PPH联合保留肛垫整形术治疗环状混合痔的临床疗效观察

目的PPH联合保留肛垫整形术治疗环状混合痔的临床疗效的观察和探究。 方法选取2014年3月至2015年3月在我科诊治的环状混合痔患者70例,分为两组,各为35例,Milligan-Morgan手术组作对照组,PPH联合保留肛垫整形术手术组作为试验组。观察记录并分析两组患者的临床疗效及并发症情况。 结果试验组患者的手术时间（37.3±5.1） min vs （48.3±4.3） min、术中出血量（21.0±3.92） ml vs （46.4±7.0） ml、术后住院时间（5.6±1.3）天vs （8.0±1.5）天、24H疼痛评分（4.5±1.5） cm vs (5.3±1.3） cm、第一次排便疼痛持续时间（24.2±4.4） min vs （34.1±5.4） min、术后疼痛持续天数（4.1±1.1）天vs （6.4±1.8）天、大便带血时间（4.0±0.8）天vs （5.5±0.9）天、肛缘水肿时间（3.5±0.7）天vs （4.9±1.1）天均比对照组低,差异有统计学意义(P<0.05);两组均出现肛门下坠等并发症,经过针对性的处理后,症状均缓解,比较无统计学意义(P>0.05)。 结论PPH联合保留肛垫整形术治疗环状混合痔,术后疼痛轻、恢复快,疗效显著,值得进一步推广。     

双入路法在腹腔镜下游离结肠脾曲的直肠癌保肛术中的应用

目的总结腹腔镜双入路法在游离脾曲的直肠癌保肛术的操作经验及应用价值。 方法回顾分析2016年4月至2017年9月由同一组手术医师完成的双入路法腹腔镜下游离结肠脾曲的直肠癌保肛手术38例患者的临床资料及短期随访结果。 结果所有手术均获成功,无中转开腹病例,术中无左侧输尿管、左肾、脾脏及胰腺损伤。手术时间为142.4±35.3 min,术中出血量98.7±34.5 ml,切除标本长度为21.1±6.7 cm,肿瘤距下切缘4.5±2.8 cm,清除淋巴结为12.7±6.3枚,术后排气时间3.6±1.7 d,住院时间12.4±3.2 d。术后并发症4例（10.5%）,其中切口感染2例（5.26%）,尿潴留1例（2.63%）,肺部感染1例（2.63%）,无吻合口漏、吻合口出血等并发症发生。全组患者随访至今,均未见肿瘤复发。 结论双入路法在腹腔镜下游离结肠脾曲的直肠癌保肛术中径路准确,解剖层面清晰、易于掌握,值得推广应用。     

Bone regeneration of dental implant dehiscence defects using a cultured periosteum membrane

OBJECTIVES: This study aimed to demonstrate the feasibility of a cultured periosteum (CP) membrane for use in guided bone regeneration at sites of implant dehiscence. MATERIAL AND METHODS: Four healthy beagle dogs were used in this study. Implant dehiscence defects (4 x 4 x 3 mm) were surgically created at mandibular premolar sites where premolars had been extracted 3 months back. Dental implants (3.75 mm in diameter and 7 mm in length) with machined surfaces were placed into the defect sites (14 implants in total). Each dehiscence defective implant was randomly assigned to one of the following two groups: (1) PRP gel without cells (control) or (2) a periosteum membrane cultured on PRP gel (experimental). Dogs were killed 12 weeks after operation and nondecalcified histological sections were made for histomorphometric analyses including percent linear bone fill (LF) and bone-to-implant contact (BIC). RESULTS: Bone regeneration in the treatment group with a CP membrane was significantly greater than that in the control group and was confirmed by LF analysis. LF values in the experimental and the control groups were 72.36+/-3.14% and 37.03+/-4.63%, respectively (P<0.05). The BIC values in both groups were not significantly different from each other. The BIC values in the experimental and the control groups were 40.76+/-10.30% and 30.58+/-9.69%, respectively (P=0.25) and were similar to native bone. CONCLUSION: This study demonstrated the feasibility of a CP membrane to regenerate bone at implant dehiscence defect.     

耳后肌筋膜骨膜瓣设计和血管网的应用解剖学研究

目的:测量耳后肌筋膜骨膜瓣内耳后动脉的走行长度、分布宽度及范围,为临床应用提供理论依据。方法:取3例尸体头颅标本行血管铸型,其中1例行聚乙烯醇-氧化铋灌注后X线摄影,分别测量耳后动脉走行的长度、分布的宽度及范围。结果:耳后动脉走行平均最大长度12.54(11.54~13.70) cm;平均最大宽度分布6.74(5.54~7.93) cm;聚乙烯醇-氧化铋灌注造影测得耳后动脉走行平均最大长度为7.84(7.72~7.95) cm;平均最大分布宽度为4.57(4.28~4.85) cm。结论:在临床上,制取耳后动脉为蒂的耳后肌筋膜骨膜瓣平均最大切取面积为12.54 cm×6.74 cm。     

带血管蒂髂骨膜瓣移位治疗股骨头缺血性坏死

目的 探讨带血管蒂的髂骨膜瓣移位治疗股骨头缺血性坏死的疗效。方法 １９８３年６月～１９９７年８月,应用带旋股外血管升支或旋髂深血管蒂的髂骨膜瓣移位治疗股骨头缺血性坏死１０６例,其中Ⅱ期６４例,Ⅲ期３９例,Ⅳ期３例。结果 １０６例经２年４个月～１６例随访,根据赵德伟制定的成人股骨头缺血性坏死修复与再造疗效评价方法,成５４例,良３８例,可９例,优良率为８６．８％。结论 带血管蒂髂骨膜瓣移位治疗股骨头缺     

改良“榫头式”髂骨瓣血管蒂移植治疗陈旧性股骨颈骨折22例疗效观察

目的：介绍改良＂榫头式＂髂骨瓣血管蒂移植内固定治疗青壮年不稳定型陈旧性股骨颈骨折的临床经验,以及研究改变张应力和剪应力为纯压缩力、恢复股骨头正常负重面积的治疗手段。方法：在青壮年组中,采用改良＂榫头式＂髂骨瓣、骨膜瓣血管蒂一直用多枚克氏针或螺钉内固定,改变原张应力及剪应力为纯压缩力的方法,治疗不稳定型陈旧性股骨颈骨折22例。结果：22例患者术后平均4.6周可扶双拐离床不负重活动,平均15.4周可弃拐室内行走。均获6年以上随访,骨折均愈合,疗效显著。结论：对青壮年不稳定型陈旧性股骨颈骨折的切开复位治疗可选择本方法。     

直肌联接术与眶骨膜固定术的比较研究

目的对比分析直肌联接术与眶骨膜固定术对麻痹性内斜视和固定性内斜视的治疗效果．方法回顾性分析了昆明医科大学第一附属医院眼科2002年2月至2013年4月收治的麻痹性内斜视50人，固定性内斜视22人．根据手术方法的不同2种内斜视各分为A组（直肌联接术）和B组（眶骨膜固定术）．分析2种手术的方法及特点，分别定性比较二组治疗前、后复视改变及眼球运动，定量比较斜视度变化；并对每种内斜视2组之间相关性进行比较．结果（1）2种内斜视A、B组术后1周，前方复视消失；术后2月，A组部分患者前方复视出现，而B组的没有变化；（2）术后1周及2月复诊，麻痹性内斜视A组眼球可向颞侧转动8°左右，其余方向运动无受限；B组眼球只能轻微上下转动，其余方向运动受限．固定性内斜视A组部分眼球可轻微内转或上下转，不能外转．B组不能运动；（3）2种内斜视术后1周A、B组斜视度检查正位至-5°（0-10△）（P〈0．05），术后2月与术后1周比较A组斜视度回退欠矫（P〈0．05），B组未回退（P〉0．05）；（4）术前及术后1周，2种内斜视A、B组之间斜视度比较无统计学差异（P〉0．05）；术后2月斜视度比较有统计学差异（P〈0．05）．结论（1）2种手术对麻痹性和固定性内斜视的斜视度矫正近期效果满意，但远期联接术较固定术易复发；（2）联接术不影响眼球转动，甚至可以恢复部分运动，而固定术对眼球运动有明显的限制作用；（3）联接术后复发，程度较重的麻痹性内斜视可以采用眶骨膜固定术，程度较轻的固定性内斜视可以采用直肌联接术．     

Periosteal Gaucher-like cells in beta-thalassemia major

A 24-year-old Chinese woman who has undergone staged surgery for craniofacial deformity secondary to β-thalassemia major is presented. Local clusters of Gaucher-like cells were found in the periosteum of the mandible. The histologic and ultrastructural features of these cells are described and the pathogenesis and differential diagnoses discussed. To the best of our knowledge, this is the first reported case of Gaucher-like cells occurring outside the lymphohematopoietic system in thalassemic patients.     

旋股外侧动脉横支联合臀中肌支大转子骨(膜)瓣的应用解剖

目的:进一步为临床应用大转子骨(膜)瓣移位术提供解剖学基础及手术方式。方法:在52侧经股动脉灌注红色乳胶的成人下肢标本上,重点对旋股外侧动脉横支、升支的臀中肌支走行、分布及臀中肌的形态、血供来源进行解剖学观测。结果:旋股外侧动脉横支起始点外径(2.5±0.8)mm,其上行支分布于大转子前外侧部,供血范围4.0cm×2.0cm×3.5cm,下行支分布于股骨前外侧的骨膜,供血范围9.7cm×4.6cm。臀中肌支起点至入肌点的距离为(3.5±0.8)cm,血管在近臀中肌止点处有小动脉穿出至大转子上部和外侧面。臀中肌由多条血管供血,诸血管肌支在肌肉内形成丰富的血管吻合网。结论:可设计旋股外侧动脉横支联合升支的臀中肌支为蒂大转子骨(膜)瓣,移位治疗股骨头缺血性坏死、股骨颈骨折、股骨中上段缺损的手术方式,并具有血供可靠、操作简便、术式灵活多样等特点。     

Light microscopic studies of pedicle and early first antler development in red deer (Cervus elaphus)

Background: Although it is known that deer antlerogenic potential resides in the periosteum of an antlerogenic region and antler forms through modified endochondral ossification, how a deciduous antler forms histologically through a permanent pedicle from the periosteum has not been reported. Methods: Histogenesis of the pedicle and the early first antler in red deer was systematically examined using light microscopy techniques. Results and Conclusions: At the pre-pedicle stage, the frontal lateral crest (under 5 mm in height) consisted horizontally of antlerogenic periosteum and underlying cancellous bone. Both the cellular layer (3.74 times, P<0.01) and the fibrous layer of the antlerogenic periosteum were much thicker than those of the margin of the antlerogenic region or the facial periosteum. The crest was formed through intramembranous ossification. When the pedicle began to develop (5–15 mm in height), some discrete clusters of mature chondrocytes appeared in the bony trabeculae, which signified the beginning of the transition of the ossification pattern from the intramem branous to the endochondral. The pedicle consisted of three portions from distal to proximal, periosteum/perichondrium, osseocartilaginous tissue, and osseous tissue. When the pedicle became visible (about 20 mm in height), it consisted of the same three portions as the pedicle initiation stage, but the osseocartilaginous portion was expanded compared to the initiation stage and the cartilaginous proportion increased distally. When the pedicle grew to 25–40 mm in height, continous cartilaginous trabeculae appeared under the apical perichondrium. The pedicle consisted of four portions from distal to proximal: perichondrium, cartilaginous tissue, osseocartilaginous tissue, osseous tissue. It was formed through endochondral ossification. All these ossification pattern changes could not be seen externally as the overlying integument was characterised by typical scalp skin. When the pedicle grew to about 60 mm in height, antler tissue was visually apparent at the apex as the hair type changed from scalp hair to the velvet-like hair of growing antler. However, this transformation could not be distinguished internally as the inside tissues were all continuous between pedicle and antler. Therefore, the histogenesis of the deer pedicle and the first antler originated from the antlerogenic cells and covered two phases: an internal phase through which pedicle was formed and an external phase which signalled the beginning of antlerogenesis. © 1994 Wiley-Liss, Inc.