两种术式治疗重度上睑瘢痕性睑内翻的疗效比较

目的：比较显微镜下Hotz法联合睑缘切开皮瓣转位术和单纯Hotz法治疗重度上睑瘢痕性睑内翻的临床效果。

方法：回顾性分析2017-07/2019-07在我院接受上睑内翻倒睫矫正术的患者60例84眼,试验组32例42眼采用显微镜下Hotz法联合睑缘切开皮瓣转位术,对照组28例42眼采用单纯Hotz法。术后随访观察至12mo, 记录患者主观症状、睑缘位置、睫毛外翻情况及满意度。

结果：试验组单眼平均手术时间长于对照组(40.8±2.57min vs 28.5±2.64min,P<0.01)。术后1、12mo,试验组治愈率分别为100%、95%,对照组治愈率分别为95%、76%,术后12mo试验组治愈率优于对照组(P=0.013)。 术后1mo两组患者满意度无差异(Z=1.1825,P=0.2371),术后12mo试验组患者满意度高于对照组(Z=3.7346,P<0.01)。

结论：对于重度上睑瘢痕性睑内翻,显微镜下Hotz法联合睑缘切开皮瓣转位术虽手术时间长于单纯Hotz法,但其远期疗效优于单纯Hotz法,术后12mo患者满意度较高。     

Bipolar Latissimus Dorsi Transposition and Functional Neuromuscular Stimulation to Restore Elbow Flexion in an Individual With C4 Quadriplegia and C5 Denervation

ABSTRACT

A bipolar latissimus dorsi transposition was performed on a 17-year-old male patient with a C4 spinal cord injury and complete peripheral denervation at C5. Electrical stimulation of the paralyzed but excitable latissimus dorsi provided elbow flexion that could not be achieved with the paralyzed and denervated elbow flexors. The muscle was attached from the coracoid to the ulna allowing the elbow to be flexed with the forearm and wrist maintained in the neutral position. Following a 6-week Immobilization period, the transposed muscle was exercised dally with intramuscular stimulation to increase both strength and endurance. By the fourth month after surgery, the subject could control elbow flexion proportionally with contralateral shoulder elevation using a shoulder position transducer. Functionally, the subject was able to use the neuroprosthetic system to bring his hand to his mouth and feed himself with the aid of a universal cuff and a support to stabilize the shoulder.     

Facial reanimation by transposition of the masseter muscle combined with tensor fascia lata,using the zygomatic arch as a pulley

We have created a new way of reanimating the face, involving transposition of the masseter muscle combined with tensor fascia lata, and using the zygomatic arch as a trochlea to reconstruct the inferior facial paralysis. We used it on five patients who had facial palsy after excision of malignant parotid tumours. The wide skin defect that exposed the masseter muscle after total parotidectomy was reconstructed with a free flap. This method differs from those of other methods of transposing the masseter muscle in that force is applied at an upper lateral angle. Our method provided dynamic raising of the upper lip, the corner of the mouth, and the nasolabial fold in four patients. We consider it to be useful, particularly for prompt surgical reconstruction of facial palsy after total parotidectomy with a wide defect in the skin of the cheek.     

blaCTX-M-55介导的宋内志贺菌耐药机制研究

目的：研究 blaCTX-M-55介导的宋内志贺菌＃1083的耐药机制。方法双纸片协同扩散法验证＃1083是否为产超广谱β-内酰胺酶（ESBL）菌株;PCR 方法鉴定其耐药基因;接合转移实验验证携带 ESBL 基因的质粒是否具有可转移性;VITEK 2仪器检测菌株对多种抗生素的 MIC 值;基因组测序鉴定介导耐药基因转移的移动元件;引物延伸实验鉴定耐药基因转录起始位点。结果＃1083为 blaCTX-M-55介导产 ESBL 的菌株,携带 blaCTX-M-55的耐药质粒可通过接合转移的方式进入受体菌 EC600,并使受体菌具有相应的耐药谱;介导 blaCTX-M-55转移的转座单元为 ISEcp1-blaCTX-M-55-Δorf477,且其上游的插入序列 ISEcp1为耐药基因提供强启动子区,促进耐药基因表达,且此表达为恒定表达,不受抗生素的诱导作用影响。结论质粒携带的 blaCTX-M-55为＃1083的主要耐药基因,插入序列 ISEcp1介导此基因的表达与传播。     

关节镜下肱二头肌长头肌腱转位治疗不可修复巨大肩袖撕裂的研究进展

目的综述关节镜下肱二头肌长头肌腱(long head of biceps tendon,LHBT)转位治疗不可修复巨大肩袖撕裂的研究进展。方法查阅近年来国内外关节镜下不同方式LHBT转位治疗不可修复巨大肩袖撕裂的相关文献,并进行总结分析。结果关节镜下LHBT转位是一种治疗不可修复巨大肩袖撕裂的有效方法,目前主要采用"断近端"、"两头断"、"断远端"及"不切断"4种方式。临床研究表明上述方式均能取得良好疗效,但远期疗效有待进一步随访明确。结论关节镜下LHBT转位治疗不可修复巨大肩袖撕裂手术简便、有效,患者损伤小、术后恢复快,但对术者技术要求较高,需严格把握手术适应证。     

Outcomes of incisional negative pressure wound therapy following brachiobasilic transposition arteriovenous fistula creation: A 1:2 propensity score matched study

Incisional negative wound pressure therapy (iNPWT) use on closed incisions has been shown to improve wound outcomes, but no studies have evaluated the use of iNPWT following brachiobasilic transposition arteriovenous fistula (BBT‐AVF). We aim to investigate the efficacy of iNPWT vs conventional wound therapy in reducing surgical site infections (SSIs) for BBT‐AVF incisions. This is a retrospective cohort study of patients who underwent BBT‐AVF creation between January 2010 and December 2017. A 1:2 propensity score matching (PSM) was performed to reduce selection bias and address for confounding factors. Study outcomes included SSI and haematoma incidence, 30‐day readmission, and 30‐day mortality. A total of 154 patients were reviewed in this study: 47 (30.5%) had iNPWT and 107 (69.5%) had conventional wound therapy. The overall median age was 60.5 (interquartile range 54–69). PSM with a 1:2 ratio resulted in a total of 117 patients (39 iNPWT and 78 conventional wound therapy). In the unmatched cohort, SSI incidence was lower in the iNPWT group (n = 1/47 [2.1%] vs n = 14/107 [13.1%], P = .035). However, incidence of SSI was comparable between iNPWT and conventional wound therapy after matching (n = 1/39 [2.6%] vs n = 9/78 [11.5%], P = .102). There was no significant difference in 30‐day readmission and 30‐day mortality. Within our study population of patients with BBT‐AVF incisions, there is a non‐statistically significant reduction in SSI incidence for patients who received iNPWT as compared with conventional wound therapy. Further prospective randomised controlled studies should be conducted to validate these findings.