唇腭裂序列治疗概要

唇腭裂是一种常见的先天畸形,在不同种族人群中其发病率有所差异,总体发病率约为1.7‰[1].裂隙部位累及单侧或双侧唇、牙槽及腭部,可伴有不同程度的鼻、耳、颌骨和颅骨等器官的畸形.唇腭裂治疗不仅要重建唇、腭部形态,更重要的是恢复语言、咀嚼、吞咽、听力及通气等功能,同时还需要关注患者的心理,最终使患者能够以完美的容貌、完善的功能和完好的心态融入社会,是一项需要在多学科医师共同协作下才能完成的复杂工作(multidisciplinary team approach)[2].     

电子束CT三维重建在髋臼骨折诊断与治疗中的应用

目的：探讨ＥＢＣＴ（电子束ＣＴ）三维重建在髋臼骨折诊断和治疗中的应用。方法１２例髋臼骨折患者均行骨盆平片、ＥＢＣＴ平扫及三维重建检查,其中７例行手术,比较以上三种方法的检查及术中情况,以显示各自的诊断价值。结果①骨盆平片只能显示髋臼骨折,不能确定骨折类型。②ＥＢＣＴ平扫可以明确骨折类型,但需要阅片者有良好的空间思维能力,并熟悉髋臼周围的解剖结构。③ＥＢＣＴ三维重建可以得到髋臼骨折最直观、最全面的图     

唇腭裂患儿序列治疗中的心理干预

目的探讨序列治疗中心理干预对唇腭裂患儿交往能力和行为问题的影响。方法将164 例唇腭裂患儿随机分为对照组与观察组各82例,观察组在“序”治疗的各阶段进行心理干预,对照组接受常规唇腭裂治疗、护理。结果观察组在心理测定的抑郁、交往不良及社会退缩方面改善显著优于对照组(均P<0.01)。结论心理干预在唇腭裂序列治疗中有着积极作用。     

CT三维重建在髋臼骨折中的应用

自 2 0 0 1年以来 ,我院对 17例髋臼骨折行CT三维重建指导临床治疗 ,取得满意效果 ,现报道如下。1　材料与方法1.1　病例资料　本组 17例 ,男 12例 ,女 5例 ,年龄 2 5～ 5 4岁。左侧 7例 ,右侧 10例。损伤原因 :车祸伤 15例 ,高处坠落伤 2例。所有患者术前均行X线片和多维CT重建检查 (见图 1) ,其中CT三维重建对髋臼进行旋转观察 ,关节解体 ,直接观察髋臼情况。按Letournel Judet分类 :双柱骨折 5例 ,T形骨折 4例 ,后柱加后壁骨折 5例 ,横形骨折 3例 ,其中合并髋关节脱位 4例 ,股骨头骨折 2例。1.2　CT三维重建方法　使用GE高档螺旋C…     

电子束CT三维重建在髋臼骨折诊断与治疗中的应用

目的　探讨EBCT (电子束CT)三维重建在髋臼骨折诊断和治疗中的作用。方法　 12例髋臼骨折患者均行骨盆平片、EBCT平扫及三维重建检查 ,其中 7例行手术 ,比较以上三种方法的检查及术中情况 ,以显示各自的诊断价值。结果　①骨盆平片只能显示髋臼骨折 ,不能确定骨折类型。②EBCT平扫可以明确骨折类型 ,但需要阅片者有良好的空间思维能力 ,并熟悉髋臼周围的解剖结构。③EBCT三维重建可以得到髋臼骨折最直观、最全面的图象。结论　骨盆平片诊断髋臼骨折是粗浅的 ,对制定治疗方案帮助有限 ;EBCT平扫能显示骨折的详细情况 ,并由此选择合适的治疗方法 ,但要制定具体的手术方案 ,需要临床医生有丰富的阅片经验 ;EBCT三维重建对制定详细的手术计划可提供正确指导 ,是目前最理想的诊断髋臼骨折的方法。     

CT三维重建在骨盆肿瘤切除与重建中的应用

目的探讨CT三维重建在骨盆肿瘤切除与重建中的临床应用价值.方法使用Siemens Plus 4螺旋CT机对17例骨盆肿瘤患者术前进行扫描,在Siemens工作站进行三维重建.根据三维重建图形为不同患者设计制作合适的内固定器具.结果术后随访6～18个月,1例术后16个月复发,行半骨盆切除及人工半骨盆重建后恢复健康,患者行走正常.1例出现肺部转移.其余病例在随访期内未发现局部复发.结论CT三维重建图像清晰地显示了术前骨盆肿瘤的细节,以最易理解的形式立体直观地显示了病变及与周围结构的关系和手术应切除的范围,有助于术前正确诊断和手术计划的制定.     

CT三维重建在脊柱翻修术中的应用

三维重建技术能够明确致压的主要病变部位,为尽快解除压迫神经,恢复功能提供保障。笔者通过对30例脊柱术后患者检查并手术,来探讨其临床价值和在治疗方案选择中的指导意义。1临床资料1·1一般资料本组30例,男性16例,女性14例,年龄20~68岁,平均36·8岁。首次手术至再次手术的时间为10个月~12年,术后随访6~20个月。颈椎术后7例,其中颈前路减压内固定术后4例,单纯后路减压术后3例;胸椎术后12例;腰椎术后11例。脊柱翻修术的原因:首次手术后神经压迫症状无缓解或复发者21例、脊柱不稳者5例、融合术失败者2例、内植物断裂者2例,其中神经压迫的原因…     

CT三维重建在踝关节骨折诊断和治疗中的应用

目的 探讨CT三维重建在踝关节骨折的分型诊断和治疗方面的临床价值.方法 42例踝关节骨折均行X线及CT三维重建检查,比较两者的检查结果,并根据CT检查结果确定最佳手术治疗方案.结果 CT三维重建诊断符合率为97.6％,X线为59.5％,CT三维重建诊断结果优于X线(P＜0.05).结论 CT三维重建对判断踝关节骨折移位、分型诊断优于X线,对手术路径和内固定方法的选择具有重要指导意义.     

CT三维重建在治疗下颌角肥大中的临床应用

目的探讨CT三维重建技术在治疗下颌角肥大中的临床指导意义。方法 2009年3月-2011年1月在CT三维重建技术指导下行下颌骨截骨术治疗下颌角肥大18例。患者均为女性;年龄20～36岁,平均25岁。单纯下颌角肥大14例;伴咬肌肥大3例,双侧不对称1例。下垂型6例,外翻型9例,内翻型3例。根据下颌角肥大分型选择合适的手术方法。术前在三维重建工作站上设计并模拟手术过程,标记截骨线及测量截骨量。结果术中无下颌骨骨折发生。术后出现面神经暂时性麻痹1例,3个月后恢复正常。患者均获随访,随访时间6～12个月,平均7.6个月。术后6个月获满意15例,基本满意2例,不满意1例(双侧不对称)。结论根据CT三维重建技术得到头颅三维模型行术前设计可以提高手术准确性,以达到设计的预期效果。     

Management of cleft lip and palate in Brazil

We aimed to evaluate the treatment protocols for cleft lip and palate that are used in Brazil, to compare them with the ones proposed from elsewhere, and to discuss the official data about admission for treatment of cleft lip or palate, or both, in Brazil. We also assessed the importance of integrated action of different specialities to treat this condition. A questionnaire related to attendance protocols was developed and sent out to all Brazilian Plastic Surgery Services connected to the Brazilian Society of Plastic Surgery, and to other units involved in such treatment. We also studied the data produced by the Brazilian Department of Health about the operations done during the past five years. Many protocols were identified, but despite much controversy in many areas, a consensus was reached about the surgical techniques, the age group most suitable to be operated on, and there was total agreement about the need for multidisciplinary management. According to the State Department of Health, the number of operations done in 1995 was 9696, and this had increased to 21?022 in 1999. The state of São Paulo had done 17?636 (84%) of all procedures in 1999.     

先天性唇腭裂患儿的围手术期护理

目的：先天性唇腭裂是口腔颌面部最常见的先天畸形,探讨如何加强对唇腭裂患儿的围手术期护理,以达到最理想的手术及术后康复效果。方法：统计我科2009年1月1日～2010年12月31日收治的120例唇腭裂患儿,总结围手术期护理经验。结果：所有患儿经过精心的护理、心理和康复治疗,均获得良好的治疗效果。结论：良好的围手术期护理以及心理护理是唇腭裂患儿手术成功及术后康复的重要保障。     

A status report on management of cleft lip and palate in India

Introduction:

This national survey on the management of cleft lip and palate (CLP) in India is the first of its kind.

Objective:

To collect basic data on the management of patients with CLP in India for further evaluation.

Materials and Methods:

A proforma was designed and sent to all the surgeons treating CLP in India. It was publicized through internet, emails, post and through personal communication.

Subjects:

293 cleft surgeons representing 112 centers responded to the questionnaire. Most of the forms were filled up by personal interview.

Results:

The cleft workload of the participating centers is between 10 and 2000 surgeries annually. These centers collectively perform 32,500–34,700 primary and secondary cleft surgeries every year. The responses were analyzed using Microsoft excel and 112 as the sample size. Most surgeons are repairing cleft lip between 3-6 months and cleft palate between 6 months to 1 year. Millard and Tennison repairs form the mainstay of lip repair. Multiple techniques are used for palate repair. Presurgical orthopedics, lip adhesion, nasendoscopy, speech therapy, video-fluoroscopy and orthognathic surgery were not always available and in some cases not availed of even when available.

Conclusion:

Management of CLP differs in India. Primary surgical practices are almost similar to other studies. There is a lack of interdisciplinary approach in majority of the centers, and hence, there is a need for better interaction amongst the specialists. A more comprehensive study with an improved questionnaire would be desirable.     

唇腭裂病人成年后的综合美容

既使是近乎完美的唇腭裂早期治疗，随着人体面部器官的生长发育，仍有可能出现鼻部、唇部畸型，因此，唇腭裂后期治疗至关重要。通过对１６０２例早期及后期唇腭裂病人的治疗体会与总结，指出各类型唇腭裂病人成年后常见的各种面颌部畸形。阐述了适用于该类病人的手术前设计、治疗原则、治疗步骤及方法。针对唇腭裂病人成年后所出现的畸形往往是多方面的这一现象，结合口腔颌面外科、正畸修复科、整形美容外科等专科特点，提出了综合美容整形的设计思路及治疗要点     

A revised classification of the cleft lip and palate

BACKGROUND:

Submucous cleft palate is characterized by muscular diastasis of the velum in the presence of intact mucosa with variable combinations of bifid uvula and hard palatal defect. Submucous cleft palate is indicated as a separate entity in most previous classifications but it has never been properly classified on an anatomical basis.

OBJECTIVES:

To revise the Smith-modified Kernahan ‘Y’ classification of cleft lip and palate deformities, and to describe the different anatomical subtypes of submucous cleft palate.

METHODS:

The present study was conducted in Hayatabad Medical Complex, Abasin Hospital and Aman Hospital Peshawar, Pakistan, from November 2010 to December 2011. All patients who presented to the outpatient departments with cleft lip and palate, with the exception of previously operated cases, were included. All cases were described according to the Smith-modified Kernahan ‘Y’ classification and the authors’ revised Smith-modified Kernahan ‘Y’ classification. All of the data were organized and analyzed using SPSS version 17 (IBM Corporation, USA).

RESULTS:

A total of 163 cases of cleft lip and palate deformities were studied, of which 59.5% were male and 40.5% were female. Smith modification of the Kernahan ‘Y’ classification completely described the cleft deformities in 93.9% of patients. However, while the Kernahan ‘Y’ classification represented the submucous cleft palate, it did not describe its different anatomical subtypes in 6.13% of patients. The revised Smith-modified Kernahan ‘Y’ classification completely described the cleft deformities of the entire study population, including the different submucous cleft palate patients.

DISCUSSION:

The Smith alphanumeric modification of the Kernahan ‘Y’ classification of cleft lip and palate came into existence after a long search and a series of modifications over the past century. This classification system describes the cleft region, site of the cleft, degree of the cleft, rare and asymmetrical clefts, and are computer database friendly. However, this classification did not describe the different anatomical subtypes of submucous cleft palate that have variable relationships with velopharyngeal insufficiency.

CONCLUSION:

The revised Smith-modified Kernahan ‘Y’ classification described in the present study can describe all types of cleft lip and palate deformities in addition to the different types of submucous cleft palate deformities.     

右美托咪定用于小儿唇腭裂手术麻醉的临床观察

目的 探讨右美托咪定用于小儿唇腭裂手术麻醉中的临床效果,为小儿唇腭裂手术麻醉安全用药提供依据.方法 先天性唇腭裂修复术患儿40例,随机分为右美托咪定组(D组)和对照组(C组).两组患儿均采用紧闭面罩8％七氟烷吸入麻醉诱导,D组同时静脉泵注右美托咪定1 μg/kg,C组给予同等容量生理盐水,均于10 min给完.两组患儿均采用气管插管静吸复合全身麻醉方法,术中维持C组采用异丙酚-七氟烷复合麻醉;D组采用右美托咪定-异丙酚-七氟烷复合麻醉,观察并记录不同时点患儿心率、平均动脉压、脉搏血氧饱和度、呼气末二氧化碳分压并进行躁动评分,记录两组呼吸抑制及躁动发生率.结果 两组患儿的手术时间、麻醉时间及苏醒时间差异无统计学意义(P＞0.05).D组患儿在气管插管即刻(T2)、术中20 min(T3)、术毕(T4)及拔管(T5)时平均动脉压和心率均明显低于C组(P＜0.05).D组躁动发生率为11.1％,明显低于C组36.4％(P＜0.05).D组无一例发生呼吸抑制.结论 右美托咪定用于小儿唇腭裂修复术安全有效,术中血流动力学平稳,术后恢复期安静、舒适,能够减少围术期并发症的发生.     

干细胞在唇腭裂患者牙槽突裂中应用的研究进展

干细胞具有自我更新能力及多向分化潜能,已被广泛应用于多个领域。相对于唇腭裂患者牙槽突裂的常规手术治疗方法,干细胞具有来源广泛、取材方便、免疫原性低等优点,整形外科医生已逐渐关注唇腭裂患者牙槽突裂干细胞治疗的研究。该文对胚胎干细胞、人间充质干细胞、颌面部来源干细胞在唇腭裂患者牙槽突裂中应用的研究进展进行了综述。     

唇腭裂1386例发病特点回顾性分析

目的：通过对唇腭裂患者临床资料进行回顾性统计分析,研究该病的发病特点,为唇腭裂的预防及治疗提供临床参考。方法：统计分析2007年1月～2010年1月手术治疗的1386例唇腭裂患者,分别从患者诊断、性别、年龄、出生地,唇腭裂裂型分布情况等方面进行回顾性调查。结果：本组病例中,单纯唇裂356例（25．69％）,唇裂合并腭裂580例（41．84％）,单纯腭裂450例（32．47％）;男809例,女577例,男：女=1．40：1;单侧唇裂伴或不伴腭裂明显多于双侧者,两者之比为5．67：1,其中左侧多于右侧（1．82：1）。结论：唇腭裂发病以唇裂合并腭裂居多,男性发病多于女性,在腭裂患者中女性发病高于男性;单侧发病多于双侧,左侧多于右侧。     

α转化生长因子基因BamHⅠ限制酶切片段长度多态性与广东地区人群非综合征性唇腭裂的关系

目的 探讨中国广东地区人群非综合性唇腭裂与α转化生长因子(transforming growth factor α,TGF-α)基因多态性的关系.方法 应用聚合酶链式反应-限制酶切片段长度多态性(PCR-RFLP)核苷酸分型技术,以BamH Ⅰ限制性内切酶消化PCR扩增产物,对107例非综合征性唇裂或唇腭裂(nonsyndromic cleft lip with or without cleft palate,NSCL/P)患者,136例正常人为对照组的TGF-α/BamH Ⅰ等位基因多态性进行分析.结果 NSCL/P患者的A1等位基因频率比正常对照组明显增高,差异有统计学意义(P＜0.05).NSCL/P患者中,有家族史与无家族史者等位基因频数,差异无统计学意义(P＞0.05);双侧NSCL/P患者与单侧NSCL/P患者的TGF-α/BamH Ⅰ基因型频率,差异无统计学意义(P＞0.05).结论 中国广东地区人群NSCL/P患者TGF-α基因中存在BamH Ⅰ多态性位点,TGF-α基因BamH Ⅰ位点与中国广东地区人群NSCL/P的发生有关.     

米库氯铵与顺苯磺酸阿曲库铵在婴幼儿唇腭裂手术中的应用比较

目的观察和比较米库氯铵和顺苯磺酸阿曲库铵用于婴幼儿唇腭裂手术中的肌松效应和安全性。方法 2012年9月至2013年9月择期行唇腭裂手术治疗的患儿60例,年龄6个月至3岁,随机分为两组,每组30例。两组均给予咪达唑仑0.1mg/kg、丙泊酚2mg/kg、瑞芬太尼1μg/kg及米库氯铵0.2mg/kg(M组)或顺苯磺酸阿曲库铵0.15mg/kg(C组)行麻醉诱导后气管插管。采用TOF-Guard加速度肌松监测仪连续监测尺神经四个成串刺激(TOF)。观察并记录肌松起效时间、临床作用时间和恢复指数,进行插管评级并观察不良反应情况。结果两组的插管条件评级差异无统计学意义。M组肌松起效时间、肌松临床作用时间以及恢复指数明显短于C组(P0.05);M组不良反应发生率明显低于C组(P0.05)。结论米库氯铵用于婴幼儿唇腭裂手术时起效快、肌松效应时间短,恢复较快。