Maxillo-mandibular distraction osteogenesis for hemifacial microsomia in children

To obviate or lessen the long period of use of orthodontic appliances after distraction for hemifacial microsomia in the mixed dentition patients, simultaneous maxillo-mandibular distraction osteogenesis has been performed in 10 patients aged 7 to 12 years with hemifacial microsomia. In these patients, there were two cases of type I, five cases of type IIa, and three cases of type IIb. A uniplanar internal distraction device was used in all cases. After maxillary Le Fort I osteotomy and mandibular ramus osteotomy, a uniplanar internal distraction device was attached to the mandible. On days 5 to 6 after surgery, distraction of 1 mm per day was started. Rigid intermaxillary fixation (IMF) using soft wires was performed at the distraction and was retained for 1 hour. Except for this period, rigid IMF was released. Distraction length ranged from 10 to 21 mm. After the distraction, a slight lateral crossbite in one case and a slight occlusal change in two cases, which did not necessitate the particular orthodontic treatment, were noted. Postoperative follow-up ranged from 16 to 40 months. The postoperative clinical course was uneventful thereafter. Maxillary growth impairment after the osteotomy has been obscure because of the short postoperative period. This procedure is effective for obviating or lessening the long duration of use of orthodontic appliances in the mixed dentition period of 7 to 14 years of hemifacial microsomia.     

Triplanar trochanteric osteotomy: a modified anterior trochanteric slide osteotomy

Current methods of trochanteric sliding osteotomy typically preserve the lateral aspect of the greater trochanter, the vastus lateralis, the abductors, posterior capsule, and the external rotators. Our modification to this technique includes leaving an anterior vertical ridge of bone that resists the anterior-directed forces acting on the osteotomy. Furthermore, a chevron-shaped osteotomy provides some additional stabilization to the proximally directed pull of the abductors. We believe these modifications improve the intrinsic stability of the osteotomy, theoretically decreasing the rate of nonunion.     

股骨远端外侧开放楔形截骨与内侧闭合楔形截骨治疗膝外翻的疗效比较

目的对比分析股骨远端外侧开放楔形截骨术与内侧闭合楔形截骨术治疗膝关节外翻畸形临床疗效及优缺点。方法笔者自2009-05—2014-06采用股骨远端内翻截骨术+Tomofix股骨远端锁定钢板内固定治疗50例(61膝)膝外翻畸形,分为观察组(采用股骨远端外侧开放楔形截骨术)和对照组(采用内侧闭合楔形截骨术治疗)。比较2组膝关节损伤与骨关节炎评分(KOOS)、主观满意度指数、股胫角度、膝关节活动度、骨折愈合时间、手术并发症等指标,综合评价该手术方法对膝关节外翻畸形的治疗效果。结果 1例失访,其余49例获得平均35.1(24~72)个月随访。所有截骨部位全部获得骨性愈合。组内KOOS评分显示术后膝关节结构和功能均获得显著改善,差异有统计学意义(P0.01),但2组间比较差异无统计学意义(P0.05)。观察组矫正度数(16.15±3.28)°,对照组矫正度数(15.06±3.65)°,2组间比较差异无统计学意义(P0.05)。膝关节活动度、主观满意指数组间和组内比较均无统计学意义(P0.05)。观察组骨折愈合时间比对照组慢,差异有统计学意义(P0.01)。结论股骨远端外侧开放楔形截骨术与内侧闭合楔形截骨术矫正膝关节外翻畸形均可取得较理想的治疗效果,内侧闭合楔形截骨骨折愈合较快,但外侧开放楔形截骨术骨量丢失少、手术操作简单,值得推广应用。     

Double innominate osteotomy

We performed double innominate osteotomy in twenty-five patients with acetabular insufficiency resulting from congenital dislocation of the hip and other lesions. Following iliac (Salter) osteotomy, the second osteotomy was carried out medial to the obturator foramen in the interval between the symphysis pubis and the pubic tubercle. In children more than six years old, adolescents, and adults, addition of the pubic osteotomy increased the amount of acetabular rotation and coverage of the femoral head that could be achieved. An additional benefit was that the femoral head could be shifted medially, decreasing the length of the femoral lever arm. The improvement in center-edge angle in the twenty-five patients averaged 27 degrees, and the acetabular index decreased an average of 19.5 degrees. The center of the head shifted medially an average of 1.5 centimeters. Hip stability was achieved in twenty-three of the patients.     

Pelvic osteotomy retractor

A retractor which displaces soft tissue from bone in deep wounds and improves lighting and instrument manipulation at its tip is described. Its particular advantage in pelvic osteotomy is emphasised.     

胫骨高位截骨术

退变性腰椎管狭窄症(denenerative lumbar sp inal stenosisDLSS)是导致中老年腰腿痛或腰痛的常见病之一[1]。CT检查是确定狭窄程度的主要依据,为探讨退变性腰椎管狭窄症CT分型在治疗中的参考价值,本文对一组综合保守治疗的退行性腰椎管狭窄症病例进行回顾性分析。1资料与方法1·1一般资料2005年1月-2007年6月共综合保守治疗退变性腰椎管狭窄症89例,病例资料完整并获近期随访者52例,其中男31例,女21例;年龄最小43岁,最大79岁,平均63岁;随访时间3~30·7个月,平均12·9个月。病程最短3个月,最长20年4个月,平均4年6个月。1·2诊断标准及分…     

Derotational akin osteotomy

This paper will present a unique approach utilized at Atlanta Hospital and Medical Center for the correction of a plantar medial shearing callus of the hallux. The procedure is a modification of the Akin osteotomy.