重度足踝部畸形8例的四维相矫治

目的：通过介绍用于重度足踝部畸形短治的外固定装置的设计和临床应用,试图为传统手术方法难以解决的重度足踝部畸形的治疗问题提供一个新的途径,方法：针对目前手术矫治重度足踝部畸形的常用方法所存在的问题,根据近年研究关于生物组织对牵张应力和时间参数效应的发现,作设计,应用特别的外固定装置矫治重度足踝部畸形,本通过典型病例介绍了外固定装置的构造及安装,外固定装置的调整和畸形的矫正,结果：应用上述装置矫治重度足踝部畸形8例,8例均随访至足踝部形得到短正,应用外固定装置的形矫正过程均在2－3mo,随访时间在畸形矫正后5-16mo,结论：采用该方法在矫治重度足踝部畸形方面取得了补步满意的效果,我们的临床应用表明,这种方法可在极轻微扣伤和不造成肢体和足部短缩的情况下治疗严重的足踝部畸形,本介绍了方法不但考虑到畸莆的情况下治疗治疗严重的足踝部畸形,本介绍了方法不但考虑到畸形的三维结构和病理特点,而且考虑到生物组织对牵张应力和时间参数的效应,所以是一种四维相的矫治方法。     

骨性Ⅲ类牙颌面畸形患者下颌后退术后近心骨段的三维变化

目的 分析骨性Ⅲ类牙颌面畸形患者双侧下颌升支矢状劈开术（BSSRO）后近心骨段三维方向位移情况,评估远心骨段后退距离与近心骨段横向间距变化量的关联。方法 横断面研究。纳入2019年6月—2021年6月于南京大学附属口腔医院就诊的30例骨性Ⅲ类牙颌面畸形患者,其中男16例、女14例,年龄18~27岁（平均21.3岁）,均接受BSSRO手术治疗。收集患者手术前1周（T0）、术后1周（T1）、术后6个月（T2）的多层螺旋CT数据进行三维重建和分析。观察项目：（1）测量手术前后不同时间近心骨段髁突顶点（Co）、髁突外极点（Cd_lat）、髁突内极点（Cd_med）、下颌角点（Go）、喙突点（Cor）、乙状切迹点（SN）在三维方向上的移动距离及横向间距变化;（2）评估远心骨段的后退距离与近心骨段术后横向间距变化量间的相关性。结果 （1）与T0时比较,T1时双侧Co点向外、下方移位,双侧Cd_med点向外、后、下方移位,双侧Cd_lat点向外、前方移位,髁突间距均增加;与T1时比较,T2时双侧Co点向内、上方移位,双侧Cd_med点向内、前、上方移位,双侧Cd_lat点向内侧移位,髁突间距均减小;与T0时比较,T2时双侧Cd_med点向后方移位,双侧Cd_lat点向前方移位：差异均有统计学意义（P值均<0.05）。髁突间距与术前差异无统计学意义（P>0.05）。（2）与T0时比较,T1时双侧Go点向外、后、下方移位,双侧Cor点和SN点向内、后、下移位,Go-Go间距增加,Cor-Cor、SN-SN间距均减小;与T1时比较,T2时左侧Go点向内、前方移位,右侧Go点向前、下方移位,左侧Cor点向上移位,右侧Cor点向前、上方移位,左侧SN点向前、上移位,右侧SN点向上移位,Go-Go间距减小;与T0时比较,T2时双侧Go点向外、下方移位,双侧Cor点向内、后方移位,双侧SN点向内侧移位,Go-Go间距增加,Cor-Cor、SN-SN间距均减小：差异均有统计学意义（P值均<0.05）。（3）远心骨段的后退距离与T0-T1期间两侧Co-Co间距增宽量呈正相关（r=0.410,P=0.025）,与T1-T2期间的Go-Go间距缩窄量呈正相关（r=0.435,P=0.016）。结论 骨性Ⅲ类牙颌面畸形患者BSSRO术后近心骨段发生明显移位,随远心骨段后退距离增加术后1周内髁突顶点间距明显增宽,而术后6个月内的下颌角标志点间距缩窄量亦随之增加。     

羟基磷灰石义眼座植入术矫治眼窝畸形

目的　观察羟基磷灰石义眼座植入术矫治眼窝畸形的临床效果。方法　剪除角膜、彻底清除眼内容物 ,环状剪除视盘和剪断视神经。剪开巩膜腔 ,植入羟基磷灰石义眼座 ,间断缝合巩膜。结果　采用此手术方法矫治眼窝畸形 2 3例 ( 2 3眼 ) ,均获良好效果。结论　羟基磷灰石义眼座是理想的眼窝充填材料 ,此手术方法简单 ,符合眼球运转功能 ,达到了眼窝整形与美容的效果。     

不同方法计算谷峰比值和平滑指数评价伊贝沙坦和吲哒帕胺缓释片的降压疗效

目的　用动态血压监测,探讨谷峰比值(T/P)和平滑指数(SI)的合理计算方法,为临床长效降压药的评价提供依据。方法　患者服用伊贝沙坦和吲哒帕胺缓释片;治疗前后用动态血压监测结果,比较整体和个体2种方法计算T/P和SI值。结果　整体计算法:伊贝沙坦的T/P分别为收缩压为71.22%,舒张压为68.47%,吲哒帕胺缓释片为93.18%和65.67%;伊贝沙坦收缩压和舒张压的SI分别为4.20和2.54,吲哒帕胺缓释片为4.28和3.02。个体计算法:T/P和SI的所有指标均低于整体计算法。结论　建议采用个体法计算T/P;据整体法计算SI考虑药物降压平稳性,同时计算其个体SI。     

人工智能在脊柱畸形诊疗中的应用

脊柱畸形是一种高致畸致残性疾病,其发病年龄可覆盖全生命周期。随着计算机技术的快速发展,人工智能有了显著的进步。目前人工智能在疾病的诊疗方面有着巨大的应用潜能,也逐渐被应用于脊柱畸形的筛查、诊治、手术决策、术中操作和并发症预测等多个方面。近年来,许多研究对此方向进行了探索,提出了很多具有优秀表现和广阔应用前景的方案与模型,本文就此做一综述。     

针刺治疗原发性高血压病的临床疗效观察

目的:以24h动态血压监测评价"活血散风、平肝降逆"针法治疗轻、中度原发性高血压患者的疗效。方法:选择107例轻中度高血压患者,予以"活血散风、平肝降逆"针法治疗4周,分别于治疗前后行24h动态血压监测并计算其谷峰比值、平滑指数后进行比较分析。结果:治疗4周后24h平均收缩压、舒张压;日间平均收缩压、舒张压;夜间平均收缩压、舒张压与治疗前比较均有显著性降低(P<0.05),收缩压、舒张压负荷也有显著降低(P<0.05)。收缩压谷峰比值为76%,舒张压谷峰比值72%,收缩压平滑指数为(1.34±0.13),舒张压平滑指数为(1.16±0.22)。结论:"活血散风、平肝降逆"针法具有良好的降压效果及满意的谷峰比值、平滑指数,临床应用安全。     

Prediction of loss of correction after hemiepiphysiodesis for the alignment of lower limb angular deformities

Guided growth by temporary hemiepiphysiodesis (HEPD) is established for the alignment of lower limb angular deformities. This retrospective cohort study was designed to assess the effect of HEPD in idiopathic coronal plane deformities around the knee and on the frontal knee joint line orientation, and to test the frontal knee joint line as predictive means for recurrence.Fourty-four patients (78 deformities: valgus n = 64, varus n = 14) were enrolled in the retrospective observational study. Mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle were assessed prior to surgery and during follow-up. The facultative frontal knee joint line angle (FKJLA) was used as predictive tool. Cases of remaining growth potential (n = 45/78) after implant removal were followed to assess rebound deformity.Pre-operative angles of the mechanical axis were corrected average 9.0 months after HEPD. Pre-operative assessment of the frontal knee joint line revealed a mean of 3.9° in valgus, and –1.0° in varus deformities. At time of complete deformity correction, mean FKJLA was –0.2° in valgus, and –0.8° in varus deformities. Mean shift of FKJLA was significantly higher after singleHEPD compared to combiHEPD (P < .001). Patients having an unphysiological FKJLA (>/<0°–3°) after correction of mechanical axis had a significantly higher risk of rebound deformity (P = .01). Regression analysis showed a 60.5% higher risk of rebound deformity per each degree deviating from the FKJLA physiological range. Age, gender, or body mass index had no impact.Temporary HEPD offers great potential for the correction of the mechanical axis and the frontal knee joint line. An unphysiological change of the frontal knee joint line is associated with a high risk of recurrent angular deformities. CombiHEPD instead of singleHEPD seems to be safer to prevent detrimental frontal knee joint line shift.Level of Evidence: Retrospective comparative therapeutic study, Level III.     

V-Y皮瓣推移术在指端缺损修复中的应用

目的 探讨V-Y皮瓣推移术在指端缺损修复中的应用.方法 选取2017年1月-2019年11月指端缺损患者150例,采用V-Y皮瓣推移术修复,术后观察有无并发症、手术效果、术后疗效、疼痛程度等情况.结果 所有患者术后均无并发症;术后随访3个月,功能评定优108例,良29例,差13例;大部分患指活动自如,手指持物稳定性良好...     

Diagnostic value of chest computed tomography images in adult Poland syndrome: a report of two cases

Poland syndrome is a rare congenital developmental deformity characterized by unilateral agenesis or hypoplasia of thoracic wall soft tissue. We report two adult cases of Poland syndrome detected by computed tomography (CT) images. CT images of the two cases depicted an asymmetric chest wall with the absence of a breast and agenesis of the pectoralis muscles. A physical examination of case 1 showed a thin right chest wall with depression of the right nipple region. Hand deformities were also observed, including brachydactyly and syndactyly. In case 2, hand deformities were not found in a physical examination. Using multi-planar reconstruction, the size, position, origin, and termination of bilateral pectoral muscles could be compared symmetrically. For patients with Poland syndrome, a timely diagnosis and treatment are important. The use of chest CT in clinical practice could play an important role in the early diagnosis and treatment of Poland syndrome.     

聚四氟乙烯移植体在颜面畸形整复中的应用

人体的组织缺损或局部形态欠佳是整形美容外科领域中经常面临的棘手问题,寻找一种安全、可靠、有效、不易被吸收的组织充填材料是多年来整形外科界追寻的目标。聚四氟乙烯是一种膨体的聚合物,没有异物排斥反应,无致癌作用,且既有一定的强度,又有一定的柔韧度,是一种理想的组织代用品。自１９９７年开始,我科应用聚四氟乙烯材料修复各种原因引起的颜面畸形共１１例。术后观察４～８个月,外形良好,无１例发生并发症。