预扩张的跨越人体中线肩胛皮瓣治疗儿童项背部巨痣(附7例报告)

采用预扩张的跨越人体中线肩胛皮瓣治疗儿童项背部巨痣7例，将儿童颈部和背部巨痣切除后，用扩张的肩胛皮瓣带蒂转移覆盖创面，供瓣区直接拉拢缝合，皮瓣均成活良好。此方法可最大程度地减少损伤和供区瘢痕，并获得良好的美容效果。     

标准外伤大骨瓣减压术及多点硬脑膜开窗治疗对冲性额颞脑挫裂伤的分析

目的 总结标准外伤大骨瓣开颅及多点硬脑膜开窗治疗对冲性额颞部脑挫裂伤的体会.方法 回顾性总结本科48例对冲性脑挫裂伤采用标准外伤大骨瓣减压及多点硬脑膜开窗治疗经过.结果 48例患者中存活36例,其中恢复良好18例,中残4例,重残9例,植物生存5例,死亡12例.结论 标准外伤大骨瓣减压手术及多点硬脑膜开窗治疗对冲性额颞脑挫裂伤,缓解脑水肿,提高救治成功率,改善生存质量是重要的手段.     

Clinical and radiological instability following standard fenestration discectomy

Background:

Post-surgical lumbar instability is an established complication but there is limited evidence in the literature regarding the incidence of lumbar instability following fenestration and discectomy. We analyzed our results following fenestration discectomy with a special focus on instability.

Materials and Methods:

Eighty-three patients between the age of 17 and 52 years who had undergone fenestration discectomy for a single-level lumbar intervertebral disc prolapse were followed-up for a period of 1–5 years. The criteria for instability included “instability catch,”, “painful catch,” and “apprehension.” The working capacity of the patient and the outcome score of the surgery were assessed by means of the Oswestry disability score and the Prolo economic and functional outcome score. Flexion-extension lateral radiographs were taken and analyzed for abnormal tilt and translation.

Results:

Of the 83 patients included, 70 were men and 13 were women, with an average age of 37.35 years (17–52 years) at 5 years follow-up. Clinical instability was seen in 10 (12.04%) patients. Radiological instability was noted in 29 (34.9%) patients. Only six (60%) of the 10 patients who demonstrated clinical instability had radiological evidence of instability. Twenty (68.96%) patients with radiological instability were asymptomatic. Three (10.34%) patients with only radiological instability had unsatisfactory outcome. The Oswestry scoring showed an average score of 19.8%. Mild disability was noted in 59 (71.08%) patients and moderate disability was seen in 24 (28.91%) patients. None of the patients had severe disability. These outcomes were compared with the outcomes in other studies in the literature for microdiscectomy and the results were found to be comparable.

Conclusion:

The favorable outcome of this study is in good agreement with other studies on microdiscectomy. Clinical instability in 12.04% of the patients is in agreement with other studies. Radiological signs of instability are seen even in asymptomatic patients and so are not as reliable as clinical signs of instability. Standard fenestration discectomy does not destabilize the spine more than microdiscectomy.     

一种可防止扩张期切口裂开的皮肤软组织扩张器植入术

目的探讨防止扩张期切口裂开的扩张器植入方法。方法在切口部位,沿扩张区域局部轮廓切线的垂直方向切开,植入扩张器。结果注水时间早,手术周期短,无切口裂开,无其他严重并发症。结论此种扩张器植入术可有效防止扩张期切口裂开,防止包膜挛缩,明显缩短手术时间。     

Fenestration of the anterior cerebral artery detected by magnetic resonance angiography

Background Fenestration of the proximal anterior cerebral artery （ACA） A1 segment is a rare anatomic variation. The purpose of the this study was to report the incidence of fenestration in the proximal segment of the anterior cerebral artery and to delineate its configurations on cranial MR angiography.
Methods Magnetic resonance angiography （MRA） was performed in 762 patients using 1.5T imagers during the period July 2007 through September 2008. All images were obtained by the three-dimensional time-of-flight （3D TOF） technique Volume rendering （VR） images in the horizontal rotation view were displayed stereoscopically. The presence of fenestration in the proximal segment of the anterior cerebral artery was identified and evaluated retrospectively by MRA.
Results Six patients （four men and two women, 15 to 63 years of age, median age 50 years） had proximal ACA fenestration. The appearance rate of ACA fenestration was 0.8% （6/762）. All 6 fenestrations were located at the A1 segment： three of them were with a slit-like shape and three were with a convex-lens-like shape, 5 of the right A1 segment, 1 of the left A1 segment.
Conclusion Recognizing ACA fenestration is important to interpret cranial MR angiographys and helpful to make a plan for neurosurgical procedures or neurological intervention.     

Results of transcatheter Fontan fenestration to treat protein losing enteropathy.

Transcatheter fenestration to create an interatrial communication has been used to treat patients with protein losing enteropathy (PLE) after Fontan operation. No systematic data have been reported assessing the results of this procedure. Our institutional database was queried to identify patients after Fontan operation who had transcatheter fenestration to treat PLE. Clinical notes, laboratory data, echocardiograms, and cardiac catheterization data were reviewed. From 1995 to 2005, 16 transcatheter fenestration procedures were performed in seven patients. Median age at fenestration was 18 years (range 13-41 years). Median duration of follow-up was 3.6 years (range 0.2-10.4 years). Techniques for fenestration included blade/balloon septostomy, stent placement, Amplatzer-fenestrated ASD device, and balloon dilation of previous stent. Size of the fenestration created was 5.2 +/- 1.1 mm. Systemic venous pressure remained unchanged after fenestration. Cardiac index increased significantly. Reduction of ascites and edema was noted after 9 of the 16 procedures. Ten of 16 (63%) of fenestrations spontaneously occluded. Three patients are free of ascites although recurrence of PLE occurred in all. One patient with a patent fenestration continues to have ascites. Two patients had Fontan takedown. One patient had conversion to a fenestrated extracardiac conduit Fontan and died postoperatively. The results of transcatheter Fontan fenestration are often disappointing. Maintaining fenestration patency is difficult. Even after "successful" fenestration, resolution of PLE may be incomplete and recurrences have occurred in all. Early consideration should be given to Fontan takedown or cardiac transplant in severely symptomatic patients with PLE who do not respond to fenestration. Transcatheter fenestration may be a bridge to a definitive procedure.     

双开窗治疗中央型腰椎间盘突出症及远期疗效分析

目的探讨双开窗手术治疗中央型腰椎间盘突出症及其远期临床疗效。方法回顾性分析我院在2001年6月至2005年2月期间行双开窗手术治疗中央型腰椎间盘突出症并有完整随访资料的患者42例,全部病例术前均行X线片、CT或MRI检查发现中央型腰椎间盘突出,患者同时出现双侧腰骶臀部症状或交替性腿部症状,且症状与影像学相符。对所有患者通过JOA腰背痛手术治疗评分、Macnab评定标准和生活质量量表进行评分。结果42例患者随访6个月至9年,平均6．2年,随访患者JOA评分为（23．58±6．35）;根据Macnab疗效标准,优36例,良4例,可2例,优良率达85．71％,无同节段症状复发和腰椎失稳现象发生。结论双开窗有限手术能彻底减压并维持脊柱的稳定性,且远期疗效好,是治疗中央型椎间盘突出症有效的可靠的方法。     

老年人颌骨囊肿开窗术的临床效果评价

目的：探讨囊肿开窗术在颌骨囊肿临床治疗中的应用。方法：对46例颌骨囊肿患者实行开窗术,吸出囊内容物,使囊腔与口腔相通呈开窗状态,碘仿纱条填塞,术后换药,并定期复查和随访。结果：所有病例均未出现长期反复感染,患者颌骨形态良好,未出现神经及邻近重要结构损伤症状。术后6个月-4年随访,X线片示骨质再生情况良好,未见有囊肿复发。结论：颌骨囊肿开窗术是一种简便、安全、效果良好的治疗老年人颌骨囊肿的方法。