Bilateral reverse U incisions and separately placed columella relaxation incision for correction of bilateral cleft lip nose deformity

The reverse U incision method has been employed for the correction of the unilateral cleft lip nose deformity for more than twenty years with satisfactory results. It has some columella lengthening effect and thus has proved to be useful for the correction of nasal deformities of bilateral cleft lip. To augment its columella lengthening effect a columella relaxation incision is added to the bilateral reverse U incision for the correction of the bilateral cleft lip nose deformity. This results in a reconstructed columella of satisfactory length and width.     

膝内侧改良切口结合NT-pc治疗粉碎性髌骨骨折

目的 寻找一种有利于粉碎性髌骨骨折术中复位、固定和术后恢复的手术入路。方法 采用膝内侧改良切口结合NT-聚髌器(NT-pc)治疗粉碎性髌骨骨折38例，其中碎骨块呈3块者18例、4块者13例、5块者5例、6块者2例。结果 38例随访时间3个月—2年6个月，除1例因二次手术病程较长、1例术后缺乏锻炼致膝关节功能稍受影响外，其他患者膝关节活动均恢复正常，切口愈合好，按李纯志等疗效评定标准，优良率94．7％。结论 膝内侧改良切口具有充分显露髌骨、切口短、组织损伤小，有利于术中手指对骨块抚平复位和对关节面复位质量的检查及术后功能恢复；NT-pc符合张力带原理，对严重粉碎性髌骨骨折的骨折面具有持续的纵向及横向的应力作用，有复位及固定的双重作用。对于严重粉碎性髌骨骨折，采用内侧改良切口及NT-pc固定不失为一种较理想的方法。     

Kimura's disease associated with minimal change nephrotic syndrome: A case report

Kimura's disease is a rare disorder that involves regional lymph nodes and the major salivary glands, which become infiltrated by eosinophils and lymphocytes. Renal lesions associated with Kimura's disease are rare. We describe the case of a 60-year-old Japanese woman who first noted a nodular mass in a salivary gland. As the nodule grew, nephrotic syndrome and heart failure developed. A biopsy of the nodule revealed Kimura's disease, and surgical excision was performed. After the operation, the heart failure and nephrotic syndrome, which were diagnosed as minimal change disease on renal biopsy, improved rapidly without steroid therapy. Four months later, the nephrotic syndrome recurred without recurrence of Kimura's disease. The patient showed marked improvement during prednisolone therapy (40 mg/d) and was in complete remission 4 weeks after the initiation of steroid therapy. This case shows that surgical excision and prednisolone therapy are useful for nephrotic syndrome associated with Kimura's disease.     

(iii) Minimal invasive techniques in the management of tibial plateau fractures

Intra-articular fractures of the proximal tibia present a wide spectrum of injury patterns with associated soft tissue injury. The last two decades have seen the techniques of management evolve from extensive open reduction and rigid internal fixation to arthroscopy-assisted minimal invasive surgery (MIS) and biologically benign internal fixation. The ultimate aim is to prevent the occurrence of late degenerative arthritis. This could be achieved in selected patients using minimal invasive surgery, which offers the advantages of better visualisation and management of intra-articular soft tissue injuries, confirmation of fracture reduction viewed from the joint surface, faster rehabilitation and fewer wound complications.     

无创正压通气不同压力支持水平对正常人呼吸做功的影响

目的 :观察无创正压通气 (NIPPV)不同压力水平对正常人呼吸做功的影响 ,为临床合理地应用NIPPV提供理论依据。方法 :选择 9例正常人行NIPPV并寻找出“最舒适”的吸气压力水平 (IPAP) ,在此压力基础上增加或减少 2 5 %的压力 ,构成低IPAP、最舒适IPAP和高IPAP三个压力水平 ,每一IPAP水平通气 15min以上 ,比较不同压力水平呼吸做功改变。结果 :受试者认为“最舒适”的IPAP为 (11.33± 3.2 0 )cmH2 O ,EPAP为 (4 .5 6± 0 .88)cmH2 O[相当于PSV水平为 (6 .77± 3.2 0 )cmH2 O]。与自主呼吸相比 ,NIPPV增加VE的同时 ,总的呼吸做功(Wtot)明显增加 (P <0 .0 5 ) ,而受试者吸气肌做功占总的吸气做功的百分比 (Wi,p/Wi)明显减少 (P <0 .0 5 )。在最舒适IPAP时 ,Wi,p/Wi降低到基础值的 14 %± 9%。这种变化趋势与IPAP的水平相关。结论 :NIPPV可以显著降低吸气肌肉做功。吸气肌做功减少的比例与IPAP的水平相关。研究的结果为NIPPV时PSV的参数设定提供了生理学的依据。     

生物医学测量及控制技术新进展

介绍生物医学测量及控制技术领域中的一些研究进展。     

Cosmetic benefits of lower midline skin incision for pediatric open heart operation

OBJECTIVE: Since we developed the procedure in 1996, we have now performed 100 pediatric open heart operations using a lower midline skin incision and a minimal sternotomy approach. METHODS AND RESULTS: To elucidate the benefits of this approach, we analyzed these 100 cases retrospectively. There was no death, and no major complication, caused by this approach, and the resulting scarring in each patient is difficult to be seen under a common undershirt. CONCLUSION: This review shows that the technique of a lower midline skin incision and minimal sternotomy approach is a safe reliable and cosmetically advantageous method for a pediatric cardiac operation.     

Minimally invasive spinal surgery

Minimally invasive surgery offers quicker recovery and less morbidity for our patients through smaller surgical wounds and less tissue trauma. Although minimally invasive surgery has progressed in other fields of surgery for many years, spine surgeons have not previously embraced this philosophy for the various reasons discussed. However, minimally invasive spinal surgery has gained much interest in recent years. With the advent of new instrumentation, technology, and techniques, the promise of minimally invasive surgery in the spinal arena has become a reality. With the use of the microscope, navigational tools, newly developed canula for retraction, and image-guided percutenous pedicle screw systems, we can accomplish the same surgical procedures as currently used through smaller wounds and with greater precision. Nevertheless, all new technology does offer us an initial challenge of steep learning curves. Minimally invasive should not equate to minimal and inadequate treatment for our patients. Furthermore, careful analysis of this new technique is underway to assess its true advantages as compared with our current and proven techniques.     

改良限制性切口额颞部除皱术

目的　为提高额颞部除皱术的效果 ,延长有效时间 ,从理论与实际观察探讨额颞部老年化改变形成的原因 ,并采用相应的手术术式进行矫正。方法　肿胀麻醉下 ,通过颞部发际缘切口入路 ,在颞深筋膜浅面剥离 ,内达颞肌前缘及眶外缘 ,下达颧弓上缘 ,后达耳屏前线。额部切口入路在帽状腱膜下剥离 ,下达眶上缘外至颞线后至枕外隆突。口腔内上颊龈沟入路在颧骨及颧弓骨膜下剥离。上述各剥离区域相互贯通 ,最后将颞区皮瓣上提 ,并将颞浅筋膜与颞深筋膜缝合固定。结果　本组共 32例 ,术后眉外侧平均上提 8mm ,鼻唇沟变浅 ,获随访的 7例为术后 3～2 4个月 ,除皱效果满意。结论　本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊 ,同时减少上面部降肌的作用 ,相对增强提肌的作用 ,再辅以筋膜及皮肤上提固定达到除皱的目的 ,效果确实、可靠、安全、持久。     

扩大经额硬膜外入路切除巨大侵袭性垂体瘤

目的:探讨采用扩大的经额硬膜外入路切除巨大侵袭性垂体瘤的临床应用.方法:1997年6月至2002年3月采用该入路显微外科切除巨大侵袭性垂体瘤10例,肿瘤主要累及于鞍上、蝶筛窦及上斜坡区.结果:本组10例中,肿瘤全切6例,次全切除3例,大部分切除1例.术后发生颅神经麻痹4例,其中动眼神经障碍3例,外展神经障碍1例.全组无手术死亡.术后影像学随访6～24个月,全切除肿瘤病例未见肿瘤复发,次全切除者无明显增大.结论:该入路可充分显露鞍区肿瘤,术野开阔,对脑组织损伤小,适用于已侵犯蝶筛窦区及上斜坡的侵袭性垂体瘤.