半侧颜面短小畸形中的下颌骨畸形与外耳畸形的相关性分析

目的 分析半侧颜面短小畸形(Hemifacial Microsomia,HFM)中的下颌骨畸形与外耳畸形之间的统计学相关性。方法 以2013年1月至2014年12月来院就诊的118例HFM患儿为研究对象,根据改良的OMENS Plus分类系统进行分型,全部病例行面部多角度拍照、面部三维扫描及头部CT检查。根据照片及面部三维扫描对外耳畸形进行分类,根据头部CT结果进行三维重建,采用Mimics软件进行下颌骨测量并分类。应用逻辑回归模型对下颌骨畸形和外耳畸形进行统计学相关性分析。结果 118例患者中,全部患者都表现为下颌骨畸形,其中M1型27例(22.9%),M2A型45例(38.1%),M2B型41例(34.7%),M3型5例(4.2%)。所有患者都存在耳部轻度到重度畸形,其中E1型20例(16.9%),E2型24例(20.3%),E3型51例(43.2%),E4型23例(19.5%)。相关系数(P=0.647)显示,两者之间没有显著的统计学相关性。结论 本组HFM患者中的下颌骨畸形与外耳畸形的严重性没有统计学相关性。     

半侧颜面短小畸形下颌骨的三维测量

目的：探讨半侧颜面短小患者下颌骨畸形特点。方法：应用医学三维软件对32例半侧颜面短小畸形患者的下颌骨进行三维测量、分析。结果：半侧颜面发育不良患者下颌骨形态特点呈现有规律的变化趋势。患侧较健侧自升支至颏部呈现欠丰满-丰满-较丰满的变化的过程,且角区多表现为缺失特点,即升支高度存在不足。结论：了解半侧颜面短小畸形患者下颌骨特点,结合临床有利于指导手术设计,达到更理想的修复效果。     

以骨延长术为主的半侧颜面短小畸形的综合治疗

目的：探讨以下颌骨延长术为主的半侧颜面短小畸形的现代综合治疗。方法：一期行下颌骨延长术,二期手术取出延长器并根据畸形的特点配合相应的辅助手术,术后接受牙科正畸治疗,共14例,结果：14例患者下同骨延长过程顺利,成骨良好,无成骨不良等并发症,二期手术后面部畸形矫正效果满意,结论：矫正下颌骨畸形是治疗半侧颜面 小畸形的关键,骨延长术是治疗下颌骨畸形的有效方法,二期手术还需要配合相应的辅助方法以完成对该畸形的综合治疗。     

半侧颜面短小畸形的综合治疗及效果评价

半侧颜面短小畸形(Hemifacial microsomia,HFM)是一种常见的颅颌面畸形,具体病因尚不清楚.HFM因疾病程度和累及部位的不同,治疗方法多种多样.目前,根据疾病程度及患者年龄采用个性化综合治疗,已得到广泛认可.根据目前临床常用的分类法,我们就HFM的综合治疗结合相关长期随访结果进行综述.     

半侧颜面短小中颏部不对称畸形的手术治疗

目的：探讨半侧颜面短小患者颏部不对称畸形的治疗方法。方法自2010年8月到2015年9月,对14例半侧颜面短小患者进行术前影像学测量和术前设计,采用颏部水平截骨的方法,对偏斜的颏部予以矫正。结果患者均一期愈合,外形满意,术后均有不同程度下唇麻木,1～6个月内均自行恢复。结论正确的手术方法选择、精确的手术设计,可有效改善半侧颜面短小导致的颏部不对称畸形。     

肩胛部游离脂肪筋膜瓣修复半侧颜面凹陷畸形

1995年以来我们采用肩胛部游离脂肪筋膜瓣移植修复半侧颜面凹陷畸形 5例 ,取得较满意效果。1　解剖基础[1 ,2 ]肩胛游离皮瓣的血管恒定 ,旋肩胛动脉及其皮动脉在三边间隙的出现几率为 10 0 %。旋肩胛动脉发自肩胛下动脉 ,穿过三边间隙到达背部 ,分为浅深两支。皮瓣的主要血管为旋肩胛动脉的浅支 ,位置表浅 ,血管的外径为 0 8～ 2 0ｍｍ ,发出升支、横支、降支 ,分别可达到冈上窝、脊柱缘、背阔肌上部与邻近血管吻合。2　手术方法2 1　脂肪筋膜瓣设计　首先标出三边间隙的位置 ,大致为肩峰尖与肩胛下角连线的中点 ,用手按压可触到凹陷感 ,…     

颜面凹陷畸形的临床分型及整复

目的为规范各类颜面凹陷畸形的临床治疗提供参考性建议。方法根据凹陷部位支撑组织的异常或被覆组织的异常情况。临床上将凹陷畸形分为三型：Ⅰ型为骨性凹陷畸形，包括先天性发育不良。后天性局部骨组织缺损、错位或塌陷；Ⅱ型为软组织凹陷畸形。包括局部软组织萎缩、缺损或黏连；Ⅲ型为复合性凹陷畸形。骨与软组织同时存在萎缩、缺损或较严重的塌陷。并依照此分型分别采用游离皮瓣、肌皮瓣或带蒂肌皮瓣填充法。局部组织瓣填充法。带蒂组织瓣加医用材料混合填充法，游离脂肪颗粒填充法。HA人工骨填充法。硅胶假体填充法。有机玻璃填充法，奥美定填充法。复杂凹陷畸形的综合治疗整复方法。为216例患者修复颜面凹陷畸形。结果随访216例患者6个月至5年，未发现严重并发症，外观效果满意。结论此颜面凹陷畸形的临床分型简单、合理。便于临床对颜面凹陷畸形的整复。具有一定的实用价值。     

半侧颜面短小畸形咬肌方向及机械效益的研究

目的 探讨半侧颜面短小畸形(hemifacialmicrosomia,HFM)患者双侧咬肌方向及机械效益的差异.方法 自2010—2019年,中国医学科学院北京协和医学院整形外科医院颌面整形中心收集23例未经治疗且单侧受累患者的CT数据,输入MIMICs 17.0软件进行三维重建,测量咬肌在矢状面和冠状面的方向角α和β...     

颜面凹陷畸形的临床分型及整复

目的为规范各类颜面凹陷畸形的临床治疗提供参考性建议.方法根据凹陷部位支撑组织的异常或被覆组织的异常情况,临床上将凹陷畸形分为三型Ⅰ型为骨性凹陷畸形,包括先天性发育不良,后天性局部骨组织缺损、错位或塌陷;Ⅱ型为软组织凹陷畸形,包括局部软组织萎缩、缺损或黏连;Ⅲ型为复合性凹陷畸形,骨与软组织同时存在萎缩、缺损或较严重的塌陷.并依照此分型分别采用游离皮瓣、肌皮瓣或带蒂肌皮瓣填充法,局部组织瓣填充法,带蒂组织瓣加医用材料混合填充法,游离脂肪颗粒填充法,HA人工骨填充法,硅胶假体填充法,有机玻璃填充法,奥美定填充法,复杂凹陷畸形的综合治疗整复方法,为216例患者修复颜面凹陷畸形.结果随访216例患者6个月至5年,未发现严重并发症,外观效果满意.结论此颜面凹陷畸形的临床分型简单、合理,便于临床对颜面凹陷畸形的整复,具有一定的实用价值.     

A minimally invasive approach for aortobifemoral bypass procedure

Surgical aortobifemoral bypass procedure for aortoiliac occlusive disease remains the gold standard treatment despite rapidly expanding range of indications for endovascular repair. Besides several disadvantages such as dysparaesthesias, hernias, and unpleasant outcome, transperitoneal exposure of the aorta is also associated with operative autonomic nerve injury. In five male patients, infrarenal aorta was exposed through a small (8 cm) supraumbilical midline incision. Incision of the posterior peritoneum above the infrarenal aorta was limited to 3 cm. A 1 cm infraumbilical incision allowed transperitoneal placement of the distal aortic clamp outside of the operative field. Four centimeters transverse incisions were made over the femoral bifurcations and implantation of the aortobifemoral graft followed. Extubation was performed after an operating time of 200 to 150 minutes with 30 to 20 minutes aortic clamping time. Nonopioids or nonsteroidal anti-inflammatory drugs were intermittently administered during 12 hours of intermediate care unit monitoring. Oral alimentation started 6 hours and complete mobilization at 48 hours postoperatively. Hospital discharge followed on the fourth to tenth postoperative day. This minimally invasive technique allows a precise and controlled open performance of all vascular anastomoses minimizing intraoperative and postoperative complications and significantly decreasing patient discomfort related to standard abdominal surgery.     

A minimally invasive medial approach for proximal tibial fractures

Numerous techniques have been described for MIPPO (minimally invasive percutaneous plate osteosynthesis) for metaphyseal or combined metaphyseal-articular fractures of the proximal tibia. Surgical management is often complicated by the initial soft tissue damage, malalignment, remaining instability, or infection. In this prospective cohort study, we describe the diagnostic procedures vital for preoperative planning. These include plain radiographs and CT scans in case of articular fracture components. The techniques for temporary stabilization and definitive fracture care using 4.5 mm DCP, LC-DCP, and LISS (Less Invasive Stabilization System) by limited medial incisions are described in a stepwise protocol. From 1996 to 1998, six fractures in six patients were studied. According to the AO classification, there were four type 41 fractures and two type 42 fractures. One patient died of ARDS. All patients had an intact medial soft tissue coverage allowing a medial approach. One patient developed a compartment syndrome, which was addressed by lateral dermato-fasciotomy prior to osteosynthesis. A LISS was used in three patients. The only complication related to surgery was in a patient with a four-part fracture with lateral comminution and a dislocated postero-medial fragment, which was reduced and buttressed with a short posteromedial 3.5 mm small fragment plate. This patient developed a deep, intraarticular infection, which was successfully treated with revision surgery; the implants were left in situ. At her latest follow-up at 18 months, she had a range of motion of 0/10/110, was back at work, and able to participate in recreational sports. The average time to healing was between 12 and 20 weeks postoperatively. There was no delayed healing, pseudarthrosis, recurrent fracture or late infection. None of the cases needed bone grafting. At the most recent follow-up, all patients were bearing full weight without walking aids. All cases achieved a neutral alignment and satisfactory range of movement. Though further data are needed we have sound reason to propagate a single medial approach and minimally invasive osteosynthesis as a sufficient and subtle technique for stabilization of these complicated fractures.     

A minimally invasive approach for plate fixation of the proximal humerus

Plate fixation for unstable fractures of the proximal humerus has seen mixed results as evidenced by the trials of new methods of fixation. The deltopectoral surgical approach is most frequently used and requires significant muscle retraction and soft tissue stripping to expose the lateral humeral neck. This may contribute to avascular necrosis and fixation failure. Lateral approaches have been limited to 5 cm distal to the acromion because of the course of the anterior branch of the axillary nerve. A recent anatomic study has demonstrated the predictability of the position of the axillary nerve as it crosses the anterior deltoid raphe, which allows it to be isolated and protected, and dissection can be extended distally. In addition, no accessory motor branches to the anterior head of the deltoid cross the raphe, so extending an incision through the raphe after protecting the main motor branch of the axillary does not place the innervation to the anterior deltoid at risk. This surgical approach allows exposure of the proximal humerus and indirect reduction of the fracture, with subsequent locking plate fixation, adhering to the principles of biological fixation.     

Direct minimally invasive approach for aortic root replacement

The author describes a minimally invasive approach for aortic insufficiency associated with severe calcification of the ascending aorta. The Bentall operation was easily performed through an 8 cm skin incision affording excellent exposure of the operating field, and with the use of CPB with vacuum-assisted venous drainage and clamping the aorta with a Casgrove flex clamp.     

A xiphoid approach for minimally invasive coronary artery bypass surgery.

BACKGROUND: The premise for adopting minimally invasive cardiac surgery techniques for myocardial revascularization is to reduce the patient's morbidity without compromising the efficacy of conventional coronary artery bypass. However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. METHODS: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 +/- 10 years and 65% were men. The mean Parsonnet score was 23 +/- 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). RESULTS: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 +/- 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 +/- 5 months. CONCLUSIONS: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay.     

Anterolateral approach for minimally invasive aortic valve replacement

Objective

Right anterior thoracotomy is the most common approach of minimally invasive aortic valve replacement (MIAVR) via intercostal mini-thoracotomy. However, there are some disadvantages including sacrificing the right internal thoracic artery (RITA). The aim of the present study was to investigate the efficacy of anterolateral thoracotomy (ALT), which is similar to lateral thoracotomy used for minimally invasive mitral valve surgery, for MIAVR.

Methods

From October 2012 to June 2013, 21 patients underwent MIAVR through ALT. Perioperative outcome of these patients was compared with those of 59 patients who underwent MIAVR via standard anterior thoracotomy (SAT) from May 2007 to September 2012.

Results

Mean age, body surface area, annular size, the ratio of aortic stenosis, and Japan score (30 days mortality), in ALT group were significantly more severe than those in SAT group. There was no significant difference in operative time; however, cardiopulmonary bypass and cross-clamping times in ALT group were significantly longer than those in SAT group. Significant differences were not found in mortality, morbidity, intubation time, blood transfusion rate, intensive care unit stay, hospital stay, and echocardiographic data such as effective orifice area index between both groups.

Conclusions

Anterolateral approach has several advantages including no need to sacrifice the RITA and cosmetic benefit in female patients, offering similar results as SAT even with more severe patient characteristics.