Study of condylar positional changes after sagittal split osteotomy for mandibular advancement: A prospective cohort study

Purpose

To analyse the possible morphologic and positional changes of the mandibular condyles after orthognathic surgery.

大鼠上矢状窦闭塞后MMP-9在脑组织中的表达

目的探讨上矢状窦闭塞后基质金属蛋白酶-9(MMP-9)在脑组织中的表达与作用。方法采用结扎法建立大鼠上矢状窦闭塞模型,干湿重法测量脑组织含水量,免疫组化法检测MMP-9蛋白质的表达,同时观察是否有白细胞浸润。结果与对照组比较,上矢状窦闭塞后6h,脑组织含水量和MMP-9表达开始增加并伴极少量白细胞浸润,第1天后,脑组织含水量、MMP-9表达和白细胞浸润数量迅速上升,第5天到高峰,第7天开始下降,第14天虽明显减少,但仍然明显高于对照组;在整个脑水肿形成过程中,MMP-9的表达与脑组织含水量呈高度正相关(r=0.92,P<0.01),与浸润的白细胞记数也呈高度正相关(r=0.84,P<0.01)。结论上矢状窦闭塞后脑组织含水量显著增加,MMP-9的表达明显增强,内皮细胞和渗出的中性粒细胞中MMP-9的过度表达,在血-脑脊液屏障破坏、白细胞浸润及血管源性脑水肿形成过程中发挥了关键作用。     

口内路径下颌骨升枝矢状劈开截骨术治疗下颌前突畸形

下颌骨升枝矢状劈开术是目前世界上使用最普遍的矫正下颌骨畸形的手术方法之一。作者采用口内入路下颌骨畸形的手术方法之一。作者采用口内入路下颌骨升枝矢状劈开截骨术治疗下颌骨前突１８２例，其中真性下颌前突１４３例，假性下颌前突３９例。年龄在１５～５８岁之间，平均２４岁。随访６个月～９年。除９例术后畸形复发需再次矫正以外均获满意效果。本文介绍了口内入路下颌骨升枝矢状截骨术的手术过程及注意事项，并着重讨论了其优缺点，可能出现的并发症及处理方法     

人体头部承受正面和侧向冲击的颅骨应力分析

在５例经防腐固定的尸体上研究了人体头部承受正面均匀冲击，正面下颏部冲击和侧向顶结节部冲击的颅骨应力分析，对于正面冲击的颅骨测量，根据颅骨的矢状面对称性，选择左侧脑颅骨，沿上矢状线，水平线和后箩布８枚应变花，在左侧下颌骨贴３枚应变花。侧向顶结节部冲击的颅骨测量采用以冲击点为圆心，在以２．５ｃｍ和５．０ｃｍ为半径的圆周线上均匀地分别布４枚和８枚应变花，并在额部，对侧翼点和后囟各置１枚应变花。将标本置于     

强直性脊柱炎后凸畸形的外科治疗

目的探讨以重建强直性脊柱炎(AS)后凸畸形矢状面平衡为目的治疗方法和疗效。方法18例AS患者,男16例,女2例。根据全脊柱侧位X线片分段测量矢状面不同部位的后凸角度进行分析,明确截骨部位;测量C7铅垂线与S1后上角的距离,了解矢状面不平衡情况;测量颏眉垂线角,确定截骨角度;在纸样上模拟截骨,观察矫形效果。行多节段经椎弓根椎体楔形截骨和椎弓根钉内固定。结果患者身高平均增高7.3cm,术后颏眉垂线角-5°~10°,术后C7铅垂线距S1椎体后上角0.5~5cm(平均2.4cm),平均改善率为88.8%。经10~38个月(平均22个月)随访,均达骨性融合,矫正度无丢失,无一例脊髓神经损伤,外观改善满意。结论测量脊柱矢状面不同部位的后凸角度,根据颏眉垂线角,确定截骨部位和后凸角度对于重建矢状面平衡具有重要意义。多节段保留上1/3椎弓根椎体楔形截骨,并应用椎弓根钉内固定系统固定可靠。     

Instrumentation for cerebrospinal fluid hydrodynamic studies in man

Instrumentation developed for the direct study of the human cerebrospinal fluid (c.s.f.) system is described. The configuration consists of a servo pressure regulator, two pressure transducers, a special function generator, an electronic pressure limiter, a strain-gauge balance, a volume and flow-rate meter, a c.s.f. conductance calculator, a 4-channel pen recorder, an x/y pen recorder and an ink-jet recorder. It is possible to regulate the c.s.f. pressure to any value between — 2·0 and 10.0 kPa or to regulate the flow rat of fluid into or out of the patient or to perform simple bolus injections/withdrawals. The c.s.f. model used allows indirect calculation of the pressure in the sagittal sinus and the pressure difference between the subarachnoid space and the sagittal sinus. The instrumentation is currently used for the study of c.s.f. pressure, c.s.f. formation rate, c.s.f. absorption rate, conductance of c.s.f outflow pathways, c.s.f. pressure/volume relationship and neurosurgical shunt systems. We have shown that the method of constant-pressure c.s.f infusion is faster than the method of constant-flow-rate c.s.f. infusion in obtaining reliable measuremnts of c.s.f. outflow conductance.     

Sagittal craniostenosis,congenital heart disease,mental deficiency and various dysmorphies in two sibs — a “new” syndrome?

This is a report on two mentally retarded sibs with similar anomalies (sagittal craniosynostosis, complex cardiovascular malformations, mandibular ankylosis) and various dysmorphic features. They could represent a new probably monogenic syndrome.Abbreviations MA multiple anomalies - MR mental retardation - CHD congenital heart disease - ASD atrial septal defect - VSD ventricular septal defect - PA pulmonary artery - PDA patent ductus arteriosus     

The anterior–posterior laxity after total knee arthroplasty inserted with a ligament tensor

Goal of this study is to determine the anterior–posterior laxity in 30° of knee flexion for a posterior cruciate retaining total knee arthroplasty with a relative dished insert and implanted with a ligament tensor. Furthermore, the correlation between these AP laxities and the postoperative range of motion (ROM) and postoperative Knee Society Score (KSS) is analysed. Fifty-one balanSys™ total knee arthroplasties were performed in 49 patients between 1998 and 2000. These arthroplasties are analysed with respect to AP laxity (Rolimeter), ROM and KSS with a mean follow-up of 4.6 years. The mean anterior laxity is 2.8 mm with no posterior laxities at all. The average postoperative ROM is 110° with an average KSS of 142. No correlations between AP-laxity and postoperative ROM or between AP-laxity and postoperative KSS are found. A posterior cruciate retaining TKA with a relative dished insert and implanted with a tensor is very stable in the anterior–posterior direction in 30° of knee flexion. This limited laxity does not seem to disadvantage the mean postoperative ROM and KSS, when compared to other TKA studies.     

Superior sagittal sinus thrombosis in a child with nephrotic syndrome

A 3-year-old male with steroid-responsive nephrotic syndrome developed a rare complication, sagittal sinus thrombosis during an episode of gastroenteritis, while on steroid therapy. Anticoagulation, as assessed by partial thromboplastin time, was difficult to maintain, despite administering high doses of heparin, infusions of fresh-frozen plasma to provide antithrombin III, and, subsequently, maximum doses of warfarin (0.3 mg/kg per day). Despite these problems the child made a complete neurological recovery.     

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation

Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12–34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24–108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1–3) and thoracic hypokyphosis (T4–T12 < 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2° to 23.4° postoperatively in the anterior group and from 7.6° to 12.9° in the posterior group (P < 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P < 0.005). The preoperative and postoperative main thoracic curve values were 63° (48–80°) and 25.2° in the anterior group and 60.6° (50–88°) and 23.6° in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.