Ⅰ度小耳畸形的个体化自体肋软骨支架移植耳廓再造术

目的 充分利用残耳组织,采用个体化的自体肋软骨支架移植进行耳廓再造,矫正Ⅰ度先天性小耳畸形.方法 2000年10月-2006年7月167例Ⅰ度小耳畸形患者(167只耳),采用个体化扩张法,以自体肋软骨支架移植进行Ⅱ期或Ⅲ期耳廓再造.Ⅰ期耳后扩张器置入术时尽量分离残耳背侧皮肤并将扩张器置于此,并对位置较高、距离发际线较近的残耳廓上部进行切开游离处理;Ⅱ期行耳三维轮廓再造时,针对耳廓缺失结构雕刻肋软骨支架,同时掀起残耳耳廓后面的皮肤,与扩张皮瓣一起包裹耳廓支架;Ⅲ期再造耳廓修整术中,如果Ⅱ期时保留的患侧耳甲腔较健侧明显偏小,可去除靠近对耳轮的部分耳甲软骨,局部皮肤应用"Z"成形术,必要时辅以植皮来扩大耳甲腔.结果 167例手术效果满意,无并发症发生.其中78例获得远期随访,随访时间1～6年(平均2.5年),再造耳廓各微细结构清晰,与健侧接近,患者及家属均满意.结论 对于Ⅰ度先天性小耳畸形,应用个性化的自体肋软骨支架移植法进行耳廓再造,不仅可以节省资源,而且外形更加逼真自然.     

耳廓软骨开窗法治疗耳廓假性囊肿25例体会

目的介绍耳廓软骨开窗法治疗耳廓假性囊肿的步骤、优点和操作体会。方法手术在局麻下进行,切口均选在耳廓前面,沿与耳轮大致平行方向作一贯穿囊肿之切口,将皮肤与囊肿表层软骨分离,切开囊肿表层软骨,吸净囊液,再以眼科剪将表层囊壁软骨大部分切除,以碘伏棉签轻拭囊腔,酒精棉签脱碘,缝合皮肤切口,适度加压包扎。术后换药1～2次,6～8d拆线。结果25例患者切口均Ⅰ期愈合,无感染或其它并发症。随访6～36个月,均无复发,耳廓无增厚硬化或其他畸形,外观效果满意。结论耳廓软骨开窗法治疗耳廓假性囊肿是一种疗效肯定的方法。     

双侧唇裂前唇双三角瓣和自体软骨移植二期矫正鼻畸形(附30例报告)

目的　利用前唇双三角瓣和自体软骨移植、二期矫正双侧唇裂术后畸形。方法　在前唇形成两个三角瓣 ,将双侧鼻翼骨完全显露分离 ,切取耳甲软骨 ,修整后将其移植固定于鼻小柱处。结果　本组共施术 30例 ,均获一期愈合 ,术后效果满意。结论　利用前唇双三角瓣和自体耳甲软骨行双侧唇裂二期修复 ,对矫正鼻小柱过短、鼻尖、鼻翼低平效果肯定     

自体软骨移植和改良Abbe瓣矫正双侧唇裂鼻唇畸形

目的　利用鼻底双三角瓣 ,自体软骨移植和改良Abbe’瓣 ,Ⅱ期矫正双侧唇裂术后鼻唇畸形。方法　利用唇裂修复时贮存鼻底两个三角瓣 ,延长鼻小柱 ,并将双侧鼻翼软骨完全游离同时切取耳甲软骨 ,修整后将其移植固定鼻小柱处 ,在下唇唇红中央设计包括下唇全层和小块三角形皮肤的改良Abbe’瓣。结果　本组共施术 2 0例 ,均获Ⅰ期愈合 ,经 0 5～ 5年临床观察及随访 ,术后效果满意 ,未见鼻唇及切取软骨耳廓发育受影响。结论　利用唇裂修复时贮存鼻底的双三角瓣 ,自体耳甲软骨移植和改良Abbe’瓣行双侧唇裂Ⅱ期矫正鼻小柱过短 ,鼻尖鼻翼低平 ,上唇过紧 ,唇珠和唇弓外形差效果肯定。     

先天性小耳畸形扩张法耳再造Ⅰ期残耳的处理

目的探讨扩张法耳再造治疗先天性小耳畸形Ⅰ期合理应用残耳的方法。方法对31例单侧先天性小耳畸形患者分别采用残耳软骨切除、残耳上中部切开、用V-Y或Y-V成形矫正残耳位置等方法治疗,同时于耳后乳突区植入50ml肾形皮肤扩张器1枚。结果残耳处理后血运良好,全部成活,切口Ⅰ期愈合。Ⅱ期耳再造后利用残耳形成的耳垂存活良好,皮肤无破溃。结论合理应用残耳是施行外耳再造术,保证再造耳皮瓣的血运及再造耳与健侧耳对称的重要因素。     

先天性小耳畸形外耳再造临床研究

 目的 探讨先天性小耳畸形的外耳再造方法.方法 应用皮肤扩张法结合自体肋软骨支架进行外耳再造102例(110耳).术中应用健耳镜面像和数字化技术真实地打印出再造患耳的相片,用以指导耳廓支架的雕刻.结果 经6个月～3年的随访观察,102例中除6例再造耳有不同程度的软骨吸收、变形外,其余再造耳的大小、形状、位置与健耳相似,外耳逼真,微细结构显示清晰.结论 利用镜面像技术和数字化技术真实的复制出要再造耳的相片,指导肋软骨支架的雕刻以及结合皮肤扩张法进行外耳再造,效果满意,是先天性小耳畸形理想的治疗方法.     

乳突区推进皮瓣在耳廓整形中的应用

耳廓部分缺损修复的方法很多,我们采用耳后乳突区推进皮瓣,覆盖移植的肋软骨创面,共12例, 效果满意,现报告如下： 1 临床资料和手术方法 1.1 临床资料：本组12例,男性9例,女性3例,年龄17～28岁,耳廓中部缺损6例,耳廓上缺损3例, 中上部缺损3例,皮瓣面积1cm×2.5cm～4×6cm, 术后外观均满意。 1.2 手术方法：根据陈氏手术设计原则,以耳轮缺损前缘为蒂,于耳廓后延至乳突区设计皮瓣,其长     

改良乳突根治并鼓室成形术的临床观察

目的探讨改良乳突根治并鼓室成形术对慢性化脓性中耳炎的疗效。方法对我院5年来48例（52耳）慢性化脓性中耳炎患者施行改良乳突根治并鼓室成形术，对其疗效进行分析。结果术后干耳及听力提高46耳，4耳听力无明显提高，术后复发2耳，治愈率为88．5％，复发率为0．39％。结论改良乳突根治并鼓室成形术治愈率高，疗效满意。该术式为治疗慢性化脓性中耳炎的理想术式，对于有条件的医院及有适应症的患者，应提倡此方法治疗。     

先天性小耳畸形合并外耳道、中耳畸形手术方案的选择

目的探讨先天性小耳畸形合并外耳道、中耳畸形的最佳治疗方案。方法对中国协和医科大学整形外科医院外耳再造中心2005年6月～10月305例（332耳）先天性小耳畸形三期法耳廓再造,以及解放军总医院耳鼻喉科1988年12月-2002年7月49例（58耳）先天性中、外耳畸形,外耳道、中耳重建病例进行回顾性分析。结果三期法行耳廓再造效果可靠,外观佳;镫骨底板活动患者外耳道、中耳重建术后听力改善明显。先行外耳道、中耳重建术者,切口瘢痕形成,影响耳廓再造皮瓣,而先行耳廓再造者,外耳道位置易偏差,影响外耳道重建术后外观。结论对先天性中、外耳畸形,有恢复外观和听力要求者,应先根据影像学结果确定外耳道口位置,再行三期法耳廓再造,在第三期修整时,同时进行外耳道、中耳重建,既可保证美观、改善听力,又可减少手术次数,是较理想的手术方案。     

耳廓创伤42例治疗体会

本文自1984年6月至1994年6月收治耳廓创伤42例，经清创缝合术，抗生素治疗，Ⅰ期愈合38例，4例因耳廓软骨膜感染至软骨坏死，形成耳廓畸形，现将治疗体会报告如下。1临床资料1．1一般情况本组男38例，女4例。年龄16～46岁，平均32岁。伤后就诊时间：1h～15d.致伤原因：工作中不慎受伤11例，打架致伤23例，手术致伤3例，交通事故致伤4例，冻伤1例。1．2临床表现单纯耳廓创伤28例，均有软骨挫伤及软骨膜撕裂伤。合并有其他部位受伤7例。伤后耳廓软骨部分缺损3例。就诊时耳廓软骨已大部或部分坏死4例。1．3治疗结果伤后即来院治疗者38例，经彻…     

耳廓烧伤64例治疗经验

目的总结耳廓烧伤的救治经验,以提高救治成功率。方法创面外涂SD Ag霜剂暴露,防止耳部受压,保持干燥与清洁,尽快消灭创面。并发化脓性耳软骨炎者,早期切开引流,清除坏死软骨,及时换药。结果64例86只耳,全部治愈。浅度烧伤10～14d治愈,深度烧伤15～31d治愈,并发化脓性耳软骨炎21～42d治愈。除5例5只耳遗留瘢痕增生、耳廓粘连外,其他耳软骨保存较好,外形基本满意。结论控制感染,封闭创面,防止耳软骨继续毁损,是耳廓烧伤的治疗关键。     

High-resolution real-time sonography and MR imaging in assessment of osteocartilaginous exostoses

High-resolution real-time ultrasonography (US) and MR imaging, using both spin-echo (SE) and gradient-echo (GE) sequences, were performed prospectively in 14 patients with solitary osteocartilaginous exostoses to assess cartilage cap thickness and bursa formation. Results were compared to surgical and histopathologic findings in all cases. Both US and MR imaging were useful in evaluating exostotic cartilage cap thickness, which is supposed to be the most reliable sign of malignant transformation. Hyaline cartilage matrix had distinctive features in US and MR imaging caused by its specific histologic composition. The formation of bursae over the protruding exostoses, which results in pain and clinically could raise the suspicion of growth and malignant transformation, was demonstrated best using GE sequences. MR imaging was thus superior to US in the detection of bursa formation.     

Relapsing polychondritis studied by computed tomography

Computed tomographic findings in a patient with relapsing polychondritis are described. Collapse of the cartilage of the nose and calcification in cartilages of the ears were clearly demonstrated. CT scanning was also helpful in evaluating the tracheobronchial tree for airway compromise, which could prove fatal in this condition.     

MR imaging and T2 mapping of femoral cartilage: in vivo determination of the magic angle effect

OBJECTIVE: The purpose of this study was to perform a quantitative evaluation of the effect of static magnetic field orientation on cartilage transverse (T2) relaxation time in the intact living joint and to determine the magnitude of the magic angle effect on in vivo femoral cartilage. MATERIALS AND METHODS: Quantitative T2 maps of the femoral-tibial joint were obtained in eight asymptomatic male volunteers using a 3-T magnet. Cartilage T2 profiles (T2 vs normalized distance from subchondral bone) were evaluated as a function of orientation of the radial zone of cartilage with the applied static magnetic field (B(0)). RESULTS: At a normalized distance of 0.3 from bone, cartilage T2 is 8.6% longer in cartilage oriented 55 degrees to B(0) compared with cartilage oriented parallel with B(0). Greater orientation variation is observed in more superficial cartilage. At a normalized distance of 0.6, cartilage T2 is 18.3% longer. The greatest orientation effect is observed near the articular surface where T2 is 29.1% longer at 55 degrees. CONCLUSION: The effect of orientation on cartilage T2 is substantially less than that predicted from prior ex vivo studies. The greatest variation in cartilage T2 is observed in the superficial 20% of cartilage. Given the small orientation effect, it is unlikely that the "magic angle effect" accounts for regional differences in cartilage signal intensity observed in clinical imaging. We hypothesize that regional differences in the degree of cartilage compression are primarily responsible for the observed regional differences in cartilage T2.     

In vitro MR imaging of hyaline cartilage: correlation with scanning electron microscopy

OBJECTIVE: Our goal was to determine how the three-dimensional structure of hyaline cartilage affects its MR appearance and to correlate this appearance with detailed structural analysis using scanning electron microscopy and freeze-fracture sectioning techniques. MATERIALS AND METHODS: In vitro 7-T spin-echo MR images of hyaline cartilage specimens from four patients undergoing above-knee amputations were obtained parallel and perpendicular to the main magnetic field. Specimens were imaged with low- and high-power scanning electron microscopy after freeze fracturing. The corresponding images from both techniques were analyzed with specific attention to the three-dimensional structure of the cartilage, collagen fibril orientation, and respective changes in the MR appearance. RESULTS: Freeze fracturing of cartilage reveals a curved fracture plane. Expected changes in signal intensity predicted by the magic angle effect correlated with observed changes in signal intensity across the thickness of the sample. Changes in individual collagen fibril orientation did not correspond to MR layering. CONCLUSION: The three-dimensional organization of collagen in cartilage has a strong influence on the MR appearance of cartilage. This influence is caused by the restriction of water mobility and the resulting magic angle effect caused by curvature of the collagen network, possibly because of the influence on proteoglycan orientation.     

MRI of cerebellopontine angle choroid plexus papilloma

We present a cerebellopontine angle choroid plexus papilloma that originated from the tuft of choroid plexus of the fourth ventricle protruding from the foramen of Luschka. MRI and CT did not establish the diagnosis, but the tumor was shown histopathologically to be a choroid plexus papilloma. Distinct features of the tumor on MRI are described and the differential diagnosis of other cerebellopontine angle tumors is discussed.     

多层螺旋CTMPR技术对镫骨结构的显示及相关数据测量

目的用MPR技术重组镫骨斜位图像，观察该层面对镫骨结构的显示状况并进行相关数据测量。方法收集因搏动性耳鸣、眩晕等需行颞骨多层螺旋CT扫描的患者50例（100耳），利用CT多平面重组技术重建出镫骨斜位图像，观察该层面对镫骨显示状况，测量镫骨高度、镫骨闭孔纵径及横径、砧镫间夹角，观察镫骨前后脚粗细、镫骨闭孔的形态及镫骨小头；将测量结果采用SPSSl3．0统计软件分析数据，比较不同侧别间的测量值，并与文献中相关标本测量值进行比较。结果①100耳镫骨斜位图像上均可显示镫骨各结构，显示率为100％；②相关测量值：镫骨高度：左侧（3．31±0．22）cm、右侧（3．34±0．27）cm；镫骨闭孔纵径：左侧（1．73±0．29）cm、右侧（1．70±0．23）cm；镫骨闭孔横径：左侧（1．544±0．30）cm、右侧（1．58±0．26）cm；砧镫间角度：左侧（84．18±13．38）°、右侧（82．79±13．24）。；镫骨闭孔形态：三角形41耳（41％，41／100）、半圆形19耳（19％，19／lOO）、圆形及不规则形分别10耳（10％，lO／lOO）、卵圆形8耳（8％，8／lOO）、梯形及长方形各4耳（4％，4／100）、方形及半卵圆形各2耳（2％，2／100）；镫骨前后脚粗细：镫骨后脚粗于前脚者77耳（77％，77／100）、前脚粗于后脚者5耳（5％，5／100）、前后脚等粗者18耳（18％，18／100）；镫骨小头：镫骨小头向前脚倾斜者37耳（37％，37／100）、倾向后脚者13耳（13％，13／100）、正中位者50耳（50％，50／100）。左右侧镫骨高度、镫骨闭孔纵径及横径及砧镫间角度测量结果，差异无统计学意义（P〉0．05）。镫骨高度、镫骨闭孔纵径及横径测量结果与文献中相关标本上所得结果比较，差异均无统计学意义（P〉0．05）；砧镫问夹角测量结果不一致。结论镫骨斜位图像可准确、全面显示镫骨结构及形态，有利于镫骨各结构的显示。     

Human articular cartilage: in vitro correlation of MRI and histologic findings

The aim of our study was to correlate MRI with histologic findings in normal and degenerative cartilage. Twenty-two human knees derived from patients undergoing amputation were examined with 1.0- and 1.5-T MR imaging units. Firstly, we optimized two fat-suppressed 3D gradient-echo sequences. In this pilot study two knees were examined with fast imaging with steady precession (FISP) sequences and fast low-angle shot (FLASH, SPGR) sequence by varying the flip angles (40, 60, 90 °) and combining each flip angle with different echo time (7, 10 or 11, 20 ms). We chose the sequences with the best visual contrast between the cartilage layers and the best measured contrast-to-noise ratio between cartilage and bone marrow. Therefore, we used a 3D FLASH fat-saturated sequence (TR/TE/flip angle = 50/11 ms/40 °) and a 3D FISP fat-saturated sequence (TR/TE/flip angle = 40/10 ms/40 °) for cartilage imaging in 22 human knees. The images were obtained at various angles of the patellar cartilage in relation to the main magnetic field (0, 55, 90 °). The MR appearances were classified into five categories: normal, intracartilaginous signal changes, diffuse thinning (cartilage thickness < 3 mm), superficial erosions, and cartilage ulcers. After imaging, the knees were examined macroscopically and photographed. In addition, we performed histologic studies using light microscopy with several different stainings, polarization, and dark field microscopy as well as electron microscopy. The structural characteristics with the cartilage lesions were correlated with the MR findings. We identified a hyperintense superficial zone in the MR image which did not correlate to the histologically identifiable superficial zone. The second lamina was hypointense on MRI and correlated to the bulk of the radial zone. The third (or deep) cartilage lamina in the MR image seemed to represent the combination of the lowest portion of the radial zone and the calcified cartilage. The width of the hypointense second zone correlated weakly to the accumulation of proteoglycans in the radial zone. The trilaminar MRI appearance of the cartilage was only visible when the cartilage was thicker than 2 mm. In cartilage degeneration, we found either a diffuse thinning of all layers or circumscribed lesions (“cartilage ulcer”) of these cartilage layers in the MR images. Early cartilage degeneration was indicated by a signal loss in the superficial zone, correlating to the histologically proven damage of proteoglycans in the transitional and radial zone along with destruction of the superficial zone. We found a strong effect of cartilage rotation in the main magnetic field, too. A rotation of the cartilage structures caused considerable variation in the signal intensity of the second lamina. Cartilage segments in a 55 °angle to the magnetic main field had a homogeneous appearance, not a trilaminar appearance. The signal behavior of hyaline articular cartilage does not reflect the laminar histologic structure. Osteoarthrosis and cartilage degeneration are visible on MR images as intracartilaginous signal changes, superficial erosions, diffuse cartilage thinning, and cartilage ulceration. Received 13 February 1997; Revision received 27 June 1997; Accepted 29 December 1997     

比较双回波稳态序列30°与90°反转角对诊断膝关节软骨损伤的价值

目的：比较三维双回波稳态(3D-DESS)序列30°与90°反转角对2级及以上膝关节软骨损伤程度的诊断准确性。方法利用1.5T MR 3D-DESS 序列分别采用30°及90°反转角成像获得13例膝关节软骨损伤患者(男2例,女11例,年龄18~68岁)的MR 图像。由2名放射科医生阅片判断：软骨损伤≥2级为阳性(P),<2级为阴性(N)。以关节镜作为金标准,并与随后行关节镜检查诊断的一致率进行比较。评估软骨损伤诊断得分分3类：3分,肯定诊断;2分,可能诊断;1分,不能做出诊断。结果通过3D-DESS 图像和关节镜检查结果作一致性比较,6个膝关节面90°反转角一致率显著较高(Kappa 值=1.000,0.843,1.000,0.806,0.967,0.909;P <0.001,P <0.004,P <0.004,P <0.002,P <0.001,P <0.001),90°反转角的图像比30°反转角的图像更好地显示所有软骨面。结论3D-DESS 序列评价膝关节软骨表面损伤,90°反转角比30°的常规设置更有效。