改进的胸锁乳突肌移位法修复晚期面瘫

目的 探讨应用带蒂胸锁乳突肌转位术，动态修复晚期面瘫的手术方法改进及效果。方法 保留胸锁乳突肌的乳突附丽点，将胸骨头及锁骨头附丽点切断，游离肌腹，经颊部皮下的弧形隧道转位与健侧上下唇的口轮匝肌缝合，替代瘫痪的口周肌肉，矫正口鼻歪斜畸形。结果 本组修复因各种原因所致晚期面瘫42例，术后恢复了静态的口角对称及一定的自主口部活动，尚无失败病例。术后最长随访3年，手术效果满意。结论 带蒂胸锁乳突肌转位术能修复晚期面瘫所致的口鼻歪斜畸形，并能重建部分口部表情功能。     

胸锁乳突肌延长术治疗肌性斜颈

１９９０年９月以来，我们以自行设计的胸锁乳突肌Ｚ延长术治疗肌性斜颈４９例。年龄２～２２岁，其中年龄小于１２岁者３４例。术后随访３个月至３年，优良率达９５．９％。文中详细介绍了手术方法，讨论了胸锁乳突肌延长术的特点和适应证以及与治疗斜颈有关的颈部应用解剖和手术要点，有关外固定和功能锻炼的必要性。强调了矫正斜颈恢复患侧的正常颈部体表形态对美学效果的重要性。     

胸锁乳突肌延长术治疗肌性斜颈

１９９０年９月以来，我们以自行设计的胸锁乳突肌Ｚ延长术治疗肌性斜颈４９例。年龄２￣２２岁，其中年龄小于１２岁者３４例。术后随访３个月至３年，优良率达９５．９％。文中详细介绍了手术方法，讨论了胸锁乳突肌延长术的特点和适应证以及与治疗斜颈有关的颈部应用解剖和手术要点，有关外固定和功能锻炼的必要性。强调了矫正斜颈恢复患侧的正常颈部体表形态对美学效果的重要性。     

胸锁乳突肌延长术治疗肌性斜颈

1990年9月以来,我们以自行设计的胸锁乳突肌 Z 延长术治疗肌性斜颈49例。年龄2～22岁,其中年龄小于12岁者34例。术后随访3个月至3年,优良率达95.9%。文中详细介绍了手术方法,讨论了胸锁乳突肌延长术的特点和适应证以及与治疗斜颈有关的颈部应用解剖和手术要点,有关外固定和功能锻炼的必要性。强调了矫正斜颈恢复患侧的正常颈部体表形态对美学效果的重要性。     

内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈4例报告

目的探讨内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈的方法和疗效。方法2005年1~8月,我院应用内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈4例,年龄5~11岁,平均8.5岁。患侧腋窝前缘置入10 mm trocar,在颈阔肌筋膜下、胸锁乳突肌胸骨头与锁骨头浅面钝性分离,注入CO2气体(压力6 mm Hg),建立颈前皮下间隙,置入30°内镜。分别在患侧颈后近锁骨上缘处及对侧胸壁近锁骨下缘处置入5 mm trocar至颈前皮下间隙,置入分离钳与电凝钩,距胸锁骨附着处1 cm电凝横断胸锁乳突肌胸骨头与锁骨头的肌纤维束,并松解胸锁乳突肌周围紧张的纤维组织。结果4例手术均获成功,手术时间分别为90、75、70、45 m in。术中出血均<1 m l。术后第1天开始功能锻炼,第2天出院。第1例颈部皮肤轻微电灼伤,2周后痊愈。1例术后出现面部皮下气肿,次日自行吸收。随访2、4、6、10个月,斜颈均矫正,切口小且隐蔽,瘢痕不明显,颈部皮肤弹性良好,对面部表情活动无影响。结论内镜下胸锁乳突肌切断松解术疗效确切,且具有微创的特点,值得临床推广。     

应用胸锁乳突肌瓣治疗晚期面瘫

目的：探讨应用胸锁乳突肌瓣治疗晚期面瘫的疗效。方法：保留胸锁乳突肌的乳突附着点将胸骨的胸骨头和锁骨头切断，游离肌腹，经颊部皮下的弧形隧道与患侧的上下唇口轮匝肌缝合，替代口周瘫痪的肌肉，治疗因面瘫所致的口鼻畸形、皮肤松弛及口角活动障碍。结果：本组8例面瘫患者术后静态时口角对称，1周后能活动患侧口角，术后1个月经训练能恢复笑容，经电话随访，所有病例口部活动术后半年恢复满意。结论：胸锁乳突肌瓣能矫正晚期面瘫所致的口鼻畸形，并重建患侧口部活动、恢复部分口部表情。     

带蒂胸锁乳突肌移位术修复晚期面瘫

目的　探讨应用带蒂胸锁乳突肌移位术动态修复晚期面瘫畸形的疗效。方法　 1999年 12月以来 ,采用带蒂胸锁乳突肌移位术修复 7例晚期面瘫 ,将胸锁乳突肌的胸骨头及锁骨头移位至患侧口周 ,替代瘫痪的口周肌肉 ,修复因面神经瘫痪所致的口鼻歪斜畸形及活动障碍。保留副神经的其余功能。结果　术后立即矫正静态时口鼻歪斜畸形 ,1周后已能活动患侧口角。术后 1个月 ,经训练能恢复笑容。经 10个月随访 ,所有患者口部活动恢复满意。结论　带蒂胸锁乳突肌移位术能修复晚期面瘫所致的口鼻畸形 ,并能重建口部表情功能     

胸锁乳突肌胸骨头肌皮瓣行舌再造术的评价

目的：用胸锁乳突肌胸骨头肌皮瓣行舌再造及其功能评价。方法：介绍一种用胸锁乳突肌胸骨头肌皮瓣行舌功能再造的新的手术方法。结果：舌再造１０例，９例肌皮瓣全部成活，经２－６年随访功能效果满意。结论：胸锁乳突肌胸骨头肌皮瓣行舌再造具有术式简单，安全，可靠，操作技术容易，易于推广，供区无明显疤痕和缺损，可一期精确完成，产生最低限度的疤痕和变形。     

带耳大神经的胸锁乳突肌肌瓣在腮腺癌手术修复中的应用

目的探讨腮腺深叶癌根治手术切除后,面部凹陷畸形及面神经缺损进行功能性修复的新方法,并评价临床疗效。方法对12例腮腺深叶癌侵袭周围骨质的患者,采取开放面神经管,将癌瘤、腮腺、受累面神经及周围骨质(包括乳突、茎乳孔、茎突及下颌升支后缘)扩大切除,利用面神经管内段正常的神经干断端与胸锁乳突肌肌瓣相连的耳大神经进行吻合,同时利用胸锁乳突肌肌瓣填充凹陷畸形。结果开放面神经管利用耳大神经胸锁乳突肌肌瓣功能性修复的方法,9例腮腺区凹陷畸形明显恢复常态,2例因肿瘤复发再次手术切除留有明显凹陷畸形,1例因局部感染,组织液化,肌肉萎缩,出现凹陷。面神经功能完全恢复,恢复时间最短为12周,最长20周,平均163周。同时提高了肿瘤的局部控制率。结论开放面神经管腮腺癌根治术,用耳大神经-胸锁乳突肌肌瓣即时修复,既达到了面部凹陷畸形的整复,又实现了面神经的功能性修复,同时减少肿瘤的局部复发,符合功能外科修复的发展要求,是一种临床应用效果比较理想的方法。     

内镜下胸锁乳突肌切断治疗肌性斜颈的疗效观察

目的探讨内镜下离断胸锁乳突肌治疗肌性斜颈的效果。方法23例肌性斜颈患儿,年龄1个月～12岁,中位数2岁6个月。右侧腋窝皮纹线内置入5mm trocar,手持镜头将胸锁乳突肌下端胸骨头和锁骨头表面的肌膜钝性分离,充入CO2气体加压至6mmHg,形成皮下空间。在外侧颈下横纹内和前胸横纹处切开3mm分别置入3mm弯钳和电刀尖。电凝或电切横断胸锁乳突肌纤维束,松解胸锁乳突肌周围的纤维组织。结果23例均在内镜下完成手术。平均手术时间51．2min（35～135min）,术中出血量均〈1ml。无损伤周围大血管和神经。1例颈部切口处皮肤轻微电灼伤,2周后自愈。术后行颈部舒展活动训练,术后第1天出院。23例随访3个月～4年,中位时间6个月,斜颈均矫正,疗效优18例,良5例,切口瘢痕不明显,皮肤弹性好,随表情无异常活动现象,无复发。结论内镜下胸锁乳突肌切断治疗肌性斜颈具有微创、恢复快、效果好的优点,瘢痕不明显,美观且不损伤颈阔肌,对表情活动无影响。     

Ultrasound as the only nerve localization technique for peripheral nerve block

Ultrasound facilitates the performance of peripheral nerve blocks and may increase block quality parameters. In this report, we show that ultrasonographic guidance makes peripheral nerve blocks possible in patients in whom the traditional methods of nerve localization are limited. Four cases are described in which conventional end points for successful blocks would have been impossible to use, whereas ultrasound guidance was successful and safe. The latter method increases applicability in a larger group of patients.     

The vascularized saphenous nerve as cross-face nerve graft

Summary The vascular anatomy of the saphenous nerve was studied by cadaver preparation, Indian ink and micropaque injection. A constant vascularized nerve graft with a good pedicle and suitable length for a cross-face anastomosis was found. The vascularized saphenous nerve was used for the first time as a cross-face graft in 8 patients with facial palsy. The Tinel-sign was followed-up and a biopsy of the nerve graft at the time of the muscle transplantation was carried out to compare the morphological results of the vascularized nerve graft with two free sural nerve grafts which were used in two patients at the same time. The functional results are demonstrated.     

A resorbable nerve conduit as an alternative to nerve autograft in nerve gap repair.

Poly-3-hydroxybutyrate (PHB) occurs within bacterial cytoplasm as granules and is available as bioabsorbable sheets. Previously, the advantage of PHB in primary repair has been investigated while in this study the same material has been used to bridge an irreducible gap. The aim was to assess the level of regeneration in PHB conduits compared to nerve autografts. The rat sciatic nerve was exposed, a 10 mm nerve segment was resected and bridged with either an autologous nerve graft or a PHB conduit. The grafted segments were harvested up to 30 days. Immunohistochemical staining was performed and computerised quantification of penetration distance and volume of axonal regeneration was estimated by protein gene product (PGP) immunostaining and calcitonin gene-related peptide (CGRP) positive fibres. Penetration and proliferation density of Schwann cells into the conduit was measured by quantifying S-100 staining. The inflammatory response was quantified with ED-1 staining for macrophages. Antibodies to vWf provided an assessment of angiogenesis and capillary infiltration. Percentage immunostaining for PGP in autograft and PHB groups showed a progressive increase up to 30 days with a significant linear trend with time and an increase in the volume of axonal regeneration. A similar pattern of progressive increase with time was observed with CGRP immunostaining for both groups and with S-100 in the PHB group. Good angiogenesis was present at the nerve ends and through the walls of the conduit. The results demonstrate good nerve regeneration in PHB conduits in comparison with nerve grafts.     

The anatomy of the posterior interosseous nerve as a graft

Thirty upper limbs from skeletally mature embalmed cadavers were studied to determine the anatomic reliability of the posterior interosseous nerve as a donor nerve graft. The posterior interosseous nerve branches 0.43 +/- 0.52 cm from the distal edge of the superficial head of the supinator and 8 +/- 1.6 cm from the lateral epicondyle form a common leash. There are 6 branches, which are arranged from the ulnar to the radial side at their origin from this leash. The first and second branches supply the extensor digitorum communis, the third branch supplies the extensor carpi ulnaris, the fourth branch supplies the extensor digiti minimi, and the fifth branch arises from the undersurface of the common leash and divides into 2 sub-branches (medial and lateral) 10.1 +/- 3.2 cm distal to the lateral epicondyle and 12.8 +/- 2.2 cm proximal to Lister's tubercle. These 2 sub-branches make an inverted V shape around the extensor pollicis longus. The medial branch supplies the extensor pollicis longus and extensor indicis proprius. The lateral branch supplies the extensor pollicis longus and extensor pollicis brevis and ends at the wrist capsule. At a mean distance of 8.1 +/- 1.2 cm proximal to Lister's tubercle the lateral sub-branch gives off its last muscular branch to the extensor pollicis longus and becomes a pure sensory terminus. As the terminal part of the lateral sub-branch approaches the wrist capsule it expands at a mean distance of 1.9 +/- 0.5 cm proximal to Lister's tubercle. The sixth branch arises from the radial side of the common leash and divides into 3 sub-branches. The first sub-branch supplies the abductor pollicis longus and extensor pollicis brevis, the second supplies the abductor pollicis longus, and the third supplies the superficial head of the supinator. This study showed that the mean length obtainable for harvesting the lateral sub-branch of the fifth branch of the posterior interosseous nerve is 6.2 +/- 0.7 cm, which represents the length of the nerve between the last muscular branch to the extensor pollicis longus to the point at which the nerve expands.     

Fracture of the hamate hook presenting as median nerve palsy

We report a case of fracture of the hamate hook presenting as median nerve palsy and discuss the etiology of this rarely seen complication. We consider that the median nerve palsy in this case was due to direct nerve compression within the carpal tunnel caused by a displaced fractured hook fragment. Received: 13 June 1995