架。结果本组27例,均获满意效果,无复发和并发症。结论本方法可同时矫正鼻中隔及外鼻畸形,消除致畸原因,重塑外鼻支架,达到了恢复鼻腔通气功能与外鼻美容的双重效果。     

脊柱畸形截骨矫形的问题与思考

正目前,脊柱截骨矫形术作为一种有效的手术方式,在脊柱畸形,尤其是重度脊柱畸形的治疗中广泛应用。相比单纯的后路内固定术,截骨矫形术对矫正脊柱的畸形,重建脊柱的整体平衡具有更好的疗效。根据截骨的方式和范围,其主要包括Smith-Peterson截骨术(SmithPeterson osteotomy,SPO),经椎弓根截骨术(pedicle     

Septal Harvesting Instruments in Rhinoplasty

BACKGROUND: Septal cartilage is the best graft material for reconstructing the nasal dorsum, columella, and tip. It is the tissue of choice in primary and secondary rhinoplasties, provided that it can be shaped into a desired contour. Because the amount of cartilage obtained with the cutting method using a swivel knife and septal cartilage scissors is insufficient, new instruments and separation methods are needed to compensate for this shortcoming. METHODS: This article presents two new instruments: the spatula suction dissector and the J & D knife. Using the spatula suction dissector, the septal cartilage was separated from the mucoperichondrium. Then, suspending the hook of the J & D knife on the septal caudal border, a 10-mm marginal incision perpendicular to the cartilage edge is made. The spatula suction dissector and/or D knife can effectively separate the tongue-and-groove articulation. RESULTS: The spatula suction dissector, J & D knife, and separation techniques make it possible to harvest sufficient amounts of cartilage in one piece without leaving any behind during rhinoplasty. CONCLUSION: There was a need for improved instrumentation to obtain sufficient cartilage than what is currently available. New instruments that made it easier, faster, and safer to harvest the cartilage are presented.     

Orthopaedic management of spina bifida—part II: foot and ankle deformities

Both congenital and acquired orthopaedic deformities are common in patients with spina bifida. Examples of congenital deformities, which are present at birth, include clubfoot and vertical talus. Acquired developmental deformities are related to the level of neurologic involvement and include calcaneus and cavovarus. Orthopaedic deformities may also result from postoperative tethered cord syndrome. The previously published Part I reviewed the overall orthopaedic care of a patient with spina bifida, with a focused review of hip, knee, and rotational deformities. This paper will cover foot and ankle deformities associated with spina bifida, including clubfoot, equinus, vertical talus, calcaneus and calcaneovalgus, ankle and hindfoot valgus, and cavovarus. In addition, this paper will address the issues surrounding skin breakdown in patients with spina bifida.     

继发性唇红畸形的修复

目的 总结继发性唇红畸形的修复方法 及手术经验.方法 分析110例继发性唇红畸形患者的临床表现,再有针对性的运用六种手术方法 进行治疗,并观察其整复效果及适应证.结果 术后随访3～12个月,测评其满意度.直线缝合法15例,均感满意;梭形L形切除缝合法23例,测评22例,20例满意.交叉三角瓣修复法45例,测评42例,38例满意.双侧矩形瓣修复双侧唇裂术后畸形17例,测评17例,14例满意;去表皮唇红瓣重叠法3例,辅助其他方法 5例,均满意;真皮移植填充修复唇红凹陷畸形7例,均满意.结论 根据唇红继发畸形的具体情况,选择相应的一种或综合性手术方法 ,术中尊重手术基本原则,灵活发挥技巧,可取得良好的疗效.     

双侧“V”形唇红瓣联合口轮匝肌成形术修复双侧唇裂术后凹陷畸形

目的探讨双侧唇裂修复术后继发红唇凹陷畸形的有效矫治方法。方法本组患者26例,均为双侧唇裂一期手术后。术中,首先切除原有瘢痕,解剖分离出两侧口轮匝肌,重建连续的口轮匝肌肌环;然后在双侧红唇瓣上分别设计＂Y＂型切口,三角瓣尖端朝向中线;最后将双侧＂V＂型三角黏膜瓣向中线推进交叉缝合,重建唇珠。结果 26例患者红唇口哨畸形均得以矫正,上唇人中得以延长。所有患者术后随访3个月至2.5年,效果良好。结论在口轮匝肌重建基础上,应用＂V＂型皮瓣推进交叉成形术,是种操作简单、效果良好的修复双侧唇裂术后继发红唇凹陷畸形的方法 。     

单侧完全性唇裂术后鼻唇畸形的修复

目的：介绍一种综合术式一次性整复单侧完全性唇裂术后鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定,以缩窄和平齐鼻底;利用埋没导引针修复鼻翼软骨复位,改善鼻孔形状;带侧翼鼻假体隆鼻突出鼻部和加高鼻翼;上唇M瓣成形修整唇红缘重建唇弓;两红唇瓣覆盖修复红唇部等。结果：单侧完全性唇裂术后继发鼻唇畸形32例,随访20例6个月～2年,外观和效果满意。结论：应用埋线法修复鼻小柱、鼻翼脚、鼻翼软骨复位,M成形术和两红唇瓣覆盖修复红唇部等术式是值得推荐的一种一次性整体修复继发鼻唇畸形的方法。     

Caudal Septal Advancement for Nasal Tip Projection and Support in Rhinoplasty

Background Management of nasal tip projection and support for positioning of the tip represent an important part of rhinoplasty operations that must be handled properly for a final satisfying result. Manipulation of the nasal tip is complex and variable. Plastic surgeons use many techniques to achieve this goal. Methods The authors propose that the caudal septal advancement technique be used to manipulate the positioning of the nasal tip, especially in cases of an underprojected tip and those requiring tip support. The authors prepare a rectangular septal cartilage, which after advancement carries the nasal tip to the desired position. Results This technique is easy to use, and the results are dependable. All the patients who underwent surgery with this technique were satisfied with the result. Conclusion The caudal septal advancement technique presents another good and reliable alternative for managing nasal tip projection and support. Presented at the 10th Congress of European Society of Plastic Reconstructive and Aesthetic Surgery 2005, 30 August to 3 September 2005, Vienna, Austria     

The Spreader-Splay Graft Combination: A Treatment Approach for the Osseocartilaginous Vault Deformities Following Rhinoplasty

Deformities following primary rhinoplasty may be located at different anatomical regions related to the primary operation. Osseocartilaginous vault deformities such as open roof deformity, over-resected bony and cartilaginous dorsum, excessive width of the middle vault, inverted-V deformity and middle vault collapse are the most frequent ones. Stair-step deformity combined with middle vault problems is uncommon. Patients with these deformities not only have poor aesthetic results, but also have moderate or severe respiratory problems due to the severity of the deformity. Spreader grafts, onlay grafts and biomaterials can be used to correct these deformities. We preferred to use the spreader-splay graft combination for severe osseocartilaginous vault deformities. In this paper we present 3 cases. Two cases had severe open roof deformity, middle vault collapse and over resection of the osseocartilaginous hump, along with severe respiratory problems. The Spreader-splay graft combination was used, along with lateral osteotomy and medialization of nasal bones to treat these patients. One patient had a very severe stair-step deformity due to over resection of the hump and excessive infracturing of nasal bones along with severe respiratory problems due to collapse of the middle vault. This deformity was corrected with proper outfracturing along the old osteotomy site and the use of spreader-splay graft combination. All patients had good aesthetic and functional outcome after the surgery. In conclusion, the spreader-splay graft combination provides a good anatomical restoration to obtain a better respiratory function and aesthetic outcome on severe osseocartilaginous vault deformities following rhinoplasty.     

Horizontal right axillary minithoracotomy: aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers

Introduction

Congenital heart defects treatment shows progressive reduction in morbidity and mortality, however, the scar, resulting from ventricular (VSD) and atrial septal defect (ASD) repair, may cause discomfort. Right axillary minithoracotomy approach, by avoiding the breast growth region, is an option for correction of these defects that may provide better aesthetic results at low cost. Since October 2011, we have been using this technique for repairing VSD and ASD defects as well as associated defects.

Objectives

To evaluate the efficacy of this method in children undergoing correction of VSD and ASD, to compare perioperative clinical outcomes with those repaired by median sternotomy, and to evaluate the aesthetic result.

Methods

Perioperative clinical data of 25 patients submitted to axillary thoracotomy were compared with data from a paired group of 25 patients with similar heart defects repaired by median sternotomy, from October 2011 to August 2012.

Results

Axillary approach was possible even in infants. There was no mortality and the main perioperative variables were similar in both groups, except for lower use of blood products in the axillary group (6/25) vs. control (13/25), with statistical difference (P =0.04). The VSD size varied from 7 to 15 mm in axillary group. Cannulation of the aorta and vena cavae was performed through the main incision, whose size ranged from 3 to 5 cm in the axillary group, with excellent aesthetic results.

Conclusion

The axillary thoracotomy was effective, allowing for a heart defect repair similar to the median sternotomy, with more satisfactory aesthetic results and reduced blood transfusion, and it can be safely used in infants.     

衰老所致泪槽和睑颊沟出现的断层解剖学研究

目的 研究老年泪槽及睑颊沟形成出现的机制.方法 采用4具60岁以上泪槽及睑颊沟明显显现的尸体标本(男2具,女2具,平均年龄67.2岁),及4具30岁以下无明显泪槽及睑颊沟出现的尸体标本(男2具,女2具,平均年龄23.5岁).对他(她)们的下睑及眶周区域做逐层解剖及断层解剖学检查,通过大体标本及组织切片观察结果,比较两组间差异.结果 老年标本的皮肤、眼轮匝肌均较年轻标本萎缩、松弛,在眼睑较薄皮肤与颧颊部较厚皮肤的交界部位形成泪槽与睑颊沟畸形;年轻人颧部脂肪上缘高于眼轮匝肌睑部与眶部的结合部,老年人颧部脂肪上缘处于眼轮匝肌睑部与眶部的结合部,与泪槽及睑颊沟出现的位置相对应;眼轮匝肌限制韧带起于眶下缘并止于眼轮匝肌睑部与眶部的结合部及眶部眼轮匝肌,老年人较年轻人松弛.结论 泪槽和睑颊沟的形成是衰老的进程所致各层组织松弛、萎缩和下移等综合因素共同作用的自然生理变化的结果,尤其是颧部脂肪上部的萎缩与下移;眶隔及眼轮匝肌限制韧带限制组织下移的作用可能是眶下缘凹陷更加凸显的原因.     

全膝关节置换治疗严重膝内翻伴屈曲畸形的疗效分析

目的：分析全膝关节置换（TKA）治疗严重膝内翻伴屈曲畸形的疗效。方法对2005年1月至2010年10月在本院行 TKA 治疗的25例（36膝）严重膝内翻伴屈曲挛缩畸形患者的临床资料进行回顾性分析,其中男7例,女18例,平均70．5岁（55～80岁）。原发疾病为骨性关节炎22例,类风湿性关节炎3例。术前术后均采用 HSS 膝关节评分系统评分,评价 TKA 的临床疗效。结果25例36膝均获得随访,平均术后随访6年（4～9年）。屈曲挛缩度由术前的（21±63）°减小到（1．1±2．3）°;内翻畸形由术前（35±4．8）°减小到（3±2．1）°;膝关节的活动度由术前（70．5±20．5）°增加到（115．1±5．3）°;膝评分平均为由（33．2±10．5）分提高到（90．7±8．5）分,功能评分平均为（35．5±14．2）分提高到（85．6±10．5）分,其中优21例（28膝）,良2例（3膝）,一般2例（3膝）;优良率为86％。多数病例术后膝关节力线正常,2例残留5°～10°的内翻畸形。结论全膝关节置换治疗严重膝内翻伴屈曲畸形能获得较好的临床效果。     

带蒂眶脂肪瓣在中老年人泪槽和睑颊沟畸形整复术中的应用

目的 探讨中老年人泪槽和睑颊沟畸形的整复方法.方法 1996至2011年,采用经皮眶脂肪释放、带蒂眶脂肪瓣充填的方法矫正中老年泪槽畸形伴或不伴睑颊沟畸形426例,其中初次手术者372例,二次手术者54例.362例术后获得3 ～ 24个月的随访观察.结果 362例随访者中,283例泪槽和睑颊沟畸形完全矫正,79例畸形明显改善;2例二次手术者,由于术前有严重的下睑凹陷,泪槽畸形纠正不满意.结论 经皮眶脂肪释放,带蒂眶脂肪瓣充填的方法,可以有效矫正中老年人泪槽和睑颊沟畸形.     

榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形

目的探讨榫卯型口轮匝肌肌瓣修复单侧唇裂术后继发人中嵴畸形的疗效。方法 2009年1月-2011年8月,收治43例单侧唇裂修复术后继发人中嵴畸形患者。男23例,女20例;年龄18～31岁,平均23.6岁。左侧26例,右侧17例。唇裂采用MillardⅠ式修复15例,MillardⅡ式修复28例。唇裂修复术至此次手术时间为15～30年,平均21.7年。术中切取双侧口轮匝肌肌瓣,水平分成上、下两层;双侧下层肌瓣相互重叠缝合,上层肌瓣形成榫卯型结构,缝合于皮下。结果术后患者切口均Ⅰ期愈合。40例患者获随访,随访时间6～34个月,平均13.4个月。双侧人中嵴隆起、对称,人中凹形态接近正常,上唇动态效果满意。术后6个月38例明显改善,2例改善不明显。结论榫卯型口轮匝肌肌瓣手术操作简便,修复单侧唇裂术后继发人中嵴畸形能较好恢复解剖结构,术后获得良好上唇外形和功能。     

(iii) The valgus and varus knee

Arthritis of the knee commonly leads to valgus or varus deformity. The authors discuss the principles of management of these deformities with total knee replacement. Virtually any deformity can be corrected. The coronal plane deformity must be corrected for a satisfactory long-term outcome to be achieved, and it is mandatory for the surgeon to achieve correct alignment and soft tissue balance. The surgeon needs to understand the soft tissue and bone abnormalities in the arthritic knee in order to make the appropriate bone cuts and soft tissue releases to ensure that the prosthetic joint will function optimally.