寰枢椎骨折的多排螺旋CT扫描及后处理评价

目的　回顾性分析寰枢椎骨折的多排螺旋CT扫描及后处理重建的诊断价值。方法　收集寰枢椎骨折患者4 4例 ,其中寰椎骨折脱位 2 0例 ,枢椎骨折 2 4例 ,所有患者经多排螺旋CT扫描后 ,经MPR与 4D -Angio后处理重建 ,分析不同处理后图象的应用价值。结果　多排螺旋CT及后处理技术可显示骨折部位与类型 ,其MRP与 4D -Angio重建不仅显示寰齿间隙的变化 ,寰齿前间隙的增宽提示横韧带的损伤 ,更可显示齿状突骨折移位的状况。结论　MSCT可清晰评价寰枢椎骨折部位、程度、脱位与否以及骨折类型。     

后路侧块和椎弓根螺钉技术治疗寰枢椎不稳

目的:评价寰枢椎后路侧块和椎弓根螺钉徒手置入技术(无须术中影像技术引导)的安全性和可靠性。方法:应用AXIS和VERTEX内固定系统(美国枢法模公司)对17例寰枢椎不稳患者进行后路侧块(椎弓根)螺钉内固定,共置入螺钉68枚。其中男11例,女6例,年龄17～71岁,平均43.5岁。AndersonⅡ型11例(陈旧性骨折4例,新鲜骨折7例),Ⅲ型5例(陈旧性骨折1例,新鲜骨折4例);上颈椎肿瘤1例。AXIS治疗15例,VERTEX治疗2例。结果:术后X线片及CT显示寰枢椎侧块和椎弓根螺钉位置良好,2枚螺钉螺纹轻微穿破寰枢椎侧块(椎弓根)外侧皮质,3枚螺钉螺纹轻微穿破寰椎后弓上侧皮质,但不影响固定强度,也未发现与螺钉相关的神经血管并发症。结论:对寰枢椎X线和CT解剖结构了解的情况下,徒手置入寰枢椎侧块(椎弓根)螺钉行内固定手术是安全可行的。     

DR与MSCT检查诊断小儿寰枢椎病变的比较研究

目的比较寰枢椎X线DR(X-RayDigital Roentgenography)检查与螺旋CT(SpiralCT)检查对诊断小儿寰枢椎半脱位的临床应用价值。方法分别对12例小儿患者进行寰枢椎X线DR检查和螺旋CT检查及重建。结果 7例X线DR检查诊断为小儿寰枢椎半脱位,而通过CT检查和重建4例诊断为小儿寰枢关节半脱位,3例为正常;2例X线DR检查误诊为齿状突骨折、寰枢椎半脱位,CT重建清楚显示为寰枢椎畸形,分别为齿状突后弓缺如1例,齿状突发育不良1例;3例小儿在拍摄颈椎张口位时不配合,寰枢椎显示欠清,CT检查清晰显示为寰枢椎半脱位。结论螺旋CT检查和重建技术较X线DR检查更易显示小儿寰枢椎半脱位征象,有助于提高临床诊断率。     

高分辨CT在寰枢椎外伤中的诊断价值

目的分析高分辨CT在寰枢椎损伤中的影像学特点和对临床的应用价值。方法收集2011年12月至2013年5月寰枢椎外伤病例90例,均行普通x线检查及CT扫描,采用高分辨CT轴位扫描,并行MPR、VR后处理及3D重建,分别分析这几种成像方法对寰枢椎外伤性改变的灵敏度及特异性。结果90例寰枢椎外伤病例中,通过高分辨CT轴位检查、MPR、VR后处理及3D重建相结合,诊断为寰椎骨折10例,齿状突骨折40例,枢椎骨折25例,单纯性寰枢关节脱位15例。寰枢关节脱位合并寰枢椎骨折患者30例。行高分辨CT扫描及后处理后诊断全部正确,x线片正确诊断为54例,占60％,其余均为误诊或漏诊。高分辨CT对寰枢椎外伤性改变的灵敏度及特异性高于普通X线片。结论高分辨cT成像可以清楚显示寰枢椎各部位外伤性改变,特别是隐蔽性创伤,能对寰枢椎损伤作出全面而准确的评价,其独特的影像学特点可做为寰枢椎外伤的首选检查方法。     

枢椎经椎板螺钉联合寰椎侧块螺钉内固定术的临床应用

目的 探讨后路经枢椎椎板螺钉联合寰椎侧块螺钉固定技术治疗上颈椎不稳的临床疗效和并发症.方法 2003年10月至2006年12月,采用此技术治疗寰枢椎不稳17例,男12例,女5例;年龄34～73岁,平均42.5岁.Anderson Ⅱ型和Ⅲ型齿突骨折14例,寰椎横韧带断裂1例,先天性游离齿突并寰枢椎不稳2例.均有寰枢椎半脱位或不稳,表现为不同程度的颈枕区疼痛,活动受限.枢椎经椎板螺钉固定技术以棘突和椎板的交界处椎板头尾方向的中点为进钉点,为避免钉道的相互干扰,第1枚螺钉的进钉点通常选择枢椎椎板的偏头侧,另1枚螺钉的进钉点偏尾侧,用高速磨钻在进钉点磨去少许皮质骨开窗后,用手钻向枢椎对侧椎板钻孔,螺钉方向在直视下与椎板平面并行,并稍向枢椎椎板背侧倾斜,以确保螺钉不穿破椎板腹侧皮质侵犯椎管,宁可穿破枢椎椎板背侧皮质骨.内固定系统均使用颈椎后路Vertex钉棒系统同定.结果 术中无一例发生脊髓和椎动脉损伤.有2例患者在剥离寰椎后弓下缘时,损伤静脉丛,用明胶海绵压迫止血成功.术后CT示枢椎椎板螺钉位置良好,未见侵犯枢椎椎管和脊髓.随访术后X线片未见明显颈椎不稳、内固定失败及螺钉松动退出.结论 枢椎后路经椎板螺钉技术固定牢固,操作简单,相对安全,值得进一步推广.     

计算机辅助设计寰枢椎椎弓根内固定数字化导向模板精确置钉

目的 提高寰枢椎后路经椎弓根手术置钉的安全性和准确性.方法 可复性寰枢椎脱位及寰枢椎不稳13例,人院即行螺旋CT薄层扫描,取患者Dicom图像经计算机三维重建后进行后路椎弓根螺钉入路安全三维通道计算机辅助设计,建立椎弓根置钉导向管与三维互补模板.在激光快速成型机上按CAD设计图以聚苯乙烯为原料,利用逆向工程原理制作相应患者个体化的骨骼模型实物和手术辅助导板,外涂树脂固化剂,经高压消毒带进手术室,利用手术导向模板辅助寰枢椎后路椎弓根螺钉置入.结果 13例患者手术顺利,可复性寰枢椎脱位及寰枢椎不稳均解剖复位,固定良好.寰枢椎椎弓根螺钉置钉位置准确,未发生任何并发症.术中出血量平均50～100 ml,手术时间平均2.0～2.5 h,平均随访12个月,5例患儿的骨融合情况仍在随访中.结论 术中在数字化椎弓根内固定导向模板引导下置钉,提高了寰枢椎椎弓根内固定置钉的安全性和准确性.     

寰枢椎旋转性半脱位的诊断

目的：探讨X线检查,螺旋CT扫描以及三维影像重建在诊断寰枢椎旋转性半脱位的不同临床意义。方法：24例行颈椎张口位片检查,其中16例和5例对照组采用螺旋CT扫描。结果：平均50%以上2次摄片,部份齿状突与侧块间距显示不清。16例螺旋CT扫描均证实齿状突与寰椎侧块间距不等,三维影像重建立体地再现寰枢椎旋转性半脱位的移位程度和齿状突发育情况。5例对照组正常。结论：常规X线多能确诊,螺旋CT扫描及三维影像重建,可弥补6诊断上的困难,同时也有利于指导治疗。     

枢椎逆向椎弓根螺钉在经口咽入路治疗寰枢椎脱位中的应用

目的 探讨枢椎逆向椎弓根螺钉在经口咽入路治疗寰枢椎脱位中的应用价值.方法 选择2009年3月至2011年10月收治的25例寰枢椎脱位患者,男11例,女14例;年龄17～65岁,平均39岁;其中创伤性寰枢椎脱位17例,游离齿状突合并寰枢椎脱位8例.均实施经口咽入路松解、复位、内固定手术,寰椎采用前路侧块螺钉固定,枢椎采用逆向椎弓根螺钉固定.术后CT扫描观察术后钉道情况,测量螺钉的外倾角、下倾角、螺钉长度等.通过比较手术前、后日本矫形外科学会(JOA)评分、寰齿间隙(ADI)评估疗效.结果 25例患者共置入枢椎逆向椎弓根螺钉50枚,平均手术时间145 min,平均出血量94 mL.枢椎椎弓根螺钉的平均外倾角为20°、下倾角为15 °、螺钉长度为28 mm.24例患者术后获得10～25个月(平均16个月)随访,术后3个月JOA评分(15.7±1.1)分和末次随访时(16.0±0.7)分较术前(8.9±1.7)分均明显提高,差异有统计学意义(P＜0.05).ADI由术前(8.7±1.5) mm改善为术后(0.8±0.9)mm,差异有统计学意义(t=2.937,P＜0.05).结论 经口咽入路实施枢椎逆向椎弓根螺钉是可行的,但该技术具有一定风险,可以在有条件的医院审慎开展.     

寰枢椎椎弓根螺钉术中复位固定融合术治疗陈旧性齿状突骨折并寰枢椎脱位

目的:总结应用后路寰枢椎椎弓根螺钉术中提拉复位固定植骨融合术治疗陈旧性齿状突骨折并寰枢椎脱位的疗效。方法:2007年1月~2010年1月收治21例陈旧性齿状突骨折并寰枢椎脱位患者,男13例,女8例;年龄13~68岁,平均38.5岁。患者均有不同程度的枕颈部疼痛和活动受限,均伴有神经功能障碍,ASIA分级:B级2例,C级13例,D级6例;JOA评分4～14分,平均8.3分。根据Anderson和D′Alonzo分型,Ⅱ型骨折17例(81%),Ⅲ型骨折4例(19%)。MRI检查示18例患者有不同程度的脊髓受压,7例脊髓受压节段髓内出现T2加权像高信号改变。均为寰椎前脱位,术前均进行颅骨牵引术,15例(71.4%)可部分复位,6例(28.6%)不可复位。术前寰齿间距(atlanto-dens interval,ADI)9～15mm,平均12.3mm。均采用后路寰枢椎椎弓根螺钉术中提拉复位固定和植骨融合术,随访观察患者临床症状和神经功能改善情况,影像学检查寰枢椎复位和植骨融合情况。结果:患者均顺利完成手术,术中均未发生椎动脉和脊髓损伤。共置入84枚寰枢椎椎弓根螺钉,术后X线片及三维CT检查3枚寰椎椎弓根螺钉内倾角偏小,螺钉部分穿破椎动脉孔内侧壁,椎动脉造影未见椎动脉损伤;1枚寰椎椎弓根螺钉内倾角过大,螺钉部分穿破椎管内侧壁,未出现新的神经损伤症状;其余螺钉位置满意。术后颈椎CT及MRI显示寰枢椎序列重建满意,齿状突区域脑脊液线清晰,脊髓无压迫,ADI为2～4mm,平均2.8mm。患者均获随访,随访时间6～36个月,平均20个月,术后6个月随访时3例患者的ASIA分级无改变,其余患者的神经功能明显改善,ASIA分级:C级3例,D级10例,E级8例;JOA评分为10～17分,平均14.6分,平均改善率为81.2%。1例患者植骨块有部分吸收,其余患者均在术后6个月获得骨性融合,融合率为95.2%;随访期间未发现螺钉松动、移位、断裂和寰枢椎再移位、失稳现象。结论:应用寰枢椎椎弓根螺钉术中提拉复位技术治疗陈旧性齿突骨折并寰枢椎脱位可获得良好的临床效果。     

枢椎椎板螺钉联合寰椎椎弓根螺钉固定治疗寰枢椎脱位

目的 评价枢椎椎板螺钉联合寰椎椎弓根螺钉固定融合治疗寰枢椎脱位的临床可行性.方法 对5例枢椎椎弓根细小的寰枢椎脱位患者,在气管插管全身麻醉下施行了枢椎椎板螺钉联合寰椎椎弓根螺钉固定术.枢椎椎板螺钉的进钉点位于棘突两侧椎板交界处,交叉置人对侧椎板内;寰椎椎弓根螺钉的进钉点位于枢椎侧块中线上,距寰椎后弓上缘最少3 mm,内斜10°,上斜5°.螺钉直径3.5 mm,枢椎椎板螺钉长26～32 mm,寰椎椎弓根螺钉长28～32 mm,结合自体髂骨植骨.结果 患者获得随访3～18个月,平均7.5个月.未发生椎动脉、脊髓损伤,术后临床症状得到不同程度的改善,X线、CT复查螺钉位置良好,无松动、断钉,植骨3个月后均达到满意融合.结论 枢椎椎板螺钉联合寰椎椎弓根螺钉固定治疗寰枢椎脱位效果满意,是又一可供选择的寰枢椎后路固定术式.     

计算机辅助设计乳房三维重建及体积测量系统的研制

目的应用CAD技术开发建立乳房三维重建及乳房体积测量的系统软件，指导临床乳房癌术后一期乳房再造的术前设计。方法收集2006年1月至2007年12月间的16例乳腺MRI检查的影像学资料．数据以医学数字成像和通信标准文件格式刻输出。应用VTK、ITK、FLTK等C^＋＋6．0程序软件编程技术进行乳房三维重建及体积测量。结果（1）开发建立了乳房再造计算机辅助设计系统；（2）通过计算机编程进行乳房边界的界定，完成了乳房三维重建：（3）在重建乳房三维立体图像的基础上，通过计算各层面及其厚度和体积，再将各层体积叠加计算出乳房体积。结论应用CAD系统三维重建乳房，具有双侧对称度高，美观、逼真的优点；应用CAD系统测量乳房体积技术精确度高，测算速度快；CAD系统乳房三维重建及乳房体积测量软件有助于乳房一期再造的术前设计。     

Anterior cruciate ligament reconstruction and physiological joint laxity: earliest changes in joint stability and stiffness after reconstruction

Physiological joint laxity is an important element of normal knee joint function, providing smooth joint movement. However, the objective evaluation of post-operative results after knee ligament surgery is usually based primarily on stability and range of motion, and joint laxity has been ignored. In this study, we measured the joint stiffness of 82 knees undergoing anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio artificial ligament, before the operation, immediately after the operation, and finally when the full range of motion was achieved postoperatively; changes in joint laxity after the ACL reconstruction were investigated. Before the operation, joint laxity was greater than that of the normal side (P < 0.01), but immediately after the operation it diminished compared not only with that observed preoperatively, but also with that of the normal side. When the full range of motion was achieved, joint laxity was lower than that observed immediately after the operation (P < 0.01), but still remained higher than that of the normal side (P < 0.01). In other words, stability was achieved, but joint laxity was diminished through the operation. In this series, a stiffer artificial ligament than the natural ACL was used, and maximum tension was applied during the operation, aiming at better stability, but this may cause diminution of joint laxity. Received for publication on Sept. 1998; accepted on Dec. 2, 1998     

Application of three-dimensional image reconstruction technology based on high-resolution CT in pyeloplasty

BackgroundThree-dimensional (3D) image reconstruction technology is widely used in surgical operations for its intuitive visualization. Pyeloplasty requiresprecise cutting and suturing. The reconstruction technology can accurately determine the location and scope of the stenosis at the junction of the renal pelvis and ureter and the relationship with the surrounding vasculature. The purpose of this article is to retrospective evaluate the application value of image reconstruction technology in pyeloplasty based on high-resolution 3D CT images.MethodsA total of 20 patients with renal pelvic ureteral junction obstruction admitted to our hospital from August 2019 to August 2020 were selected. In this group, left pyeloplasty was performed in 8 patients and right pyeloplasty in 12 patients. In terms of conditions, there was 1 case with secondary pyeloplasty, 6 cases of patients with kidney stones, 2 cases with renal ectopic blood vessels, 1 case with renal prolapse, 1 case with horseshoe kidney, and 1 case with ureteral polyps. There were 12 males and 8 females, with an average age of 34.65±10.67 years and an average body mass index (BMI) of 22.48±3.03 kg/m². In all patients, 3D CT reconstruction technology was used to guide the formulation of robot-assisted laparoscopic pyeloplasty plans; verify the consistency between the actual operation and the preoperative planning; and observe the operation time, blood loss, postoperative exhaust time, indwelling drainage tube time, and follow-up for comorbidities.ResultsThe operation was successful in all 20 patients. The actual operation was 100% consistent with the preoperative planning, the operative time was 160.80±63.26 min, the intraoperative blood loss was 47±30.45 mL, the postoperative exhaust time was 1.15±0.37 days, the drainage tube indwelling time was 4.35±1.50 days, and the average follow-up time was 7.95±3.41 months. There were no complications.ConclusionsThree-dimensional image reconstruction technology based on high-resolution CT has high clinical application value in the treatment of ureteropelvic junction obstruction (UPJO), which simplifies the operation process and shortens the operation time, and is a valuable tool for auxiliary surgeons in devising the operation plan.     

保留残余束支及残端纤维重建前交叉韧带

[目的]探讨保留残余的束支以及断端纤维进行前交叉韧带重建的方法及意义。[方法]关节镜下证实前交叉韧带损伤47例,其中部分束支断裂15例,完全断裂26例,韧带松弛6例。对前交叉韧带部分损伤的束支或韧带松弛者予以保留,对完全断裂的残端不做清理,采用自体四股腘绳肌腱单束重建前交叉韧带,股骨端采用Rigid-Fix固定,胫骨端采用IntraFix固定。[结果]术后均得到随访,时间12~24个月,平均19个月,术后膝关节稳定性增强,Lysholm膝关节功能评分,术前平均68.6分,术后平均94.9分,较术前提高26.3分。Lachman试验阴性43例,弱阳性3例,阳性1例。按Insall膝关节疗效评定标准,优38例,良9例。[结论]保留残余韧带重建ACL,有助于移植肌腱再血管化和本体感觉的建立,有利于维持膝关节的稳定性。     

瘢痕性隐耳的手术修复

目的探讨瘢痕性隐耳的定义及其伴有部分或完全耳垂缺损的手术修复效果。方法采用局部皮瓣加全厚皮片分区移植法,分别完成耳廓与颅侧壁及乳突部粘连松解、颅耳角形成、耳轮重建、耳垂再造或重建手术,对26例33只瘢痕性隐耳进行矫正。结果所有皮瓣均100％成活,移植皮片95％以上存活;耳廓外形尚较满意,主要结构可辨,颅耳角基本恢复。术后随访3个月至1年．结果表明,耳廓外形保持良好,患者满意。结论针对瘢痕性隐耳的畸形特征,采取相应的手术方法,是矫正瘢痕性隐耳的有效手段。     

Results of isolated posterolateral corner reconstruction

Background  

Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique.     

Beard and Moustache Reconstruction

Beard and moustache reconstruction has gained more popularity and acceptance over the last decade. The procedure is done for the correction of facial areas with hair density deficit and also for the cosmetic enhancement of pre-existing facial hair. The surgical technique includes the harvesting of grafts from the scalp by the follicular unit excision (FUE) or follicular unit transplantation (FUT) technique and then placing them in either premade slits or by stick and place method. The advancement and refinement of procedure over the years has aided in achieving the optimal aesthetic results, with minimal side effects.