关节镜下半腱肌腱、股薄肌腱重建前交叉韧带

目的总结膝关节镜下半腱肌腱、股薄肌腱重建前交叉韧带的方法及疗效,分析其优、缺点。方法2004年1月～2005年10月应用半腱肌腱、股薄肌腱和微型纽扣钢板重建前交叉韧带22例,术前和术后进行Lachman试验评估膝关节的稳定性,用Lysholm评分方法评定膝关节功能。结果随访6～24个月,平均(16.0±10.3)个月,术前Lachman试验均为阳性,术后20例为阴性,2例为阳性,术前、术后比较差异有统计学意义(χ2=42.50,P<0.01);术前Lysholm评分40～85分,平均(56.36±10.20)分,术后70～100分,平均(92.76±11.20)分。术后膝关节功能有明显改善(t=3.14,P<0.01)。结论半腱肌腱、股薄肌腱和微型纽扣钢板重建前交叉韧带具有移植物强大、操作简单、并发症少、近期疗效满意等优点。     

Exstrophic anomalies: Recent advances and long term outlook

Exstrophy-epispadias complex has been a difficult disease to treat. As in the minds of the public and most physicians alike, these children are crippled with life-long ailments and multiple operations. Much of the morbidity of this condition relates to failure to preserve urogenital tract function in these children. In recent years, through better understanding of the exstrophic anatomy and improved surgical techniques, complete repair of the exstrophic anomaly has become possible as soon as the child is born. Results of such closure indicate that such repair is not only feasible but mandatory for a successful outcome. Continence rate and cosmetic appearance are superior to the conventional 3-stage technique. Such repair is also socially acceptable as the parents will bring home a normal-looking baby with much fewer operations expected in the future. It is anticipated that complete one-stage exstrophy closure in the newborn period will revolutionize the outcome of all exstrophy patients.     

Iliotibial band reconstruction with allograft fasciae latae tissue: Imaging aspects of a novel surgical technique

We describe a unique case of 43-year-old male who presented with a persistent lateral knee pain caused by impingement between a femoral surgical screw and the iliotibial band, which was treated with surgical resection of the screw debris. The patient had reincidence of the symptoms and a magnetic resonance showed a wide and unrepairable tear of the iliotibial band, which was treated with interposition of a folded fasciae latae allograf. After the procedure, the patient had excellent clinical results and imaging evaluation showed progressive allograft integration. This case highlights the imaging findings and surgical aspects of an iliotibial band reconstruction, a novel surgical procedure that could be considered in patients with an unrepairable iliotibial band injury.     

10-Year Experience with the Modified Pectoralis Major Flap: The Use of the Deltopectoral Flap to Reduce Skin Tension

Purpose: Pectoralis major myocutaneous flap has been the work horse flap for head and neck reconstruction. However, due to the bulky nature of the pedicle it is not uncommon to struggle to achieve tension free closure of the neck skin incision. This case series presents a modified pectoralis major flap technique to overcome the difficulty of tight closure or the need to graft the residual cutaneous defect. Method: This 10-year study includes 73 patients who underwent modified pectoralis major flap reconstruction for complex laryngo-pharyngeal defects following resection of tumours involving larynx, hypopharynx oropharynx and cervical oesophagus. The modified technique involves accommodating a deltopectoral fasciocutaneous flap which rotates over the pedicle to insert into the neck incision providing extra tissue to achieve a tension free closure. Results: 73 patients underwent the procedure, 80% were male. Mean age of patients was 62.8years. Larynx was the most common site and the average size of the tumour was 34.8 mm. 13 patients developed minor complications such as wound dehiscence out of which 10 were managed conservatively, 3 patients required additional reconstructive procedures. 13 patients developed pharyngocutaneous fistula and 6 developed Neopharyngeal stenosis. 51 patients achieved good swallowing and 55 developed intelligible speech following recovery. Conclusion: We recommend the use of this technique as an effective method to achieve tension free neck incision closure and improved cosmetic results especially in centres which do not have free flap facility readily available.     

头颈肿瘤游离皮瓣修复术后皮瓣坏死及皮瓣相关并发症影响因素分析

目的 分析皮瓣坏死及术后出现皮瓣相关并发症的影响因素。方法 回顾性分析因头颈肿瘤行游离皮瓣修复患者的年龄、性别、手术时长、吸烟、酗酒、高血压、糖尿病、术前放疗、血管吻合方式等对皮瓣坏死及皮瓣相关术后并发症的影响作用。结果 年龄、性别、手术时长、吸烟、酗酒、术前放疗、血管吻合方式不是头颈肿瘤患者游离皮瓣修复后皮瓣坏死及发生皮瓣相关术后并发症的危险因素;糖尿病是头颈肿瘤患者游离皮瓣修复后皮瓣坏死的危险因素(P=0.006),高血压(P=0.040)、糖尿病(P=0.024)是出现皮瓣相关术后并发症的独立危险因素。结论 在有游离皮瓣修复指征的头颈肿瘤但伴随有糖尿病、高血压疾病的患者中,经过全身情况评估后个体化选择修复方式。     

螺旋CT三维重建在颅底病变的应用

目的：探讨螺旋ＣＴ３Ｄ重建的临床应用价值和重建技术。方法：３０例中男性１８例，女性１２例，均经手术和病理证实。均用螺旋ＣＴ扫描，层厚３～５ｍｍ床进速度为３～５ｍｍ／ｓ，薄层重建１～３ｍｍ，颅内肿瘤均行增强扫描。３Ｄ重建在独立诊断台上进行，选择重建时的合适阈值，颅骨１００～２００Ｈｕ，肿瘤８０～１００Ｈｕ，分别进行颅骨、肿瘤及血管的３Ｄ重建并用假彩色技术处理，使用不同的旋转轴观察病变，测量肿瘤在三维空间的距离、角度和体积。结果：全部病例都能清楚显示病变的立体解剖图像及其与周围关系，显示瘤体与血管关系者２２例。结论：３ＤＣＴ简化了观察者的思维过程，可直观地了解病变在三维立体空间的实际大小、形态、位置及周围组织结构的立体解剖关系，为制订手术方案和放疗计划提供了客观依据。并可用于形象化教学。     

改进的计算机辅助眶鼻窦重建术治疗复发性眶鼻窦黏液囊肿的效果

目的:评价作者改进的计算机辅助眶鼻窦重建术治疗复发性眶鼻窦黏液囊肿的临床效果。方法:回顾性分析河南省人民医院2008年7月至2018年1月接受改进的计算机辅助眶鼻窦重建术治疗复发性眶鼻窦黏液囊肿45例的临床资料。观察手术效果。术后随访25～44个月。结果:所有患者术后视力(BCVA, logMAR)优于术前( ...     

Role of Perforating Artery Pedicled Neurotrophic Flap in the Treatment of Compound Tissue Defect of Tibia Using the Ilizarov Technique

ObjectiveTo describe our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in the management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.MethodsA pedicled flap with a marked perforator artery was applied for soft tissue coverage after radical debridement and temporary external fixation. In the second stage, the Ilizarov external fixator was used in place of the temporary external fixator for reconstruction of the segmental bone defect by distraction osteogenesis. Twenty‐five patients (16 men and nine women; mean age, 39.2 years) were treated by using this combined technique between 2008 and 2016. All cases were graded initially as Gustilo–Anderson grade IIIB open fractures. The soft tissue defect after radical debridement ranged from 9 cm × 5 cm to 14 cm × 11 cm, and the average size of segmental defect was 5.2 (Range, 2.5–8.5) cm. Seventeen of these patients had a history of local infection. The bone structure and function were evaluated by two independent evaluators using Paley''s criteria.ResultsTwenty‐five patients were followed up for an average of 28.96 (Range, 15–48) months. The distally based sural neurovascular flap was applied in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. The flap area ranged from 10 cm × 5 cm to 14 cm × 12 cm. Sufficient coverage of soft tissue defect was achieved in all cases. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.94 (Range, 4.5–9.5) cm. The residual discrepancy was <1 cm in all cases, which was not clinically significant. The function was evaluated as excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in seven patients. Complications during treatment included pain, pin tract infections, ankle midfoot joint stiffness, and docking site nonunion. No recurrence of infection was observed in infected patients. All cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.ConclusionsThe combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis is an effective alternative approach in the salvage treatment of massively traumatized and chronically infected lower extremities.     

全身动态18 F-FDG PET/CT显像以不同输入函数重建对肺癌定量参数的影响

目的探讨使用两种不同输入函数重建氟-18-氟代脱氧葡萄糖(18F-FDG)正电子发射断层扫描/计算机断层扫描(PET/CT) Patlak多参图像对肺癌病灶定量参数的影响。方法回顾性分析在安徽医科大学第一附属医院核医学科完成全身动态18F-FDG PET/CT扫描的肺癌患者的扫描原始数据, 总扫描时间为75 min。采用两种输入函数进行Patlak多参重建:①以0～75 min降主动脉时间-放射性曲线(TAC)为输入函数(IDIF)。②以耶鲁大学研发的基于人群的输入函数(PBIF)。Patlak多参数分析软件分别以上述输入函数重建获得代谢率(MRFDG)、分布容积(DV)图像, 感兴趣区法勾画病灶获得多参定量信息包括MRFDG及DV的最大值(max)、峰值(peak)和平均值(mean), 采用配对t检验进行统计分析。结果 27例接受全身动态18F-FDG PET/CT成像的肺癌患者的原始数据, 以两种不同输入函数进行Patlak重建, 得到肺癌病灶MRFDG-IDIF和MRFDG-PBIF的max、peak及mean值分别为:(0.26 ± 0.15)、(0.19 ± 0.12)、(...