Bone augmentation after soft‐tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration

Objectives: The success of bone augmentation, for example of the alveolar ridge, might be endangered by dehiscence of the soft tissue that covers the augmented bone. Soft‐tissue coverage can be achieved without tension through pre‐augmentation tissue expansion with hydrogel expanders. We used a periosteal chamber to study the influence of tissue expansion on microcirculation and osseointegration in an in vivo animal model. Material and methods: Sixteen isogeneic Lewis rats were randomised into two groups. Additional eight animals served as donors of isogeneic bone grafts (Group 3, n=8). The bone grafts were harvested and implanted into Group 1 animals (n=8) (without tissue expansion) and Group 2 animals (after tissue expansion). In Group 2 (n=8), hydrogel expanders were inserted subperiosteally at the site to be augmented for 21 days. We used intravital microscopy to monitor microcirculation in vivo for 19 days after implantation. Specimens from both groups were evaluated histologically. Results: During the entire study period, functional microvessel density in the region above the augmentation material was significantly higher after previous tissue expansion (P>0.05). Both groups showed physiological microcirculation around the augmentation material. Histology revealed bone osseointegration of the bone graft in the group with tissue expansion and the presence of connective and granulation tissue in the group without tissue expansion. Conclusions: Pre‐augmentation soft‐tissue expansion with hydrogel expanders leads to higher functional microvessel density in the tissue above the augmentation material and thus, to more rapid osseointegration. The use of hydrogel expanders appears to increase the probability of success, especially of pre‐implant bone augmentation. To cite this article:
von See C, Gellrich N‐C, Jachmann U, Laschke MW, Bormann KH, Rücker M. Bone augmentation after soft‐tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration.
Clin. Oral Impl. Res. 21 , 2010; 842–847
doi: 10.1111/j.1600‐0501.2009.01847.x     

皮肤软组织扩张器水囊内液体污染状况与皮瓣质量相关性研究

通过对33个水囊内液体进行细菌培养和对33个皮瓣进行临床血循环观察对比,发现皮肤软组织扩张器水囊内液体污染状况与皮瓣血循环有显相关性。提示用水囊时要严格灭菌,每次注水要无菌操作,同时提出了甲硝唑注射液可作为一种新的、可行性水囊内介质。     

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。     

SKy骨扩张器椎体后凸成形术治疗骨质疏松性脊柱压缩骨折

目的:探讨一种新的SKy骨扩张系统用于椎体后凸成形术中治疗骨质疏松性椎体压缩骨折的临床效果.方法:对22例共32个椎体压缩骨折患者(62～90岁),应用新型器械SKy骨扩张器系统进行经皮穿刺、塌陷椎体扩张后注入骨水泥.随访观察患者疼痛视觉模拟评分(vasual analogue scale,VAS)及并发症情况.结果:32个椎体经单侧或双侧椎弓根穿刺成功完成手术,手术时间30～120 min,骨水泥注入量每个椎体(4.8±1.1) ml(3.0～6.8 ml),骨水泥沿针道反流1个椎体,反流入椎旁静脉1个椎体,均无临床症状,无椎管内漏及椎间隙漏,无其他并发症.所有患者疼痛缓解,VAS术前平均为(7.6±0.8)分,术后第1天平均为(3.5±0.5)分,第7天平均(2.8±0.6)分,术后1个月平均(2.4±0.6)分;随访12～26个月,症状均显著改善且无反复.22个椎体高度明显增加.结论:SKy骨扩张器椎体后凸成形术能达到消除疼痛、恢复椎体高度的目的,是治疗老年性骨质疏松性压缩骨折的有效方法.     

应用扩张皮瓣修复下眼睑外翻

目的探讨利用皮肤软组织扩张技术,修复各种原因所致下眼睑外翻。方法利用皮肤扩张器对40例各种原因所致下眼睑外翻患者行后期整复治疗,扩张器容量最小30ml,最大150ml;扩张时间2～3个月,扩张满意后面部皮肤以局部皮瓣旋转或推进整复下眼睑外翻。结果40例患者疗效基本满意,随访2年未见复发,其中2例因皮瓣局部臃肿行修薄术,扩张皮瓣色泽及质地均接近正常皮肤。结论在下眼睑外翻的后期整复中,合理应用皮肤软组织扩张技术可以取得较好的治疗效果,供区切口隐蔽,而且不易复发。     

Primary and secondary breast reconstruction with a permanent expander

Summary The second generation of tissue expanding prostheses is the permanent expander. It has been used in a series of 88 breast reconstructions following mastectomy for malignant and premalignant disease in 49 secondary and 39 primary reconstructions, the longest follow-up being 45 months and the shortest 12 months. Pre- and postoperative radiotherapy (45 gy) has been the major source of complications: implant loss (11%), infection (2%); capsular contracture-Baker's grade III–IV (90%); and, improper positioning should also be mentioned. Primary reconstruction is no longer performed if postoperative radiotherapy is scheduled. The results were totally different if radiotherapy was omitted after primary reconstruction. The expansion was smooth, an attractive breast shape with mild ptosis was easily achieved, and only minor complications were encountered. A permanent tissue expander, either alone or covered with a latissimus dorsi flap, remains our first choice in breast reconstruction.     

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     

大鼠坐骨神经急性延长的实验研究

目的 探讨急性扩张延长周围神经的合理注水量与延长值。方法 使用组织扩张器对3组（每组8只）大鼠坐骨神经行一次性扩张延长,注水量分别为3ml、5ml、7ml。分别于注水前、注水后即刻、注水后保持5min、去水囊后15min,进行肌电测定;并在光镜、透射电镜下进行组织学观察。结果 （1）延长值（起始长度均为1．5cm）：分别为8．33％、14．7％、20．4％。（2）肌电结果：3ml、5ml组的运动神经传导速度与复合肌肉电位（CMAP）的潜伏期,神经扩张前和扩张后相比无明显差别。7ml组则比术前明显减慢及延长。（3）轴突密度：3ml、5ml组扩张部与正常段神经相比无明显差异。7ml组轴突的密度则明显降低。（4）形态学：3ml、5ml组的神经结构基本正常,7ml组束膜间有血管扩张、间质水肿、出血及脱髓鞘变化。（5）超微结构：3ml、5ml组神经髓鞘为圆形,排列规则;7ml组神经髓鞘明显皱缩变形。结论 大鼠坐骨神经一次性扩张延长的合理注水量为5ml,延长值为14．6％。     

微切口小隧道置入扩张器修复面颈部皮肤软组织缺损

目的：寻求一种皮肤软组织扩张囊全新置入方法,以缩短扩张囊置入后的治疗周期。方法：运用套管针穿刺原理及内窥镜技术,研制专用剥离器械和置入器械,采用微切口小隧道充注式置式法修复面颈部皮肤软组织缺损。结果：10例面颈部皮肤软组织缺损病人采用本法治疗,扩张囊置入后治疗周期为3周－4周,软常规扩张器手术置入法缩短3周－5周,结论：微切口小隧道充注式皮肤软组织扩张囊置入法,因无需担心扩张囊置入后对手术切口愈合的影响,使首次扩张囊注液时间提前前到了手术当日进行,同时缩短了两次注液的间隔时间,可显著地缩短扩张囊在体内留置时间及患者的住院治疗周期,大幅度降低了患者的住院医疗费用。