用鼻唇沟真皮瓣治疗下面瘫的临床观察

面瘫的治疗方法很多,如颞肌和咬肌肌瓣转移和阔筋膜条悬吊等法,因术后面部表情处于静止状态,效果并不理想。目前认为效果最好的是Anderl提出的横过面部的神经移植术和Thompson介绍的自体肌肉移植术,其最大优点是术后能恢复正常     

自体阔筋膜膀胱尿道悬吊术的疗效及并发症

作者报告采用自体阔筋膜进行膀胱尿道悬吊术治疗压力性尿失禁的疗效、局部并发症和患者满意度。手术采用自体大腿的两条厚的阔筋膜制成吊带材料,将该吊带置入尿道下,并于耻骨上将其轻轻系紧。采用标准问卷的方式(BUDI 6 )随访,再加上是否使用尿垫、术后满意度和活动是否受影响等问题。共调查了1993年至2 0 0 0年由同一术者完成自体阔筋膜吊带膀胱尿道悬吊术的10 0例女性患者,平均随访时间4 .4年(0 .8～9.3年)。85 %的女性患者的尿失禁消失或改善,93%的病例7d后手术部位无疼痛。无手术部位感染和下肢血栓并发症。83%患者的生活质量改善,只…     

自体阔筋膜袢成形术治疗下肢深静脉瓣膜功能不全

对下肢深静脉瓣膜功能不全的105例患施行自体阔筋膜袢成形术，所有肢体同时行浅静脉手术。95．2％(100/105)的患下肢酸胀、沉重、水肿、疼痛等症状消失，所有患浅静脉曲张消失。合并溃疡的15例中愈合11例。皮肤色素沉着的50例中肤色恢复正常43例。经彩超复查90．5％(95／105)的病人深静脉瓣膜功能恢复正常，其余改善至Ⅰ—Ⅱ级。自体阔筋膜袢成形术能有效治疗下胶深静脉瓣膜功能不全。     

经阴道穿刺自体筋膜尿道悬吊治疗压力性尿失禁(附13例报告)

目的:探讨一种治疗女性压力性尿失禁的新手术方法.方法:采用经阴道穿刺自体筋膜尿道悬吊术治疗女性压力性尿失禁患者13例,用自制管状穿刺针经阴道前壁切口将自体筋膜(腹直肌前鞘,阔筋膜)条,绕过尿道中段,调整好悬吊张力后,将两端分别固定于腹直肌鞘上,比较手术前后尿垫试验和咳嗽试验结果.结果:术后随访6～18个月,平均12个月,治愈率84.62%,显效15.38%,所有患者尿失禁症状均得到控制.结论:经阴道自体筋膜尿道悬吊术简单易行,操作安全,损伤性较小,并发症少,费用低廉.     

自体阔筋膜治疗下肢深静脉疾病的研究

用犬的阔筋膜制成阔筋膜束,将阔筋膜束缝合固定于犬踝关节的屈肌腱膜上。三个月后取出阔筋膜束作组织学检查及物理性能检查,证实游离的阔筋膜移植后,不会缺乏营养,变性坏死,不会失去弹性和张力而不能在运动时起到作用。在试验取得成功的基础上,作者应用于临床,代替静脉外肌袢,治疗50例下肢深静脉瓣膜功能不全患者,疗效满意。     

阔筋膜修复腰椎间盘纤维环的组织学观察

目的:探讨阔筋膜修复腰椎间盘纤维环的可行性。方法:16只健康成年新西兰大耳白兔,经腹膜外入路切开L4/5椎间盘纤维环,摘除髓核,模拟临床人工髓核置换术方法置入人工髓核,用自体阔筋膜修复纤维环切口。分别于术后4、8、12及16周处死动物,取手术节段椎间盘进行大体和组织形态学观察。结果:术后4周,阔筋膜表面有薄层肉芽组织增生,少量炎性细胞浸润;阔筋膜纤维中未见炎性细胞浸润。术后8周,阔筋膜表面有较多纤维肉芽组织形成和炎性细胞浸润;阔筋膜纤维中未见炎性细胞浸润。术后12周时,大量连贯的纤维肉芽组织封闭阔筋膜表面,其中可见大量炎性细胞;阔筋膜纤维中未见炎性细胞浸润。术后16周时,纤维肉芽组织、阔筋膜与纤维环之间紧密结合;阔筋膜纤维中未见炎性细胞浸润;阔筋膜维持原有的正常结构:胶原纤维纵向排列,其纤维细胞呈梭形,与纤维走行方向一致。结论:用兔自体阔筋膜修复腰椎间盘纤维环切口移植的阔筋膜不被受区组织吸收降解,能保持其原有的组织结构,从而保持它固有的坚韧力学性能。     

腘静脉外跖肌袢形成术

自行设计采用(?)肌腱做袢材料的腘静脉外肌袢代瓣术,即腘静脉外(?)肌袢形成术,克服了以往袢材料长度不足、中间有接头、组织损伤较大有排斥反应等缺陷,手术设计合理,操作简单,经60例临床应用,手术已趋成熟和标准化,可做为该类手术的首选术式,也适于基层医院推广。     

甲状腺手术致喉返神经损伤的修复

目的探讨甲状腺手术致喉返神经损伤的修复时机及预后,进一步提高修复效果。方法对１２例甲状腺手术致喉返神经损伤者采用了不同术式及不同时机神经修复或再支配术,其中即刻手术６例,延期手术６例;喉返神经直接吻合５例,膈神经与喉返神经远侧断端吻合选择性支配环杓后肌,同时颈袢分支胸骨舌骨肌支与喉内收肌支吻合选择性支配喉内收肌１例,颈袢主支与喉返神经内收肌支吻合３例,颈袢胸骨甲状肌蒂植入左环杓后肌３例。结果术后随访６个月以上。即刻手术较延期手术效果好,选择性神经修复术较喉返神经直接吻合好,且延期手术１２个月以上效果较差。结论甲状腺手术致喉返神经损伤应尽早修复,最晚不超过１年。     

腘静脉外肌袢形成术并发症再探讨

目的　对腘静脉外肌袢形成术后并发症作再度探讨。 方法　将１９８１ 年至１９９７ 年１２月内手术的１ ２８４ 例患者,共１６３２ 条下肢中,发生并发症的患肢１５１ 条,根据临床表现、患肢静脉和淋巴造影检查、多功能周围血管检测仪和动态压力测定等的资料,作全面的临床分析,找出并发症的原因,并提出防治的措施。 结果　早期并发症（ 术后６ 个月以内） 以小腿肿胀和深静脉血栓形成为主,在１２８ 条患肢中各为１８ 条（１１－９％） 和９１ 条（６０－３％ ）;２３ 条患肢发生远期并发症（ 术后６ 个月以上） ,以肌袢过短、粘连（１５ 条,９－９％ ）和腘静脉血栓形成（８ 条,５－３％ ） 为主。 结论　肌袢术后并发症多因适应证和手术操作不当,以及手术本身的某些缺陷而引起。熟练、正规的手术操作和选择良好的肌袢替代物,是提高肌袢术疗效的关键     

生物袢治疗下肢静脉瓣膜功能不全性疾病的研究

我们采用自体阔筋膜作生物袢，治疗下肢深静脉瓣膜功能不全性病变５０例，共５０条下肢，随访６～３０个月，疗效良好者占９４％，有效率为１００％，从而认为，这是一种值得推广的手术方法。     

Histological comparison of autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein for vascular patch graft material in a canine arteriotomy model.

Autogenous fascia lata has found little clinical use as a vascular patch graft material. Previous experience, however, suggests that it possesses attributes that might make it useful in this regard. To assess its efficacy as a vascular patch graft, nine adult mongrel dogs each underwent four arteriotomies with placements of patch grafts. The four sites included both carotid arteries and both femoral arteries. In each animal, one of four patch graft materials (autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein) were placed as patch material at the arteriotomy site utilizing 7-0 running sutures and loop magnification. The site for placement of each graft material was rotated serially in the animals so that each site would have equal numbers of all four graft materials applied. The animals were killed at either 6 to 8 weeks or 11 to 12 weeks after angiography of all four vessels. The specimens were then evaluated histologically. No difference was observed among any of the patch graft materials with regard to myofibroblast plaque formation. Inflammatory responses were noted to be substantially less in the canine fascia lata group than in the other three groups. Granuloma formation, however, appeared to be most significant in the autogenous canine vein group. Only one vessel was occluded. Aneurysm or pseudoaneurysm formation was not noted in any specimen. It appears from the above results that autogenous fascia lata may be an appropriate alternative to currently utilized arterial patch graft materials and that it should be evaluated further for this purpose.     

Scalp, skull, and dura reconstruction on an emergency basis

Severe cranial trauma caused by an industrial accident resulted in loss of scalp, skull, dura, and brain tissue in the left frontal region of a 55-year-old man. Successful one-stage total reconstruction of the defect was accomplished using a patch of fascia lata, autogenous split rib graft, and a free forearm flap on an emergency basis. A ten-month follow-up showed uneventful recovery and a good cosmetic result.     

Autologous fascia lata transplantation for heart valve replacement: A two-year experience at the National Heart Hospital, London

Between April 1969 and December 1970, 201 patients underwent 262 valve replacements with frame-mounted autologous fascia lata valves in the aortic, mitral, and/or tricuspid positions at the National Heart Hospital. A single fascia lata valve was inserted in 146 patients and multi-valve replacement was performed in 55 instances. Hospital and late mortality are comparable with that following other procedures of heart valve replacement. One hundred and fifty-four patients with 193 fascia lata valves were available for follow-up. A retrospective analysis of this method of valve replacement has been undertaken to assess the suitability of fascia lata as a heart valve substitute as well as the clinical results achieved by this method of valve replacement.     

Autologous fascia lata for heart valve replacement

To obviate the drawbacks of prosthetic devices and in search of a better substitute for diseased heart valves a technique of using autologous fascia lata grafts attached to a support frame was developed. The technique of preparing mounted fascia lata grafts is briefly outlined and their surgical implantation into the mitral, tricuspid, and aortic areas is described. Since April 1969, 83 fascial grafts have been inserted into 76 patients with very good immediate and short-term results. Ten patients succumbed within the operative period. None of these deaths was due to failure of the graft per se. Thromboembolic manifestations have been completely absent although anticoagulants were not used. All sixty-six survivors are very much improved. Data concerning the structure and function of fascia are presented and the experimental and clinical use of fascia lata in extracardiac and cardiac surgery is reviewed. The use of autologous, living, fascia lata valves is considered to be a better approach for heart valve replacement because autologous fascia maintains its structure unchanged after transplantation and, being under mechanical stimulation, it retains its functional properties.     

Reconstruction of the lateral ligaments of the ankle using solvent-dried and gamma-irradiated allogeneic fascia lata

We have described a method of anatomical reconstruction of the lateral ligaments of the ankles with instability using allogeneic fascia lata dried with solvents and sterilised with gamma irradiation. Twenty ankles of 20 patients were assessed objectively and subjectively after a mean follow-up of 4.2 years (3.1 to 10). The result was excellent in 12 (60%), good in seven (35%) and fair in one (5%); none had a poor result. Stress radiography showed that the angle of talar tilt improved from 12.3+/-4.2 degrees (mean +/- SD) to 5.9+/-3.0 degrees and that the anterior drawer distance decreased from 9.2+/-3.9 mm to 4.4+/-2.5 mm. Neither infection nor limitation of movement occurred after operation. Fascia lata allografts provide a good alternative to autogenous grafts such as the peroneus brevis tendon.     

Extrusion of enucleation implants: treatment with secondary implants and autogenous temporalis fascia or fascia lata patch grafts.

We performed one autogenous fascia lata graft and 11 autogenous temporalis fascia grafts in eight patients with extrusion of an orbital enucleation implant and in four patients with a bulging implant who could not wear a prosthesis. Excluding one patient with inadequate follow up, 10 of the 11 patients (91%) successfully retained their implant. One patient had severe conjunctivitis followed by anterior migration of his implant 2 1/2 years after patch grafting, necessitating replacement of the implant. We conclude that autogenous temporalis fascia patch grafting is an effective treatment for orbital enucleation implant extrusion or a bulging implant.     

阔筋膜代瓣术治疗下肢静脉曲张的临床应用

继研究了大腿阔筋膜的血液供应来源及血管配布特点之后，将阔筋膜代瓣术应用于临床，治疗因下肢深静脉多瓣膜功能不全所致的大隐静脉曲张．已施术３例，近期疗效满意。     

Clinical application of a physically and chemically processed human substitute for dura mater

OBJECT: Allogenic human fascia lata used in neurosurgery as a dura mater substitute can be associated with the risk of virus and bacterium transmission and with a delay in its incorporation due to immunological and inflammatory reactions. The authors review their preliminary experience with a chemically and physically processed fascia lata graft. METHODS: Grafts that had been treated with solvent detergents, freeze-dried for conservation, and gamma irradiated (25,000 Gy) for sterilization were placed into 17 patients during neurosurgical procedures performed to treat brain tumors, cerebral malformations, trigeminal neuralgia, and posttraumatic lesions. The handling properties of the material, surgical wound features, and hematological parameters were evaluated. The average follow-up period was 23.8 +/- 2.2 months (mean +/- standard deviation). The handling properties and biocompatibility of these human dural substitutes were highly satisfactory and no major complications were observed. Postoperative computerized tomography or magnetic resonance images obtained in 13 patients revealed no abnormal findings at the site of fascia lata implantation. In one patient who underwent a second surgery performed 12 months after the initial operation, this dural substitute was found to have been recolonized by host fibroblastic cells and replaced by autologous collagenous tissue. CONCLUSIONS: Human fascia lata that has been rendered safe by applying physical and chemical treatment is a fully biocompatible alternative to the dural graft materials currently available.     

Endoscopic access to fascia lata for use in static facial reanimation—a cadaveric and clinical study

Background

Current methods of autogenous fascia lata harvest for the static surgical treatment of longstanding facial paralysis often result in a high level of donor site morbidity and unsightly visual scarring on the patient’s lateral thigh due to the open technique traditionally used. With endoscopic access already being widely used in other areas of plastic and reconstructive surgery, it was hypothesised that it would be feasible to retrieve sufficient amounts of fascia lata endoscopically to achieve satisfactory static facial reanimation.

Methods

In the first instance, we used an 85-year-old female cadaver selected from the regular stock at the University of Glasgow to establish if retrieval of fascia lata endoscopically was feasible. Through two small incisions on the lateral aspect of the thigh (proximally and distally), we successfully retrieved a strip of fascia lata measuring 9?×?2.5 cm. Due to the ease of access, one of the authors then performed endoscopic retrieval of the fascia lata for five patients requiring static facial reanimation.

Results

It was shown that in all cases it was feasible to retrieve sufficient amounts of fascia lata to perform static facial reanimation with a similar operating time compared to the open technique which is currently used. In addition, there were no complications related to donor site morbidity.

Conclusions

We have shown that endoscopic access to the fascia lata for use in static facial reanimation is perfectly feasible, with no complications, minimal scarring and no significant increase in operating time compared to the traditional open technique currently used. Level of Evidence: Level V, therapeutic study.     

Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation

Purpose: The purpose of this study is to describe the technique of medial patellofemoral ligament reconstruction using autogenous hamstrings or autogenous fascia lata and report the results at a minimum 2-year follow-up. Type of Study: This study represents a case series. Patients with patellofemoral instability following patellar dislocation were restrospectively reviewed after being treated with medial patellofemoral ligament reconstruction. No concurrent control group was used. Methods: Nineteen consecutive patients underwent medial patellofemoral repair or reconstruction in the treatment of patellar instability after patellar dislocation. The reconstructions were performed using autogenous gracilis and/or semitendinosus tendons or a strip of autogenous fascia lata. Fifteen patients were available for interview, examination, and radiographic evaluation, with a mean follow-up of 31.5 months. Results: Subjectively, 10 knees had excellent results, 3 knees obtained good results, 1 knee had a fair result, and 1 knee had a poor result, for a total of 93% improvement overall. Using Fulkerson’s functional knee score, 93% had good or excellent results. The average postoperative result on Kujala’s score for anterior knee symptoms was 88 (range, 80-100). The Tegner activity level averaged 6.8 preinjury and 6.7 postoperatively. Radiographic evaluation showed significant improvements in the congruence angle by an average of 20° (P =.0006), and in the lateral patellofemoral angle by an average of 10° (P =.0003). Conclusions: Surgical reconstruction or repair of the medial patellofemoral ligament provides favorable results for the treatment of recurrent patellofemoral dislocations with regard to radiographic findings, patient satisfaction, and functional outcome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 298–306