去除肥大下颌角手术时对面动脉出血的处理

目的探讨去除肥大下颌角手术时对面动脉出血的处理方法。方法对59例下颌角肥大患者进行面动脉预先处理,手术时预置面动脉结扎线,术后去除。结果59例患者中有6例7侧面动脉损伤出血,由于及时结扎面动脉而没影响手术进程及效果。结论口内切口去除肥大下颌角,术野小、腔隙深,面动脉易损伤且不好止血,采取预先留置面动脉结扎线方法能有效解决面动脉出血问题。     

“磨削法”在下颌角肥大矫正术中的应用

目的 探讨"磨削法"在下颌角肥大矫正术应用中的安全性及有效性.方法 384例下颌角肥大患者在局麻下利用自行研制的塑形器对肥大下颌角进行磨削塑型.观察统计术中血管、神经损伤情况、术后并发症发生情况及面部轮廓改型效果.结果 384例求术者无一例神经、血管意外损伤发生,术中便于操作,术后恢复快、改型效果好.结论 "磨削法"进行下颌角肥大矫正,安全性高,且术后下颌角曲线优美,有效避免了"第二下颌角"的出现.     

下颌角整形截骨线厚度的三维CT测量及临床意义

目的测量下颌角整形截骨线周围骨质的厚度,为手术提供解剖学依据。方法应用螺旋CT扫描37例行下颌角整形术的青年女性的下颌骨,三维重建后测量设计的截骨线上位于双侧下颌升支后缘,下颌升支中部、下颌第3磨牙后缘,2、3磨牙之间,1、2磨牙之间,第2前磨牙与第1磨牙之间垂直切面的截骨线处的骨质厚度。所得到的结果应用Spss11.5软件进行分析。结果截骨线的骨质于第2、3磨牙下方最厚,向前向后逐渐减小,升支区最小。结论下颌角整形截骨线厚度三维CT测量对手术有指导意义,可减少手术的并发症。     

经口内入路下颌角磨骨截骨整形术患者术后呼吸道的护理

目的总结经口内入路下颌骨磨骨、截骨整形术后呼吸道的护理,探讨保持术后呼吸道通畅的有效措施。方法回顾性分析113例在全麻下经口内入路下颌角磨骨、截骨术后的护理资料,分析保持该类手术患者术后呼吸道通畅的护理措施。结果 2例患者术后伤口出血、渗血较多,予以相应处理后平稳恢复。113例患者术后均未发生严重的呼吸困难,上呼吸道护理效果满意,痊愈出院。结论经口内入路下颌角磨骨截骨整形术后存在的多种因素均可造成患者呼吸道梗阻,术后应仔细观察病情,采取适当的体位,应用合理的绷带技术,及时清除呼吸道分泌物等是保持呼吸道通畅的有效护理措施,为术后患者平稳恢复提供良好的保障。     

口腔入路髁突颈及下颌支骨折复位内固定术

目的为避免面颈部留下手术瘢痕，探讨从口腔入路复位固定髁突颈及下颌骨支骨折的方法。方法采用口腔内下颌骨矢状截骨手术切口入路，用摆动锯将下颌支后缘垂直截骨，取出升支后缘骨块，髁突游离取出，体外直视下与升支后缘骨块固定后再从口腔原切口回植入，钛板固定。15例17侧采用本方法治疗，其中2例为外地医院行下颌角截骨整形术中意外将下颌骨髁突颈部劈裂骨折，其余13例为闭合性骨折。结果术后1年复查全部患者的开口范围25～40mm，平均为35．8mm，1例有患侧后牙早接触，下切牙中线偏斜1mm。另1例张口约25mm，轻度受限，其余患者咬合关系良好，无主诉关节疼痛与弹响症状。全部患者无面神经、耳大神经损伤，无涎瘘，面颈皮肤无手术瘢痕结论在目前美容要求越来越高的趋势下，口腔入路具有无外部瘢痕优势，且不会损伤面神经缺点是操作范围较小，增加了下颌支后缘垂直截骨。     

改良Pelet手术治疗外翻

1992-06～1998-06,我们对较严重的　外翻患者采用改良Ｐｅｌｅｔ术式进行矫正,效果满意。报道如下。1　临床资料本组12例24足,女性9例18足,男性3例6足。年龄23～55岁。入院后摄双足正斜位Ｘ线片,测量跖间角及外翻角。手术方法:行第一跖趾关节背侧“Ｓ”形切口,常规作“Ｈ”或“Ｕ”形切开跖趾关节囊,切除骨赘。在跖骨颈部作“弧形”杵臼截骨,矫正跖骨头关节面的倾斜及旋转畸形,用直径2.7ｍｍ的皮质骨加压螺钉、“冂”形钉或交叉克氏针固定跖骨头。根据畸形情况需做　内收肌止点切断移位,关节囊重叠缝合,伸　长肌腱延长等辅助手术。术后用石…     

膝关节置换矫正外翻畸形时个性化截骨与统一6°外翻截骨的中期疗效比较

目的探讨膝关节置换矫正外翻畸形时个性化截骨与统一6°外翻截骨中期疗效。方法将2008年1月至2014年1月在我科行膝关节置换矫正外翻畸形患者32例,随机分为观察组和对照组,各16例。观察组患者给予个性化截骨膝关节置换术;对照组给予统一6°外翻截骨膝关节置换术。根据X线片比较术前和术后膝外翻角度,应用HSS膝关节评分系统进行中期疗效评价。结果术后随访6个月,两组患者切口均一期愈合,无感染、无腓总神经麻痹发生。两组患者术后膝外翻角度、膝关节HSS评分、膝关节活动度较手术前明显好转,差异具有统计学意义(P<0.05)。观察组患者平均手术时间、下床活动时间、术后平均引流量明显低于对照组患者,差异有统计学意义(P<0.01)。结论个性化截骨技术保证每位患者都有适合自己的截骨模具,从而达到理想的手术效果。     

跗骨窦联合外侧纵形切口与传统外侧L型切口治疗Sanders Ⅱ型跟骨骨折的比较研究

目的比较跗骨窦联合外侧纵形切口与传统外侧L型切口行切开复位内固定治疗SandersⅡ型跟骨骨折的疗效,探讨更为合理有效的手术入路方式。方法纳入2014年1月—2015年1月湖州市第一人民医院骨科收治的40例SandersⅡ型单侧闭合性跟骨骨折患者,根据切口方式不同分为观察组及对照组,每组20例;观察组采用跗骨窦联合外侧纵形切口,对照组采用传统外侧L型切口。比较两组患者的年龄、坠落高度、伤后至手术时间,以及跟骨术前、术后及末次随访的B9hler角和Gissane角,并采用Maryland足功能评分、健康调查简表(SF-36)比较两组的临床疗效。结果两组在年龄、坠落高度、伤后至手术时间等方面差异无统计学意义(P0.05)。观察组术后平均随访时间为(13.4±2.0)个月,均未出现相关切口并发症;对照组术后平均随访时间为(14.3±2.4)个月,早期出现皮缘坏死及切口红肿渗出各1例;两组末次随访时均获得临床骨性愈合。两组术后B9hler角和Gissane角同术前相比均显著改善,差异有统计学意义(P0.05)。末次随访时观察组Maryland评分、SF-36评分为(82.6±11.8)、(82.6±7.2)分,对照组为(81.1±12.9)、(79.7±8.8)分,两组比较差异无统计学意义(P0.05)。结论跗骨窦联合外侧纵形切口可以取得同外侧L型切口相似的临床疗效,但其对切口软组织保护较好,且发生距下关节僵硬的概率较低。     

腰椎后路截骨矫正强直性脊柱炎合并重度胸腰椎后凸畸形的临床疗效

目的 评估腰椎后路截骨手术矫正强直性脊柱炎(ankylosing spondylitis, AS)合并重度胸腰椎后凸畸形的临床疗效。方法 2020-10至2021-06共收治AS合并胸腰椎后凸畸形患者11例,其中合并Andersson损害(Andersson lesion, AL) 1例,平均(32.8±3.4)岁;患者均有腰背部疼痛及后凸畸形,术前胸椎后凸角59.36°±12.63°;腰椎前凸角-0.54°±32.89°;颏眉角31.82°±12.25°。10例AS后凸畸形患者均在L₂行经椎弓根椎体截骨术(pedicle subtraction osteotomy, PSO),1例AS合并AL后凸畸形患者采用腰椎后路经损害处清创、截骨矫形。综合评价术后影像学、临床疗效及并发症。结果 患者手术顺利,耐受性良好,术后平均胸椎后凸角55.18°±11.59°,腰椎前凸角43.91°±19.14°,颏眉角1.82°±0.83°。患者均获随访,无血管、神经损伤,无应力性骨折等并发症。结论 经L₂行PSO截骨矫正AS重度后凸畸形,合并AL后凸畸形行经损...     

前跗关节楔形截骨术治疗高弓仰趾畸形足(附20例分析)

本文对1973年以来收治的20例高弓仰趾畸形足进行了临床分析。针对畸形特点采用相应的截骨方法,对18只足进行随诊,平均随诊5年7个月,均获得优良效果。本文重点讨论以下两点:(1)高弓仰趾畸形足的畸形焦点是足纵弓的高度增加及前足下垂,其纵弓的顶点位于舟楔关节处,故在此处进行截骨是最合理的,且优于McElvenny和Caldwell的跖跗关节截骨术及Japas设计的V形跖跗关节截骨术;(2)高弓仰趾畸形足的X线测量与手术疗效有密切关系。通过对内弓角、外弓角、距跖角及跟1长度,跟5长度的测量,把畸形分为重、中、轻3度,作为决定本病治疗措施的依据。     

Melnick-Needles syndrome: radiographic alterations in the mandible

After the adventitious finding of bilateral loculations in the mandibular rami and erosion of the coronoid processes of the mandible of a patient with Melnick-Needles syndrome (osteodysplasty), the jaws of four other individuals with the same disorder were examined for similar changes. The coronoid process of the mandible was grossly hypoplastic in all patients, and the rami were markedly abbreviated. In four of the five patients the angle was rounded. In three of five patients, loculations of unknown nature were found in the mandibular rami. Several patients exhibited impacted molar teeth.     

GoGn-SN角及其相关因素的X线头影分析

背景与目的GoGn-SN平面角是代表垂直骨面型的重要指标。本文旨在探讨GoGn-Sn角在错畸形诊断与治疗中的重要性。方法本文通过对128名恒牙初期儿童X线头影测量,以下颌平面与前颅底平面交角为因变量,作了相关分析。结果下颌平面角在三类错畸形中无显著差异。下颌平面角与Y轴角,N-S-Ar,S-Ar-Go,Ar-Go-Gn,Ar-Gn,前面高/后面高呈正相关关系,与后面高及SNB呈负相关关系,提示下颌平面角与生长发育方向,生长型,下颌骨形态位置关系密切。结论在分析时应注意前颅底平面斜度对其的影响。     

螺旋CT三维重建诊断下颌骨骨折的价值

目的 探讨螺旋CT三维重建诊断下颌骨骨折的价值.方法 采用德国西门子SOMATOM Balance螺旋CT扫描机，共检查下颌骨骨折病人34例，其中，男25例，女9例．年龄19岁～53岁，平均年龄465岁，所有病例均有外伤史并经下颌骨螺旋CT扫描.结果 本组34例中全部进行图像三维重建，其中，下颌体骨折15咧，角部骨折3例，下颌支骨折4例，下颌骨髁状突骨折并颞颌关节脱位或半脱似5例，下颌骨多处骨折7例。结论 螺旋CT三维重建对了解下颌骨骨折的3D空间表现及制定治疗方案有重要意义，可以作为下颌骨骨折的常规检查方法。     

CT findings in osteoradionecrosis of the mandible

 CT scans of ten patients in whom the diagnosis of mandibular osteoradionecrosis was proven pathologically or by clinical follow-up were reviewed. All ten patients had bony abnormalities (cortical interruptions and loss of spongiosa trabeculation) on the symptomatic side. These were predominantly seen in the body of the mandible (premolar and molar region, eight patients), in some of these cases extending into the retromolar triangle (two patients) or mandibular angle (two patients). In the remaining two patients the abnormalities were in the ramus and angle. The two patients treated with iridium implantation showed localized lingual-sided cortical destruction. Three patients had a pathological fracture. The cortical destruction was buccal-sided in two and both buccal- and lingual-sided in three of the other five patients. Contralateral bony abnormalities were present in four patients. Soft tissue thickening on the symptomatic side was seen in nine patients. As the bony abnormalities in mandibular osteoradionecrosis are often associated with a soft tissue mass, CT differentiation from tumor recurrence can be diffficult. The association with cortical defects distant from the position of the original tumor (buccal surface or opposite side of mandible) should evoke the possibility of mandibular osteoradionecrosis.     

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.     

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.     

Unifocal versus multifocal mandibular fractures and injury location

Mandibular fractures are frequently encountered in the trauma setting and comprise a significant number of facial injuries. The purpose of this study was to evaluate the prevalence and injury patterns of unifocal and multifocal mandibular fractures using thin-section imaging. Following IRB approval, 220 patients with mandibular fractures identified on maxillofacial CT scans performed between October 2008 and February 2011 were retrospectively reviewed. Examinations were performed on 64-multidetector row CT scanners with axial images acquired at 1.25-mm slice thickness. The location and number of fractures as well as causative mechanisms were recorded. Fractures were unifocal in 108/220 (49 %) and multifocal in 112/220 (51 %) patients. The mandibular angle was the most common fracture site in both unifocal and multifocal mandible fractures. In cases with multifocal mandibular fractures, bilateral fractures were more common (83 %) than unilateral multifocal mandibular fractures (17 %). Fractures involving the parasymphysis, the mandibular body, or ramus were significantly associated with the presence of additional mandibular fractures (p?<?0.0001). While multifocal and unifocal fractures occurred in near equal frequency, bilateral multifocal fractures were much more common than unilateral multifocal mandibular fractures. Alveolar ridge fractures were exclusively seen in unifocal mandibular fractures.     

Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients

BACKGROUND AND PURPOSE: Imaging of patients with a clinical diagnosis of mandibular osteoradionecrosis (ORN) is often performed to support that clinical suspicion, evaluate the extent of the disease, or exclude coexistent tumor recurrence. The purpose of our study was to describe the clinical, MR imaging, and CT features of five patients with mandibular ORN associated with prominent soft-tissue abnormality in the adjacent masticator muscles. METHODS: The MR and CT examinations of five patients with mandibular ORN associated with soft-tissue abnormalities in the adjacent masticator muscles were reviewed. All patients had received external beam radiotherapy for primary head and neck malignancies, with a total radiation dose range of 60 Gy to 69 Gy in 30 to 38 fractions. RESULTS: CT revealed the typical osseous findings of cortical disruption, trabecular disorganization, and fragmentation in all five patients. Abnormal diffuse enhancement of the adjacent masseter and pterygoid muscles was noted in all patients. Four patients had prominent mass-like thickening of these muscles adjacent to the osseous abnormality. Of the three patients who underwent MR imaging, all showed homogeneous abnormal T1 hypointensity, T2 hyperintensity, and intense enhancement of the bone marrow in the involved mandible. The masticator muscles adjacent to the osseous abnormality also showed abnormal T2 hyperintensity and intense diffuse enhancement on MR images. CONCLUSION: Mandibular ORN can be associated with prominent soft-tissue thickening and enhancement in the adjacent musculature. These changes can appear mass-like and are not related to tumor recurrence or metastatic disease.