不同整形技术治疗儿童唇裂鼻畸形的临床效果

目的探讨不同整形技术治疗儿童唇裂鼻畸形的临床效果。方法本院自1994年1月至2011年1月期间对本院133例单侧唇裂继发鼻畸形患者分为自行设计的鼻翼软骨环状结构修复及整体旋转复位治疗组（A组）36例、开放式唇裂鼻畸形整形术治疗组（B组）47例、新生儿唇裂修复组（C组）28例以及早期唇裂鼻畸形整形术组（D组）22例,对比分析不同手术方法的临床疗效。结果术后对4组患者随访24个月,A组优良率为94．44％,B组优良率为97．87％,C组优良率为96．43％、D组优良率为95．45％,各组优良率比较差异无统计学意义（P〉0．05）。4组治疗前鼻翼外侧脚及鼻孔纵径至中线距离术前健侧及患侧相比均存在明显的差异（P〈0．05）,矫正后各组健侧与患侧相比差异无统计学意义（P〉0．05）。随访2年各组患者术后并发症发生率差异无统计学意义（P〉0．05）。结论鼻翼软骨环状复合结构修复使鼻尖、鼻翼及鼻底形态都有所改善,开放式唇裂继发鼻畸形整形术是目前较彻底的鼻翼软骨整形术,新生儿唇裂修复安全有效。唇裂修复早期的鼻整形有望改善鼻形态发育。     

The relationship between phalangeal bone density and vertebral deformities

Radiographic absorptiometry (RA) of the phalanges is a convenient and reliable technique for measuring bone mineral density (BMD). It needs only a radiograph of the hand, which can be sent for evaluation to a central facility, whereas other techniques require specialized equipment. We assessed the relationship between RA measurements and the presence of vertebral deformities in a population-based cohort of postmenopausal women, and to compare the results with simultaneously obtained BMD of the hip by dual-energy X-ray absorptiometry (DXA). A total of 389 women aged 55–84 (mean age 67.2 years, SD 8.7) were randomly selected from a large general practice. RA, DXA of the hip, and vertebral deformities in the lateral spine X-rays by vertebral morphometry were assessed. Thirty-eight women (9.8%) had severe (grade II) vertebral deformities, and their BMD at the phalanges and femoral neck was significantly lower than that of women without severe vertebral deformities. Odds ratios for the presence of severe vertebral deformities of 1.5 (95% CI: 1.1–2.1) for RA and 1.3 (95% CI: 0.9–1.9) for DXA, together with similar receiver operating characteristics curves, were found using age-adjusted logistic regression. Phalangeal BMD is related to vertebral deformities at least as closely as BMD of the femoral neck BMD. RA may therefore help to evaluate fracture risk, especially if no DXA equipment is available. Received: 21 July 1998 / Accepted: 1 July 1999     

髁突骨软骨瘤及其继发牙颌面畸形的治疗

骨软骨瘤属于良性肿瘤,髁突是颌面部骨软骨瘤易受累的部位.髁突骨软骨瘤主要表现为关节区肿块、关节功能异常,常继发不对称性牙颌面畸形.手术仍是治疗的主要方法.手术应彻底切除肿瘤、重建关节功能、纠正错畸形以获得稳定良好的口颌系统功能.同时应矫正其异常和畸形容貌,以达到功能与形态俱佳的效果,常需以多种手术结合为主的综合治疗方案.本文从髁突骨软骨瘤的病因、临床特点、影像学特点、治疗目标和手术方式等方面对该病的诊治作一系统论述.     

The bipartite tarsal navicular bone: Radiographic and computed tomography findings

Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms perse, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant.     

三维超声在胎儿肢体畸形诊断中的应用

目的:探讨三维超声在胎儿肢体畸形诊断中的应用价值。方法:对31例产前常规二维超声检查怀疑胎儿肢体发育异常的病例进行三维超声检查,并与产后结果对照,比较二维、三维图像提供病变部位及细节的准确性。结果:所有病例都能够进行三维扫查并取得表面或最大透明三维立体图像,二维及三维超声对病变部位的检出率分别为81.1%(56/69)、94.2%(65/69),对病变细节的检出率分别为76.8%(53/69)、91.3%(63/69),差异均有统计学意义(χ2分别为7.111、8.100,P均<0.05)。结论:三维超声对胎儿肢体畸形的病变部位及细节具有较高的诊断价值。     

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Park等[1]在行二期唇裂鼻畸形整复术时,发现患侧鼻翼软骨有着正常同样的大小和厚度,只是附着和形状发生了异常。基于这一发现,鼻软骨畸形被认为是源于唇裂形成后产生的异常肌肉应力的分布,而不是由于原发的软骨畸形。     

Decreased Bone Mineral Density in Neurofibromatosis-1 Patients with Spinal Deformities

A cross-sectional study was carried out to obtain data on the bone mineral density status of a group of neurofibromatosis-1 patients with spinal deformities, and to search for possible accompanying changes in the bone mineral turnover. Neurofibromatosis-1 is a heredofamiliar disorder that is associated with a variety of skeletal anomalies (mostly spinal deformities) in 10–50% of patients. Intraoperatively, a poor vertebral bone quality has been observed. Efforts have been made to identify factors preventing curve progression, to optimize operational planning and to explain the pathomechanism. As part of the preoperative evaluation, dual-energy X-ray absorptiometry was used to assess the bone mineral density of the lumbar spine in 12 patients with neurofibromatosis-1, supplemented by laboratory blood/urine investigations. A significant decrease in bone mineral density of the lumbar spine was measured. An inverse relation was suggested between the severity of scoliosis and the lumbar spine Z-scores. No pivotal alterations were identified in the laboratory measurements. The bony tissue abnormality observed intraoperatively in neurofibromatosis-1 patients may be described as a diminution of the axial bone mineral density. The biochemical parameters do not support the presence of hyperparathyroidism, renal disorders or other associated diseases influencing the bone mineral turnover. The evaluation of bone mineral density in the course of the preoperative planning is proposed in neurofibromatosis-1; the exact background and the role of a possible osteoporosis in the prognosis remain to be elucidated. Received: 12 January 2001 / Accepted: 21 March 2001     

A review and dental management of persons with craniosynostosis anomalies

Individuals with craniofacial deformities have a higher risk of developing oral diseases. This article discusses craniosynostosis and its oral problems. Dental treatment protocols based on general, facial, oral, and psychological aspects are offered.     

埋没导引缝合针在双侧唇裂继发畸形修复中的应用

目的　探讨双侧唇裂继发畸形的解剖学修复。方法　采用埋没导引缝合针缝合法 ,对于引起畸形的主要因素 :鼻翼软骨向两侧移位 ,鼻降肌挛缩 ,口轮匝肌移位 ,鼻孔底瘢痕挛缩等进行彻底松解后 ,牢固准确地复位、固定 ,以恢复其正常的解剖关系。结果　自 1998年以来 ,共收治 2 6例双侧唇裂继发畸形患者 ,除 1例叉状皮瓣远端坏死外 ,余均顺利成功。随访 1～ 2年效果满意。结论　本手术不仅简单省时 ,而且能达到从解剖学角度修复畸形     

同期整复鼻畸形伴鼻中隔偏曲治疗方法探讨

目的探讨安全有效地治疗鼻畸形伴鼻中隔偏曲的手术方法和效果，方法采用鼻外进路，保留鼻中隔软骨，矫正鼻中隔偏曲，联合单面骨膜带蒂骨瓣折骨法处理骨锥畸形。结果59例患者鼻畸形伴鼻中隔偏曲均1次矫正，随访1～6年无复发和并发症。结论本手术方法具有视野大、操作方便等优点。鼻畸形伴鼻中隔偏曲患者均可通过鼻中隔鼻整形术同期矫正，收到外鼻美容与鼻腔通气功能恢复的双重效果，