胫神经腓肠肌内侧头肌支切断的小腿减肥术

目的探索缩小小腿腓肠肌改善小腿外形的手术方法。方法通过窝皮肤皱襞4~5cm横切口,切断胫神经腓肠肌内侧头肌支,使腓肠肌内侧头失神经萎缩,达到小腿减肥的目的。测量并记录小腿周径和外形的变化。结果本组16例患者行胫神经腓肠肌内侧头肌支切断术后,小腿最大周径平均缩小(3.5±1.1)cm。小腿内侧曲线变得平缓。患者术后可立即下地行走,无明显肿胀。随访半年,站立、行走等日常活动未受影响。结论行胫神经腓肠肌内侧头肌支切断术,可缩小小腿,改善小腿外形,方法简便、安全,效果明显,同时不影响患者的行走功能。     

胫神经腓肠肌内侧头肌支切断的小腿减肥术

目的探索缩小小腿腓肠肌改善小腿外形的手术方法.方法通过窝皮肤皱襞4～5cm横切口,切断胫神经腓肠肌内侧头肌支,使腓肠肌内侧头失神经萎缩,达到小腿减肥的目的.测量并记录小腿周径和外形的变化.结果本组16例患者行胫神经腓肠肌内侧头肌支切断术后,小腿最大周径平均缩小(3.5±1.1)cm.小腿内侧曲线变得平缓.患者术后可立即下地行走,无明显肿胀.随访半年,站立、行走等日常活动未受影响.结论行胫神经腓肠肌内侧头肌支切断术,可缩小小腿,改善小腿外形,方法简便、安全,效果明显,同时不影响患者的行走功能.     

抽脂结合腓肠神经内侧头离断术在小腿塑形中的应用

目的:探索抽脂结合腓肠神经内侧头离断在改善小腿外形的临床疗效。方法:通过腘窝皮肤皱襞处取3～5cm横切口,抽取脂肪结合离断腓肠神经内侧头,使皮下脂肪容积减少和腓肠肌内侧头失神经萎缩,达到小腿塑形的目的。测量并记录小腿周径和外形的变化。结果:本组14例患者行皮下抽脂结合离断腓肠神经内侧支术后,小腿最大周径缩小(3.5±1.5)cm。小腿内径曲线变得平缓。抽脂结合离断腓肠神经内侧头术后,患者休息2～3天后可下床行走,早期有轻度不适,适应2天后症状基本消失。随访半年,站立、行走等日常活动未受影响。结论:抽脂结合离断腓肠神经内侧头术,可缩小小腿容积,改善小腿外形,方法简便、安全,效果明显,同时不影响患者的日常功能活动。     

腓肠肌内侧头肌支神经切断小腿减肥术应用解剖及临床效果观察

目的介绍将腓肠肌内侧头肌支神经切断使之萎缩,改善小腿粗壮外形的方法。方法解剖20具尸体腿,观察、测量腓肠肌内侧头肌支神经,为手术提供解剖学基础。对16例腓肠肌内侧头肥大者行腓肠肌内侧头肌支神经切断小腿减肥术,测量并记录小腿周径和外形变化。结果腓肠肌内侧头肌支神经在窝处从胫神经发出,以独立1支走向肌门者占40%,中途分成2支者占30%,与腓肠内侧皮神经共干起始者占30%。以股骨内上髁水平线为基线,该肌支起点平均高度为(-6.6±13.7)mm,起始处宽度(2.3±0.4)mm,长度为(42±12)mm。16例术后小腿最大周径平均缩减(3.5±1.1)cm,内侧曲线平缓。术后早期可下地行走,无明显肿胀。随访半年,日常活动未受影响。结论腓肠肌内侧头肌支神经切断小腿减肥术简便、安全、效果明显,不影响受术者的行走功能。     

远端蒂小腿皮神经营养血管肌皮复合组织瓣的解剖学研究

目的观测小腿皮神经营养血管链与周围肌肉内血管的吻合情况,为设计远端蒂小腿皮神经营养血管肌皮复合组织瓣转位术提供解剖学资料。方法对30侧红色乳胶灌注的成人下肢标本进行解剖,系统观测小腿皮神经营养血管链与周围肌肉内血管的吻合情况。结果腓肠神经营养血管为主的浅筋膜血管网与腓肠肌内、外侧头的肌皮穿支吻合,吻合支均为2—3支,内侧头的肌皮穿支较外侧粗大,位置恒定;隐神经营养血管主要通过胫后动脉肌间隙支的肌皮支与比目鱼肌肌支吻合,肌支2～3个,管径(0.5±0.2)mm,均有1—2支静脉伴行;腓浅神经营养血管分别向内、外侧发出2～3支肌支营养趾长伸肌和腓骨长肌,肌支外径(0.4±0.2)mm,皆有一支静脉伴行,另1～2支筋膜皮支浅出营养皮肤。结论远端蒂小腿皮神经营养血管肌皮复合组织瓣血供可靠,可以为修复特殊类型踝足部软组织缺损提供良好的供区。     

胫神经腓肠肌肌支切断小腿减肥术应用解剖探讨

目的:为临床胫神经腓肠肌肌支切断小腿减肥术提供形态学依据。方法:采用局部解剖学研究方法,观察测量胫神经在腘窝附近各分支走行位置、起点、长度及宽度。结果:胫神经在腘窝处发出4条主要分支:腓肠内侧皮神经、腓肠肌内侧头肌支、腓肠肌外侧头肌支和比目鱼肌肌支。变异情况主要有两种:①腓肠内侧皮神经与腓肠肌内侧头肌支共干起始(30%);②比目鱼肌肌支与腓肠肌外侧头肌支共干起始(30%)。腓肠肌内侧头肌支和腓肠肌外侧头肌支起点的平均高度分别为(-6.6±13.7)mm(、2.4±16.7)mm,神经起始处宽度分别为(2.3±0.4)mm(、2.5±0.4)mm,从起点到肌门处神经长度分别为(42±12)mm(、50±13)mm。结论:腓肠肌内、外侧头肌支从胫神经发出的位置比较恒定,神经较粗,较长,容易解剖分离。在腘窝皮肤皱褶处做长4～5cm横切口可暴露腓肠肌内、外侧头肌支。术中应注意神经变异情况,保护腓肠内侧皮神经和比目鱼肌肌支。     

腓肠神经营养血管肌皮瓣的解剖与临床应用

目的 探讨腓肠神经营养血管肌皮瓣转移修复足踝部软组织缺损的解剖学依据及其临床应用效果.方法 对30侧成人下肢灌注标本进行解剖,系统观测小腿后区浅层中血管神经的分支、分布及相互交通吻合情况.在此基础上,2004年2月以来应用逆行腓肠神经营养血管肌皮瓣修复足踝部软组织缺损7例.结果 以腓肠神经、小隐静脉及股后皮神经的营养血管为主的浅筋膜血管网与深部的腓肠肌内外侧头有恒定的交通吻合,吻合支均为2～3支,腓肠肌内、外侧头肌皮穿支分别位于内外侧头肌间沟两侧(1.8±0.5)cm、(3.7±0.9)cm,内侧头的肌皮穿支较外侧粗大,位置恒定,更靠近中线.7例肌皮瓣的肌肉面术中可见渗血活跃,血供良好,皮瓣均成活,所有病例均经2～6个月以上随访,骨髓炎治愈,肌皮瓣外形满意.结论 带部分腓肠肌内外侧头肌肉的逆行腓肠神经营养血管皮瓣可以良好成活,手术操作简便,系足踝部软组织缺损可以选择的供区.     

小腿三头肌神经肌支的终支切断术之应用解剖

目的　为临床行肌门处选择性神经终支切断术 ,解除肌痉挛 ,提供形态学依据。方法　将至比目鱼肌近侧、腓肠肌内侧头、腓肠肌外侧头的神经肌支及其在肌门处的终支解剖分离 ,观察各终支的形态及分布。结果　神经发出终支较血管分支早。比目鱼肌近侧神经肌支 85 %为 1支 ,分为 2～ 6支终支 ,以 2支终支最多见 ;腓肠肌内侧头神经肌支 85 %为 1支 ,终支为 3支者占 95 % ,在肌门处发终支者占 75 % ;腓肠肌外侧头神经肌支为 1支 ,95 %分为 3支终支 ,在肌门处分为终支者占 80 %。结论　小腿三头肌的神经肌支 ,一般在肌门处发终支。各肌支的终支数目较恒定。小腿三头肌各肌门位置相对集中。模拟手术每侧可在同一切口内完成。     

腓肠神经-小隐静脉逆行岛状肌皮瓣的局部解剖与临床应用

目的：介绍腓肠神经-小隐静脉逆行岛状肌皮瓣的局部血管解剖研究与临床应用经验。方法解剖3个成人小腿灌注标本,观察腓肠神经-小隐静脉血管轴与腓肠肌内外侧头肌支和肌皮穿支之间的吻合关系,根据观察结果设计以腓动脉肌间隔穿支供血的逆行岛状腓肠肌皮瓣修复4例足踝部创面,皮瓣面积10～16 cm ×6～9 cm。结果在腓肠神经穿出深筋膜前,腓肠神经-小隐静脉血管轴与两侧的腓肠肌肌支间各有2～4个吻合。在穿出深筋膜后,与两侧的腓肠肌肌皮穿支间各有2～3个吻合。在腓肠肌腱腹交界（约为小腿中点）的近侧2～4 cm 内,有1～3支肌皮穿支血管与腓肠神经血管轴相交通。据此设计的肌皮瓣完全成活。结论腓肠神经-小隐静脉逆行岛状肌皮瓣血供可靠、转移方便,较传统的腓肠神经营养血管皮瓣可切取面积更大,是修复足踝部组织缺损的好方法。     

重建感觉的逆行腓肠神经营养血管岛状皮瓣失败二例

例 1,男性 ,30岁 ,车祸致左足跟皮肤撕脱 ,面积 8ｃｍ× 10ｃｍ ,跟骨外露。经术前充分准备 ,行重建皮肤感觉的逆行腓肠神经营养血管岛状皮瓣 (以下简称腓肠神经皮瓣 )修复跟骨皮肤缺损。术中逆行切取皮瓣 ,但保留腓肠神经内侧支于原位不动。而将腓肠神经外侧支从近端切断保留于皮瓣中向下翻转 ,在外踝后方将皮瓣中腓肠神经外侧支与腓肠神经内侧支远端吻合 ,以便使未切断的腓肠神经内侧支长入皮瓣中 ,术中分离腓肠神经内侧支近端较顺利 ,而远端困难。术后皮瓣血运良好 ,但第 2ｄ皮瓣发生肿胀 ,水泡 ,逐渐变紫 ,于术后 10ｄ皮瓣完全坏死。例 …     

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.