改良Chevron截骨术联合Akin截骨术治疗足母中重度外翻的临床分析

目的 探究改良Chevron截骨术联合Akin截骨术治疗中重度足母外翻的临床效果。方法 回顾性分析2015年1月至2017年1月我院收治的50例中重度足母外翻病人的临床资料,依据手术治疗方式的不同将其分为改良Chevron截骨治疗组（20例,36病足）和联合手术治疗组（30例,50病足,改良Chevron截骨术联合Akin截骨术）。应用美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society, AOFAS）踝与后足功能评分系统评价患足功能,采用疼痛视觉模拟量表（visual analogue scale, VAS）评估两组病人患足疼痛情况,测量两组病人手术前后的足母外翻角（hallux valgus angle, HVA）和第1、2跖骨间角（inter-metatarsus angle, IMA）评价手术效果。结果 联合手术治疗组病人的术中出血量为（33.75±5.27） ml,手术时间为（55.14±12.89） min,均高于改良Chevron截骨治疗组［（12.88±4.75） ml,（27.67±10.12） min］,差异均有统计学意义（t=3.293,P=0.018;t=4.293,P=0.012）。联合手术治疗组术后1周、1个月、1年的VAS评分［（3.24±0.98）分、（2.17±0.45）分、（1.31±0.12）分］均优于改良Chevron截骨治疗组［（3.42±0.74）分、（2.57±0.36）分、（1.88±0.45）分］,差异均有统计学意义（t=2.267,P=0.028;t=2.991,P=0.017;t=2.542,P=0.021）。两组病人术后的HVA、IMA、AOFAS评分、满意度评分、AOFAS优良率比较,联合手术治疗组［12.67°±2.13°、8.31°±1.02°、（81.21±9.24）分、（91.67±4.12）分、88.8%］优于Chevron截骨治疗组［10.42°±3.52°、7.59°±1.33°、（62.22±6.42）分、（75.32±5.91）分、60.00%］,差异均有统计学意义（t=2.742,P=0.037;t=2.984,P=0.029;t=3.342,P=0.012;t=3.943,P=0.007;χ²=7.274,P=0.032）。结论 改良Chevron截骨术联合Akin截骨术治疗中重度足母外翻具有更好的术后效果,值得进一步推广应用。     

改良鼻外侧截骨术治疗歪鼻畸形的临床疗效

目的 分析对歪鼻畸形患者采用改良鼻外侧截骨术治疗的效果。方法 选取2022年11月-2023年12月 南京市玄武艺星医疗美容门诊部收治的90例歪鼻畸形患者,按治疗方法不同将患者分成参比组（45例）和 研究组（45例）。参比组行不对称驼峰锉削术治疗,研究组行改良鼻外侧截骨术治疗,比较两组鼻外形偏 斜值、鼻塞情况、鼻整形美观度以及不良反应发生情况。结果 两组治疗后鼻外形偏斜值低于治疗前,且 研究组低于参比组（P＜0.05）;两组治疗后VAS评分低于治疗前,且研究组低于参比组（P ＜0.05）;两组 治疗后ROE评分高于治疗前,且研究组高于参比组（P ＜0.05）;两组不良反应发生率比较,差异无统计 学意义（P＞0.05）。结论 针对歪鼻畸形患者,改良鼻外侧截骨术可改善其鼻外形偏斜、鼻塞情况,且鼻 整形美观度较高,具有较高安全性。     

联合截骨矫形治疗重度强直性脊柱炎驼背畸形——附1例报告

强直性脊柱炎驼背畸形在临床上较为常见,后期外科矫形手术是改善畸形、提高生活质量的有效治疗方法。治疗重度驼背畸形伴有双髋关节屈曲强直的患者,术者需要有较高的手术技术、术前要有周密的计划才能取得良好的手术效果。本院于2006年5月对1例重度强直性脊柱炎驼背畸形的患者进行驼背矫形,于2007年4月行双侧人工全髋关节置换术,取得了满意的疗效,现报告如下。     

脊椎截骨术治疗驼背畸形45例报告

自１９９１～１９９３年应用脊椎骨截骨术治疗驼背畸形４５例，畸形矫正最小２０°，最大８０°（Ｃｏｂｂ法），截骨平面为１～３处不等。４４例达到驼背畸形基本矫正的满意效果，１例并发不全截瘫。文中介绍了手术的适应证，手术方法及术后处理。脊椎骨截骨术，截骨面从棘突、椎板、椎弓根到椎体，不易损伤脊髓和神经根，不波及软骨面处理问题，不导致前纵韧带断裂，椎体前方崩开，截骨面对合好，愈合快，脊柱三柱稳定     

改良Chevron联合Akin截骨术治疗类风湿性拇外翻1例

患者,女,58岁,因双足疼痛不适11年于2019年6月17日至我院就诊.查体:双侧前足明显增宽,足横弓消失,双足拇外翻畸形(见图1A),前足第1跖趾关节内侧明显突起,左足第2～5趾屈曲畸形,第2 ～5 跖趾关节脱位.入院诊断:① 类风湿关节炎;② 双足拇外翻畸形;③左足第2～5锤状趾畸形.     

畸形顶椎全脊椎楔形截骨术矫正重症脊柱畸形

重症脊柱畸形是脊柱外科难治疾患之一,许多学者进行了不断的探讨,以求获得更好的治疗效果[1～3]。作者自1988年3月以来,应用自制的脊柱截骨器械,采用畸形顶椎全脊椎一次楔形截骨术,矫正重症脊柱畸形30例,平均矫正率68.3%,经观察效果满意,现介绍如下。1临床资料 本组男21例,女9例;年龄13～31岁。其中特发性脊柱侧凸16例,先天性脊柱侧凸8例,结核性脊柱后凸6例,术前平均弯度92.1°(Cobb法),术后平均弯度29.2°,术后平均身高增加5.1cm。截骨部位,T102例,T112例,Tl2 6例, L; 10例, L。 6例, L。 2例, L。 2例。术中输血600～2000ml(平均1100m…     

改良颏截骨前徙联合假体置入治疗小颏畸形

目的 介绍一种改良的颏截骨术联合假体置入治疗小颏畸形,使隆颏术后颏部具有更佳的美容效果.方法 选择口内切口入路,采用改良的颏部水平"几"型截骨后前徙内固定术,并联合置入合适假体,达到改善颏部后缩,延长颏突度和颏长度,同时改善颏正中区域外形.结果 采用该方法共治疗11例患者,其中3例行单纯颏截骨前徙术,8例行颏截骨前徙联合假体置入术,术后颏部形态均得到明显改善,患者满意度高.结论 改良颏截骨前徙联合假体置入治疗小颏畸形,可以明显改善患者的面部外观,重新建立颏部美容曲线,效果满意.     

Massive bleeding after a tooth extraction: Diagnosis of unknown arteriovenous malformation of the mandible,a case report

IntroductionArteriovenous malformations (AVMs) are very rare. Only 5% of them occurs in the jaws but they can manifest with dramatic bleeding and be life-threatening.Presentation of caseWe report the case of a 11-year-old healthy girl who presented a massive hemorrhage after extraction of the right mandibular first primary molar. This patient received a blood transfusion and was hospitalized in pediatric intensive care unit. CT angiography highlighted an AVM of the mandible. Treatment consisted in selective embolization.DiscussionA review of the literature shows that the majority of AVMs of the jaws are often unknown until severe bleeding occurs during dental surgery. The low specificity of radiological signs on panoramic radiography makes the diagnosis particularly challenging. Their management requires an interdisciplinary approach. Selective embolization has a place of choice in the treatment of these complex pathologies.ConclusionAlthough AVMs of the jaws are rare, they are frequently revealed through a massive hemorrhage during tooth extraction. Dentists have to suspect them when young patients present some clinical features, as spontaneous gingival bleeding, unexplained dental mobility, or facial asymmetry.     

Colonic mesenteric lymphatic malformation presenting as an intraabdominal abscess in an infant: A case report

IntroductionLymphatic malformations are low-flow vascular malformations most commonly located in the head and neck; isolated intraabdominal involvement is rare.Presentation of caseAn 8-month-old previously healthy male presented with a 9-day history of fevers. On examination, right-sided abdominal tenderness was noted. Ultrasound revealed a large heterogeneous mass, and CT scan revealed a rim-enhancing cystic mass adjacent to the right colon. Laboratory investigation including blood cultures was normal. His fever resolved with broad-spectrum antibiotics. Diagnostic laparoscopy revealed a large, firm mass arising from the mesentery of the right colon. An open right hemicolectomy with ileocolonic anastomosis was performed. The infant tolerated the procedure well, and he was discharged home on postoperative day four, pathologic examination identified a mesenteric lymphatic malformation with secondary abscess formation.ConclusionThis atypical presentation of an uncommon entity was instructive in several ways, particularly illustrating the diagnostic pitfalls that can be introduced by superinfection.     

后壁截骨治疗特殊髋臼后柱伴臼顶嵌顿压缩骨折1例

<正>患者,男,60岁,2020年2月因车祸伤后左髋部、左前臂疼痛伴活动受限1 d入院。入院前1 d患者发生车祸（具体机制不详）,致左髋部、左前臂疼痛,伴活动受限,无法行走,伴左膝疼痛,伴头昏及胸壁疼痛,伤后无意识障碍、恶心呕吐、四肢麻木无力,无胸闷气紧、腹痛等。于当地县医院就诊,DR及CT提示左侧尺桡骨骨折,左侧髋臼骨折;腹部彩超提示：左侧脾挫伤。予以左前臂石膏固定,左髋臼关节脱位手法复位等治疗后转入我院。入院后专科查体：     

Case report: HIV negative isolated scrotal Kaposi's sarcoma

INTRODUCTION

Kaposi''s sarcoma (KS) is a rare angioproliferative disorder of the vascular endothelium. The development of KS requires Human Herpes Virus 8 (HHV-8) infection. An associated HIV infection is usually seen. Isolated scrotal KS has rarely been reported. In this article, we present a case of KS that primarily involved the scrotum in a HIV negative patient.

PRESENTATION OF CASE

A 71-year old male patient admitted to the outpatient department due to nodular lesions on the scrotum. The patient declared that these lesions were present for nearly 5 years. Past medical history revealed that he underwent left thoracotomy and upper lobectomy in 2006 for adenosquamous lung carcinoma. Then, he received a single cycle of adjuvant chemotherapy consisted of docetaxel and cisplatin. Physical examination revealed 3 black small nodules on the scrotum. The anti-HIV test was negative. All scrotal lesions were surgically excised. The pathological investigation revealed KS of the lymphangioma-like type.

DISCUSSION

The pathogenesis of KS has still not been clearly elucidated. However, it is known that all forms of KS are associated with HHV-8 infections. A defect in immune system was almost always necessary. Therefore, KS is usually associated with HIV infection. KS of the penis has been reported in HIV negative patients. Very few cases of scrotal KS have been presented. In a recent review, only 1 patient had scrotal KS out of 32 cases with HIV negative KS. In our case, the patient received a cycle of chemotherapy that might affect his immune system. The lymphangioma-like type is a common morphological sub-type. While lymph edemas are commonly observed in this sub-type, no edema in the lymphs was present in our case.

CONCLUSION

Classical KS is generally observed in the lower extremities, it can rarely affect scrotal skin as isolated lesions. Therefore, a careful physical examination should also include scrotum for these patients.     

腹腔镜联合手术96例临床分析

目的:探讨腹腔镜联合手术的方法与优点。方法:回顾分析1998年以来我院行腹腔镜联合手术96例患者的临床资料,其中同时行腹腔镜胆囊切除术与阑尾切除术52例,子宫肌瘤切除术12例,附件切除或附件囊肿切除术6例,腹腔镜辅助阴式全子宫切除术3例,腹腔内粘连松解术8例,胆总管探查"T"管引流术15例。结果:96例腹腔镜联合手术均获成功,无中转开腹及并发症发生。术后患者均痊愈出院。结论:腹腔镜联合手术安全可行,值得临床推广应用。     

Unicompartmental knee arthroplasty combined with high tibial osteotomy in anteromedial osteoarthritis: A case report

Introduction and importanceAnteromedial osteoarthritis (AMOA) is a common knee pathology. However, the best treatment of AMOA remains unclear. Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are surgical options for AMOA patients who do not benefit from conservative treatment. We aimed to show an unusual treatment option where UKA and HTO are performed simultaneously.Case presentationWe present a 52-year-old man with AMOA secondary to spontaneous osteonecrosis of the knee (SONK) and metaphyseal tibial varus malalignment, who was successfully treated with a combined UKA and HTO. His functional scores were excellent at the 5-year follow-up.Clinical discussionAdvanced SONK that causes AMOA can be treated with osteochondral autograft transplantation (OAT), HTO, UKA, or total knee arthroplasty (TKA). Although good results have been reported selecting appropriate patients for all of these methods, the best treatment method remains unclear.ConclusionAlthough HTO and UKA are alternative treatments for AMOA, successful results can be obtained using both in individual cases.     

尤文氏肉瘤误诊为非骨化性纤维瘤1例

正患儿,女,11岁,主因右小腿近端内侧疼痛1周于2016年4月入院。现病史:无明显诱因出现负重行走时右小腿近端内侧疼痛1周,疼痛可忍受,休息后缓解,自发病以来伴夜间低热,每晚20时体温37.5℃左右,持续约2 h。无其他不适。未进行相关诊治,为进一步诊治经门诊收入我院。自发病以来睡眠、大小便、体重等基本无变化。既往体健。无类似发作史及家族史。查体:双下肢等长,右胫骨近端内侧     

腹腔镜手术治疗异位妊娠104例临床分析

目的：总结腹腔镜手术治疗异位妊娠的方法和经验。方法：分析腹腔镜手术治疗104例异位妊娠的方法和效果。结果：104例异位妊娠患者均顺利完成腹腔镜手术。平均手术时间为（40.0±15.0）min,平均住院4d,无并发症发生,治愈率100%。结论：腹腔镜手术治疗异位妊娠安全可靠,术后患者痛苦小,康复快。