拉力螺钉技术在下颌骨骨折中的应用

目的探讨拉力螺钉技术在下颌骨骨折治疗中的应用问题。病例和方法50名下颌骨颏部、下颌角、髁突骨折患者,男37例,女13例;中位年龄31岁(15～65岁),接受拉力螺钉固定。术后1～2周及3～4个月复诊。拍摄下颌曲面断层片、开口后前位片,检查骨折复位情况,咬合关系及开口度、开口型等情况。结果①所有患者术后伤口均I期愈合,未见感染征象;②39例颏部骨折患者中,除3例(7·69%)术中拉力螺钉固定后骨折线轻度错位外,其余病例复位均良好;2例下颌角骨折患者术中复位良好;17例髁突骨折患者,除1例拉力螺钉固定松脱,手术去除螺钉外,11例髁突骨断端位置理想,5例髁突位置仍有轻度移位。术后3至4个月复诊,所有患者咬合关系均良好,X线片示骨折线愈合良好;16例(17侧)髁突骨折患者开口度均大于35mm,其中2例患者开口有2～3mm偏斜。结论拉力螺钉技术应用最少的植入物即可获得坚强固定的效果,操作简单,费用相对低廉,二期取钉手术简化,因此在下颌骨骨折的治疗中有着广泛的应用前景。     

下颌关节髁状突骨折的手术治疗

目的对下颌关节髁状突骨折手术和非手术治疗的临床病例进行比较，探讨手术治疗的适应证。方法经临床体检和CT检查确诊的18例髁状突骨折伤员，单侧骨折13例，双侧骨折5例，共23侧髁状突骨折；复杂伴有骨折片移位的11例伤员行手术治疗，骨折复位和坚强内固定。非手术保守治疗7例；其中2例粉碎性骨折因伴有颈椎损伤被迫保守治疗，6个月后因关节强直行关节成形术。病例随访时间3～12个月。结果18例伤员中17例无关节区疼痛症状，开口度基本满意，丌口型正常。5例单线性骨折保守治疗均未出现开口受限和开口型异常，骨折复位坚强内固定11例开口度为（36．1±1．8）mm，显著大于单线性骨折保守治疗者[（34．0±3．7）mm，P〈0．05]，单线性骨折保守治疗者的开口度显著大于粉碎性骨折经保守治疗者[（32．1±3．6）mm，P〈0．05]。骨折复位坚强内固定11例的治疗周期为[（16±1．8）d]，显著短于单线性骨折保守治疗者[（42±3．8）d]和粉碎性骨折伤员经保守治疗者[（222±2．2）d，均P〈0．05]；单线性骨折保守治疗者的治疗周期亦显著短于粉碎性骨折伤员经保守治疗者（P〈0．05）。结论下颌髁状突骨折单纯的线性骨折不伴骨折片移位者非手术治疗可取得较好的疗效。对于粉碎性骨折或伴有骨折片移位者则需要手术治疗，骨折复位坚强内同定以减少关节腔积血。     

银屑病性关节炎累及颞颌关节2例国内首报

目的:探讨银屑病性关节炎颞颌关节受累的临床及影像学特点。方法:分析我院2例银屑病性关节炎患者颞颌关节受累的临床、影像、实验室检查特点,并对文献进行复习。结果:2例银屑病性关节炎患者,颞颌关节疼痛、晨僵、周围肌肉酸痛及压痛,CT检查见下颌骨髁状突骨皮质侵蚀,骨皮质下囊肿,关节面骨质硬化,关节窝扩大。结论:银屑病性关节炎可累及颞颌关节,但易被忽略。     

颌间牵引钉在上下颌骨复合骨折中的应用效果评价

目的 评价颌间牵引钛钉在上下颌骨复合骨折中应用的临床效果.方法 28例上下颌骨骨折患者,年龄19～65岁,平均年龄32.6岁;车祸伤21例,殴打伤4例,其他伤3例;双发骨折21例,多发骨折7例.先在上下侧切牙与尖牙之间、第二前磨牙与第一磨牙之间共8个点,各将一枚骨内颌间牵引钛钉通过牙龈直接植入颊侧牙槽骨作为固定源,并用钢丝双股缠绕后进行上下对应结扎,使上下颌骨处于稳定的正常咬合状态,再行切开复位内固定,术后行骨内颌间牵引0~2周.结果 操作时间不超过10 min.28例上下颌骨复合骨折均获得良好的复位和骨性愈合,咬合关系良好,无明显并发症.结论 骨内颌间牵引钉能缩短手术复位操作时间,对上下颌骨的整复固定和功能恢复效果良好.     

爪形手矫治术后的指间关节强直

爪形手矫治术后将手制动已成为常规,传统方法是于腕中立位从上臂到手指的石膏管型制动。即整个手和前臂都被制动,因此都会发生强直,术后需要相当长的时间来矫正。为设计一种更好的,能减少术后指关节强直,对疗效无不良影响的术后制动方法,作者研究了50个病人的50只爪形手,术前指间关节无强直,修复后以三种不同的方法进行制动(传统法20只手,改良Ⅰ法10只,改良Ⅱ法20只)。改良Ⅰ法:石膏管型超过掌指关节为度,指间关节不予制动。改良Ⅱ法:先以肘下到指尖的掌侧石膏托制动,掌指关节于屈曲90°位,指间关节中立位,然后从前臂到近节指骨中部再打成管型石膏。因此,指间关节仅在掌侧有石膏托制动,背侧无,故近侧指间关节有一定程度的主     

多方向分化附属器肿瘤伴斑痣一例北大核心CSCD

患者女,41岁。患者于不到1岁时无明显诱因左侧头顶部出现淡黄色圆形斑片,随年龄增长逐渐增大呈斑块状。2年前局部出现乳头状损害,表面发红、潮湿。约同一时间左颞部出现黑色肿物,逐渐增大并中心破溃,均无自觉症状。患者约1岁时在左颌面、颈项、躯干、上肢淡褐色斑基础上出现黑褐色斑疹,渐增多、扩大,累及同侧手背,并出现丘疹。皮肤科检查：左侧头部皮肤淡黄色斑块基础上分别见约3 cm × 2 cm、2 cm × 1 cm新生物,色鲜红,表面如菜花状,境界清楚,触之较硬,表面糜烂,其间散在大小不等的黑色及淡红色丘疹。左侧颞部一约1.5 cm × 1.5 cm大环形黑色肿物,中心溃疡形成。左侧面颊、下颌、颈项、前胸、肩背、上肢、手背淡褐色斑片,边界清,其上可见黑褐色斑疹及丘疹,触之韧。取多处皮损同时行组织病理检查,头部菜花状皮损诊断为乳头状汗管囊腺瘤,黄色斑块状皮损诊断为乳头状汗管囊腺瘤合并皮脂腺瘤,颞部黑色增生性皮损诊断为毛母细胞瘤并基底细胞上皮瘤,下颌黑素丘疹样皮损及下颌褐色斑丘疹样皮损均诊断为斑痣。结合患者临床表现,诊断：多方向分化附属器肿瘤（乳头状汗管囊腺瘤、乳头状汗管囊腺瘤和皮脂腺瘤、毛母细胞瘤并基底细胞癌）,斑痣。     

鬓角区瘢痕性秃发修复方法的探讨

目的探讨鬓角区瘢痕性秃发的修复方法及其效果。方法萎缩性瘢痕采用分次切除4例;分次切除加额颞顶有发头皮瓣旋转推进3例;带颞浅动脉头皮岛状瓣转移1例;微小头皮片毛发移植3例,其中同期以耳轮缺损缘为蒂耳后乳突区皮瓣修复耳轮大部缺损1例;头皮预扩张鬓角重建4例。结果除瘢痕分次切除额鬓角发际线不整1例外,14例效果满意。结论根据鬓角区瘢痕部位、形状大小、邻接有发头皮残存状况、患者意愿及经济能力等因素选择修复方法。面积小于3.0 cm×2.5 cm的宜采用分次切除或毛发移植;大部分或完全缺失者,用头皮扩张术可获得较理想的鬓角重建。     

Swanson人工跖趾关节置换术治疗终末期第二跖趾关节病

目的 探讨Swanson人工跖趾关节置换术治疗终末期第二跖趾关节病的临床疗效。方法 分析2009年1月至2021年9月首都医科大学附属北京同仁医院足踝外科中心及同济大学附属同济医院骨科收治的第二跖趾关节病患者资料,应用Swanson可屈曲铰链式跖趾关节假体实施人工跖趾关节置换第二跖趾关节手术36例(共36趾)。采用美国足踝外科协会Maryland跖趾关节百分评分系统、疼痛视觉模拟评分法(visual analogue scale,VAS)评分和美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分对疼痛、功能及客观体征进行评分。结果 36例(36趾)获得随访,随访时间18～86个月,平均38.1个月。Maryland评分术前为43～78分,平均62.5分;术后为67～95分,平均91.8分。优26例(72.2%),良8例(22.2%),可2例(5.6%),手术优良率为94.4%。VAS平均评分从术前8.4(6～9)分改善到术后2.4(1～5)分,差异有统计学意义(P <0.05)。末次随访AOFAS评分...     

螺钉内固定术与微型接骨板跨关节内固定术对足跖跗关节损伤患者关节功能的影响比较

目的比较螺钉内固定术与微型接骨板跨关节内固定术对足跖跗关节损伤患者关节功能的影响。方法选取本院98例足跖跗关节骨折患者,根据治疗方法的不同,分为A组和(45例,行螺钉内固定术)和B组(53例,行微型接骨板跨关节内固定术)。比较两组手术情况、足关节功能评分情况及术后并发症发生情况。结果相比A组,B组负重锻炼时间、骨折愈合时间及内固定物取出时间均明显缩短(P<0.01)。与A组(77.78%)比较,B组足关节功能优良率(96.23%)明显升高(P<0.05)。两组住院时间和术后并发症发生率比较,差异无统计学意义(P>0.05)。结论相比螺钉内固定术,微型接骨板跨关节内固定术可有效促进足跖跗关节骨折患者骨折愈合,缩短负重锻炼时间和内固定物取出时间,从而可有效促进关节功能的恢复,且安全性良好。     

A-T皮瓣修复颞部皮肤肿瘤切除后缺损32例

目的 介绍应用A-T皮瓣修复颞部皮肤肿瘤切除术后创面缺损的经验和体会。方法 在遵循皮肤肿瘤切除原则基础上彻底切除皮肤肿瘤,设计A-T皮瓣修复颞部皮肤缺损,A形两侧切口线顺应眼部鱼尾纹走向,T形底边为顺应或平行发际线和耳前轮廓线的曲线,形成上下两个推进皮瓣修复中间三角形缺损,术后的切口线隐蔽。结果 本组共32例患者,颞部皮肤缺损面积最大2.8cm×4.0cm,术后皮瓣全部成活,外形美观。随访2年,未见复发,效果满意。结论 应用A-T皮瓣修复颞部皮肤肿瘤切除术后创面缺损,术后可获得满意的美容修复效果。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.