缩短皮肤软组织扩张疗程的方法探讨

目的:探讨缩短皮肤软组织扩张疗程和提高扩张质量的方法。方法:从扩张器的选择和埋藏位置、切口缝合方式和注水策略三个方面总结80例182个扩张器的临床应用效果。结果:77例扩张效果满意,3例出现并发症:血肿2例,感染1例。结论:切口错位分层缝合是扩张器满意注水的基础;合理选用和放置扩张器以及从早、从快、从超量注水是缩短皮肤软组织扩张疗程和提高扩张效果的重要措施。     

The role of hemoglobin based blood substitutes in transfusion medicine

A cell-free oxygen transporting blood substitute would obviate many of the current concerns about conventional red cell transfusion therapy. Moreover, a stable oxygen-carrying solution could have benefits and applications not possible with red cell transfusions, such as the treatment of acute hypovolemic shock in acute care settings, the treatment of patients such as Jehovah's Witnesses who refuse blood transfusions, the priming of blood oxygenation pumps, ex vivo organ perfusion prior to transplantation, and in vivo perfusion in order to enhance sensitivity to radiation therapy. Among potential blood substitutes that transport oxygen, attention has focused on perfluorocarbons and a variety of hemoglobin preparations, either in free solution or encapsulated into lipid vesicles. In the design and production of hemoglobin solutions the following criteria must be met: low toxicity and antigenicity; efficacy as a plasma expander; prolonged survival in the circulation; adequate oxygen carrying capability and efficient oxygen unloading to tissues; long shelf life. Extensive preclinical testing and recent clinical trials have been performed on human and bovine hemoglobin chemically crosslinked to present rapid leakage of hemoglobin through the kidneys. Bovine hemoglobin has intrinsically low oxygen affinity simulating that of human hemoglobin in red cells. An alternative and attractive strategy is the production of human hemoglobin in E. Coli, thus enabling appropriate genetic mutations to optimize function. These include creation of peptide linkers to enhance plasma survival and amino acid replacements that permit a finely regulated lowering of oxygen affinity.     

皮肤外扩张器的研制与临床应用

我们自１９９３年６月起，开始研制皮肤外扩张器，其原理为通过持续对皮肤进行牵引，以获得＂额外＂皮肤组织。经临床应用３８例，表明本方法具有以下优点：操作简单，不需手术埋置扩张器，并发症少，安全可靠，并可提供准确的皮肤扩张面积数据。其中１８例已随访６个月，疗效稳定，外形及功能满意。为临床修复组织缺损提供了一种新途径。     

Intraoperative scrotal expansion before prosthesis insertion

The use of an intraoperative sustained limited expansion (ISLE) tissue expander before placing a testicular prosthesis in a hypoplastic scrotum is described.     

高粘度骨水泥结合膨胀式椎体成形器械治疗骨质疏松性椎体压缩骨折的效果观察

目的观察并分析高粘度骨水泥结合膨胀式椎体成形器械和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果。方法选取2014年10月至2017年2月期间在我院住院的OVCF患者共224例为研究对象。采用随机双盲法分为两组,观察组112例采用高粘度骨水泥结合膨胀式椎体成形器械进行椎体成形术治疗,对照组112例采用高粘度骨水泥PKP治疗。比较两组手术时间、术中出血量、骨水泥注射量、骨水泥渗漏发生率和骨水泥弥散系数,术前、术后1 d及术后1年两组Cobb角、椎体高度及视觉模拟评分法(visual analogue scale,VAS)评分变化,术后满意度。结果观察组手术时间、术中出血量及骨水泥注射量均显著少于对照组(P0.05),观察组骨水泥渗漏发生率显著低于对照组(P0.05),两组骨水泥弥散系数比较差异无统计学意义(P0.05);术后1 d及术后1年,两组Cobb角和伤椎前缘高度比较差异无统计学意义(P0.05);术后1 d及术后1年,两组VAS评分比较差异无统计学意义(P0.05);两组术后满意度比较差异无统计学意义(P0.05)。结论高粘度骨水泥结合膨胀式椎体成形器械治疗OVCF患者与高粘度骨水泥PKP治疗效果相似,但可有效缩短手术时间,减少出血量,降低骨水泥渗漏率,纠正后凸畸形,恢复椎体高度,减轻疼痛,提高术后满意度。     

皮肤软组织扩张器手术常见并发症及其对策

目的探讨皮肤软组织扩张术常见并发症的种类、发生原因、预防措施及处理方法。方法回顾性分析我科2005年至今各部位软组织扩张术68例76个扩张器手术的并发症种类、常见原因及预防处理措施。结果血肿12例(15.78%),I期术后部分表皮坏死5例(6.57%),切口延迟愈合及周围瘢痕溃疡感染3例(3.9 4%),转移皮瓣尖端部分表皮坏死7例(9.2 1%),扩张器及注射壶外露2例(2.63%),切口处部分毛发脱失2例(2.63%),未发生明显扩张器渗漏、扩张器不扩张及感染等严重并发症。结论本组软组织扩张术治疗体表瘢痕及瘢痕性秃发并发症少,无严重并发症发生,安全性高、效果好。     

Evaluation of subjective and objective cyclodeviation following oblique muscle weakening procedures

PURPOSE: To evaluate the subjective and objective cyclodeviational changes following different weakening procedures on superior and inferior oblique muscles. DESIGN: Comparative case series. MATERIALS AND METHODS: In a prospective institution based study, 16 cases of A pattern horizontal strabismus having superior oblique overaction were randomized to superior oblique weakening procedures: either silicon expander or translational-recession. Similarly, 20 cases of V pattern horizontal strabismus with inferior oblique overaction were randomized for inferior oblique weakening procedures: either 10 mm Fink's recession or modified Elliot and Nankin's anteropositioning. Cyclodeviation was assessed subjectively with the synoptophore and objectively using the fundus photograph before surgery and 3 months postoperatively. Change in cyclodeviation was measured by subjective and objective methods. The index of surgical effect (ISE) was defined as the net torsional change postoperatively. RESULTS: The difference between the extorsional change induced by the two superior oblique procedures, silicone expander (-6 degrees ) and translational recession (-11.3 degrees), was statistically significant (P=0.001). Translational recession caused more extorsional change (ISE=296%) than silicone expander surgery (ISE=107%). The two inferior oblique weakening procedures, Fink's recession (+2.5 degrees) and modified Elliot and Nankin's anteropositioning (+4.7 degrees) produced equitable amount of intorsional shift with no statistical difference (P=0.93). Objective measurements were significantly more than the subjective measurements. CONCLUSIONS: Different weakening procedures on oblique muscles produce different changes in cyclodeviation, which persists even up to 3 months. Subjective cyclodeviation is less than the objective measurements indicating partial compensation by sensorial adaptations.     

Repair of a giant omphalocele by a modified technique

 Large omphaloceles that contain centrally herniated liver pose challenges to surgical closure, the most significant being the space limitation of the abdominal cavity. In addition, the “pedicled” nature of the liver on the inferior vena cava creates a predisposition to acute hepatic vascular outflow obstruction as the liver is reduced into the abdominal cavity. In such cases, the alternatives include conservative treatment or staged silo reduction. The worst complication of silastic silo (SS) placement is tension and infection of the fascia with disruption of the suture line. Once infection or premature disruption occurs, closure of the defect is difficult or impossible. This case report details a different management technique for a newborn with a giant omphalocele and presents an interesting variation of the usual SS technique that may be helpful in the management of some cases, especially in an emergency. The thick silk sutures applied in the present case absorbed the tension and the silastic sheet prevented the risks of infection and adhesions. Accepted: 28 July 1999