先天性复拇畸形术后随访分析

目的报告先天性复拇畸形手术治疗结果的家长主观评价, 及与Chung分型之间的相关性。方法对我院自2019年1月至2021年1月收治的先天性复拇畸形病例33例进行回顾性分析, 按照Chung分型, Ⅰ型17例, Ⅱ型4例, Ⅲ型6例, Ⅳ型6例。对患儿家长的主观评价结果进行分析, 包括功能和外观VAS评分、术后功能和外观不满意之处、再手术意向、拇指抓握情况、日常生活及社交情况。Chung分型的VAS评分差异比较采用单因素方差分析, 其余计量资料采用t检验。结果术后随访时间为15～42个月, 平均22.2个月。ChungⅡ型外观评分显著低于Ⅰ、Ⅲ、Ⅳ型的外观评分。Ⅳ型患儿家长再手术意向最低。家长对外观不满意包括拇指偏斜、拇指粗细差异、瘢痕等;对功能不满意包括拇指活动度降低、拇指力量减弱等。其中拇指偏斜、瘢痕、拇指力量减弱对家长外观或功能的评价有显著影响。大部分患儿日常生活和社交评估获得良好的结果。结论复拇畸形术后功能和外观家长短期随访整体满意度较高, 指体偏斜是影响术后结果和满意度的主要因素, 这些结果均与Chung分型相关。     

儿童复拇畸形WasselⅣ型的新分型及治疗体会

[目的]阐述儿童先天性复拇畸形Wassel Ⅳ型的新分型和治疗方法.[方法]对本院2005年8月～2008年1月治疗的73例80拇先天性复拇畸形进行回顾性分析统计,男性45例(62%),女性28例(38%);平均年龄1.83岁.对病例作Wassel分型,其中的WasselⅣ型进一步新分成4个亚型,根据不同的分型和畸形程度进行个性化治疗,包括单纯多指切除术,合并各种皮瓣、肌腱、韧带、关节囊等软组织矫形手术的多指切除术,改良的Bilhaut手术,少数大龄患儿还可行截骨矫形术.[结果]65例术后平均随访9.6个月,对治疗结果用改良的Tada评分进行评估,优61拇,良12拇,中6拇,差1拇.[结论]先天性复拇畸形的治疗,应该根据畸形的分型和严重程度采取个性化的治疗,对于畸形严重的Wassel Ⅳ-4型近节指骨重复型,在疾病的早期即行合并各种软组织矫形的多指切除术,手术效果优良,有效避免再次骨性手术.     

Wassel Ⅱ型复拇指畸形两种术式的长期疗效比较

目的 比较赘指切除加侧副韧带重建术和Bilhaut-Cloquet术两种术式治疗Wassel Ⅱ型复拇指畸形的长期疗效,探讨合理的术式选择方法.方法 回顾性研究了10例患儿(11指)Wassel Ⅱ型复拇指畸形的病例,其中有3指复拇畸形采用Bilhaut-Cloquet方法治疗,8指采用赘指切除加侧副韧带重建方式进行矫治,手术时年龄为6个月～10岁.重点分析术后功能恢复和外观恢复情况.结果 术后本组病例平均随访时间[(12.4±2.1)年,(x)±s,下同],两种术式都能获得比较好的拇指指间关节的稳定性;在拇指指间关节活动度方面,赘指切除加侧副韧带重建术后平均为(51.7±10.1)°,而Bilhaut-Cloquet术后平均为(11.7±9.3)°,两者差异有统计学意义.在拇、示指捏力方面两者差异无统计学意义.在患指术后末节指骨对线方面Bilhaut-Cloquet术具有一定的优势,但该术式术后均残留指甲的线状沟槽或突起.结论 对于WasselⅡ型复拇指畸形宜早期采用赘指切除加侧副韧带重建术进行矫治,如果患儿年龄较大,两个末节指骨发育较均衡,可考虑采用Bilhaut-Cloquet术.     

儿童先天性拇指多指畸形的手术时机及方法

目的 探讨儿童先天性拇指多指畸形的手术时机及方法.方法 对2007年12月至2012年2月进行手术治疗的132例154指先天性拇指多指畸形的临床资料进行回顾性分析.男性85例,女性47例;年龄2个月至13岁,平均(1.53±2.47)岁.所有患者术前均进行详细专科检查和影像学评估,根据患儿年龄、Wassel分型及畸形程度制订个体化的手术方案,包括单纯多指切除术,合并各种皮瓣成形、肌腱移位(移植)、韧带重建、关节囊修复等矫形手术,11例6岁以上的患儿酌情行截骨矫形术.结果 132倒154指中104例117指获得随访,时间为6～55个月,平均36.7个月,根据改良Tada评分进行评估,优77指,良21指,中15指,差4指;3指术后2年出现继发性成角畸形,1指术后3年掌指关节桡侧残留骨骺,再次手术后外形及功能基本恢复正常.结论 先天性拇指多指畸形的手术时机应根据拇指骨化中心出现时间而定,Wassel Ⅰ、Ⅱ型手术选择在1岁6个月远节指骨骨化中心出现后,Ⅲ、Ⅳ型则选择在1岁近节指骨骨化中心出现后,而Ⅴ、Ⅵ型选择在2岁6个月掌骨骨化中心出现后,Ⅶ型可选择在2岁6个月后进行;手术方法应遵循个体化治疗原则,侧副韧带、肌腱及关节囊重建、矫正尺偏(或桡偏)畸形是手术重点.     

以McBride手术原理为主要方法矫治Ⅳ型复拇指术后后遗畸形

[目的]探讨小儿 Wassel Ⅳ型复拇术后畸形的矫正方法.[方法]自2002年2月～2008年12月,应用McBride手术原理结合综合矫治的方法,治疗Ⅳ型复拇术后遗畸形32例36指.[结果]32例36指,术后进行1～5年(平均28个月)随访,按TAM评定法优良率为100%,拇指外形及功能均取得满意效果.[结论]应用以McBride手术原理为主要方法矫治该型畸形,手术设计合理、操作简单,可取得较好疗效.     

复拇指畸形治疗中骨关节的处理

目的 报告复拇指畸形治疗中骨关节的处理疗效.方法 对52例65指复拇指畸形的患者,针对不同类型,采用截骨关节矫形、侧副韧带肌腱修复重建和指套状瓣修复存留指等方法进行治疗,术后随访观察拇指关节外形和功能恢复情况.结果 术后随访到38例47指,随访时间为5个月至9年,其中4例4指术后出现不同程度的畸形,经过2次手术后,得到良好矫正.其余43指,术后拇指外形和功能均得到了明显改善,优良率为91.5%.结论 复拇指畸形治疗中,关节的处理是矫形手术的关键,如处理不当会导致术后继发性畸形.     

儿童Ⅵ～Ⅶ型复拇指畸形的显微外科组合治疗

目的探讨儿童先天性特殊类型Ⅵ～Ⅶ型复拇指畸形的显微外科组合治疗方法。方法 2009年3月-2016年7月,采用赘生拇指指血管神经蒂的指移位矫形主干拇指10例,其中9例赘生拇指掌骨一同切除,并重建拇内收肌止点。结果 10例术后均获3～24个月随访,外形改善,骨轴线正常,矫形拇指指体接近正常指,矫形拇指对指及外展功能正常。虎口开大4～6cm,矫形拇指感觉正常。结论通过显微外科的组合方法将主干拇指和赘生拇指合二为一,恢复矫形拇指和虎口外形及功能,是矫正先天性Ⅵ～Ⅶ型复拇指畸形的一种有效途径。     

M形皮瓣在儿童Wassel Ⅳ型复拇指畸形合并虎口狭窄矫形术中的应用

目的总结儿童Wassel Ⅳ型复拇指畸形合并虎口狭窄矫形术中应用M形皮瓣修复创面的疗效。方法 2010年5月—2018年12月,收治10例Wassel Ⅳ型复拇指畸形合并虎口狭窄患儿。男7例,女3例;年龄1～5岁,平均1.9岁。轻度虎口挛缩5例,中度5例。术中切除桡侧指体并开大虎口后,应用M形皮瓣修复创面。结果术后皮瓣均成活,创面Ⅰ期愈合。患儿均获随访,随访时间8～15个月,平均12个月。患儿家属对拇指外形满意,拇指对掌及对指功能良好,虎口未进一步挛缩。末次随访时,根据改良Tada评分标准,获优9例、良1例,优良率100%。结论儿童Wassel Ⅳ型复拇指畸形合并虎口狭窄矫形术中,采用M形皮瓣修复重建虎口,操作简便,不增加额外损伤,疗效满意。     

桡偏型拇指挛缩畸形的手术治疗

目的探讨桡偏型拇指挛缩畸形矫形手术的治疗效果。方法对2009年6月至2013年6月收治的12例桡偏型拇指挛缩畸形患者进行矫形手术,采用瘢痕切除及软组织挛缩松解,骨关节矫形及尺侧稳定结构重建,食指背侧皮瓣或游离植皮修复组织缺损的治疗方案。术后定期随访,了解关节融合情况、相关并发症及拇指活动功能。根据Kawabata保留指关节活动范围、关节稳定性及成角畸形来评分。结果术后皮瓣及植皮完全成活,伤口均一期愈合。患者均获随访6~21个月,平均13个月,术后拇指外观及功能均得到明显改善。末次随访时拇指功能按照Kawabata等标准评定,由术前(1.92±1.11)分增加到术后(3.83±1.28)分,其中优8例,良3例,差1例,优良率为91.7%。术后1例拇指再发桡偏畸形。结论桡偏型拇指挛缩畸形通过软组织挛缩松解、骨关节矫形重建及组织缺损修复,可明显改善拇指外观及功能。     

复拇畸形术前拇指正位与斜位X线表现的差异及其临床意义

目的 探讨复拇畸形术前拇指正位和斜位X线表现的差异及其临床意义.方法 纳入重庆医科大学附属儿童医院烧伤整形科收治的复拇畸形患儿355例(复拇指391个).男230例,女125例;年龄4个月～12岁3个月,中位年龄14个月;36例为双侧畸形.依据复拇畸形Wassel分型方法,患指包括Ⅰ型和Ⅱ型68个、Ⅲ型和Ⅳ型231个、...     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.