胸骨抬举加肋软骨成形治疗小儿漏斗胸

目的 总结胸骨抬举加肋软骨成形治疗小儿漏斗胸的经验。方法 1994年1月至2003年10月，采用胸骨楔形切骨后缝合固定和肋软骨部分切除成形后缝合固定的方法治疗57例漏斗胸小儿，随访6个月～10年，内容包括胸廓外形、临床症状、胸部X线正侧位片。结果 无手术死亡，除1例术后6个月胸骨出现轻度下陷外，其余矫形效果满意，临床症状明显好转，术后漏斗指数FI与正常儿童差异无显著性。结论 胸骨抬举加肋软骨成形治疗小儿漏斗胸近、远期效果满意。     

自体软骨碎屑回植对肋软骨修复再生的影响

目的 研究切取自体肋软骨后将软骨碎屑回植包埋人供区软骨膜内,对肋软骨修复和再生的影响.方法 取8～10周龄生长期雄性家兔16只随机分成4组,每组4只.实验各组在完整保留软骨膜、肋骨软骨连结处的情况下切取一段肋软骨,对缺损部位采用直接缝合、软骨碎屑回植后缝合及软骨碎屑回植加生物蛋白胶封闭空隙后缝合3种方法处理,3种处理方法在各实验组家兔两侧肋软骨中两两配对;健康对照组不做任何处理.术后16周处死家兔后观察各组胸廓及修复段的大体形态,常规HE染色病理切片,并行生物力学检测测定各肋软骨修复段的强度.结果 各实验组家兔的胸廓整体形态均较良好,各组及各处理方法之间并无明显差别;HE染色病理切片观察可见各组修复组织均主要为纤维组织,回植的小块软骨虽能够有效存活,但无明显增殖.生物力学检测显示:不回植组的修复组织强度为(193.92±41.41)N、回植组为(318.88±28.28)N、生物蛋白胶组为(301.00±39.52)N、健康对照组为(300.54±38.35)N,不回植组明显低于后3组(P<0.01).而后3组组间比较差异均无统计学意义(P>0.05).结论 将软骨碎屑回植虽不能促进透明软骨的再生修复,但能明显加强修复组织的强度,加强胸廓的稳定性,从而间接降低胸廓畸形的发生率.     

成软骨诱导的骨髓间充质干细胞膜片修复肋软骨供区缺损的实验研究

目的采用兔胸廓损伤动物模型,观察成软骨诱导的骨髓间充质干细胞膜片对肋软骨供区再生修复的影响。方法将16只家兔随机分为4组,每组4只,分别为健康对照组,实验1、2、3组。健康对照组家兔无任何处理,对实验组的每组双侧第4—6肋软骨均采用不同的2种方法处理,同侧3根肋软骨采用同一种方法处理,3种方法在每组中两两配对。3种方法分别为：①直接缝合软骨膜;②骨髓间充质干细胞膜片折叠数层成圆筒状填塞人肋软骨缺损处缝合;③成软骨诱导的骨髓间充质干细胞膜片同法折叠数层成圆筒状填塞入肋软骨缺损处,缝合封闭缺损。3种方法在各实验组兔两侧肋软骨中两两配对,健康对照组不做处理。术后16周,处死家兔取材进行大体观察,常规HE染色,并行生物力学检测,测定所有肋软骨的抗压强度及弯曲强度。结果各实验组家兔的胸廓整体形态均较良好,各组及各处理方法间无明显差别。生物力学检测显示,3种处理方法之间均存在差异（P〈0．01）,方法3处理的修复组织的抗压、弯曲强度与健康对照组比较,差异无统计学意义（P〉0．05）;方法1、2处理的修复组织的抗压、弯曲强度明显低于健康对照组（P〈0．01）;方法2处理的修复组织的抗压、弯曲强度优于方法1。组织切片HE染色病理观察,可见方法1、2处理的修复组织主要为纤维组织,方法3处理的修复组织内,可见新生的软骨细胞和大量的软骨细胞外基质。结论成软骨诱导的骨髓间充质干细胞膜片可以促进肋软骨供区软骨细胞的再生,修复肋软骨供区缺损,维持胸廓的正常形态和稳定性,从而降低术后胸廓畸形的发生率。     

开胸术后切口感染合并肋软骨炎的综合治疗

目的：探讨开胸术后切口感染合并肋软骨炎的治疗方法。方法：2011年1月至2014年1月我院收治的166例开胸术后切口感染、不愈的患者,其中35例患者合并肋软骨炎,男26例,女9例,年龄35～79岁,平均年龄（58.9±15.0）岁,术前采用分泌物细菌培养+药敏、清创、封闭负压引流;术中彻底清创、去除受累肋软骨、钢丝取出、双侧胸大肌转移修复;术后引流、应用敏感抗生素等综合治疗,封闭创面。结果：35例患者术后3～15d拔除引流管,27例患者创面术后10～15d后一期愈合;1例患者形成肌瓣下窦道,经换药后创面愈合;4例患者行二次手术清创后创面愈合,其中1例患者为出院后6个月复发,再次入院手术清创后3周创面愈合;3例患者行三次手术清创后创面愈合。35例患者术后均随访6个月～2年,创面愈合良好。结论：采用术前清创、封闭负压引流、术中彻底清创、去除受累肋软骨、钢丝取出、双侧胸大肌转移、围手术期应用敏感抗生素等综合治疗是修复开胸术后切口感染合并肋软骨炎的一种有效方法,取得了良好的临床疗效。     

延伸蒂部的腹直肌肌皮瓣修复颈胸部创面的研究

目的 通过CT血管造影(CT angiography,CTA)三维重建测量肋软骨宽度、厚度以及肋间隙距离,探讨采用截断下位肋软骨延伸蒂部的腹直肌肌皮瓣修复颈胸部创面的可行性。方法 以2013年7月-12月行胸部CTA的30例患者作为研究对象,其中男17例,女13例;年龄44~70岁,平均56岁。于CTA三维重建图像上测量第3~7肋软骨宽度、厚度以及第3~6肋肋间隙距离,计算顺序截断第7、6、5、4肋软骨后蒂部延伸长度。2012年7月-2013年11月,采用该方法延长带蒂腹直肌肌皮瓣的蒂部后修复4例颈胸部创面。结果 常规方法切取腹直肌肌皮瓣蒂部长度约为6 cm;按顺序截断左侧第7、6、5、4肋软骨后,皮瓣蒂部可平均延长4.07、7.99、12.50、17.48 cm;按顺序截断右侧第7、6、5、4肋软骨后,皮瓣蒂部平均延长4.63、10.82、16.64、22.05 cm。临床应用4例中,术后3例皮瓣顺利成活,1例皮瓣远端发生部分坏死,经对症处理后成活。除1例失访外,其余3例均获随访6个月,皮瓣外观、质地均较满意。结论截断下位肋软骨可以延伸带蒂腹直肌肌皮瓣的蒂部,能满足修复颈胸部创面的要求。     

肋软骨骨折的诊治体会

我们从 1995年元月至 1999年元月诊治肋软骨骨折 16例 ,报告如下。1　临床资料本组 16例 ,男 12例 ,女 4例 ;年龄 16～ 5 9岁 ,平均 2 8岁。直接损伤 11例 ,间接损伤 5例 ,合并肋骨骨折 3例 ,肺挫伤气胸 2例。临床表现胸肋软骨区局部肿胀 ,疼痛部位可扪及台阶或凹凸 ,按压浮动或骨擦感 ,经Ｘ线检查仅 3例合并肋骨骨折 ,8例经ＣＴ薄层扫描示肋软骨骨折 ,局部Ｂ超检查 8例 ,本组肋软骨骨折明显移位 4例 ,多肋软骨骨折 2例。骨折部位 :第二前肋 3例 ,第三前肋 2例 ,第五前肋 3例 ,第六前肋 4例 ,第七前肋 3例 ,第八肋 1例。2　治疗方法　　按肋…     

开胸术后肋软骨炎的整形外科治疗

目的探讨开胸术后肋软骨炎的治疗方法。方法对单根的肋软骨炎,在压痛最明显处直接切除受累的肋软骨;对胸上部多根肋软骨炎,可在胸部正中(开胸之瘢痕处)切开,切除受累的肋软骨;对胸下部、肋弓处肋软骨炎,除在胸部正中切开外,再向外下沿肋弓切开,形成以上部为蒂的胸部皮瓣,再切除受累的肋软骨;对肋软骨炎伴胸锁关节炎者,在胸部正中切开,形成一侧的胸部皮瓣,将受累的肋软骨及胸锁关节切除,应用胸大肌瓣转移填塞胸锁关节缺损处。术后行滴注引流,应用敏感抗生素。结果本组7例,2周后伤口愈合,效果良好。结论彻底清除感染的肋软骨是治疗开胸术后肋软骨炎的有效方法。     

漏斗胸修复术的胸廓重塑

为了探索漏斗胸修复术后如何才能重塑一个完善的胸廓，对１９７５年１０月～１９９６年１２月，采用的胸骨翻转术８例，胸骨上举术１４３例治疗的漏斗胸患儿，进行了３个月～１４年随访。结果表明，术后３个月即可发现重建的胸廓有新生肋软骨再生，６个月时变得较坚韧，１年时已成为基本正常的胸廓，此时拔除金属支杠最佳。认为，肋软骨的再生是胸廓重塑的基础，应按照肋软骨再生规律，改进手术操作。术后坚持康复疗法，均可获得一个较满意的胸廓     

带软骨膜的薄层肋软骨作大翼软骨外侧脚支撑移植物在唇裂继发鼻畸形中的应用北大核心CSCD

目的探讨带软骨膜的薄层肋软骨作大翼软骨外侧脚支撑移植物在唇裂继发鼻畸形矫正术中的应用及临床效果。方法 2015年10月—2017年4月,收治28例唇裂继发鼻畸形患者。男16例,女12例;年龄18～31岁,平均24岁。继发鼻畸形左侧11例、右侧13例,双侧4例。采用鼻唇肌肉三维定向立体重建修复术矫正畸形,术中取自体肋软骨行鼻小柱、鼻背支撑,同时以带软骨膜的薄层肋软骨作大翼软骨支撑。术前及术后6～8个月摄鼻底位照片,以鼻小柱与上唇交界中点为O点,通过O点的横向水平线记为X线、纵向线(即面中线)记为Y线。测量手术前后患侧鼻孔最高点至X线距离、患侧鼻孔最外侧点至Y线距离,计算单侧畸形患者双侧鼻孔最高点对称性、鼻孔最外侧点对称性;所有患者鼻尖最高点至X线距离。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间6～24个月,平均12个月。患者鼻翼大小、形态稳定,无软骨外露、血肿、感染等发生。术后4例切口瘢痕明显、3例鼻孔及鼻翼不对称,1例患侧鼻翼外侧脚位置欠佳。单侧畸形患者双侧鼻孔最高点对称性术前为57.643%±27.491%、术后为90.246%±18.769%;鼻孔最外侧点对称性术前为77.391%±30.628%、术后为92.373%±21.662%;手术前后比较差异有统计学意义(P<0.05)。患侧鼻孔最高点至X线距离、鼻孔最外侧点至Y线距离、鼻尖最高点至X线距离手术前后比较差异有统计学意义(P<0.05)。肋软骨供区无胸廓外形改变。结论带软骨膜的薄层肋软骨支撑力好、长期效果稳定,可作为唇裂继发鼻畸形中鼻翼软骨移植理想材料。     

肋软骨三维CT重建技术在成人耳廓再造中的应用

目的探讨运用肋软骨三维形态测量技术,指导成人先天性小耳畸形耳廓再造术中肋软骨采伐的可行性。方法自2014年1月至2014年12月,对46例成年先天性小耳畸形患者,术前运用三维CT分别测量第6、7、8肋软骨的三维形态和CT值,并根据测量结果,选择雕刻耳支架的肋软骨量。所有患者术后随访4~12个月。结果第6、7、8肋软骨双侧不对称20例(43.48%),肋软骨钙化明显者14例(30.43%),肋软骨采伐术中折断1例(2.17%),术后胸廓轻度畸形2例(4.35%)。结论术前肋软骨三位形态的测量可以准确评估肋软骨情况,有助于提高成人先天性小耳畸形患者耳廓再造术中,肋软骨采伐的效率及质量,并降低术后并发症。     

可注射性生物材料构建同种异体工程化软骨

目的研究在有免疫力的动物体内应用生物材料聚氧化乙烯丙烯凝胶构建同种异体工程化软骨的可行性.方法无菌条件下取新生兔关节软骨,经II型胶原酶消化8～12小时后,将软骨细胞和生物材料复合成细胞浓度为5×107/ml的复合物并移植于兔皮下,并以边注射,边后退的方法做条索状注射,以了解可否形成预定棒状软骨.同时分别设立单独注射细胞和材料两个对照组.分别于4、6、8及12周取材行大体观察,石蜡切片HE染色、SafraninO染色、Masson's三色染色,了解软骨形成情况.结果2周后即可于皮下触及新生结节,4周后取材即有基质分泌及胶原形成.于6周左右软骨接近成熟,生物材料基本吸收.8周、12周软骨基本接近正常软骨.同时可以见到以注射的方式塑形而成的棒状软骨.实验中未见明显的免疫排斥反应.而对照组未见软骨形成.结论生物材料聚氧化乙烯丙烯凝胶具有良好的生物相容性、可降解性、无细胞毒,是较理想的组织工程生物材料;应用该实验方法可在有免疫力的动物体内形成同种异体工程化软骨,并可以通过注射的方法进行简单的塑形.     

126例全耳再造术取自体肋软骨的体会

目的 探讨和总结二期全耳再造术中取自体肋软骨的手术方法和相关问题.方法 在2003～2006年126例先天性小耳畸形患者采用二期全耳再造术时取患耳对侧自体肋软骨,保留软骨膜,部分患者剩余软骨切碎后软骨膜腔隙回植.结果 本组126例,取下肋软骨均满足手术需求,无一例发生气胸.术后随访时间最长1年,未见明显的胸廓畸形及发育障碍.结论 本手术方法可减少取自体肋软骨时气胸的发生,胸廓畸形的产生和软骨的回植及软骨膜的保留相关.     

Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients

Purpose

The cause of pectus excavatum has been hypothesized to be overgrowth of the costal cartilage. According to this theory, the length of costal cartilages must be longer in the side of deep depression in asymmetric patients. To challenge this hypothesis, we measured the lengths of ribs and costal cartilages and investigated lateral differences.

Subjects and methods

Twenty-four adolescent and adult patients with asymmetric pectus excavatum (14-30 years of age) with no history of surgery were investigated in this study. The fifth and sixth ribs and costal cartilages were individually traced to measure their full lengths on 3-dimensional computed tomographic (CT) images. As an index of asymmetry, sternal rotation angle was measured in the chest CT images. Patients with a 21° or greater angle of sternal twist were designated as an asymmetric group and those with an angle of smaller than 20° as a symmetric group. Lateral differences in the fifth and sixth costal and costal cartilage lengths were compared between the groups.

Results

On comparison of the costal and costal cartilage lengths in the asymmetric group, the right fifth ribs and costal cartilages were significantly shorter than the left (P = .02 and .03, respectively), and right sixth ribs were also significantly shorter than the left (P = .004), but right sixth costal cartilages were not (P = .31). In the symmetric group, the lengths of the left and right fifth ribs and costal cartilages were showing no significant difference (P = .20 and P = .80, respectively), and those of the sixth ribs and costal cartilage were also showing no significant difference (P = .97 and P = .64, respectively).

Discussion

The ribs and costal cartilages on the right side with severer depression were significantly shorter or not different than those on the contralateral side. Based on these findings, the theory of costal cartilage overgrowth is contradictory.The etiology of asymmetric chest deformity should be reevaluated.     

The effect of costal cartilage resection on the chest wall development: a morphometric evaluation.

OBJECTIVE: In repair of thoracic wall deformities, there is a debate in the literature regarding the optimal age and the type and number of costal cartilage resections. We evaluated the effect of costal cartilage resections on the chest wall development in young rabbits. METHODS: Fifty apparently healthy, 6 weeks of age, male New Zealand white rabbits were evaluated in five groups, each including 10 subjects. Group 1 served as control for the observation of normal thoracic development. Rabbits in group 2 underwent partial and rabbits in group 3 underwent total resections of the right third and fourth costal cartilages; those in group 4 underwent partial and rabbits in group 5 underwent total resections of the right third to sixth costal cartilages. Anteroposterior, horizontal and vertical diameters of the chest were measured before operation and repeated at 24 weeks of age. RESULTS: Upper and lower anteroposterior diameters of the thoracic wall and horizontal diameters of the left hemithorax differed significantly among groups (p=0.011, p=0.004, and p=0.002, respectively). Upper anteroposterior diameter was 49 mm in group 1 and 44 mm in group 3 (p=0.009). Lower anteroposterior diameter in group 5 (66 mm) was significantly less than that in group 1 (70 mm) (p=0.039) and there was also a statistically significant difference between group 4 (71 mm) and group 5 (66 mm) (p=0.002). Horizontal diameters of the left hemithorax in group 3 (32 mm; p=0.005) and 5 (32 mm; p=0.008) were significantly different when compared to group 1 (26 mm). Growth in right hemithorax was statistically less than that in left side in all operated groups except in group 2. CONCLUSIONS: Thoracic resections in young rabbits have demonstrated that the costal cartilage resection is not an innocent procedure as it severely affects the chest wall development especially in anteroposterior direction and the thoracic growth is markedly retarded when growth centers of the ribs are not preserved and/or four or more ribs are resected.     

兔肋软骨膜对肋软骨移植后生物力学性能影响的研究

目的:探讨新西兰大白兔肋软骨膜对肋软骨自体异位移植后生物力学的影响,为临床上选取最佳肋软骨移植物提供理论依据。方法:6周龄新西兰大白兔6只,取单侧6、7、8带软骨膜肋软骨,每个标本随机分为等长两段,一段保留软骨膜,一段去除软骨膜,分别埋植于兔的背部两侧对称部位。于12周后取出两组埋植软骨,剥去带肋软骨膜者的软骨膜,埋植前不带肋软骨膜者不作处理。据试验机要求制成相应大小标准试件。采用SHIMADZU(日本,AGS-X型)试验机行拉伸、压缩和弯曲试验。结果:带软骨膜组肋软骨极限抗拉强度及最大拉伸应变、最大压缩强度及最大压缩应变、最大弯曲强度及弯曲破坏时间均大于不带软骨膜组,两组之间差异有统计学意义(P<0.05)。结论:带软骨膜肋软骨生物力学性能优于不带软骨膜者。     

手术矫治Poland 综合征

目的探讨手术矫治Poland 综合征的方法. 方法 1990年5月～2002年5月,对3例年龄分别为3、12和16岁的女性Poland综合征患儿进行了胸壁成形术矫治,患儿均有胸大肌缺如、胸小肌发育不良及肋软骨缺损等畸形.其中1例行自身肋软骨移植、右侧背阔肌移位术,另2例行自身肋软骨移植、涤纶布片修补术. 结果术后分别随访1、7和10年,结果显示患儿胸壁外观恢复满意,患侧上肢及胸背部功能正常,生长发育无异常. 结论 Poland综合征是一组涉及多部位的先天畸形,应根据病变的程度和范围制定手术治疗计划,方可取得较满意的效果.     

Costal cartilage graft with perichondrium,a possible anti-adhesive material

Background: Adhesion occurs as a part of the wound healing process, but it sometimes compromises patients’ daily activities. The authors were looking for materials and methods that could prevent adhesion, and noticed that the costal cartilage has possibility. The anti-adhesive property of the costal cartilage was examined histologically.

Methods: Thirty-five patients with microtia who provided consent for participating in this study were enrolled between April 2008 and March 2015. In the first stage of microtia reconstruction surgery, the excess cartilage was used to create these three types of specimens: (A) a piece of cartilage retaining the perichondrium on one side, (B) a piece of only cartilage parenchyma sliced with a plane parallel to the long axis of costal cartilage, and (C) the costal cartilage in a plane perpendicular to the long axis sliced pieces. These specimens were implanted into the subcutaneous fat of the chest. After at least 6 months in the second stage of surgery (i.e. auricular elevation), these specimens, wearing a little around the adipose tissue, we removed and examined histologically.

Result: A fibrosis formation of the perichondrium side of Specimen A was thicker significantly than that of the cartilage side. A fibrosis formation of Specimen B was thicker significantly than that of the cartilage side of Specimen A.

Conclusion: It was suggested that, if there is perichondrium, the costal cartilage parenchyma surface makes less adhesion with surrounding tissues. Costal cartilage with unilateral perichondrium is likely to be an effective surgical material for adhesion prevention.     

The etiology of pectus carinatum involves overgrowth of costal cartilage and undergrowth of ribs

Purpose

We compared the length of costal cartilage and rib between patients with symmetric pectus carinatum and controls without anterior chest wall protrusion, using a 3-dimensional (3D) computed tomography (CT) to evaluate whether the overgrowth of costal cartilage exists in patients with pectus carinatum.

Subjects and methods

Twenty-six patients with symmetric pectus carinatum and matched twenty-six controls without chest wall protrusion were enrolled. We measured the full lengths of the 4th–6th ribs and costal cartilages using 3-D volume rendering CT images and the curved multiplanar reformatted (MPR) techniques. The lengths of ribs and costal cartilages, the summation of rib and costal cartilage lengths, and the costal index [length of cartilage/length of rib * 100 (%)] were compared between the patients group and the control group at 4th–6th levels.

Results

The lengths of costal cartilage in patient group were significantly longer than those of control group at 4th, 5th and 6th rib level. The lengths of ribs in patient group were significantly shorter than those of control group at 4th, 5th and 6th rib level. The summations of rib and costal cartilage lengths were not longer in patients group than in control group. The costal indices were significantly larger in patients group than in control groups at 4th, 5th and 6th rib level.

Conclusion

In patients with symmetric pectus carinatum, the lengths of costal cartilage were longer but the lengths of rib were shorter than those of controls. These findings may supports that the overgrowth of costal cartilage was not the only factor responsible for pectus carinatum.