自体髂软骨及松质骨移植在牙槽突裂同期行鼻畸形整复术中的应用

目的　探索牙槽突裂与鼻畸形同期整复的新方法。方法　对 4 2例牙槽突裂患者采用自体髂骨及松质骨充填牙槽裂隙 ,髂嵴软骨片覆盖并充垫塌陷的梨状孔外缘及鼻侧区 ,同时利用鼻前庭黏膜软骨复合组织瓣V Y推进法整复鼻畸形。结果　 9～ 11岁患者牙槽突高度恢复平均为86 7% ,厚度恢复平均为 89 6 % ,牙槽突外形和功能为Ⅰ、Ⅱ级 ,尖牙在骨移植区萌出 ,梨状孔外缘鼻侧区低陷处高度恢复 ,鼻翼塌陷畸形恢复 ,鼻孔形态对称 ;12岁以上患者牙槽突高度恢复平均为70 1% ,厚度恢复平均为 71 7% ,牙槽突外形和功能为Ⅱ级、Ⅲ级 ;2例 18岁患者鼻背长轴、鼻端偏斜未能改善。结论　利用自体松质骨和软骨来修复牙槽突裂并同时进行鼻畸形整复 ,既能保证牙槽突高度、牙弓连续性的恢复 ,鼻畸形的改善 ,又能防止鼻背、鼻端长期畸形发展而造成难以矫正的偏斜 ,同时也能尽早消除因畸形给患者带来的心理障碍 ,是一种比较理想的整复方法     

后路脊椎V型截骨术治疗创伤性脊柱后凸畸形

目的总结应用椎弓根钉-棒系统后路脊椎V型截骨术治疗创伤性脊柱后凸畸形的临床经验、技术要点及效果。方法将创伤性脊柱后凸畸形的病人分为两组，进行对比分析。治疗组：应用椎弓根钉-棒系统后路V型截骨内固定术29例；对照组：应用前路椎体骨折复位内固定融合术26例。结果与对照组相比，治疗组术后畸形复发率显著低于对照组（P〈0．05），断钉、松动等并发症发生率显著低于对照组（P〈0．05），骨折不融合、纠正后凸畸形度数对比无显著性差异（P〉0．05）。结论应用椎弓根钉-棒系统后路V型截骨术治疗的创伤性脊柱后凸畸形可有效防止手术后畸形再发生，矫正后凸畸形彻底、安全、可靠。     

不同骨延长器治疗肢体畸形并大段骨缺损

[目的]利用Ilizarov支架、Orthofix肢体重建系统（Orthofix LRS）及Hybrid固定系统（Hybrid Fixation System）与Orthofix LRS的组合，对不同的肢体畸形并大段骨缺损进行矫形及骨延长治疗，同时观察其疗效。[方法]自2000年8月-2004年3月分别用Ilizarov支架、Orthofix LRS及Hybrid支架与Orthofix LRS的组合进行骨痂牵开／骨段滑移治疗合并肢体畸形的大段骨缺损。畸形处采用线形／楔形截骨。畸形愈合并骨短缩者楔形截骨后进行骨痂牵开骨延长术，骨不连并畸形及短缩者接合点加压与截骨矫形骨段滑移延长同时进行。[结果]矫正股骨短缩畸形7cm1例，胫骨6例，内翻畸形2例，后成角畸形2例，混合畸形2例。平均延长5．3cm（4．5—7cm），平均延长时间3．5个月，平均延长后外固定时间7个月，无神经血管损伤，膝踝关节活动未受影响。[结论]Ilizarov支架、Orthofix LRS、Hybrid固定系统与Orthofix LRS的组合用于骨痂牵开／骨段滑移治疗合并肢体畸形的大段骨缺损均能达到矫形及骨延长的治疗目的。Orthofix LRS及Hybrid固定系统与Orthofix LRS的组合较Ilizarov支架操作简便，安全可靠，患者乐于接受。     

Secondary reconstruction of the short philtrum in the bilateral cleft deformity

Summary This technique for reconstruction of the short philtrum requires an understanding of the viscoelastic properties of the skin and how to use these to increase skin dimensions. This is combined with contouring and splinting with a subcutaneous cartilage graft. Three representative cases are presented to illustrate the method to achieve an aesthetically acceptable lip and its long-term follow-up. No complications have been encountered using this over a 15-year period. The technique can be combined with other secondary reconstructive procedures on the lip and palate. Work completed at: Providence Hospital, 16001 West Nine Mile Road, P.O. Box 2043, Southfield, Michigan 48037, USA     

Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study

The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 × 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.     

羊膜建库及其临床应用研究

目的 :制备与保存羊膜 (Amnioticmembrane,AM ) ,为临床移植治疗眼表泪液 (Ocularsur face&Teardisease ,OSTD)提供新鲜羊膜 (Freshamnioticmembrane ,FSAM )、冻干羊膜 (Frozenam nioticmembrane ,FZAM )并观察其眼表重建的特点与临床疗效。方法 :采用目前国际公认的羊膜制备与保存方法 ,制备FSAM、FZAM并进行保存研究 ,经组织染色和电子显微镜检查 ,观察保存羊膜的形态及其活性 ;并将FSAM、FZAM应用于 12例OSTD患者 ,行患眼FSAM或FZAM移植术。通过术后印迹细胞学追踪观察移植后AM上皮细胞存活与移行、替代时间 ,评估AM移植重建眼表的临床疗效。结果 :FSAM、FZAM在光镜和电镜下均与正常球结膜组织结构相近 ,主要结构为胶原纤维和网状纤维。 12例OSTD患者行羊膜移植术 (Amnioticmembranetransplantation ,AMT)后均未见明显急性排斥反应 ,术后 1～ 2周可见少量新生血管长入植片 ,AMT后印迹细胞学追踪检查 ,术后 3个月为阴性 ,4个月出现阳性反应。所有患者术后随访 5～ 18个月 ,平均 11个月 ,AM在术后 4～ 9个月逐渐溶解、消失 ,移植区眼表的色泽与结构基本恢复正常。结论 :FSAM、FZAM是目前理想的结膜替代材料并可有效地用于重建角、结膜表面 ,减轻炎症反应 ,减少新生血管的生成 ,抑制纤维组织增生 ,防止     

齿槽裂植骨整复畸形鼻

目的:探讨齿槽裂及鼻底进行天然多孔骨(Bio-OssCollagen材料)移植整复畸形鼻的可行性和临床疗效。方法:对12例齿槽裂及鼻底行Bio-OssCollagen材料植入整复手术。结果:随访9￣12月外形恢复良好,唇部和鼻底丰满,鼻翼提升,X线片示齿槽裂及鼻底植入Bio-OssCollagen材料基本被自体骨取代。结论:用Bio-OssCollagen材料代替自体骨植入齿槽裂及鼻底整复畸形鼻,均效果良好。     

INTRA- AND INTERINDIVIDUAL VARIATION IN THE PHARMACOKINETICS OF TACROLIMUS (FK506) IN KIDNEY TRANSPLANT RECIPIENTS—IMPORTANCE OF TROUGH LEVEL AS A PRACTICAL INDICATOR

Background: Tacrolimus (FK506) is currently used as the primary immunosuppressant in clinical kidney transplantation in some centers. The purpose of this study was to evaluate the pharmacokinetics of this drug and to see if trough level, which has been used widely in therapeutic drug monitoring, can be used as an appropriate substitute for other pharmacokinetic measurement tests. Methods: The blood concentration-time curve was studied in 10 kidney transplant recipients on 26 Occasions after oral dosage of 2 to 18 mg every 12 hours. Whole blood concentration was measured by two-step irnmunoabsorption assay. Methylprednisolone was used as a concomitant immuno-suppressive drug. Results: The blood concentration-time curves showed remarkable interindividual variation. lntraindividual variation was also found, but the degree of variation was slight compared with interindividual variation. On 17 occasions of measurement in one patient, the dose was significantly correlated with trough (r = 0.684). C_max (r = 0.838) and AUC_0–12 (r = 0.817). In nine patients on nine occasions, however, the dose was not significantly correlated with trough (r = 0.351), C_max (r = 0.270) or AUC_0–12 (r = 0.355). t_max ranged from one to four hours (mean + SD; 2.8 + 1.3) and fluctuated in both intra- and interindividual measurements. In spite of a wide variation in the blood concentration-time-curve patterns, a highly significant linear relationship between trough and C_max or AUC_0–12 was observed in both intraindividual (C_max, r = 0.876; AUC_0–12, r = 0.926) and interindividual (C_max, f = 0.943; AUC_0–12, r = 984) measurements. Concluslons: We conclude that trough level is a practical acceptable indicator of the blood levels of tacrolimus, and can be used to monitor blood concentration.     

冠状动脉畸形及其临床意义

目的：研究冠状动脉畸形及其临床意义。方法：在460例冠状动脉的解剖中，发现7例冠状动脉异常，并对此动脉开口移位和冠状动静脉瘘进行解剖与观察。结果：在7例中，5例冠状动脉开口移位，经动脉圆锥前、主动脉后或主动脉与肺动脉干之间横过心底，到达其分布区。单一（右）冠状动脉Ⅱ型或一冠状动脉发自对侧主动脉窦提供解释：此冠状动脉畸形的青年，可在运动时或运动后猝死。2例冠状动静脉瘘，显示冠状动脉和肺动脉干与左室之间，存在毛细血管前吻合。结论：冠状动脉畸形在临床实践中有其意义，其发生有它的胚胎学基础。     

Frontonasal dysplasia in the Klippel-Feil syndrome: A new associated malformation

This paper describes an 8-year-old girl with Klippel-Feil syndrome (KFS) associated with frontonasal dysplasia, Sprengel deformity and postaxial polydactyly. These findings are tentatively explained on the basis of a single mutant gene for KFS with broad action in the morphogenesis of the skeletal system.