术前CT血管造影在游离腓骨瓣移植中的应用

目的：探讨术前CT血管造影在游离腓骨瓣移植中的临床应用价值。方法：对13例利用腓骨瓣或腓骨肌皮瓣修复颌骨缺损患者的临床资料进行回顾性分析,应用三维重建软件SimPlant Pro 11.04对其术前CTA原始DICOM数据进行分析。结果：腓动脉起始外径为（3.03±0.57）mm,腓骨头尖距腓动脉起始垂直距离为（43.11±10.11）mm,腓骨头尖距穿支血管垂直距离为（172.46±27.99）mm。腓动脉起于胫后动脉。结论：动脉走行恒定,起始外径较粗。术前CT血管造影无创、准确、直观,对游离腓骨瓣移植具有重要手术指导价值。     

超声检查在腓骨肌(皮)瓣修复下颌骨缺损中的作用

目的　研究超声检测技术在腓骨肌 (皮 )瓣修复下颌骨缺损过程中的作用。方法　 9例腓骨肌 (皮 )瓣修复下颌骨缺损的病例 ,术前彩超检查以确定腓动脉是否单独存在 ,带皮瓣修复者 ,将腓动脉皮支体表定位。单纯腓骨瓣转移者 ,术后超声多普勒听诊仪检测移植瓣动脉的血流情况。结果　 9例腓动脉均单独存在 ,术后腓骨瓣及所带皮瓣全部存活。彩超检查确定腓动脉皮支的位置及数量 ,便于所带皮瓣的术前设计和术中操作 ;超声多普勒听诊检查结果准确地反映了移植瓣动脉的血流状态。结论　超声检查在腓骨肌 (皮 )瓣修复下颌骨缺损术前观察腓血管的结构 ,术后监测组织瓣的存活性方面有重要意义     

CT血管造影在血管化髂骨肌瓣临床设计中的应用

目的:探讨CT血管造影(CT angiography,CTA)在血管化髂骨肌瓣临床设计中的应用价值。方法:选取2014年8月~2015年9月,收治的12例拟行血管化髂骨肌瓣修复手术的患者。术前行CT 血管造影,利用影像工作站(Philips Medical Systems),观察并测量旋髂深动脉(deep circumflex iliac artery,DCI)起始管径、起始点与双侧髂前上棘连线的成角以及起始点至髂前上棘的距离。依据成角的角度及距离行旋髂深动脉起始点体表定位,并模拟血管化髂骨肌瓣切取。结果:旋髂深动脉起始管径(2.8±0.61) mm,旋髂深动脉起始点与双侧髂前上棘连线的成角(55±1.7)°,旋髂深动脉起始点距髂前上棘的距离为(65.1±1.24) mm。依据重建影像可以成功模拟血管化髂骨肌瓣的切取。结论:CT 血管造影可以准确显示旋髂深动脉的解剖位置,能够指导血管化髂骨肌瓣的制备。     

超声多普勒血流仪在游离腓骨瓣皮岛设计中的应用

目的探讨超声多普勒血流仪在游离腓骨瓣皮岛设计中的应用价值.方法采用超声多普勒血流仪探测腓骨后缘中下份小腿外侧皮肤的腓动脉穿支,根据穿支的位置设计腓骨复合瓣的皮岛,结合术中所见情况进行比较,并观察术后皮岛的存活情况.结果3l侧腓骨后缘中下份的小腿外侧皮肤共测得腓动脉穿支89支(1～4支/侧,平均2.87支/侧),术中发现穿支的总数为87支(1～4支/侧,平均2.8支/侧),超声多普勒血流仪探测腓动脉穿支的准确率为91.0%,假阳性和假阴性率分别为8.98%和6.90%.皮岛面积最大12cm×8cm,最小3cm×1.5cm.3l例腓骨瓣中,1例因静脉血栓经抢救无效后去除,其余的30例均获得成活,所有的皮岛均获得100%成活.结论超声多普勒血流仪可以较为准确地探测到小腿外侧的腓动脉穿支血管,提高了游离腓骨瓣皮岛设计的准确性和可靠性,具有一定的临床应用价值.     

CTA与多普勒筛查腓动脉变异的临床影像学研究

目的:通过分析血管化腓骨肌皮瓣制备前及制备中发现的腓动脉变异情况,探讨大型血管化游离腓骨肌皮瓣制备前选择性使用CT血管造影技术(computed tomography angiography,CTA)的必要性.方法:回顾性收集单中心近10年经CTA或术中发现的各类腓动脉变异情况,分析不同腓动脉血管的分类及分布情况.结果...     

颌内动脉的临床解剖及其意义

目的　为了防止髁突颈部手术损伤颌内动脉提供详细的解剖资料。方法　解剖 30侧成人尸体头颅标本 ,通过乙状切迹水平线和髁突颈部后缘垂直线 ,观测颌内动脉起始部到该二线上、下 ,内、外的垂直距离及其走行。结果　颌内动脉起始到乙状切迹水平线上、下距离分别为 0 .31cm± 0 .1cm和 0 .2 5cm± 0 .12cm ,重叠 7例 ;到髁突颈部后缘垂直线内、外侧距离分别为 0 .2 3cm± 0 .10cm和 0 .32cm± 0 .15cm ,重叠 5例。颌内动脉走行于翼外肌浅、深层率分别位 90 %和 10 %。结论　乙状切迹水平线和髁突颈部后缘垂直线是保护颌内动脉的重要标志。     

改良的游离腓骨瓣制备方法

目的 :介绍一种改良的游离腓骨瓣制备方法。方法 :在暴露小腿外侧肌间隙后 ,首先完成整个腓骨血管蒂的解剖 ,随后再分离腓骨外侧和前方的肌肉附丽 ,待完成腓骨上下端的截骨后 ,将腓骨向后旋转 ,暴露小腿骨间膜并于直视下切开 ,最后将腓骨向前旋转 ,切断腓动、静脉远端及胫后肌 ,完成腓骨瓣的制备。结果 :采用此方法完成 2 0例游离腓骨瓣制备 ,平均手术时间明显少于常规的方法 ,单纯腓骨瓣需 40～ 5 0min ,腓骨骨肌皮瓣需 5 0～ 70min。结论 :改良的游离腓骨瓣制备方法克服了常规方法的缺陷 ,更为快捷、简便、安全、可靠 ,值得推广 。     

下颌角手术相关颌后静脉走行的CTA研究

目的:应用CTA(血管造影术)影像测量颌后静脉与下颌角手术相关解剖,为避免手术中损伤颌后静脉提供指导。方法:选择30名正常成人下颌角及周围血管CTA扫描图像,应用ADW4.2图像处理软件测量颌后静脉距下颌角处颌骨各边缘的三维解剖位置。结果:颌后静脉距下颌角点的距离为(11.26±2.34)mm;在下颌角点上10 mm处距下颌骨后缘为(8.18±2.12)mm;在下颌角点上20 mm处距下颌骨后缘为(6.38±2.12)mm;在下颌角点上30 mm处距下颌骨后缘为(3.18±2.12)mm,在下颌角点上40 mm处距下颌骨后缘为(2.18±1.16)mm。结论:在下颌骨后缘手术时位置越高颌后静脉距下颌骨越近,手术越容易损伤颌后静脉;参照测量获得的解剖数据在下颌角成型手术中能避免损伤面前静脉及颌后静脉。     

带血管蒂颊垫上瓣的应用解剖

对２０侧成人尸体头面部进行了解剖，观测了颊动脉，颊神经、咀嚼脂肪垫体部，面神经的颊支及腮腺导管等结构。颊动脉多从上颌动脉的翼肌段发出，分支分布于颊肌上２／３的后部、咀嚼脂肪垫体部的下４／５，入颊垫处外径１．１±０．２ｍｍ；起始处距入颊垫处２８．５±６．２ｍｍ。取３０ｍｍ×２５ｍｍ的带颊动脉蒂颊垫瓣，可转位至下颌支、下颌体、软腭、硬腭、上颌骨及上颌窦等处。文中还讨论了与颊垫上瓣临床应用有关的解剖问题     

腓骨游离组织瓣在口腔颌面外科的应用

目的：本文结合我科应用游离腓骨瓣重建口腔下颌骨缺损的体会，论述了腓骨瓣的解剖、制作、用途及优缺点等问题。方法：腓骨瓣均以腓动、静脉为蒂，制作时采取先断腓骨，后解剖血管蒂的方法，使手术操作更容易，更安全。切取骨皮瓣时，皮岛以穿支血管为蒂，修复粘膜或皮肤缺损，或充作“监测瓣”。结果：自１９９６年１１月至１９９７年９月，我科共进行腓骨游离瓣移植术２６例，全部获得成功，９例携带皮岛者亦无１例发生坏死。结论：腓骨可提供２５ｃｍ长的皮质骨段，适于下颌骨缺损的即刻修复；还可同期或延期植入种植牙，恢复口腔的咀嚼功能，是目前修复下颌骨复合缺损的较好方法     

The microvascular thenar flap as a new possibility for super-thin soft tissue reconstruction in the oral cavity—Initial clinical results

We report the first clinical use of a free microvascular thenar flap for reconstruction of intraoral soft tissues. In 9 patients with a recurrent oral squamous cell carcinoma (SCC), a new primary oral SCC, or a defect of the hard palate after radiotherapy, we covered the soft tissue defect, after resection of the tumour or local preparation, with a microvascular thenar flap. All patients had had combined resection and irradiation for treatment of the initial tumour. In every case the thenar flap was harvested from the left forearm. Arteries were anastomosed to cervical arteries on either side. The veins were anastomosed to the deep jugular or subclavian vein. Patients were followed up clinically after 3, 6, and 12 months and radiologically every 6 months. The mean length of the pedicle was 21 cm. The mean width of the flap was 27 mm (range 24–30) and the mean length 37 mm (range 26–49). All anastomoses worked well. All flaps healed without major complications. A thin but stable layer of soft tissue resulted in every case. All patients were able to wear their prostheses. Good functional and aesthetic results were seen at each follow-up visit, and there were no signs of relapse. The microvascular thenar flap is well-suited for reconstruction of thin layers of soft tissue in the oral cavity. The long pedicle and hairlessness are also ideal for covering intraoral defects after previous operations and in necks with few if any vessels. Primary wound closure is possible in many cases.     

皮瓣肌皮瓣在颌面部组织缺损中的应用

本文介绍自１９７８年１月至１９８６年１２月应用显微外科技术立即修复颌面部缺损３１３例的经验。在这些病例中用游离皮瓣８０例，成功率占９３．７％；带蒂皮瓣２３３例，成功率占９７．０３％。并在皮瓣类型的选择，舌再造功能效果和皮瓣肌皮瓣的优缺点进行了讨论。     

腮腺良性肿瘤两种切除术式的疗效比较

目的 :探讨改良腮腺部分切除术在腮腺良性肿瘤治疗中的临床应用价值。方法 :回顾性分析漯河市中心医院收治的62例腮腺良性肿瘤病例,按照手术切除方法的不同分为改良组和传统组,传统组采用传统腮腺浅叶切除术治疗,另一组采用保留腮腺咬肌筋膜的"肿瘤+腮腺部分切除术"治疗(研究组),比较两组患者的疗效、并发症发生率及复发率。结果:术后随访6~48个月,两组患者的复发率无显著性差异(P>0.05)。研究组术后并发症发生率显著低于传统组(P<0.05)。结论:改良腮腺部分切除术手术创伤小,术后并发症少,在直径<4 cm的腮腺浅叶良性肿瘤手术中,具有很高的临床应用价值。     

A pedicled palatal periosteal flap for the closure of oro-antral fistula

Various surgical techniques have been developed for oro-antral fistula (OAF) closure, all of which have some drawback. Twenty consecutive patients with an OAF were enrolled in this prospective study. A trapezoid full-thickness flap extending from the palatal area to the buccal gingiva was raised, including the fistula at its centre. The palatal free end aspect was split into two layers and the deep periosteal layer was folded deep to the flap over the bony defect, thereby sealing the fistula. The superficial layer was returned to its primary position and sutured. The patients were followed for 3 months. Nineteen patients showed immediate OAF closure. One patient showed a residual oro-antral communication of 0.5 mm in diameter that resolved spontaneously within 4 weeks. The pain level (on a visual analogue scale) was highest at the first follow-up week, with a mean score of 5.5, which decreased to a mean level of 2.5 in the second week and 0 in the fourth week. The mean satisfaction level was 9.85 on a scale of 0–10 (10 representing total satisfaction). The pedicled palatal periosteal flap is a simple and effective surgical technique with high predictability and patient satisfaction levels, offering one more alternative for the treatment of OAF.     

Comparative Study Between Two Flaps—Trapezoidal flap (TZF) and Ocshenbein-Leubke Flap (OLF) in Periapical Surgeries

The ultimate goal in surgical endodontics is not only the eradication of periapical pathosis but also preservation of periodontal tissues using suitable surgical techniques. Treatment outcomes are no longer acceptable without considering the esthetic consequences of all involved dentoalveolar structures. It is critical that incisions and tissue elevations and reflections are performed in a way that facilitates healing by primary intention. The large variety of flaps available for periapical surgeries reflects the number of variables to be considered before choosing an appropriate flap design. In this study; Ocshenbein-Leubke (OL) and trapezoidal (TZ) flaps have been compared in terms of their efficacy and comfort. Twenty patients of ASA category I, between the age group of 12–40 years were randomly selected to undergo periapical surgery by utilizing one of two flaps. All the subjects were free of periodontal disease. Demographic variables were found to be statistically similar. OL flap was found to be better than TZ flap with respect to time of flap reflection, accessibility, duration of surgery and post-operative pain. The OL flap takes less time for reflection with nearly the same accessibility, less post-operative pain and less complication as compared to TZ flap. We conclude that OL flap gives better results when compared to TZ flap.