多发性面骨发育畸形2例

1　病例报告例1　男,20岁。先天性面部凹陷畸形,要求整形入院。查体:颜面不对称,面中1/3短小,双侧颞骨体及颧弓、颧下部塌陷,以右侧为甚,左眼眶下缘高于右眼眶下缘2～3mm,双眼下睑外翻,双侧眶下区塌陷,眼球外突,右耳郭为一皮赘,无外耳道及耳屏,仅在皮赘上方有一直径为0.1cm的洞形结构,不能窥入,左耳郭较小,外耳低平,舟状窝不明显,无明显外耳道及耳附属结构,仅在耳轮脚上、下方各有一皮肤小洞,不能探入,听力减弱。入院诊断为TreacherCollins综合征。入院1周在全麻下行左髂骨切取 双侧颧骨植骨术,术中采用头皮内冠状切口,向下剥离皮肤,暴露眶…     

眼眶神经纤维瘤病的CT表现

目的:探讨眼眶CT扫描诊断神经纤维瘤病 I 型(NF1)的应用.材料和方法:回顾性分析17例具有完整临床资料的NF1眼眶CT征象,全部病例均经手术病理和/或临床证实.结果:NF1眼眶CT的主要表现为:上睑肥厚,眶周及颞、颧部丛状神经纤维瘤;蝶骨发育不良,蝶骨大小翼或额骨眶板缺失;颅眶骨畸形,眶腔不对称性扩大,眶上、下裂及视神经孔扩大;眼球突出,体积增大;眶内软组织肿块;泪腺肿大,眼外肌肥厚,视神经增粗.结论:眼眶CT扫描对NF1病变侵犯范围、能否手术和手术方式选择具有重要的应用价值.     

眼眶骨折中视神经创伤性损害的CT评价

作者报导了10例眼眶骨折并视神经损伤。除个别病例作的是常规头颅扫描,以眶上线-外耳道联线为基线,扫描后将眼眶区单独放大外,大多数病例都作了眶区扫描。以眶下缘-外耳道连线为基线,层厚2mm,分别取软组织和骨窗摄影。经CT     

颅盖骨常见局限性骨病的影像学诊断

颅盖骨由外板、板障及内板组成,包括额骨、顶骨、枕骨、颞骨及部分颧骨和蝶骨大翼。颅盖骨局限性骨病主要有良性肿瘤、恶性肿瘤、肿瘤样病变、炎性疾病、郎格罕细胞组织细胞增生症等。这些病变除少数疾病外,在颅骨的发生率较低,临床较为少见,影像学表现研究较少,加之部分病变缺乏影像学特征,影像诊断存在一定的困难性。笔者对颅盖骨局限性骨病的影像学表现进行综述。     

成人正常眼眶结构的CT测量

目的　建立正常成人CT轴位扫描眼外肌的直径标准、眼外肌群直径总和与颧骨间距比值及眼球的正常位置。方法　从10 0例正常成人共 2 0 0个眼球结构中 ,在轴位CT上分别测量眼外肌的直径、颧骨间距、从颧骨间平面到眼球后缘的距离、球后至眶尖的距离及视神经鞘的宽度 ,同时分析眼外肌群直径总和与颧骨间距的比值。结果　眼外肌正常直径范围 :内直肌 2 .7～ 5 .2mm ,平均 4.0mm。外直肌 1.8～ 4.9mm ,平均 3.4mm。下直肌 5 .4～ 9.1mm ,平均 7.8mm。上直肌群 6 .7～ 10 .2mm ,平均 8.5mm。视神经鞘为 3.1～ 5 .6mm ,平均 4.4mm。眼球后缘正常位置为颧骨间线后 8.7mm(范围 5 .4～ 11.9mm) ,球后至眶尖 33mm(范围 2 4～ 42mm) ,眼外肌总和与眶骨间距比值为 0 .2 3(范围 0 .19～ 0 .2 6 )。结论　CT测量眼眶结构简便易行 ,并检出测量的参考层面标准     

伞骨致眶颅贯通伤一例

患者 ,男 ,1 1岁。因开自动伞时伞骨刺入眶内 1 8ｈ来诊。体检 :意识清 ,言语流利。左眼内眦外上方约眶上孔下缘处 ,见伞骨断端经眼睑刺入眶内 (其余部分已在外院剪掉 ) ,眼球活动自如 ,视力视野正常 ,眼底无异常。急诊行ＣＴ及眼眶正侧位Ｘ线片检查 ,显示有细长金属异物经眼眶刺入颅内 ,颅内段长约1 .5ｃｍ。入院后 ,即行开颅探查术。于全麻下经翼点入路 ,咬除部分蝶骨嵴 ,显微镜下沿蝶骨嵴分别分入侧裂池、颈内动脉池、视交叉池。见伞骨经眶上裂入颅 ,在视神经及颈内动脉下方见一硬膜外小血肿约 0 .5ｃｍ× 0 .5ｃｍ大小 ,伞骨顶端未完全…     

颅眶颌面部钩形金属异物贯通伤一例

患者，男，33岁，因车祸致伤头面部，一个锐角形钩状钢筋自左眼眶下方穿入头部。体检：意识恍惚，左眼肿胀、外凸，球结膜水肿，左眶下缘内侧皮肤裂伤长约2．5cm，可见钢筋残端外露约0．5cm：颅骨正侧位X线片可见直径约0．8cm的钩形金属异物，自左侧上颌窦穿入，经眶下进入眶后部近眶尖处，穿破眶上内侧壁及蝶骨平台进入颅内，转折指向鸡冠方向达额窦后壁。颅脑CT可见钩形异物造成额叶的挫裂伤灶，骨窗位显示骨折累及蝶骨、视神经孔、眶壁及上颌窦、额窦。入院诊断：颅、眶、颌面金属异物贯通伤，脑挫裂伤，颅底骨折。入院后急诊在全身麻醉下进行初步清创后做额部冠状切口，保留带蒂骨膜瓣，做过中线的额部游离骨瓣，见额窦内侧壁粉碎骨折，骨折线向下延至左侧眶上壁。该区域硬膜广泛破损，有挫碎脑组织外溢。常规处理额窦并以骨蜡严密封闭，将挫灭脑组织清除，暴露前颅窝底达前床突，见左眶上壁粉碎骨折，骨缺损约2．0cm×3．0cm，眼外肌外露，骨折线通过鞍结节向后下延伸，金属异物自眶后部穿出，指向鸡冠方向，颅内段长约4．5cm。此时将面部创口适当扩大，摘除上颌窦粉碎骨折片，显露异物的颅外部分长约6cm，达上颌窦深处，自颅内沿窦道方向向外下轻推异物，同时自颅外牵拉，将异物缓慢旋转取出，未发生大的活动出血，严格修补颅底，清创术毕。术后患者恢复良好，随访4个月，除左眼视神经损伤外无其他神经系统损伤。     

Crouzon综合征颅面部的CT表现(附8例报告)

目的 总结Crouzon综合征颅面部的CT表现,提高对该病的认识.资料与方法 回顾性总结分析8例Crouzon综合征颅面部CT征象.结果 CT均表现为眼眶、鼻腔鼻窦、颞骨、颌骨及颅底的异常.眼眶:眶腔变浅,眶外壁夹角增大,眶距增宽以及眼球突出16眼,视神经迂曲7眼,眼外肌增粗10眼;鼻腔鼻窦:鼻腔狭窄伴鼻中隔偏曲8例,鼻窦发育差6例,鼻咽腔变窄7例;颞骨:壶腹型内耳道8例,乳突气化差4例,乳突炎4例;颌骨:上颌骨发育不良,硬腭高拱,口腔顶壁呈倒"V"字形6例;颅底:颅骨内板弥漫性深大脑回压迹,蝶骨大翼狭长菲薄,颞窝变小,前颅窝底低位,颈静脉球窝增大8例,蝶鞍异常5例,乙状窦前位4例.结论 CT能够为Crouzon综合征颌面部的异常改变及其并发症的评估提供客观依据.     

外固定器在小腿筋膜间隔综合症中应用(附2例报告)

我院骨科对两名胫腓骨骨折合并小腿筋膜间隔综合症病例,利用骨延长器反向牵引杆及自行设计悬空架作外固定器,采用外固定治疗,取得了理想效果。现报告如下:病例一患者x xx,武警战士,左小腿被石柱倒塌压砸致伤,胫胖骨中上1/3处粉碎骨折,肢体畸形肿胀明显,局部张力高,有张力性水泡,足背动脉消失,肢体感觉与肌肉功能障碍。诊断:胫排骨骨折合并小腿筋膜间隔综合症。当时采取急诊小腿筋膜间隔多处切开及跟骨牵引治疗     

《请您诊断》病例20答案:绿色瘤一例

病例资料CT示右眶和右上颌窦后外侧壁骨壁及翼板见骨质疏松、骨质破坏,局部相当于右侧中颅窝、颞窝及颞下窝软组织密度类圆形肿块,侵犯鼻咽、蝶窦、斜坡及右侧眶骨,向眶内生长,右眼球突出;右侧翼内外肌颞肌受累（图1、2）。     

rhBMP-2对兔下颌骨牵引成骨的影响及BMP-4的表达

 目的 通过观察兔下颌骨牵引成骨过程,探讨不同剂量重组人骨形成蛋白2(rhBMP-2)在不同时间对成骨区新骨生成的影响及其BMP-4的表达.方法 日本大耳白兔48只行单侧下颌骨牵引,分别将不同剂量 rhBMP-2胶原复合物植入骨切开处,间歇期5 d,牵引速度0.4 mm/d,2/d,共牵引5 d.用免疫组化方法观察牵引成骨新骨生成区BMP-4在固定1、7、14、28 d时的表达及新骨生成情况.结果 随着稳定期延长,牵引间隙内新骨逐渐生成.1.5 mg BMP-2剂量组的新骨生成优于对照组,3 mg BMP-2剂量组的新骨组织在同一时期内最多.BMP-4主要定位于成骨细胞和软骨细胞中,表达高峰出现在稳定期的1、7 d,此后逐渐下降,第28天阳性表达微弱.结论 rhBMP-2能促进牵引成骨,并具有浓度依赖性,BMP-4可能在牵引成骨的早期发挥重要作用.     

Medpor植入修复眶壁爆裂性骨折并发眼球内陷术后视功能评估

目的应用高密度多孔聚乙烯Medpor植入体薄片植入进行眶壁缺损修复,观察其对外伤性眶壁爆裂性骨折并发眼球内陷的修复效果,评估术后患者的视功能恢复情况。方法1996年12月-2005年6月,共治疗眶壁爆裂性骨折并发眼球内陷患者68例,男38例,女30例;年龄18～50岁,平均31.2岁。受伤至手术时间14 d～6.5年,合并复视患者45例,视力较受伤前降低者39例。采用下睑缘切口,于下眶缘骨膜下沿内下眶壁向眶尖方向潜行剥离。充分暴露骨折部位和松解嵌入上颌窦的眼眶组织并使其复位,使之成为骨膜下间隙。依据眼球的内陷程度,采用Medpor修复眶内下壁及其他眶壁缺损,矫正眼球内陷畸形。结果68例患者术后眼球内陷均得到明显改善。45例复视患者中36例治愈。39例视力下降患者中13例视力较术前有不同程度改善。无复视加重和视力下降现象。全部患者经2个月～8年随访,眼球内陷程度均稳定在2 mm以内,无畸形复发及其他并发症发生。结论高密度多孔聚乙烯Medpor植入体组织相容性好、并发症少、视功能恢复好,可作为眶壁爆裂性骨折并发眼球内陷修复术的首选植入物之一。     

感觉神经缺失对兔下颌骨牵张成骨影响的生物力学观察

目的研究离断下牙槽神经对兔下颌骨牵张成骨新生骨痂生物力学性能的影响。方法对20只新西兰白兔进行双侧下颌骨牵张成骨,左侧（实验侧）在手术显微镜下暴露并切取约0．6cm下牙槽神经,保护下牙槽血管束,右侧（对照侧）仅暴露下牙槽神经而不切断。术后动物随机分为2组,分别在固定期14、28天取材。对双侧兔下颌骨新生骨痂进行外径测量、苏木精-伊红（HE）染色及生物力学测试。应用SPSS12.0软件包进行配对t检验,分析离断下牙槽神经侧与对照侧牵张区新生骨痂上述指标的差异。结果双侧牵张区新生骨痂长度与外径未见明显差异（P〉0．05）;离断下牙槽神经侧牵张间隙可见神经组织完全变性,对照侧牵张间隙内神经组织完好。三点弯曲测试显示固定期14、28天时实验侧最大载荷及挠曲强度分别比对照侧低40．1％、26．8％（P〈0．05）。结论离断下牙槽神经可引起牵张区新生骨痂生物力学强度不足,提示感觉神经系统在牵张成骨的成骨过程中起到一定调控作用。     

下颌牵张成骨中应用神经生长因子对神经损伤修复的作用

目的研究下颌骨牵张成骨中全身注射神经生长因子(NGF)对损伤的下齿槽神经的修复作用。方法新西兰白兔48只,全麻下行双侧下颌骨牵张成骨术,术后第4天以0.5mm/12h的速度牵张,共10天。术后即分别给予肌注NGF0.6μg/d×20天和相当量生理盐水。采用BL-420F生物机能实验系统及检测设备,分别在术前、牵张期结束、固定期1、2、4周时行感觉神经动作电位(SNAP)测试。结果在牵张完成时、固定期1周,NGF组和对照组的SNAP波幅和潜伏期无统计学差异;在固定期2、4周,NGF组波幅明显高于对照组,而潜伏期明显低于对照组(P0.05)。结论全身注射NGF有利于牵张成骨中下齿槽神经功能的恢复。     

Pulmonary effects of submerged oxygen breathing in resting divers: repeated exposures to 140 kPa.

To detect cumulative effects of and check required recovery times between underwater exposures to 130-140 kPa oxygen, we assessed pulmonary oxygen toxicity after resting dives for four and six hours on two, five, and six or ten days, and three hours twice on each of two days. Despite a slight downward trend in diffusing capacity, four-hour resting dives could be repeated for at least ten days if intervals between them were 20 hours: 17% of divers had mild symptoms; 5%, mild changes in flow-volume parameters. In contrast, six-hour resting dives caused symptoms in 33% of divers. When dives were repeated daily (after 18 hours), but not with one day off (after 42 hours), changes in diffusing capacity accumulated, and hyperoxic myopia occurred after five dives. Divers complained of fatigue more with daily than with alternate day dives. When daily exposure was split into two three-hour dives, the incidences of symptoms and changes in pulmonary function depended on the surface intervals: on the second day, with two and 16 hours between dives, two three-hour dives were similar to a six-hour dive; with four and 14 hours, to a four-hour dive; with six and 12 hours, to a six-hour dive.     

The early effect of ibuprofen on the mechanical properties of healing medial collateral ligament

We tested the hypothesis that injured ligaments in rabbits treated with ibuprofen would have decreased values of mechanical properties compared with the values of those treated with a placebo. In 24 New Zealand White rabbits, the medial collateral ligament of one hindlimb was ruptured; the contralateral ligament served as an internal control. The rabbits were treated orally, twice daily, with a 14-day course of either 35 mg of ibuprofen per kilogram of body weight or a placebo. The rabbits were sacrificed at 14 or 28 days, and the ligaments were tested in tension to failure at 0.15 mm/sec. There was no statistically significant difference in the values of mechanical properties of ligaments from rabbits treated with ibuprofen versus those treated with placebo at either 14 or 28 days after injury. Our findings suggest that there is no early deleterious effect of a short course of ibuprofen on the mechanical behavior of medial collateral ligaments.     

突发呼吸道传染病疫情期间一线工作人员不适症状及睡眠质量分析

 目的 分析突发呼吸道传染病疫情期间一线工作人员不适症状及睡眠质量。方法 选取某部56名一线工作人员作为研究对象,通过问卷调查统计在污染区工作时,头晕、心慌、呕吐或晕厥等不适症状的发生情况,并将出现不适症状≤2次的29名工作人员设为对照组,将出现不适症状>2次的27名工作人员设为观察组。比较两组人员年龄、BMI、日常锻炼情况、首次发生时的值班时段、睡眠状况,以及睡眠状况和不适症状的相关性。结果 与对照组比较,观察组年龄、BMI、日常锻炼情况、入睡困难频率和实际睡眠时间差异均无统计学意义。与对照组比较,观察组应用药物催眠比例更大(P＜0.05),对睡眠质量的自我评价更低(2.67±1.04 vs 3.24±0.95,P＜0.05)。56名一线工作人员中有39名(69.64%)首次发生不适时处在夜班时段,不适症状出现次数与睡眠质量自评得分呈负相关(r=-0.345,P=0.009)。结论 突发呼吸道传染病疫情期间一线工作人员发生不适症状的状况较为普遍,以夜间为主,可能与任务期间睡眠质量低有关。     

Infantile acute subdural hemorrhage probably caused by injury to the diploic channels

A 6-month-old, previously healthy boy hit the right frontal region of his head against the corner of a plastic toy box. At presentation, a small area with scalp discoloration was noted in the right frontal region. Head computed tomography at the level of discoloration revealed an intracranial hematoma, 5 mm in maximal thickness, below the coronal suture. In addition, there were bony bridges connecting the frontal and parietal bones. Furthermore, a linear crack was found in the diploe of the frontal bone in contact with the coronal suture. Cerebral MRI confirmed linear hyperintensity between the inner tables. We assumed that a kind of ping-pong ball fracture was caused by the head blow, centering on the coronal suture, resulting in rupture of contacting diploic channels and tear of the dura mater, and forming a subdural hematoma. Acute subdural hemorrhage may be caused by an insignificant blow to the coronal suture in infantile patients with underdeveloped cranial bones and sutures, accompanied by subtle external findings.     

Effects of gravitoinertial force variations on vertical gaze direction during oculomotor reflexes and visual fixation

Recordings of horizontal and vertical eye movement were obtained on eight subjects exposed to repeated patterns of vertical and horizontal optokinetic stimulation, visual fixation with a fixed or unseen target, and voluntary head oscillation in the high force and free-fall periods of parabolic flight. The downward shift of the beating field of vertical optokinetic nystagmus (OKN) observed in previous experiments was confirmed in the present study. The same directional shift was also noticed during optokinetic after-nystagmus (OKAN). Vertical direction of gaze clearly shifted downward during the decreased gravitoinertial force level when subjects were exposed to horizontal optokinetic stimulation, or when they attempted to track an unseen target in the dark with the head stationary or actively moved up and down. A vertical nystagmus with slow phases directed upward was observed during transition from high force level to free-fall when subjects were fixating their gaze on a stationary target. These findings are in agreement with those showing a general downward drive of the eyes on the first exposure to microgravity during orbital flight and an upward drive on the first day of return. Although this drive could be a consequence of a disorientation experienced by subjects undergoing parabolic flight or by astronauts, the phenomenon also supports the hypothesis of a tonic influence exerted by the otoliths on the postural and extra-ocular musculature in order to compensate for the downward pull by the gravitoinertial forces.     

Case report of exertional rhabdomyolysis in a 12-year-old boy

INTRODUCTION: Exertional rhabdomyolysis has been well characterized, and many case reports exist. No cases of exertional rhabdomyolysis in young healthy children (preteen) have been published. CASE SUMMARY: Reviewed were the medical records of a 12-yr-old boy who participated in an indoor physical education class where excessive (>250) repetitive squat jumps were performed as punishment for talking in class. The boy, who reported intense muscle soreness in the thighs and dark urine 2 d postexercise, was brought to the emergency room by his parent. His serum creatine kinase (CK) was 92,115 U.L(-1) and urinalysis indicated the presence of blood and protein. He was transferred to another hospital that evening, admitted, and treated for 7 d. His serum CK rose to 244,006 U.L(-1) at 4 d postexercise. CONCLUSION: Although exertional rhabdomyolysis is rare in young children, it can occur when excessive exercise is spurred on by an adult.