眉部运动的显微外科解剖学研究及其临床意义

目的：为解决除皱术中眉毛上提效果欠佳,不够持久的问题。方法：对10例新鲜尸体进行了大体及显微解剖。结果：证实了额肌深面“滑动层”和“滑动间隙”的存在,观察了眉内侧2／3自皮肤向深面发出固定到眉嵴处的眉毛支持韧带,外侧上方的颞融合线和下方的眉限制韧带静态固定结构,上述结构决定了眉毛的形态;阐述了额肌、皱眉肌和降眉肌的眉毛动力机制,探讨了老年性外侧眉毛下垂主要由于外侧的滑动脂肪垫向下“疝出”所致。结论：通过破坏“滑动间隙”,切断颞融合线和眉限制韧带,切除外侧滑动脂肪垫,达到眉部上提的良好、持久效果。     

内镜下全腹膜外Sublay修补在腹壁疝中的应用

目的评价腹壁疝内镜下全腹膜外Sublay(TES)手术的效果并总结经验。方法回顾性总结国内10所医院自2016年3月至2019年7月115例腹壁疝内镜下TES手术的患者资料。分析患者情况、疝的特点、手术经过和结果。结果115例计划实施TES的患者中,因严重腹膜破损中转为IPOM修补患者1例,其余均成功手术。可以缝合缺损患者108例(94.74%),需要永久补片固定患者15例(13.16%)。放置引流患者76例(66.67%),中位手术时间为144 min,术中无严重并发症发生。随访时间3~45个月,总并发症发生率为20例(17.54%),其中出现血清肿患者5例(4.38%)。绝大多数患者术后仅出现轻微疼痛,未出现慢性疼痛。结论在腹壁疝的治疗中,对熟悉腹壁解剖的外科医师而言,TES是一种有效、安全的修复手段。在熟悉手术的基础上适应症可逐步拓展。     

不同年龄组正常人群影响最大胸椎后凸角的相关因素分析

目的：本研究通过对不同年龄组正常人群矢状位参数进行分析,旨在报道正常人群脊柱骨盆参数参考值范围,并探索不同年龄段引起最大胸椎后凸角改变的影响因素。 方法：本研究纳入自2015年1月至2018年月于两所医院健康体检中心的正常人群,收集人口统计学参数以及矢状位影像学参数。通过将人群分为≤40岁组与＞40岁组,对比分析不同年龄组人群的矢状位参数,并对不同年龄组影响最大胸椎后凸角max TK的因素进行相关性分析。结果：本研究共计纳入191例正常人群,其中≤40岁组94人,平均年龄为28.5±6.4岁;＞40岁组97人,平均年龄为53.9±8.3岁。不同年龄组人群在胸1椎体矢状位倾斜角T1 Tilt（18.6±6.5 vs. 20.6±5.5, P=0.023）, 胸椎后凸下端椎倾斜角TVA（15.3±5.3 vs. 17.5±6.6, P=0.013）,max TK（33.9±8.3 vs. 38.0±9.4, P<0.001）,max LL- max TK（14.9±8.9 vs. 12.3±9.4, P=0.048）及矢状面躯干偏移SVA（-2.5±21.8 vs. 6.1±20.9, P=0.006）上存在显著差异。在年龄≤40岁的人群中,T1 Tilt、TVA、max LL及骶骨倾斜角SS与max TK显著相关,而在年龄＞40岁的人群中,年龄、T1 Tilt、TVA、max LL及骨盆入射角PI与max TK显著相关。结论：max TK随着年龄增长呈现上下均匀增长趋势,在＞40岁的人群中,max TK与年龄呈现正相关关系。此外,不同年龄阶段,骨盆对于max TK改变的代偿呈现出不同的模式。     

正常人收缩期左侧房室平面位移的超声心动图检测

目的：利用超声心动图检测正常人左侧房室平面位移幅度。方法：被检对象为１４４ 例正常人,男７２ 例,女７２ 例。按不同年龄分为６ 组,分别为：Ⅰ组（ｎ＝ ２４ ,３～６ 岁）;Ⅱ组（ｎ＝２４ ,７～１４ 岁） ;Ⅲ组（ｎ＝２４,１５～１９ 岁） ;Ⅳ组（ｎ＝ ２４,２０～３９ 岁）;Ⅴ组（ｎ＝２４ ,４０ ～５９ 岁） 及Ⅵ组（ｎ＝ ２４ ,≥６０ 岁）。结果：①左心收缩期房室平面位移测值在Ⅰ组～Ⅴ组之间无显著性差异（ Ｐ＞０－０５）,而Ⅵ组测值较Ⅰ组～Ⅴ组的测值均低（ Ｐ＜ ０－０５）;②左心收缩期房室平面位移测值不受心率、血压、体表面积及性别的影响。结论：①左侧房室平面位移测值受年龄因素影响;②制定正常左侧房室平面位移测值可以不考虑心率、血压、体表面积及性别的影响     

The relationship between transverse plane leg rotation and transverse plane motion at the knee and hip during normal walking

The purpose of this study was to test the clinical hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with those of the transverse plane motion at the knee and hip. Twenty subjects underwent kinematic assessment during walking at 108 steps/minute. The transverse plane rotation of the leg relative to the foot was used to indicate rearfoot complex pronation and supination. Taking into account errors inherent in kinematic assessment involving skin mounted markers, it is unlikely that a correlation exists between the range of internal leg rotation during the contact phase and the total range of transverse plane leg rotation during gait and the corresponding values for the transverse plane motion at the knee and hip. Correlation tests were performed to assess the temporal characteristics of the motions at the joints that showed that there was no correlation between the transverse plane motion in the rearfoot complex, knee and hip. Thus the hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with the transverse plane motion at the knee and hip was rejected.     

An anterior extraperitoneal incision for donor nephrectomy that spares the rectus abdominis muscle and anterior abdominal wall nerves

PURPOSE: To perform open donor nephrectomy with the least amount of body alteration and complication, a short extraperitoneal incision was developed that preserves the ipsilateral rectus abdominis muscle and abdominal branches of the intercostal nerves. MATERIALS AND METHODS: Donor nephrectomy using the new incision was performed in 11 consecutive patients. RESULTS: Morphine was required for pain relief for 1 to 3 days (mean 1.8), patients tolerated diet at 1 to 4 days (mean 2.2) and postoperative stay was 2 to 5 days (mean 3.5). Complications were minimal, consisting of postoperative fever 1 day in duration. A viable kidney was provided for transplantation in each case. CONCLUSIONS: The extraperitoneal, rectus abdominis muscle and nerve sparing incision resulted in a short course of pain medication, early diet toleration and a short hospital stay.     

Rectus abdominis myocutaneous flap in radical oncopelvic surgery: A safe and useful procedure

AIMS: The aim of this retrospective study was to evaluate the usefulness of rectus abdominis myocutaneous (RAM) flaps to treat locally advanced pelvic gynaecological or digestive tumours. METHODS: We reviewed 46 patients, who received RAM flaps after radical oncopelvic surgery, including: (a) total vaginal reconstruction (TVR); (b) partial vaginal reconstruction (PVR); (c) perineal reconstruction (PR). RESULTS: Between 1989 and 1998, 46 patients underwent pelvi-perineal reconstruction with RAM flaps after radical pelvic surgery for carcinoma of the cervix (n=22), anal carcinoma (n=11), rectal carcinoma (n=7), or other pelvic tumours types (n=6). There were two post-operative deaths. Overall surgical morbidity was 45, 6% (n=21). Specific morbidity of the RAM flap was 21, 7% (n=10). Global re-intervention rate was 13% (n=6). CONCLUSION: Rectus abdominis myocutaneous flap in radical oncopelvic surgery is useful for vaginal or perineal reconstruction and prevention of pelvic collections after extended resections with a low rate of associated morbidity.     

Using the Smith-Watson-Topper Parameter and Its Modifications to Calculate the Fatigue Life of Metals: The State-of-the-Art

The Smith-Watson-Topper parameter (SWT) in its original form was designed to estimate the fatigue life of metal materials in a uniaxial load state (tension–compression) in the range up to fatigue crack initiation, with non-zero mean values. This parameter is based on the analysis of both stress and strain. Therefore, the stress–strain criterion is the focus, rather than the energy criterion. This paper presents the original SWT model and its numerous modifications. The first part presents different versions of this parameter defined by the normal parameters. Then, it presents versions defined through the tangent parameter and the most promising parameter defined through the tangent and normal parameters. It was noted that the final form of the equivalent value is defined either by stress or by an energy parameter. Therefore, the possible characteristics from which the fatigue life can be determined are also presented.