“One-piece” patient-specific reconstruction plate for double-barrel fibula-based mandibular reconstruction

Segmental mandibular defects require reconstruction. The fibula flap serves as a versatile flap in restoring mandibular contour and bony height. With the advances in computer-aided design and additive manufacturing technology, an innovative “one-piece” patient-specific reconstruction plate to facilitate double-barrel fibula flap shaping and bone securing was developed; the plate is described in this study. The “one-piece” plate is fabricated with individualized specifications and is mainly composed of three components: the long-bar reconstruction plate, a short-bar plate, and connecting bars. Our initial experiences showed that mandibular reconstructive surgery was greatly facilitated by the “one-piece” reconstruction plate for double-barrel fibula flap reconstruction and achieved satisfactory outcomes. A well-designed clinical trial is required to confirm the superiority of the “one-piece” reconstruction plate in the future. ClinicalTrials.gov registration: NCT03057223.     

正常儿童青少年黄斑厚度的分布及相关影响因素

目的：探讨正常儿童青少年黄斑厚度的分布情况及其相关影响因素。方法：描述性研究。选取2014年7月至2016年8月就诊于昆明市儿童医院眼科的正常儿童青少年284例（568眼），年龄4～17 （10.1±2.8）岁，屈光度为-8.00～+6.00 D。利用光学相干断层扫描（OCT）对其黄斑部直径6 mm范 围内9个区域（A1-A9）的视网膜进行扫描并测量厚度。根据性别、眼别、年龄（≤10岁组、>10岁组） 及等效球镜度（SE）（近视：SE≤-0.50 D；正视：-0.50 D相似文献   

联体尺动脉穿支皮瓣在多指毁损伤修复中的临床应用

目的探讨联体尺动脉穿支皮瓣修复多指毁损伤的临床效果。方法回顾性分析2011年3月至2017年10月东莞长安新安医院收治的12例多指毁损伤患者,男8例,女4例,年龄(32.6±4.3)岁,范围18~56岁。4指毁损伤2例,3指毁损伤4例,2指毁损伤6例。皮肤软组织损伤位置均为远掌横纹或指掌横纹以远,指骨为近节以远。皮肤总缺损面积(135.6±12.3)cm^2,范围6.0 cm×16.0 cm^6.0 cm×35.0 cm,应用皮瓣总面积(143.5±11.2)cm^2,范围5.0 cm×20.0 cm^3.2 cm×47.0 cm(双侧前臂)。双前臂尺动脉穿支皮瓣5例,单侧7例,所有皮瓣均为2条以上穿支蒂。皮瓣均设计为长条状,螺旋缠绕包裹于伤指骨,皮瓣穿支动脉与相应指固有动脉或掌背动脉吻合,伴行静脉与相应指掌侧静脉或掌背静脉吻合,皮瓣浅静脉与相应指背静脉或掌背静脉吻合,皮瓣神经与相应指固有神经或掌背相应感觉神经吻合。供区除1例植皮外,其余均直接缝合。术后随访观察疗效,包括感觉、外观、血液循环、骨吸收及手运动功能、日常生活、恢复工作情况等。评价标准为中华医学会手外科学会断指再植功能评定试用标准。结果所有皮瓣均成活,1例皮瓣末稍有约1.5 cm×1.5 cm坏死,二期缝合修复。所有病例均获6个月至6.5年随访,平均16.7个月,皮瓣质地良好,无色素沉着,外观无臃肿,指端无瘢痕或磨损,两点辨距觉6~10 mm,平均8.6 mm。术后半年骨吸收发生率59.4%(19/32),指短缩平均0.8 cm,其中5例6指取髂骨植骨。伤指拿捏及持物功能部分恢复,日常生活无明显影响;患手握力平均达到健侧的60.3%。参照断指再植功能评定试用标准:优2例,良5例,差4例,劣1例,优良率58.3%(7/12)。供区外观可。结论联体尺动脉穿支皮瓣为多指毁损或脱套伤患者的临床修复提供了一种有益的思路和有效的手术方案,效果良好。     

Clinical Features,Treatment, and Visual Outcomes of Japanese Patients with Posterior Scleritis

ABSTRACT

Purpose: The purpose of this study is to describe clinical features and visual outcomes of Japanese patients with posterior scleritis.

Methods: Clinical records of 10 patients (13 eyes) presenting between 2006 and 2016 were retrospectively reviewed.

Results: The mean age was 50.1 ± 20.8 years; 50% were women, and three patients had bilateral disease. Associated anterior scleritis (11 eyes, 85%) and serous retinal detachment (8 eyes, 62%) were common at presentation. Treatment consisted of corticosteroids (all patients) and immunosuppressive agents (seven patients). The mean subfoveal choroidal thickness was significantly reduced over follow-up [611 μm at baseline, 298 μm (p < 0.01) at 1 month, and 238 μm (p < 0.01) at 1 year]. Recurrent inflammation was observed in six patients. A best-corrected visual acuity of 0.8 or better was achieved in all 13 eyes at 3 years and 71% of eyes at 5 years.

Conclusion: Although 60% of patients with posterior scleritis had recurrence, visual outcomes were favorable.     

带阴毛穿支皮瓣的应用解剖

目的　探讨阴阜区穿支血管的解剖学特征，为修复头面部带毛区皮肤软组织缺损提供解剖学基础。 方法　选用体积分数10%甲醛常规防腐固定的成人尸体标本15具（30例，男18例、女12例），采用乳胶灌注、显微解剖、摹拟手术等方法，重点观测：①阴阜区穿支血管的起始、走行、分支与分布；②阴阜区穿支间的吻合情况。 结果　阴阜区皮肤血供主要由阴部外浅动脉供养，该动脉自股动脉发出后行向内上，在大隐静脉末段内、外侧分出上、下两支。上支向内上跨过腹股沟韧带进入阴阜部，并在前正中线附近与对侧同名动脉相吻合，走行过程中发皮支供养阴阜部阴毛覆盖区大部皮肤。下支近水平行向内侧进入耻骨前区，沿途分支营养股内侧部上份、耻骨前区及阴囊（唇）。上、下支起始外径分别为（1.2±0.2）mm和（1.1±0.3）mm。 结论　阴阜区皮肤血供丰富，可以阴部外浅动脉穿支为蒂设计带阴毛阴阜区皮瓣修复头面部带毛区皮肤软组织缺损术式。