不同方法治疗后咬肌厚度减少的比较研究

目的通过比较三种方法治疗后的咬肌厚度变化，评价不同方法在减少咬肌厚度中的应用价值。方法自2005年8月至2006年12月，对13例下面部缩窄整形患者，于术前应用B超检查，术后12周、24周测量咬肌厚度。结果下颌角截骨、下颌角截骨＋咬肌部分切除及下颌角截骨＋咬肌注射A型肉毒素三种治疗方法，术后24周，咬肌厚度平均减少2．637％、30．286％和36．878％。结论下颌角截骨＋咬肌注射A型肉毒素比下颌角截骨＋咬肌部分切除或单纯下颌角截骨手术能更有效地减少咬肌厚度。     

下颌角弧形截骨术后咬肌厚度的变化

目的观察下颌角弧形截骨术后咬肌形态的变化，为下颌角肥大矫治手术提供指导。方法采用超声成像技术对10例行下颌角弧形截骨术的受术者行双侧（20侧）咬肌厚度测定，测量时间为术前及术后半年，于受术者肌肉松弛状态下分别在3个不同平面（A平面：口角与耳垂连线所在平面；B、C平面分别为与A平面平行，跨度为1cm的上下两平面）测量咬肌的最大厚度，观察比较咬肌厚度变化。结果A平面咬肌厚度术前平均值为（1．168±0．155）cm，术后平均值为（1．133±0．176）cm，与术前相比差异无统计学意义（P〉0．05）；B平面咬肌厚度术前平均值为（1．215±0．178）cm，术后平均值为（1．108±0．210）cm，与术前相比差异无统计学意义（P〉0．05）；C平面咬肌厚度术前平均值为（1．223±0．192）cm，术后平均值为（0．979±0．118）cm，与术前相比差异有统计学意义（P〈0．05），术前术后咬肌厚度减少值平均为（0．244±0．121）cm，术前术后减少百分比平均为（19．22±7．785）％。结论下颌角弧形截骨术后近角区咬肌可发生明显萎缩，轻、中度下颌角肥大者可单纯行下颌角弧形截骨术，无需切除咬肌。     

A型肉毒毒素治疗良性咬肌肥大远期疗效观察

目的：评价A型肉毒毒素治疗咬肌肥大的远期疗效。方法：对18例（34侧）咬肌肥大患者进行A型肉毒毒素肌肉注射治疗。其中16例双侧咬肌肥大就医者每侧注射剂量为50U／lml，2例单侧咬肌肥就医者每侧注射剂量为60U／lml。观察治疗前后不同时期就医者咬肌厚度变化情况及不良反应和并发症发生情况。结果：治疗后不同时期的咬肌厚度均较治疗前减小（P〈0．001），药物注射后4—12周咬肌厚度减小最明显。平均随访时间78．5±18．8个月，患者总体满意率为83％，无严重并发症发生。结论：A型肉毒毒素可以替代手术治疗咬肌肥大。     

下颌角截骨术后面下部X线头影测量的研究

目的观察并使用X线片测量下颌角截骨术后面下部正、侧位形态及下颌角区软硬组织的改变情况。方法选择28例接受下颌角截骨术的患者，对其术前及术后1年的头颅正侧位片进行X线头影测量分析，对比研究手术前后面下部宽度及下颌角开张度等数据的变化。结果28例患者下颌角间距（Go—Go）平均减少10．6mm，面下部软组织宽度（Ab—AB）平均减少15．9mm，软组织厚度平均减少5．3mm；下颌角开张度（Ar—Go—Me）术前平均值为113．5°，术后平均值为125．1°，与术前比较差异有显著的统计学意义（P〈0．01）；下颌平面角（MP—HP）术前平均值为18．8°，术后平均值为27．6°，与术前比较差异有显著的统计学意义（P〈0．01）。结论通过X线头影测量分析发现，下颌角截骨术能有效地缩小下颌角间距及面下部宽度，增加下颌角开张度，改善侧方轮廓。     

A型肉毒毒素治疗鱼尾纹对眉下垂的矫正

目的：探讨A型肉毒毒素在治疗鱼尾纹时对眉下垂的矫正效果。方法：随机选择单纯作鱼尾纹治疗者为研究对象，采用A型肉毒毒素对称性多点注射法治疗鱼尾纹，观察除皱效果，并测量治疗前后内眦点、瞳孔、外眦点到相应眉上缘的垂直距离。结果：本组共9例，18侧，治疗前内眦点、瞳孔、外眦点到相应眉上缘的垂直距离分别为（3．17±0．21）cm，（2．43±0．24）cm，（2．92±0．44）cm，治疗2周后的距离分别为（3．18±0．21）cm，（2．43±0．23）cm，（3．14±0．45）cm（P〈0．01），除皱有效率为100％。结论：A型肉毒毒素在去除鱼尾纹时对矫正眉下垂具有良好效果。     

小切口第一跖骨远端截骨术矫正踇外翻畸形

目的：探讨小切口第一跖骨远端截骨术矫正踇外翻畸形的疗效。方法：2003年以来采用小切口第一跖骨远端截骨术治疗踇外翻畸形300例共542只足，不做内固定。对所有患者采用美国骨科足踝外科学会（AOFAS）蹲趾-跖趾-趾间评分标准进行临床评估，并结合影像学诊断综合评价手术疗效。结果：AOFAS总平均分为89．4±10．2分。影像学评估，术后踇外翻角（HVA）为12．8°±5．8°（4°～22°），较术前34．6°±9．6°（18°～68°）改善22°±8．4°；第一二跖骨间角（IMA）为7．6°±1．8（6°～11°），较术前14．3°±3．2°（11°～21°）改善6．7°±2．4°，P〈0．05表示有显著性差异。542只患足，498只对术后疗效满意，满意率91．5％。结论：小切口第一跖骨远端截骨术矫正踇外翻，临床效果可靠，不需内固定，手术切口美观，值得推广。     

女性下颌角肥大截骨范围的量化及手术方法的选择

目的探讨女性下颌角轮廓特点,量化下颌骨截骨范围,寻找适合手术方法的途径。方法术前X线测量正常女性面部下颌角的间距比值,得到下颌角与下面部和颧部协调的比例关系;针对下颌角肥大特点,分别采用耳后切口、口内切口、口内外联合切口和咬肌注射肉毒毒素的方法,矫正下颌角肥大。结果测得正常女性下颌角度为(120.0±5.9)°、升支髁突垂线夹角为(10±2)°、乳突下颌角高度与下面高度比值为1∶(2.00±0.30)。硬组织正位片测量,双下颌角间距与双颧间距比值为1∶(1.30±0.14);软组织侧位测量,耳垂下颌角高度与下面高度比值为1∶(2.00±0.20);软组织正位片测量,双下颌角间距与双颧间距比值为1∶(1.20±0.12)。32例患者中,7例行耳后切口,5例行口内外联合切口,10例行口内切口,3例行耳后切口附加口内切口,7例行咬肌注射肉毒毒素。术后均取得了满意的手术效果。结论术前量化截骨范围,不仅有利于手术方法的选择,而且可以使下颌角与下面部和颧部的比例更协调。     

女性下颌角肥大截骨范围的量化及手术方法的选择

目的 探讨女性下颌角轮廓特点,量化下颌骨截骨范围,寻找适合手术方法的途径.方法 术前X线测量正常女性面部下颌角的间距比值,得到下颌角与下面部和颧部协调的比例关系;针对下颌角肥大特点,分别采用耳后切口、口内切口、口内外联合切口和咬肌注射肉毒毒素的方法,矫正下颌角肥大.结果 测得正常女性下颌角度为(120.0±5.9)°、升支髁突垂线夹角为(10±2)°、乳突下颌角高度与下面高度比值为1(2.00±0.30).硬组织正位片测量,双下颌角间距与双颧间距比值为1(1.30±0.14);软组织侧位测量,耳垂下颌角高度与下面高度比值为1(2.00±0.20);软组织正位片测量,双下颌角间距与双颧间距比值为1(1.20±0.12).32例患者中,7例行耳后切口,5例行口内外联合切口,10例行口内切口,3例行耳后切口附加口内切口,7例行咬肌注射肉毒毒素.术后均取得了满意的手术效果.结论 术前量化截骨范围,不仅有利于手术方法的选择,而且可以使下颌角与下面部和颧部的比例更协调.     

闭式针锯截骨和关节镜手术治疗伴有内翻的膝骨性关节炎

[目的]探讨联合应用胫骨近端闭式针锯截骨和关节镜手术治疗伴有内翻的膝骨性关节炎的疗效。[方法]对17例伴有内翻的膝骨性关节炎的患者，通过关节镜手术和胫骨近端闭式针锯截骨，外固定器固定治疗。[结果]术前Lysholm评分为（43．2±8．5）分，术后1年为（78．5±9．5）分，术后2年（7例）为（91．6±6．4）分。[结论]本手术方法是治疗伴有内翻的膝骨性关节炎的～种有效方法，胫骨近端闭式针锯截骨是一种较为理想的截骨方法。     

外侧闭合楔形胫骨近端截骨术的远期疗效分析//韩国首尔庆熙大学医学院矫形外科

[目的]探讨胫骨近端截骨术治疗原发性胫骨近端骨性关节炎的远期疗效以及最佳的截骨矫正角度。[方法]自1985～1997年，79例（111膝）原发性骨性关节炎患者接受了胫骨近端截骨术。其中男5例（5膝），女74例（106膝）；年龄37～70岁（平均55岁）。根据术后胫股角（FTA）分为3组。Ⅰ组61膝FTA〈7°；Ⅱ组23膝FTA7°～9°；Ⅲ组27膝FTA≥10°。所有病例术前、术后按特种外科医院评分系统（HSS）评分。[结果]术后随访2年4个月～14年1个月（平均9年6个月）。术前HSS平均60分，术后1年平均94分，末次随访平均87分。采用2种方法判定手术失败：方法1为需行人工全膝关节置换术者，随访4年和14年手术成功率分别为99％和85％；方法2为需行人工全膝关节置换术者或术后HSS评分〈60分，随访4年和14年手术成功率分别为96．4％和75．1％。[结论]胫骨近端截骨术是治疗单间室骨性关节炎的有效方法，但术后胫股角应矫正到外翻7°以上（范围10°～15°）。     

Outcome study of hallux valgus surgery--an AOFAS multi-center study.

Three hundred and eleven patients have been enrolled in a multi-center prospective study evaluating the outcome of hallux valgus surgery by the members of the American Orthopaedic Foot and Ankle Society. One hundred seventy-nine of these patients have completed six-month follow-up questionnaires, and 195 have completed 12-month questionnaires. The AAOS Lower Limb Outcomes Data Collection Questionnaire and the Foot and Ankle Outcomes Data Collection Questionnaire were used to assess patients' perceptions of their results. Both of these instruments are validated lower extremity instruments. They contain the SF-36 instrument as well as questions relating to lower extremity function. At six- and 12-month follow-up, significant improvement has been noted in the patients' SF-36 physical function scores, role physical scores, and bodily pain scores. Role emotional scores were increased at six months but returned to baseline at 12 months. The scores for physical health and pain and satisfaction with symptoms for the lower extremity have significantly improved. The global foot and ankle score and shoe comfort score from the foot and ankle module have also significantly improved. This outcome study is the first to focus on the patient's perception of results of hallux valgus surgery and demonstrates a significant improvement in pain, function, and satisfaction after bunion surgery performed by members of the American Orthopaedic Foot and Ankle Society.     

Comparative study of thyroidectomies

Background: We have performed endoscopic thyroidectomy by an anterior chest approach and by an axillary approach. In this study, we evaluate the efficacy of these two types of endoscopic procedures and conventional open surgery. Methods: Each procedure was performed in 15 patients. The degree of surgical invasiveness and the nature of patients' complaints after surgery were compared using results of the operation and a questionnaire. Results: Although the mean operating time for the endoscopic procedure was significantly longer than for open surgery, there was no postoperative pain difference in the three groups. Three months after surgery, the incidence of swallowing discomfort was higher in the open surgery group than in endoscopic surgery group. All of the patients treated using the axillary approach were satisfied with the cosmetic results. However, three patients (20%) treated using the anterior chest approach and 11 patients (73%; p < 0.01) who underwent open surgery complained about the cosmetic results. Conclusions: The incidence of postoperative complaints after endoscopic surgery is significantly lower than after open surgery. Patients treated using the axillary approach can obtain cosmetic results superior to those achieved with other procedures.     

Ultrastructural study of osteosarcoma

Twenty one cases of common type of osteosarcoma were investigated light and electron microscopically. Ultrastructurally, osteosarcoma could be classified into 4 types of cells, osteoblast-like, chondroblast-like, fibroblast-like and small round cell types. Another type of tumor cells, occasionally encountered in the tumor tissue, were myofibroblastic, osteoclastic and filopodial cells of subdivided groups. All of these were constituents of groups of tumor tissue, and were histopathologically manifested with osteoblastic, chondroblastic, fibroblastic and small round cell types of each predominant cell groups, respectively. However, the main tumor cells essentially consisted of osteoblast-like cell with prominent osteoid formation; hydroxyapatite with dense crystalline structure was characteristically deposited in the dense collagenous matrix. Osteoids also showed several structural varieties of matrix vesicles. These structural relationship to the osteoid were also discussed.     

Neuroanatomical study of micturition

There are three superimposed centres of micturition: the sacral spinal centre, which is the oldest centre controlled by the pontine centre situated in the brain stem, which in turn is under the control of multiple subconscious structures: cerebellum, striate nucleus, hypothalamus and conscious structures: limbic cortex, frontal ascending and parietal ascending circumduction. The nervous pathways consist of the classical spinal pathways as far as their point of emergence. The innervation involves 2 systems:--a supra-levator system consisting of the essentially sympathetic superior hypogastric plexus and the essentially parasympathetic inferior hypogastric plexus which innervates the seminal tract, the bladder and the prostatic urethra;--a infra-levator system consisting of the internal pudendal nerve which innervates the striated sphincter.