Pubovaginal slings: Past, present and future

Renewed interest in the pubovaginal sling procedure for stress urinary incontinence has occurred in response to recent reports of poor durability and inconsistent efficacy associated with simple cystourethropexy. Many of the failures are felt to represent patients with an unrecognized component of intrinsic sphincteric deficiency. Historically slings have a favourable cure rate, but have been perceived as having unacceptably high rates of prolonged urinary retention and secondary detrusor instability. This article reviews the preoperative evaluation and indications for pubovaginal slings, describes the evolution of the current techniques, and discusses choice of sling material, surgical approach, results and complications. It is hoped that this review will stimulate interest in this versatile but technically challenging procedure.     

游离筋膜覆盖在颈椎前路减压植骨术中的应用

目的 :探讨一种颈椎前路减压、植骨术后预防骨块滑脱的技术。方法 :采用自身游离的阔筋膜片 ,与两侧颈长肌及上下残留的前纵韧带缝合的方法 ,对 3 8例患者进行随访与观察。结果 :3 8例 5 5个椎间隙无 1例发生骨块滑脱或移位 ;结论 :本方法简便易行 ,无需特殊器械 ,并能有效预防颈椎前路植骨块的滑脱     

阔筋膜张肌肌纤维分布的研究

目的研究阔筋膜张肌的肌纤维型分布 ,探讨其生理功能 ,为临床肌移植提供资料。方法在肌腹中部取材并立即置入液氮 ,随后作恒冷箱冰冻横切片 (- 2 0℃ ,厚 15 μm) ,肌球蛋白ATP酶染色。结果阔筋膜张肌的Ⅰ型纤维构成比平均为 5 4 5± 1 4 % ,左右侧别间差异无统计学意义。结论阔筋膜张肌是一块力弱的带状肌 ,在静力和动力状态下保持身体平衡。     

Neuromuscular adaptations in older males and females with knee osteoarthritis during weight-bearing force control

Background

Females exhibit significantly greater incidence, prevalence, and severity of osteoarthritis (OA) compared to males. Despite known biological, morphological, and functional differences between males and females, there has been little sex-related investigation into sex-specific biomechanical and neuromuscular responses to OA.

筋膜穿支血管在髋关节OCM入路中解剖学定位的研究

目的探寻在髋关节前外侧(OCM)入路中筋膜穿支血管与肌间隙及神经界面的关系。方法解剖经甲醛溶液常规防腐固定处理33侧髋部,均无肢体畸形及手术史。探查髂前上棘至大转子外侧最凸处连线附近血管穿筋膜点并探明该血管与臀中肌阔筋膜张肌肌间隙的位置及臀上神经的关系;观察在2011-06~2013-06间在我科行87台髋关节前外侧入路手术中发现筋膜穿支血管及其与臀中肌阔筋膜张肌肌间隙的位置关系。结果臀中肌与阔筋膜张肌肌间隙所在附近筋膜表面血管位置较为恒定。在尸体标本中约91%(30例)的标本在肌间隙中部可见穿支血管,穿支血管均来自肌间隙深面。在髋关节置换手术中发现有筋膜穿支血管的约为90.8%(79例),血管均来自肌间隙深面。臀上神经入肌点与筋膜穿支血管最短距离为(5.62±1.18)cm,安全范围与股骨长度及髂嵴最高点与大转子外侧最凸处的距离均有明显相关关系,相关系数分别为0.84、0.61。结论筋膜穿支血管与臀中肌阔筋膜张肌肌间隙关系恒定,在髋关节置换OCM入路中采用筋膜穿支血管定位准确,安全。     

Natale et. al.'s response to Stecco's fascial nomenclature editorial

Despite their importance in anatomy, physiology, pathology and surgery, the fasciae and the fascial spaces have been poorly described in classic textbooks. This little attention depends on the fact that these fasciae vary in thickness and composition, especially at the cervical level. Indeed, in the main literature they have been described in different forms. Furthermore, the definition itself of the fascia is not consistent in a variety of authors. As a consequence, different criteria have been used to define and classify the fascial systems. In this paper, a brief terminological history and the most common nomenclatures and classifications of the fascia have been summarized.     

腮腺下极良性肿瘤术后味觉出汗综合征的预防研究

目的：回顾分析不同手术处理方式对腮腺下极良性肿瘤术后味觉出汗综合征的预防作用。方法将临床收治的122例腮腺下极（包括后下极）良性肿瘤病例随机分为A,B,C,D 4组,A组作为对照组,采用传统腮腺腺叶及肿瘤切除术,B组应用单纯腮腺部分切除术,C组行保留腮腺筋膜的腮腺部分切除术,D组腮腺部分切除术后,术区覆盖异种脱细胞真皮基质。术后随访12～36个月,通过Minor试验了解味觉出汗综合征情况。结果 A组41例患者发生味觉出汗综合征24例（58．54％）。 B组35例,发生12例（34．29％）。 C组26例,发生3例（11．54％）。 D组20例,查见2例（10．00％）。 A组与B,C,D 3组任何一组比较,均存在差异（ P＜0．05）。 B组与C,D任意一组间比较,均存在差异（P＞0．05）,C,D两组间差异不明显（P＞0．05）。结论对于腮腺下极良性肿瘤,腮腺部分切除术后保留腮腺筋膜或应用异种脱细胞真皮基质均可有效预防术后味觉出汗综合征的发生,但脱细胞真皮基质应用范围更为广泛。     

Fascial manipulation as an adjunct to physiotherapy management in obstetric brachial plexus palsy: A case report

The integrity of connective tissue sheaths surrounding the nerves influences both the severity and the potential for recovery of brachial plexus lesions.This study presents an innovative, early onset, multidisciplinary approach to obstetric brachial plexus palsy. This approach is aimed at functional recovery of the nerve lesion and includes mobilization of the fascia using the Fascial Manipulation® method.This case study discusses how, in addition to conventional treatment, interventions aimed at the fascial system can potentially affect tension around the neural sheaths, enhance proprioceptive input and facilitate movement to influence obstetric brachial plexus palsy outcomes.     

第一掌骨背逆行筋膜皮瓣修复拇指皮肤缺损

目的介绍一种修复拇指皮肤缺损的新型逆行筋膜皮瓣。方法取１０只新鲜尸体手，从桡动脉灌注红色乳胶，对第一掌骨背及拇指指背软组织的血管进行显微解剖，根据其血管分布设计成第一掌骨背逆行筋膜皮瓣。自甲根部桡侧缘至第一掌骨同侧背侧缘的连线为轴心线，其蒂部宜设在拇指指间关节近侧１ｃｍ以近的轴心线上。结果第一掌骨背及拇指指背软组织的血供主要由拇指两条指掌侧固有动脉向指背侧发出的分支，在指背筋膜内与两侧指背动脉及桡神经浅支伴行血管（桡、尺侧各２条）形成的血管网提供。１９９６年２月～１９９７年９月，临床应用该皮瓣修复拇指皮肤缺损６例，皮瓣全部成活。结论第一掌骨背及拇指指背软组织血供丰富，可形成第一掌骨背逆行筋膜皮瓣。该皮瓣设计合理、血供可靠、操作简便，适用于修复拇指，尤其是拇指桡侧皮肤的缺损     

伤指背筋膜岛状皮瓣修复手指软组织缺损

目的 介绍以伤指指背筋膜为蒂，带指固有神经背侧支的岛状皮瓣顺行或逆行转移修复指腹或指背软组织缺损的方法。方法 在手指近、中节背侧沿指固有神经背侧支走行方向设计并切取筋膜蒂皮瓣，切取皮瓣时蒂部带一矩形皮瓣，以减轻转位后皮瓣蒂部的张力。皮瓣顺行转移不需缝合神经，逆行转移时与受区神经缝合。皮瓣切取范围不超过手指侧中线，切取面在腱周浅层，皮瓣转移轴线沿指固有神经背侧支走向。结果 本组17例22指皮瓣全部成活。结论 采用伤指指背筋膜蒂岛状皮瓣转移修复指腹或指背皮肤缺损是一种简单安全，行之有效的手术方法。