Study of Yang's Onion Flap Technique for Release of Scarred Eponychium and Nail Fold Reconstruction in Burn Patients

Background  Abnormalities of fingernail growth and appearance are among the most common deformities encountered after burn injury to the hand. Various techniques used for resurfacing defects include incision of the scarred eponychium and advancement of the distal segment, flap reconstruction-distally, and proximally based transposition/advancement flaps, composite graft techniques, microvascular transfer. In the present study, we used an onion flap to release scarred eponychium and nail fold reconstruction in a single stage without using soft tissue from another area. Materials and methods  Forty-four burnt fingers were operated using Yang''s onion flap technique. Patients were assessed for flap necrosis, hematoma and infection in the early postoperative period and for donor site scar, nail appearance, and symptomatic relief in a follow-up for at least 4 months. Results  The flap was successfully performed on all fingers. Only two fingers had flap necrosis. There was no incidence of hematoma or infection. The donor site scar and nail plate appearance improved and was acceptable to most patients after surgery. There was also significant relief in daily activities in 19 out of 28 symptomatic patients. Conclusion  Yang''s flap to correct nail deformities in burn patients is feasible in Indian scenario. It is associated with a low complication rate and improved nail appearance. There is also significant symptomatic relief in performing daily activities after surgery.     

Outcomes of Eight‐Plate Epiphysiodesis for Residual Clubfoot Deformities

ObjectiveThe outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight‐plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot.MethodsWe retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid‐foot, which in detail, an eight‐plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight‐bearing radiographic measurements including talo‐first metatarsal angle, calcaneo‐fifth metatarsal angle and medial‐to‐lateral column length.ResultsA total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow‐up (range, 28 to 54 months). The average talo‐first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo‐fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow‐up. The mean ratio of the medial‐to‐lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t = 3.566; P < 0.001).ConclusionsEight‐plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy.     

肌功能性重建在面横裂整复中的应用

目的：总结9例先天性面横裂的手术治疗体会,探讨肌功能性重建术在面横裂整复中的作用。方法：采用上唇黏膜瓣联合皮肤“Z”字成形术整复先天性面横裂9例,术中解剖复位口轮匝肌和颊肌进行肌功能性重建。结果：所有病例创口均I期愈合,无口角裂开或瘘管形成。无论静态或动态时,双侧口角形态自然对称,面颊部无明显凹陷性畸形。结论：上唇黏膜瓣联合皮肤“Z”字瓣法整复先天性面横裂,设计简单,操作方便,术中经肌功能性重建后可形成圆滑自然的口角及丰满的面颊部形态,且不影响张口,值得推广。     

器械过伸疗法治疗强直性脊柱炎脊柱屈曲畸形

目的:通过前瞻性单盲临床研究,观察自创的"器械过伸运动疗法"对强直性脊柱炎脊柱屈伸功能障碍的改善作用。方法:选取2007年12月~2009年11月在本院强直性脊柱炎专科门诊就诊的患者60例,随机分为2组,在服用同样维持药物的前提下,1组进行使用器械运动疗法的功能训练,1组不做任何处理,治疗前和治疗2个月以后观察2组患者脊柱功能活动度指标(指地距,枕墙距,脊柱长度,Schober指数)、Dougados强直性脊柱炎脊柱功能指数和腰背肌肌力,对所得数据进行统计分析。结果:治疗组在治疗2个月后自身前后各项指标改善程度比较差异有统计学意义(P0.05),对照组各项指标改善程度比较差异无统计学意义,组间数据比较有统计学意义差异(P0.05)。结论:"器械过伸运动疗法"在改善强直性脊柱炎患者脊柱活动度方面有一定临床疗效;能够改善强直性脊柱炎患者Dougados强直性脊柱炎脊柱功能指数,明显提高强直性脊柱炎患者腰背肌的肌力,从而改善患者的脊柱畸形程度。     

正颌术中髁突定位技术的研究进展

正颌手术后髁突移位可导致患者复发以及出现颞下颌关节症状。为减少术后髁突移位,众多髁突定位技术运用于临床中。旨探讨髁突定位技术预防术后出现关节症状及复发的有效性,本文回顾近20年内国内外正颌术中髁突定位技术的相关文献,经文献归纳发现,定位技术以稳定术前髁突位置为最终目的,可分为非计算机辅助和计算机辅助定位技术。目前计算机辅助设计与制造髁突定位装置(computer-aided design/computer-aided manufacturing condylar positioning devices,CAD/CAM CPDs)定位效果最佳,由牙支持式与骨支持式导板组成。其余各技术定位效果由高到低排序:CAD/CAM钛板定位>手法定位>计算机辅助导航系统>影像定位系统。各定位技术的精准度可达到与髁突术前位置相差1～2 mm与1°～2°,有效预防术后复发以及关节症状,为不同级别的外科医生和不同难度的病例提供临床参考。该领域仍缺乏大样本和长时间随访的随机对照试验。未来需进一步研究,以优化现今髁突定位技术,提升其临床实际效用及开拓新型定位技术。     

苦豆子总碱对雄性小鼠生殖细胞辐射损伤的影响

目的:研究苦豆子总碱对60Coγ射线照射雄性小鼠生殖细胞的影响.方法:小鼠腹腔注射苦豆子总碱,采用60Coγ射线全身均匀照射,剂量为5.0Gy,检测受照小鼠染色体畸变率、精子畸形率、睾丸指数以及对其睾丸组织进行病理学观察.结果:辐射损伤后小鼠染色体畸变率、精子畸形率增加,睾丸指数下降并发生形态学改变.苦豆子总碱可促进上述受损指标的恢复.结论:苦豆子总碱对受照小鼠雄性生殖细胞具有一定的保护作用.     

Chest radiograph prevalence of vertebral deformity among young and middle-aged population of mixed city dwellers and rural residents

BackgroundTo interpret the importance of minimal and mild vertebral deformities (VDs) among elderly subjects, we need to know their prevalence among mostly non-osteoporotic subjects.MethodsWe retrospectively analyzed VDs among 408 female and 374 male patients who had lateral chest radiographs due to mild illness or for routine healthcheck, all with indications other than spine disorders or metabolic disorders. The study subjects were divided into four age groups, i.e., ≤20, 20–34, 35–44, and ≥45 years. For those aged >20 years, 27.2% females had family roots from farming communities, and 26.4% males had the history of being a farmer or physical laborer (this was 36.1% for males aged ≥45 years). Fracture shaped vertebral deformities (FSVDs) were VDs radiographically indistinguishable from vertebral fracture. Acquired short vertebrae were those with decreased vertebral anterior and middle heights, while without anterior wedging or bi-concave changes, and the diagnosis required at least two adjacent short vertebrae in the same subject.ResultsCongenital VDs were observed in four cases (three males, one female). In the age group of ≤20, 20–34, 35–44, and ≥45 years, females had any FSVD prevalence of 13.4%, 8.3%, 11.8%, 25.8% respectively, while the prevalence was 29.3%, 26%, 34.3%, 44.8% respectively for males. From the female ≤20 years group to the 21–34 years group, cases involved multiple vertebrae decreased from 53.8% to 16.7%. For cases ≤34 years, no female case had ≥ mild FSVD (which was defined to have ≥20% vertebral height loss), while five male cases had ≥ mild FSVD. For the 35–44 years group, vertebral endplate depression was noted among 2.0% of the females and 2.9% of the males. Among the cases aged ≤44 years, there was only one male and one female had acquired short vertebrae. For the male cases, acquired short vertebrae prevalence was 15.6% in the group of ≥45 years.ConclusionsFSVD is common among young and middle-aged population (≤44 years) assumed with normal bone strength, and with a higher FSVD prevalence among men. FSVD may heal among younger subjects, and physical labor may increase VD prevalence.     

深度手烧伤的治疗及功能康复

目的 :探讨深度手烧伤早期创面修复及功能康复最好的治疗方法。方法 :应用中厚皮、异体去细胞真皮基质作支架加自体刃厚皮片移植 ,腹部真皮血管网皮片及超薄皮瓣移植等手术方式 ,进行深度手烧伤早期切削痂。结果 :2 94例 4 6 2只手功能良好者 138例 2 32只手 (5 0 % ) ,功能较好者 79例 134只手 (2 9% ) ,功能障碍者 77例 96只手 (2 1% )。结论 :应用早期切削痂植皮的方法可减少瘢痕增生和畸形 ,使深度手烧伤后获得满意的外形和功能     

等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致的上气道梗阻患者13例

目的 评估内镜下等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致上气道梗阻患者的疗效。 方法 回顾性分析13例双侧声带麻痹导致的上气道梗阻患者的病例资料,其中男6例、女7例,27~73岁,所有患者均接受等离子射频辅助双侧声带后端切断术。总结评估该手术的临床疗效。 结果 13例随访时间1年1个月~2年11个月,所有患者无严重并发症发生。一次拔管率为84.44%(10/13),二次手术拔管率为88.89%(11/13),拔管时间1~3个月,中位数1个月,上气道梗阻均未复发。 结论 内镜下等离子射频辅助双侧声带切断术操作简单、手术风险小,同时治疗双侧声带麻痹效果可靠,是双侧声带麻痹导致上气道梗阻的有效治疗方法之一,也可作为其他治疗失败的补救治疗措施。