骨固定赝复体修复面部严重缺损畸形

骨固定赝复体修复面部严重缺损畸形邹丽剑王炜面部严重缺损畸形常同时伴面部某一器官（眼、鼻、耳等）的缺失，手术整形修复，常需多次手术完成，疗程长，痛苦大，形态也欠逼真。故过去常靠戴用赝复体治疗，但难于稳妥固定，为此，出现了骨固定赝复体的方法。１一般赝复体...     

骨固定赝复体修复面部严重缺损畸形

面部严重缺损畸形常同时伴面部某一器官(眼、鼻、耳等)的缺失,手术整形修复,常需多次手术完成,疗程长,痛苦大,形态也欠逼真。故过去常靠戴用赝复体治疗,但难于稳妥固定,为此,出现了骨固定赝复体的方法。1 一般赝复体修复存在的问题面部赝复体很久以来就被视为耳、鼻、眼等缺损修补的可取方法。用硅胶制做的赝复体可根据需要选择色泽,更接近于患者的肤色,且形态逼真。但赝复体的固定一直苦无妥善之策。虽然在某些情况下运用缺损区的倒凹、卡环、皮管及眼镜、发夹等装饰物能获得一     

纯钛支架耳赝复体修复全耳郭缺失

目的 介绍自行设计的纯钛支架及硅胶耳赝复体对全耳郭缺失患者进行修复的方法,并对此方法的效果进行评价。方法 将自行设计的纯钛（国产钛99.8%）支架置入全耳郭缺失的患者,利用螺旋CT扫描数据及图像处理技术构建镜像数字三维耳郭模型,并利用自动成型系统加工,形成耳赝复体模型，辅助完成耳赝复体的制作。结果 本组11例患者经1.5年的随访,纯钛支架无松动，耳郭外形较好,但耳赝复体有不同程度的褪色和硬化。其中1例患者赝复后2周支架穿出处的皮肤轻度红肿,经处理并要求患者注意清洁后痊愈。结论 纯钛支架耳赝复体修复全耳郭缺失其方法简单、创伤小、效果可靠,治疗时间较短，费用较低，值得推广使用。     

获得性耳廓缺损的修复

目的探讨获得性耳廓缺损的手术修复方法。方法采用组织扩张器结合自体肋软骨支架移植或Medpor支架置入、耳赝复体等多种方法进行修复。结果长期随访观察,再造耳廓皮瓣色泽红润、柔软、感觉功能无明显异常;移植耳廓软骨支架无软化、吸收、变形;Medpor支架偶有外露;再造耳廓位置、形态、大小和对侧基本一致;耳赝复体外形佳,固定牢靠。结论组织扩张器结合自体肋软骨支架移植的方法,疗效满意、并发症少,是获得性耳廓缺损的主要治疗方法;组织扩张器结合Medpor支架置入和耳赝复体制作治疗是其有益的补充。     

纯钛支架耳赝复体修复全耳郭缺失

目的介绍自行设计的纯钛支架及硅胶耳赝复体对全耳郭缺失患者进行修复的方法,并对此方法的效果进行评价.方法将自行设计的纯钛(国产钛99.8%)支架置入全耳郭缺失的患者,利用螺旋CT扫描数据及图像处理技术构建镜像数字三维耳郭模型,并利用自动成型系统加工,形成耳赝复体模型,辅助完成耳赝复体的制作.结果本组11例患者经1.5年的随访,纯钛支架无松动,耳郭外形较好,但耳赝复体有不同程度的褪色和硬化.其中1例患者赝复后2周支架穿出处的皮肤轻度红肿,经处理并要求患者注意清洁后痊愈.结论纯钛支架耳赝复体修复全耳郭缺失其方法简单、创伤小、效果可靠,治疗时间较短,费用较低,值得推广使用.     

三种修复全耳廓缺失术式的临床应用分析

目的 探讨3种修复全耳廓缺失术式的最佳适应证,观察并比较其临床疗效.方法 对960例全耳廓缺失者分别采用皮肤软组织扩张术结合自体肋软骨支架法(786例)、皮肤软组织扩张术结合Medpot耳支架法(355例)、置桩赝复体法(24例)修复,分析不同术式的适应证,并对其临床效果分别进行评估.结果 3种术式均可获得满意的耳廓外形,肋软骨耳支架法适用于乳突区皮肤完好的30岁以下患者;Medpor耳支架法适合成年、特别是30岁以上,或局部皮肤有轻度炎性反应之患者;置桩赝复体法适用于耳后乳突区皮肤损伤严重,或不愿接受其他再造方式之患者.结论 根据适应证合理选择术式,方可获得满意的临床疗效.     

种植体支持的赝复体修复眼眶部缺损

目的探讨种植体支持的赝复体修复眼眶部缺损的修复技术及临床效果.方法因肿瘤切除术后致眼眶部缺损患者2例,男1例,48岁;女1例,23岁.在患者眼眶区分别植入4个种植体,半年后行二期手术,暴露种植体安放愈合基台,二期术后7周开始取印模进行赝复体制作,2～3周完成.赝复体使用专用硅橡胶材料制作,均采用磁性固位方式. 结果修复术后分别随访2年和8年.种植体骨结合牢固,未出现种植体周围炎性反应.修复制作过程顺利,固位可靠,患者对外观、颜色均满意. 结论种植体支持的赝复体可以应用于眼眶部缺损的修复,手术创伤小,患者佩戴方便,固位可靠,外观效果满意.     

纯钛种植体界面骨愈合及其生物力学研究

自瑞典的Branemark教授于1965年率先将钛制人工牙根用于无牙颌患者以来，以纯钛为代表的种植体除了在种植义齿领域取得令人瞩目的成绩外，作为赝复体的骨内固定源，以其创伤小、形态佳、固定持久等优点在颅颌面严重毁损修复、关节假体固位、截肢后功能重建等领域得到了广泛的应用，极大     

经牙槽嵴顶上颌窦提升非植骨伴同期种植疗效观察

目的:探讨上颌后牙区种植时,经牙槽嵴顶的上颌窦底提升术(以下简称上颌窦内提升术)非植骨同期植入种植体修复上颌后牙缺失的临床疗效。方法:选择2013年1月-2014年1月来笔者科室行种植牙手术的24例接受上颌窦内提升非植骨术患者,内提升高度2~4mm,平均高度3.2mm,同期植入种植体,共植入种植体30颗,随访观察。结果:一期手术半年后,经X线检查种植体与周围组织形成良好的骨性结合,常规行种植修复,经两年观察种植体无不良反应,行使功能良好。结论:上颌窦内提升手术创伤小,在严格选择手术适应证的情况下,对垂直骨高度不足的上颌后牙区牙齿缺失,上颌窦内提升后非植骨同期植入种植体也能获得良好的种植骨结合效果。     

美学区的单牙缺失种植修复

目的 探讨应用xive种植系统行美学区单牙缺失种植修复的临床效果.方法 2002年11月至2007年6月,36例患者共植入了36颗xive种植体,用于修复美学区单牙缺失.其中男27例,女9例,平均年龄(28.5±12.6)岁,31颗牙冠采用粘结固定,5颗牙冠采用横向螺钉固定.20颗种植体植入手术同期或植入前进行了各种骨增量手术.所有种植体最终冠修复完成后随访时间3～47个月,平均(20.7±8.6)个月.结果 随诊期间内1颗种植体在负重5个月时松动取出.其余种植体均良好行使功能至今,种植体累积存活率为97.3%.结论 用xive种植系统行美学区单牙缺失的种植修复,近期效果好,远期效果有待追踪.     

自体耳软骨联合硅胶假体在隆鼻术后再次鼻整形中的应用

目的 探讨自体耳软骨联合硅胶假体移植在再次鼻整形中的应用价值.方法 对29例初次应用硅胶假体隆鼻术形态欠佳的患者,使用自体耳软骨联合硅胶假体移植进行修复.结果 本组29例患者随访3~12个月,27例鼻部形态良好,鼻背延长,鼻尖抬高,鼻唇角角度改善,鼻尖皮肤无红肿,未发现假体外形显露、下移、排异反应等并发症,手术效果满意.其中2例患者术后拆线时发现鼻背部不对称,予以假体包囊分离缝合固定后效果满意.结论 自体耳软骨联合硅胶假体能延长鼻背,抬高鼻尖,有效防止鼻尖假体外形显露、张力过大、皮肤变薄、鼻尖皮肤穿孔等并发症发生,手术效果满意,值得推广.     

Long-term study of quality and safety of osseointegration for the retention of auricular prostheses.

The aim of this article is to describe the safety and quality of the osseointegrated implant technique for the retention of craniofacial prostheses, to present a protocol for collection of clinical data, and to discuss the impact of the procedure on the patient quality of life. A protocol was designed and used to study patients who had received auricular prostheses consecutively since 1979 at our department. The patients were asked to answer a questionnaire designed to describe symptoms and problems specific for someone wearing an auricular prosthesis. In total, 99 patients received 107 prosthetic ears (8 patients had bilateral defects) retained on 309 implants (2 to 4 implants/ear). Patients of all ages were represented, and only 9 discontinuities were reported. Most patients (95%) wear their prosthesis every day, in most cases more than 10 hours/day. The follow-up period ranged from 1 to 12 years, giving a total of 2624 postoperative observations of implants, with a 3% incidence of significant skin reaction. We conclude that the surgical technique for auricular prostheses retained on osseointegrated implants is simple and associated with a low rate of peroperative and long-term complications. It offers a high degree of stability and aesthetic satisfaction.     

自体肋软骨+medpor耳基复合耳廓支架一期全耳再造

目的　介绍一种制作简便 ,立体感强 ,不易吸收变形 ,柔韧性良好的复合耳廓支架。方法　采用外形细圆 ,有一定拱形弧度的自体第 9肋软骨制作外耳轮 ,以medpor做耳基形成复合耳廓支架 ,依照健侧耳廓模型塑形固定 ,覆盖颞浅筋膜及皮片 ,行一期全耳再造术。结果　临床应用 9例均效果满意 ,再造耳廓形态自然 ,立体感强 ,质感柔韧 ,术后随访 3个月～ 2年无一例支架外露或吸收变形。结论　自体肋软骨 medpor耳基复合耳廓支架综合了自体肋软骨及medpor耳支架二者优点 ,弥补了肋软骨耳支架易于吸收变形、雕刻塑形困难 ,而medpor外耳轮偏硬 ,容易出现支架外露等各自不足 ,具有实用性强、操作简单、创伤小和并发症少等优点 ,是目前全耳再造术中较为理想的耳廓支架。     

Miniseminar: Bone-anchored hearing AIDS (BAHA) in children

BAHA is today a well-accepted treatment modality in adults and it has received FDA approval for use in children above the age of 5 years.The educational objectives of this miniseminar are to present the current status of the use of BAHA in children.The panel will discuss:(1) indications and contraindications; (2) selection of patients; (3) surgical procedure; (4) handling of complications; and (5) postop treatment.In the panel there are surgeons with extensive experience in the treatment of children with external ear canal atresia. Topic to be discussed include when an ear canal reconstruction should be recommended and when a BAHA may be a better alternative. The recommendation of timing between BAHA vs external ear reconstruction/implant retained auricular prosthesis will be covered.The use of BAHA in single-sided conductive loss and experience with bilateral BAHA in children will also be discussed together with the special surgical considerations in children. The panelists will present their view on how to handle the soft and thin bone in the mastoid of the child and how to proceed if the dura of the middle cranial fossa is exposed; the wall of the sigmoid sinus is damaged; or if the air-cells of the mastoid process are entered. Additionally, how to increase bone volume with the use of membrane technique will be described.The importance of soft tissue handling during surgery and pointers and pitfalls will be discussed.The seminar will also cover postop and follow-up routines.     

自体耳软骨联合膨体聚四氟乙烯矫正短鼻畸形

目的：介绍一种矫正先天性短鼻畸形的手术方法一自体耳软骨联合膨体聚四氟乙烯（expanded polytetrafluethlene,ePTFE）,对先天性短鼻畸形患者行鼻部延长及鼻尖成形术。方法：采用闭合式切口,钝性分离鼻背筋膜后间隙至合适范围,充分松解鼻翼软骨处连接韧带,根据患者自身要求雕好鼻假体,耳屏软骨固定于假体小柱端成“L”形,耳甲腔软骨置于鼻尖处,缝合固定双侧鼻翼软骨肉侧角于“L”形植入体短臂上。结论：对145例患者随访1～2年,鼻延长长度为5～11mm,平均为9mm,伴有鼻尖低平者,鼻尖突出度增加3～7mm,平均5mm,均获得满意效果。结论：采用自体耳甲腔软骨及耳屏软骨联合ePTFE可以有效延长鼻长度,疗效可靠,可作为矫正先天性短鼻畸形的方法之一。     

The importance of auricular prostheses for speech recognition

OBJECTIVES: To examine the effects of an auricular prosthesis on sound levels at the entrance of the ear canal by measuring the auricular prosthesis transfer function (APTF) and to determine the effect of the prosthesis on speech recognition in noisy hearing conditions. METHODS: Eight prostheses were used to measure the APTF. A microphone at the entrance of the ear canal measured sound pressure levels with the prosthesis present or absent while the head was rotated 360 degrees at 30 degrees increments. The Hearing in Noise Test was modified by the APTF to simulate the absence of an auricular prosthesis. Speech recognition was measured by testing 11 subjects with the unmodified Hearing in Noise Test and the modified Hearing in Noise Test. RESULTS: The APTF changed with the head's position relative to the speaker. The mean (SD) maximal gain provided by an auricular prosthesis was 8.1 (2.7) dB at 4.6 (1.0) kHz and 9.7 (1.7) dB at 11.5 (0.9) kHz at 0 degrees rotation. During speech testing, the auricular prosthesis improved the mean (SD) signal to noise ratio by 1.7 (1.7) dB at 0 degrees (P < .001), 0.9 (2.2) dB at 90 degrees (P =.04), and 0.5 (2.3) dB at 180 degrees (P =.52). CONCLUSIONS: The acoustic gain provided by an auricular prosthesis increases speech recognition in noisy environments. Auricular prostheses not only restore aesthetics but also improve hearing.     

Radial Head Fractures: Indications and Technique for Primary Arthroplasty

Abstract The treatment of complex radial head fractures remains a challenge for the orthopedic surgeon. Novel implants and improved surgical techniques have made reconstruction of the radial head with open reduction and internal fixation possible in most cases. However, extremely comminuted radial head fractures with associated instabilities still require replacement of the radial head with a prosthesis to allow rehabilitation with early motion of the elbow, and thereby optimizing the functional results of these potentially devastating injuries. In this article we discuss the surgical considerations related to radial head replacement, encompassing the indications for radial head arthroplasty, implant selection, surgical technique, rehabilitation protocols, and complications related to radial head prosthesis.     

Use of cartilage graft for an orbital socket implant

After enucleation, a spherical implant of some material is placed into the muscle cone to give bulk to the orbital socket area. This also allows better movement of the artificial eye prosthesis, which is placed in the socket to give the appearance of a normal eye. If there is loss of the spherical implant because of infection or extrusion for other reasons, there is a resulting enophthalmos of the prosthetic eye. Replacement of this spherical implant with another implant of alloplastic material often results in secondary extrusion. In other cases, there is downward displacement of the spherical implant with pressure against the prosthesis and lower lid. This causes undue stretching of the lower fornix and lid area with inability to hold the prosthesis in place. To correct these two problems, we have found that an autogenous cartilage graft is useful for an implant that will not extrude and that holds its position. Examples of this technique and preoperative and postoperative cases are described here. We have used this technique over the past 11 years and have achieved good success in 15 patients.