单蒂横行腹直肌肌皮瓣乳房再造中Ⅳ区皮瓣的取舍

目的探讨单蒂横行腹直肌肌皮瓣乳房再造术中Ⅳ区皮瓣的取舍。方法通过16例实施单蒂横行腹直肌肌皮瓣乳房再造术，术中观察皮瓣的皮色、断面出血颜色，并利用近红外血氧监测仪测定皮瓣各区的组织血氧饱和度，决定Ⅳ区皮瓣的取舍。术后观察指标包括术后并发症及美学效果。结果16例中5例Ⅳ皮瓣的肤色正常、断面出血呈鲜红色而非暗红色、组织血氧饱和度不低于Ⅲ区组织血氧饱和度的95％。在接受了保留Ⅳ区皮瓣的单蒂横行腹直肌肌皮瓣乳房再造术后，再造乳房全部成活，无严重术后并发症，患者对再造乳房均很满意。结论近红外血氧无创检测有助于决定Ⅳ区皮瓣的取舍。有选择地实施保留Ⅳ区皮瓣的单蒂横行腹直肌肌皮瓣乳房再造术，可用于大面积胸壁缺损或乳腺尾叶的修复重建。     

碱性成纤维细胞生长因子在实验性硬脑膜重建中的应用

[目的] 探讨碱性成纤维细胞生长因子( bFGF)在实验性自体筋膜硬脑膜重建中的应用价值.[方法]取 SD大鼠 35只,分成 5组.其中 A组 3只,直接将背部筋膜覆盖在硬膜外, B组 5只,采用自体筋膜硬脑膜重建模型,通过免疫组织化学方法观察这两组大鼠自体筋膜硬脑膜移植的愈合过程及细胞因子 bFGF在其中的表达; C组、 D组、 E组各 9只,分别进行自体筋膜硬脑膜重建, D组加用外源性 bFGF, E组仅用明胶海绵,通过脑脊液漏研究、免疫组织化学方法研究外源性 bFGF对自体筋膜重建硬脑膜愈合过程的影响并用 RT- PCR方法研究内源性 bFGF mRNA的表达情况.[结果] 大鼠自体筋膜移植硬脑膜部位 bFGF表达明显; C、 D、 E组大鼠重建硬脑膜抵抗脑脊液漏压力值( mmH2O)分别为 311± 75, 497± 153, 338± 88,Ⅰ型胶原纤维表达值分别为 4.9± 0.8, 10.9± 1.6, 5.3± 0.9, D组均好于对照组( P< 0.05);内源性 bFGF mRNA的表达没有明显变化.[结论] 在自体筋膜移植硬脑膜的愈合过程中 bFGF可能起了重要的作用;外源性 bFGF处理的大鼠其移植筋膜愈合要好于对照组.     

髋臼内壁内移截骨全髋置换治疗成人髋臼发育不良的有限元分析及临床意义

目的 通过计算机辅助设计有限元分析,找寻髋臼内壁截骨的合适内移范围,为临床工作提供理论依据.方法 利用SolidWorks 2005软件,建立髋臼发育不良骨盆的三维模型,模拟髋臼内壁内移截骨术式,使髋臼内壁骨从未完全陷入盆腔内保持2 mm骨性接触处开始,逐渐内移至完全陷入盆腔内7 mm处,每隔1 mm为1个实验组,分成10个实验组.每组髋臼人为划成4个象限,分别对各组假体臼-骨界面间进行计算机模拟对比力学实验分析,测量出髋臼假体-骨界面间的Mises应力及剪切应力值,找寻出应力分布较为均匀的实验组.结果 Mises应力及剪切应力均有1个象限内的值较大,通过2次统计学分析计算,得出实验结果.结论 当髋臼内壁内移至未完全陷入盆腔内1 mm处到完全陷入盆腔内1 mm处的范围内,髋臼假体-骨界面间的应力分布均匀,最佳位置在完全陷入盆腔内1 mm处.     

Regeneration of the hamstring tendons after harvesting for arthroscopic anterior cruciate ligament reconstruction: a histological study in 11 patients

The purpose of our study is to evaluate whether the hamstring tendons can regrow after harvesting for anterior cruciate ligament (ACL) reconstruction and whether the regenerate tissue can be histologically characterized as tendinous. Eleven of the patients (eight female and three male; mean age, 23 years; range 17–37 years) consented to participate in this study. One year after the ACL reconstruction, surgical biopsy was done. Regeneration of the tendon was detected macroscopically in 9 of the 11 patients. Histologically and immunohistochemically, the regenerated tendons closely resembled normal ones. The results of this study show the hamstring tendons can regenerate after harvesting for the ACL reconstruction.     

Femoral attachment of the anterior cruciate ligament

Endoscopic anterior cruciate ligament (ACL) reconstruction is one of the most popular orthopaedic procedures. Correct tunnel positioning is a prerequisite to success. Current surgical techniques are unable to duplicate the complex anatomy and function of the native ACL. Surgery mainly aims at restoring anteroposterior laxity. The ACL is not isometric and only a few fibers are nearly isometric over the full range of motion. However, a nearly isometric behaviour of the ACL graft is desirable. Isometry is mainly influenced by femoral attachment; thus the femoral tunnel position has a greater effect than the tibial on graft length changes. The purpose of this article is to describe the anatomy of the femoral ACL insertion and to discuss the surgical techniques used to replicate it.     

Surgical treatment for ureterocele with special reference to lower urinary tract reconstruction

OBJECTIVES: We reviewed the results of surgical treatment for children with ureterocele, especially addressing the importance of the lower urinary tract reconstruction. METHODS: We present medical records of 91 children with ureterocele (31 with the intravesical type, and 60 with the ectopic type) treated during the last 14 years. As the initial treatment, we carried out transurethral incision of the ureterocele (TUI). In patients with persistent reflux, breakthrough urinary tract infection (UTI), or signs of bladder outlet obstruction due to a collapsed cele wall, we recommended that patients undergo lower urinary tract reconstruction irrespective of the renal function involved in ureterocele. The average follow-up period was 5 years (ranging 1 year and 6 months to 14 years). RESULTS: Transurethral incision of the ureterocele was carried out as the initial treatment on 68 patients (75%). A total of 34 patients (21 intravesical [68%] and 13 ectopic [22%]) were followed medically after TUI alone. Reconstruction of the lower urinary tract was carried out in 59 patients (65%). Nephroureterectomy combined with bladder level reconstruction was carried out in four children with single system and non-functioning kidney. Follow-up voiding cystourethrography showed that only one girl had reflux, which disappeared after the first follow-up examination. Postoperative UTI occurred in 12 patients (20%) with ectopic ureterocele. Voiding dysfunction was suspected in eight patients. CONCLUSION: We believe that the primary objective for patients with ureterocele, especially of the ectopic type, is to reconstruct the original pathology of the lower urinary tract that may give rise to reflux, obstruction, or abnormalities of urination. Although surgery at the bladder level can be challenging, the lower urinary tract reconstruction successfully corrects the vesicoureteral reflux and bladder outlet pathology under a cosmetically acceptable incision.     

Preference for donor site scar orientation in pedicled latissimus dorsi breast reconstruction

A survey was carried out to ascertain the preference for donor site scar orientation in patients undergoing pedicled latissimus dorsi breast reconstruction and their views on breast reconstruction in general. One hundred twelve women (59 Chinese, 53 Western) completed the questionnaire. Participants were asked to state their preferred scar orientation (i.e., oblique, horizontal, or vertical) based on photographs showing the position of the scars. Demographic information and views on issues surrounding breast reconstruction in general were also collected. Data was analyzed non-parametrically with chi-square test and t test. The mean age of participants was 39.5 years (20–73 years). Seventy-seven percent of the participants would opt for an immediate breast reconstruction if offered (p < 0.001). Eighty-six percent would have objection to the use of silicone implant as a whole or part of a reconstruction (p < 0.001). Vertical and horizontal scars were the preferred orientation, with no women choosing the oblique orientation as their first choice (p < 0.001). The non-Chinese of 40 years or older, as well as Chinese women from all age groups, preferred the horizontal scar (p < 0.05). We demonstrated that both culture and age impact on the preferred scar orientation in breast reconstruction. Women in the age group we commonly reconstruct favored the horizontal scar. However, the younger women of non-Chinese origin tended to favor the vertical scar.