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。     

Resurfacing large skin defects of the face and neck with expanded subclavicular flaps pedicled by the thoracic branch of the supraclavicular artery

Background

Supraclavicular flaps had been widely used as pedicled flaps to reconstruct face and neck defects. However, the size of this traditional flap was limited even after expansion. In this study, we present a flap pedicled by the thoracic branch of supraclavicular artery (TBSA). The flap is located at the subclavicular region, and has the advantage of large dimension, matching colour and thin thickness.

Methods

In this series, 24 patients with ages ranging between 3 and 49 years (30 flaps with six patients in bilateral fashion) were treated in the authors’ institution.

Results

The maximum size of the flap was 25 cm × 25 cm, whereas the minimum size was 15 cm × 10 cm. The average size of the flaps was 241.1 ± 95.7 cm². Twenty-six flaps (86.7%) survived completely. Total flap loss was seen in one patient (3.3%) and was treated with reverse harvesting skin graft. Partial flap necrosis occurred in three flaps (10.0%). Through a mean time of 10-month follow-up, the colour and the texture of the flaps matched with the recipient area. No conspicuous flap contracture was observed.

Conclusion

This expanded subclavicular flap pedicled by the TBSA has proved to be a promising method with satisfactory outcome and high success rate.     

Class II subdivision with skeletal transverse maxillary deficit treated by single-sitting bone-borne appliance:: A case report

This case report describes orthodontic treatment including both skeletal maxillary expansion and unilateral distalization by means of a single bone-borne appliance followed by clear aligner therapy in a young adult patient. A surgical guide was digitally designed and three-dimensionally printed to facilitate the placement of four miniscrews in the palatal vault. The miniscrews were fitted and the bone-borne appliance was delivered in a single clinical appointment. The postexpansion photographic records and models demonstrate the opening of the palatal median suture, the pure skeletal expansion, and the resolution of the left crossbite after 40 activations. Specifically, left molar Class I was obtained in about 5 months without any loss of anterior anchorage, and the subsequent aligner phase achieved all of the objectives established in the treatment plan. This case report shows clearly how careful digital planning of miniscrew insertion and the delivery of a pure bone-borne appliance in a single sitting enabled good clinical outcomes to be achieved in an acceptable timeframe, without side effects, even in a young adult patient.     

Use of Preexpanded Forehead and Neck Skin in Case of Giant Facial Hairy Naevus: Planning and Technique

A congenital nevi is a pigmented patch which requires complete surgical excision for cosmetic reasons. Here, we report a case of a patient with facial hairy pigmented lesion, occupying the right half of her face since birth, who underwent complete surgical excision and staged reconstruction utilizing, preexpanded forehead and neck skin. We used two rectangular tissue expanders with 150 and 300 cubic cm of volumes inserted in the forehead and the neck, respectively. The length of the expanders selected were equal to 1.2 to 1.5 times the length of their respective lesions, whereas the width of the base of the expanders were approximately similar to the width of their defects. It is concluded with this case report that tissue expansion provides a good cosmetic and anatomical correction to cover large defects, with adjacent skin having similar properties.     

CBCT对种植钉辅助上颌快速扩弓技术治疗青少年上颌骨宽度不足的扩弓效率评价

目的：分析并评估应用种植钉辅助上颌快速扩弓技术（MARPE）治疗青少年上颌骨宽度不足（MTD）的扩弓效率,为制定其临床治疗方案提供参考。方法：收集20例MTD并进行MARPE治疗的青少年患者的临床资料,采用锥形束计算机断层扫描术（CBCT）测量治疗前后患者颊侧上颌宽度（BMW）、腭侧上颌宽度（PMW）、腭中缝扩大量（SE）、上颌骨性扩弓器（MSE）的扩大量（AE）和第一磨牙角度（MA）及治疗前后BMW和PMW改变值（ΔBMW和ΔPMW）,计算骨性扩弓量百分比、牙槽骨的弯曲量百分比及其余效应百分比。结果：与治疗前比较,扩弓治疗后MTD患者不同牙位处BMW和PMW增大（P<0.05）,双侧MA减小（P<0.05）。与第一磨牙处ΔPMW比较,第一磨牙处ΔBMW较大（t=3.047,P<0.05）;与第一磨牙处SE比较,第一磨牙处ΔBMW较大（t=9.655,P<0.05）。与第一前磨牙处ΔBMW比较,第一磨牙处ΔBMW较大（P<0.05）。由第一磨牙、第二前磨牙至第一前磨牙处骨性扩弓效率百分比逐渐降低,而牙槽骨的弯曲量百分比及其余效应百分比逐渐升高。结论：应用MARPE治疗青少年MTD,可有效打开腭中缝,骨性扩弓效率可达74%以上。     

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.     

皮肤扩张器法治疗手套状皮瓣术后重度虎口挛缩

目的 探讨采用皮肤扩张器治疗手套状皮瓣术后重度虎口挛缩畸形的临床疗效.方法 自2017年2月至2018年10月,四川现代医院手外科采用皮肤扩张器治疗7例手部手套状皮瓣术后导致重度虎口挛缩的患者.一期在皮瓣下埋置50～100 ml的皮肤软组织扩张器1个,术后7～10 d开始注入生理盐水,5～10 ml/次,2次/周,扩张...     

应用带导药系统的扩张器加速扩张的临床研究

目的　探索加快组织扩张速度和提高皮瓣扩张质量的新型扩张方法。方法　对 16例患者不同部位应用带导药系统的新型扩张器进行皮肤软组织扩张 ,在扩张的同时导入罂粟碱。结果　NEM(newexpansionmethod ,新型扩张法 )和GEM(generalexpansionmethod ,常规扩张法 )扩张至额定容量所需要的平均时间分别为 2 6d和 5 1d ;全部扩张完成后两种扩张法扩张器的实际注水量超过额定容量的百分比分别为 92 .41%和 2 7.12 %。扩张后扩张区皮肤血流量是 (v) :NEM :1.2 7± 0 .2 8;GEM :0 .6 4± 0 .11。表面积即时回缩率的比较为 :NEM :2 0 .17± 1.74;GEM :38.2 6± 2 .0 1。结论　采用NEM方法 ,扩张速度快 ,皮瓣的即时回缩率低 ,血运好。     

皮肤软组织快速扩张的实验研究

以白色乳猪为实验动物，分为常规扩张组（ＣＥＧ），快速扩张组（ＲＥＧ）和对照组（ＣＯＮ）。在囊内压及皮肤血流的监测下定期扩张。扩张结束后分别进行皮肤血流动力学、物理学、组织学及超微结构的观察、测量。结果表明：快速扩张后皮肤即时回缩率较常规扩张重。快速扩张可致组织增生，但增生的程度与扩张的间隔时间有关。快速扩张不损害皮肤胶原纤维的结构。因此，在充分估计缺损区大小及即时回缩重的情况下，临床上可考虑采用。