眶隔脂肪合理化释放结合眼轮匝肌肌瓣翻转填充在凹陷型睑袋整复术中的应用体会

目的 研究眶隔脂肪合理化释放结合眼轮匝肌肌瓣翻转填充术在凹陷型睑袋整复术中的应用效果.方法 回顾性分析2018年4月至2020年1月到我院就诊的下睑眶缘凹陷型睑袋要求行整复治疗的32例患者的临床资料,均进行眶隔脂肪合理化释放结合眼轮匝肌肌瓣翻转填充术,术中松解眶下缘眶隔,根据患者实际情况有选择性地释放眶隔内脂肪,并适当...     

下睑睑颊沟区凹陷畸形修复的临床效果观察

目的：探讨眶膈脂肪填补凹陷改良术修复下睑、睑烦沟区凹陷畸形的临床效果。方法：对14例下睑、睑烦沟区凹陷畸形病人施行修复手术，先在皮肤与眼轮匝肌间和眼轮匝肌与眶膈间潜行分离至眶下缘或向下分离至颧骨，肌瓣向外上牵拉固定于外眦眶骨膜上；保留眶膈内脂肪组织填充于凹陷处，用以修复下睑、睑烦沟区凹陷畸形。结果及结论：14例均取得满意效果，术后下睑、睑颊沟区凹陷畸形得到矫正，眼周皮肤平复、饱满。提示修复和加强前壁支持组织，利用眶膈脂肪填补凹陷是矫正下睑、睑颊沟区凹陷畸形，恢复年轻容貌的有效方法。     

眼睑皮肤迟缓症的手术疗效分析

眼睑皮肤迟缓症是一种较少见的眼睑皮肤病,以眼睑反复无痛性红肿为特征,继之引起眼睑皮肤萎缩松驰。作者2003~2007年共通过手术治疗15例,效果满意,现报告如下。1资料与方法1.1一般资料本组15例30眼,男5例,女10例,年龄18~50岁,其中45岁以下9例(60%),发病时间2~19个月,平均7.5个月,所有有患者均有双上睑无凹陷性红肿反复发作的病史,眼睑皮肤呈暗红色,松驰下垂,其中9例伴有泪腺脱垂。所有病例全身检查未见异常。1.2手术方法①麻醉:双眼同时手术,2%利多卡因+肾脏腺素少许局部浸润麻醉;②皮肤切口:在上睑缘上方7~8 mm相当于重睑切口作全层皮肤切开;③暴露眶隔:分离皮下组织至睑缘,切除睑缘上一束眼轮匝肌,钝性分离切口上方皮下组织及眼轮匝肌,此时可见松驰的眶隔及其下脱垂的脂肪;④分离眶隔至节制韧带处,打开眶隔尽量切除脱出的脂肪,电灼止血,间断缝合固定。伴有上睑下垂者同时做提上睑肌缩短;⑤伴有泪腺脱垂者行眶隔缩短加固:先沿睑缘部将颞侧1/3眶隔板层剪开小口,切口两端作预置缝线后,全层剪开颞侧1/3眶隔,此时便有眶脂肪及黄白色泪腺组织脱出创口,将眶隔组织切除3~4 mm,再将脱出的泪腺组织托入眶...     

不同类型眼袋的术式选择及疗效分析

目的探寻不同类型的眼袋最有效且合适的外科治疗方法,并进行疗效分析。方法收集进行眼袋整复的患者98例,其中24例为单纯眶脂肪疝眼袋,52例为下睑膨隆伴皮肤松弛型眼袋,22例为皮肤松弛伴眶下缘凹陷型眼袋,分析这三种类型手术方式、并发症的差异,并比较术后疗效。结果单纯眶脂肪疝出型眼袋结膜入路眶隔后及眶隔前入路手术的效果差异无统计学意义(χ2=0,P>0.05)。且行结膜入路切口≥1 cm时,应于内、中、外三点定位缝合结膜下组织,以利于创口对合生长。对于下脸膨隆伴皮肤松驰型患者皮瓣法术后效果优于肌皮瓣法(χ2=5.30,P<0.05)。对于重度下睑松弛患者,处理外眦可以减少术后下睑外翻、下睑退缩的发生率(P<0.05)。对于有眶下缘凹陷的患者,行Hamra术可以有效预防术后眶下缘凹陷(χ2=6.29,P<0.05)。结论不同类型的眼袋应选用不同的手术方法,增加手术成功率,减少手术创伤和并发症的发生。     

结膜入路法眶隔脂肪释放转移术的围术期护理

<正>结膜入路法眶隔脂肪释放转移术是在局部麻醉下通过下眼睑内侧做切口至眶隔,在眼轮匝肌与眶隔之间向下剥离至眼轮匝肌下缘,充分暴露眶隔与眶下缘骨膜,沿眶下缘剪开眶隔,彻底释放脂肪,整理、修剪并固定,填充眶下缘的凹陷区来治疗眶下脂肪先天过度发育,脂肪疝出且合并眶下区凹陷明显的病人。这类病人下眼睑呈袋状畸形,眶下区凹陷,不同程度给人们衰老、疲劳之感[1]。手术虽然关键,但全面系统的围术期护理亦极其重要,做好围术期护理可以调整病人的     

结膜囊入路眼袋整复术60例报告

1992～ 2 0 0 2年 ,作者采用结膜囊入路行眼袋整复术 6 0例 ,效果满意 ,现报道如下。1　临床资料1.1　一般资料　本组男 5例 ,女 5 5例 ,平均年龄 34(2 0～ 4 8)岁。无皮肤松弛者占 4 5例 ,伴轻度皮肤松弛者 10例 ,有明显皮肤松弛者 5例。1.2　手术方法　先用 1%地卡因滴眼行结膜表面麻醉后 ,再用 1%利多卡因 3ｍｌ行局部浸润麻醉。浸润区域自切口至眶下缘手术区。于下穹窿结膜中部做横向 0 .5ｃｍ切口 ,用眼科弯剪刀向前下钝性分离 ,在轮匝肌的深面暴露眶隔 ,用小弯血管钳夹住并提起眶隔筋膜可见眶内脂肪 ,分开眶隔筋膜 ,轻压眼球 ,可见眶…     

改良下睑袋整形术治疗下睑松垂的临床体会

目的对下睑松垂患者应用改良的下睑袋进行术对其进行整形,并对其临床效果进行观察与探讨。方法选取自2013年7月至2015年1月间在我院进行下睑袋整形手术的患者共计242例(484眼),其中有男性患者60例,女性患者182例,患者年龄在39岁至67岁之间,平均年龄为50.6岁,针对下睑松垂的患者其下睑袋临床的病理特点选取下睑缘的切口,将皮肤垂直地切开,并将眼轮匝肌暴露出来,向眶隔以稍远的分离1mm至2mm之间,以45度的角度向下斜行,剖开患者的眼轮匝肌,将眶隔显露出来,将多余的脂肪去除并进行重置,在对眶隔进行加固后,将皮肤的切口缝合,所有进行整形手术的患者均在手术一周后将切口的缝线拆除。结果 242例患者在手术后其下睑松垂的现象均得到了解决,由护理人员对患者进行为期3个月至2年时间的随访,患者的眶下区均得到了较为理想的改善,睑缘以及下险的形态十分自然,并无睑球分离以及下睑外翻等现象出现。结论应用改良过后的下睑袋整形手术对于下睑松垂患者病理的特检有着较强的针对性,是一种较为理想的下睑袋的整形方法。     

老年性上睑下垂的手术治疗

目的：探讨老年性上睑下垂的手术效果，对8例老年性上睑下垂的临床资料进行回顾性分析。方法：距睑缘5～6mm作重睑标记线。沿标记线切开皮肤并去除多余皮肤。分离切口上下沿轮匝肌。暴露睑板及提上睑肌腱膜，术中见睑板前表面光滑，腱膜与睑板断离，切开眶膈。暴露腱膜前脂肪垫，在此眶脂肪后为提上睑肌腱膜。眶隔与提上睑肌汇合的下方有一明显白线，证明了腱膜未附着，于睑板上1／3的半层经眶膈缘、提上睑肌缘、眶膈缘作3～4针缝线，并调整缝线高度，使上睑缘达角膜上缘、睑缘弧度满意后结扎缝线。问断缝合上睑皮肤及睑板形成双重睑。结果：8例中。12眼老年性上睑下垂均得以矫正。眼睑闭合功能正常。无眼睑畸形发生，也无复发病例。结论：此方法使老年性上睑下垂病理改变得到解剐复位。维持了眼睑的正常结构，从而使提上睑肌生理功能能得以恢复，上眶区凹陷畸形得以矫正。     

眶隔脂肪联合腹部脂肪瓣矫正上睑凹陷40例临床分析

目的探讨眶隔脂肪结合腹部脂肪瓣转移填充矫正上睑凹陷的临床应用。方法 40例上睑凹陷患者应用眶隔脂肪联合腹部脂肪瓣矫正。注射足量局部麻醉药物后,于眼轮匝肌深面剥离,边界超过凹陷标记线约2mm,先将眶隔脂肪释放并于凹陷处固定;再自脐周取适量脂肪组织,分别与眶隔脂肪及周围组织固定以填充上睑凹陷。结果 38例术后效果满意,2例因矫正不足再次行填充手术。结论眶隔脂肪联合腹部脂肪瓣转移填充术是治疗上睑凹陷的有效方法,具有矫正效果自然、供区组织量充足等优点。     

两种不同手术方式在单睑并轻度上睑凹陷中的应用

目的 探讨眶隔脂肪瓣转移联合重睑术与自体块状脂肪移植联合重睑术在重睑术中矫正上睑凹陷的效果。方法 选择2019年11月至2022年9月间于新乡医学院第三附属医院医疗美容科行重睑成形术的53例患者。其中25例患者行自体块状脂肪移植联合重睑术（对照组）,28例患者行眶隔脂肪瓣转移联合重睑术（观察组）。比较两组患者基线资料。随访至术后6个月,比较两组患者术后并发症情况、上睑凹陷矫正满意度,并进行统计学分析。结果 两组患者基线资料无统计学差异（P>0.05）。观察组术后并发症、上睑凹陷矫正度、术后满意度均优于对照组（P<0.05）。结论 眶隔脂肪瓣转移联合重睑术应用于重睑术时对矫正上睑凹陷有较好的效果,是一种简单有效的手术方式。     

Surgical Complications of Peptic Ulcer

Baggy eyelids result from redundant eyelid skin with or without herniated orbital fat. The condition can be surgically corrected. Blindness is a rare surgical complication, and a complete ophthalmologic evaluation should be carried out to document preoperative visual status.     

Sonographic findings of a Bochdalek hernia: the importance of ring-down artifacts

Bochdalek hernia is the most common congenital diaphragmatic hernia. It may be incidentally identified on CT. We report the sonographic findings in a case of Bochdalek hernia, which showed ring-down artifact posterior to the herniated intra-abdominal fat.     

腰椎间隙突出髓核内压力与相邻神经根的受压程度

背景有关突出髓核占位性变与腰椎间盘突出症神经根受压程度及手法治疗的观察比较多见,尚缺乏从突出髓核内压力入手的相关量化研究.目的观察腰椎间盘突出症患者突出髓核内压力对神经根受压程度的影响.设计病例对照观察.单位空军总医院全军正骨疗法中心.对象选择2002-10/2003-12空军总医院骨科行手术治疗腰椎间盘突出症患者30例,正骨疗法中心行手法治疗的腰椎间盘突出症患者15例.干预①30例手术患者根据直腿抬高试验分为直腿抬高阳性组、直腿抬高阴性组,测量术中患者突出髓核内压力大小;手术前后直腿抬高高度.②15例手法治疗患者,手法治疗后当即测量直腿抬高高度的变化.③椎间盘突出髓核大小测量为CT和/或MRI上横截面椎间盘突出顶点到椎体后缘的最大垂直距离.主要观察指标①患者腰椎间盘突出髓核内压力,突出髓核大小.②患者直腿抬高高度.结果纳入30例手术治疗患者,15例手法治疗患者,全部进入结果分析.①患者腰椎间盘突出髓核内压力,突出髓核大小手术患者直腿抬高阳性组患者突出髓核内压力明显高于阴性组患者[(2.119±0.753),(0.483±0.420)kPa,P＜0.01].阳性组和阴性组两组患者突出髓核大小无明显差异[(4.688±1.991),(4.857±2.033)mm,P＞0.05].②患者直腿抬高高度手法治疗患者治疗后直腿抬高高度明显高于治疗前[(54.000±16.388)°,(72.668±15.338)°,P＜0.01],手法治疗前后CT或MRI显示突出髓核大小无改变(P＞0.05).结论①椎间盘突出髓核对神经根的压迫与突出髓核内压力有关,突出髓核内压力较大时患者直腿抬高受限,突出髓核内压力较小时直腿抬高不受限.突出髓核对神经根的压迫与突出髓核大小尚未见明显影响.②推测手法治疗可以通过降低突出髓核内压力减轻甚至解除神经根受压,可能不是仅依靠改变突出髓核空间占位达到治疗目的.     

Soft Tissue Masses of the Knee Related to a Focal Defect of the Lateral Patellar Retinaculum

We report on the imaging features of 6 soft tissue masses in the anterolateral aspect of the knee related to a focal defect of the lateral patellar retinaculum. In 4 patients (3 female and 1 male; 6–65 years) presenting with nontender palpable soft tissue masses in the anterolateral aspect of their knees, ultrasonography showed a focal defect of the lateral patellar retinaculum with herniation of the Hoffa fat pad, which was only visible in flexion. A magnetic resonance imaging examination performed in 1 case confirmed the defect in the lateral patellar retinaculum but did not show a mass, as the knee was examined only at 10° of flexion. The 2 remaining patients (one male and 1 female; 62 and 55 years) presented with soft tissue masses in their anterolateral knees in both flexion and extension. These masses were related respectively to a lipoma of the Hoffa fat pad and to a ganglion cyst, both herniated through a defect of the lateral patellar retinaculum. Our cases suggest that a focal defect of the lateral patellar retinaculum may be a route for Hoffa fat pad herniation as well as a route for superficial extension of infrapatellar fat lesions such as lipomas and ganglion cysts.     

Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy

Thirty percent to 95% of patients with lumbar radiculopathy secondary to a bulging or herniated disc improve to a pain-free and functional level with nonsurgical treatment. What happens to the herniated disc material as this improvement occurs is unclear. We present two patients with lumbar radiculopathy documented by physical examination and electrodiagnostic testing. Both patients had herniated disc material at the L5 to S1 level on computed tomography (CT) scans corresponding to the side and level of their lesion on physical examination and electrodiagnostic testing. In both instances, the radiculopathy resolved with conservative treatment. CT scans were repeated in three months on one patient and four months on the other. The scans showed major resolution of the herniated disc material in both patients. These two cases demonstrate that in some patients with proven radiculopathy secondary to herniated nucleus pulposus, the herniated disc material will no longer be visible on CT scan and is presumed to resorb as the symptoms abate.     

A Study on Dispersion and Rate of Fat Infiltration in the Lumbar Spine of Patients with Herniated Nucleus Polpusus

[Purpose] This study investigated the relationship between herniated nucleus pulposus (HNP) and fat infiltration of muscles around the spine by measuring body mass index (BMI) and fat infiltration of the muscles around the spine. [Subjects and Methods] Subjects were 82 people, both men and women they were divided into two groups, a normal group and a patient group who were suffering from serious HNP between L4 and L5. Of the anthropometric measurement, and fat infiltration muscles by measuring the cross-sectional area from the center of the disc to the muscle around the spine and the cross-sectional area of fat infiltration. [Results] Fat infiltration rate of each lumbar layer in the normal group was different L34–L45 and L45–L5S1, but not between L23–L34. Fat infiltration in the muscle between the normal group and patients with HNP was different in the layers and the difference was greatest in the L5–S1 layer. [Conclusion] We performed correlation analysis of BMI and the total fat infiltration rate in each group to find the relationship between obesity and fat infiltration in the lumbar spine. Fat infiltration increased, and normal people or patients with chronic back pain are considered to be exposed to other diseases as fat infiltration in the lumbar spine increases.Key words: Fat infiltration, Herniated nucleus pulposus, Low back pain     

Surgical treatment and outcomes of lumbar radiculopathy

Lumbar disk herniation is a significant cause of lumbar radiculopathy and results in billions of dollars in health care expenditure. Herniated lumbar disks cause mechanical and chemical irritation of the nerve roots leading to complaints of sciatica. Surgeons have several surgical options when approaching herniated disks, including various microsurgical procedures. The 3 most prominent studies to date on surgical and nonsurgical management of herniated disks agree on the efficacy of surgery over medical management in the short term but have some discrepancies when looking at long-term results. Cauda equina syndrome is a variation of lumbar disk herniation in which patients experience a combination of saddle anesthesia, abnormal lower extremity reflexes, and neurogenic bowel or bladder symptoms.     

新生儿期膈疝的超声表现及诊断价值

目的探讨新生儿期膈疝的超声声像图特点。 方法选择2000年1月至2017年12月首都医科大学附属北京儿童医院超声及手术病理检查确诊为新生儿期膈疝的患儿19例,平均出生（12.8±11.7）d,其中3例产前已诊断膈疝,11例表现为呼吸困难,3例表现为呕吐,2例表现为心动过速。总结19例新生儿超声声像图特点。 结果19例新生儿膈疝术前超声显示自左侧胸腔内疝入小肠4例,胃底2例,脾脏3例,1例疝入物为左侧肾上腺及左肾上极;右侧胸腔内疝入肠管3例,4例疝入物为部分肝脏右叶及胆囊,2例疝入物为右肾上腺及右肾。食道裂孔疝疝入物均为胃。后外侧疝表现为膈肌不连续,位于腹腔内或腹膜后的脏器通过不连续的膈肌进入胸腔水平。食道裂孔疝表现为胃体通过食管裂孔疝入胸腔。术前超声诊断后外侧疝16例,食道裂孔疝2例,1例膈疝与膈膨升不能鉴别。与术前相关影像及手术检查结果对照,术前超声诊断符合率为94.74%（18/19）。 结论新生儿期患儿胸壁软组织薄,超声检查可清晰实时多角度显示膈肌情况,诊断符合率不低于CT或磁共振成像,且无放射性损伤,是新生儿期膈疝患儿首选的影像学检查方法。     

Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis,herniated nucleus pulposus and pulmonary comorbidities

A 70‐year‐old man with severe pulmonary comorbidities was referred to our institution for treatment of a right L5 nerve impingement. He had suffered from spinal canal stenosis and herniated nucleus pulposus (HNP) at the level of L4‐L5 for more than a year and had been treated conservatively. However, the pain could not be alleviated, and his primary care physician scheduled posterior decompression surgery. During this procedure, the anesthesiologist refused to induce general anesthesia because of the patient's very poor pulmonary condition. Subsequently, the patient was referred to us. We used a transforaminal approach with percutaneous endoscopic discectomy, with the patient under local anesthesia. First, herniated nucleus pulposus fragments at the disc level were removed. With a trephine drill, the upper part of the L5 pedicle was removed, which allowed for the extraction of dorsally migrated fragments. Following complete removal of the herniated nucleus pulposus fragments, osseous decompression was performed. The osseous endplate of L5 (anterior part of the lateral recess) was removed to enlarge the lateral recess so that decompression of the L5 nerve root was possible. The patient's lower back pain and right leg pain subsided following surgery. Percutaneous endoscopic discectomy is useful for patients with severe comorbidities as it can be done with local anesthesia.     

头针及整脊治疗腰椎间盘突出症髓核大小的改变

背景:临床上通过一定的方法可减少突出椎间盘内容、降低椎间盘内压的效果,使已突出的间盘组织还纳或复位.目的:观察腰椎间盘突出物髓核治疗前后大小的变化情况.方法:随机将60例腰椎间盘突出症患者按就诊先后顺序随机数字抽签法均分为头针组、整脊组、头针合整脊组,进行不同手法的治疗.另取同期健康体检人群20例设为正常对照组.观察各组患者椎间盘突出髓核经治疗后能否回纳.结果与结论:与正常对照组比较,其他3组治疗前突出髓核的大小差异有非常显著性意义(P＜0.01);3组治疗前后突出髓核的大小比较,差异无显著性意义(P ＞ 0.05);3组疗效比较,差异亦无显著性意义(P ＞ 0.05).结果证明3种手法治疗腰椎间盘突出症对椎间盘突出髓核的回纳无明显作用.