Interatrial septum rupture during balloon measurement of a patent foramen ovale in a young patient presenting cryptogenic stroke.

We report the case of a 36-year-old woman admitted for cryptogenic stroke, in whom the Patent Foramen Ovale (PFO) diameter measurement, with a purpose built sizing balloon, performed before the closure procedure, was complicated with the rupture of the inter-atrial septum generating an Atrial Septal Defect (ASD) with a significant left-to-right shunt. This kind of complication may not be easy to handle, changing the initial procedural strategy from PFO to ASD closure technique requiring specific material and operator's technical skill.     

吻合血管的胸脐皮瓣移植修复足踝部大面积软组织缺损

目的 探讨吻合血管的胸脐皮瓣移植修复足踝部大面积软组织缺损的临床效果.方法 对18例足踝部大面积软组织缺损(其中11例伴胫前或胫后血管节段损害)采用胸脐皮瓣游离移植修复创面.创面面积12cm×6cm～32cm×12cm.结果 移植皮瓣全部成活,3例足跟部缺损的病人术后因长期磨擦形成足跟部慢性溃疡;3例皮瓣臃肿,需再次手术整形.其余病例外观和足踝部功能恢复满意.结论 胸脐皮瓣为腹壁下动脉供血,血运丰富,血管解剖恒定,血管蒂长,可切取面积大且易于切取,适宜修复足踝部软组织缺损,尤其适用于缺损面积大、胫前或胫后血管之一长节段损害者.     

The long-term results of meniscus transplantation for articular cartilage defects in the knee joint

The purpose of this study was to examine the long-term clinical results of meniscus transplantation for articular cartilage defects in the knee joint. The type of study was case series. From October 1990 to June 1995, eight cases underwent allogenic or autogenic meniscus transplantations for articular cartilage defects, and seven cases were available for follow-up evaluations. The age at surgery ranged from 14 to 42 years of age (average 22.5). In one case, transplantation of tissue-engineered cartilage was performed due to pain 5 years after surgery. The other six cases were followed up for 8–13 years (average 10.1). The size of the cartilage defect ranged from 1.0 to 6.3 cm² (average 2.8 cm²). Patients were evaluated with the Lysholm score and MR images. We also performed arthroscopic examinations in three cases at the final evaluation. This study leads to the conclusion that meniscus transplantation for articular cartilage damage is not comparable to autologous chondrocyte transplantation. Two cases showed a good clinical outcome but the tissue remained as fibrocartilage tissue in the long-term.     

Periosteal transplantation to the rabbit patella

Autologous periosteal transplantation (without chondrocyte cell transplantation) for treating traumatic articular cartilage defects of the patella gives pain relief in uncontrolled clinical studies. To study the whole transplanted area macroscopically and microscopically, animal studies are motivated. In this pilot study, we reproduce the surgical technique for periosteum transplantation on human patella to a rabbit model. A full-thickness cartilage defect of the whole patella was created in eight adult female rabbits. The defect was treated with autologous periosteal transplantation. After surgery, the rabbits were allowed free activity. This is the difference compared to the treatment in humans, where our group uses CPM for 5 days and non-weight-bearing for 12 weeks. After 21 weeks, there was a diffuse synovitis in all transplanted knees, and in five of eight knees there were signs of osteoarthritis in the patello-femoral joint. Histologically, in three animals, small islands of hyaline cartilage surrounded by fibrocartilage were seen in the transplanted area. In the other five animals, fibrocartilage was the predominant tissue. In contrast to previous experimental studies using a rabbit model, we did not achieve hyaline cartilage resurfacing.     

外伤性颅骨缺损钛网修补38例治疗体会

目的：探讨三维钛网颅骨缺损修补术的意义、时机及临床经验。方法：对38例外伤后颅骨缺损钛网修补术患者进行回顾性分析。结果：所有患者钛网固定可靠、无浮动,外观对称美观。无头皮感染及排斥反应,无咀嚼功能受限。结论：三维钛网是目前较为理想的颅骨缺损修补材料,条件允许下宜尽早进行,术中几点技巧的应用可有效避免术后并发症。     

完全型大动脉错位伴室间隔缺损、肺动脉狭窄的外科治疗

治疗完全型大动脉错位伴室间隔缺损、肺动脉狭窄(TGA/VSD,PS)的手术方式有Rastelli手术、Lecompte手术、Nikaidoh手术、Yamagishi手术以及动脉转位 左心室流出道扩大术等多种术式,Rastelli手术和Lecompte手术损伤小,但远期并发症多;Nikaidoh手术和Yamagishi手术解剖纠治完全,但手术损伤大;动脉转位术 左心室流出道扩大术适应证相对较狭窄。因此,在TGA/VSD,PS的外科治疗上,应根据患者的自身情况和手术指征采取不同的手术方法。现对上述手术术式的优缺点、适应证、禁忌证、疗效和展望进行综述。     

钛合金板置入在颅骨缺损修复中的应用

目的:探讨钛合金板置入在颅骨缺损修复中的应用。方法:对12例颅骨缺损的患者先进行三维CT检查,设计个性化的钛合金板置入以修复颅骨缺损。结果:本组患者均愈合良好,无感染、钛板外露及头皮血运障碍,避免了再次手术。结论:应用钛合金板修复颅骨缺损,具有良好的生物学力度,抗击性强,并发症少,生物相容性好等优点,可获得较好的治疗效果。     

阴囊皮瓣修复阴茎缺损的临床应用

目的探讨阴囊皮瓣修复阴茎大部分缺损的临床效果。方法对由不同原因引起阴茎缺损的17例患者，采用阴囊皮瓣进行修复。在阴囊根部两侧阴囊前动脉之间的无血管区剥离一腔隙，将延长后的阴茎海绵体经腔隙转移至阴囊皮瓣的下方，以包绕海绵体创面，皮瓣缝合后瘢痕在阴茎腹侧。结果切口均Ⅰ期愈合。术后随访患者1～9年，未出现皮瓣坏死现象，阴茎的外观及功能恢复较好。结论阴囊皮瓣的血运丰富、组织柔软、弹性好、伸缩性强，而且此手术切口隐蔽，是修复阴茎缺损较理想的皮瓣。     

不同骨延长器治疗肢体畸形并大段骨缺损

[目的]利用Ilizarov支架、Orthofix肢体重建系统（Orthofix LRS）及Hybrid固定系统（Hybrid Fixation System）与Orthofix LRS的组合，对不同的肢体畸形并大段骨缺损进行矫形及骨延长治疗，同时观察其疗效。[方法]自2000年8月-2004年3月分别用Ilizarov支架、Orthofix LRS及Hybrid支架与Orthofix LRS的组合进行骨痂牵开／骨段滑移治疗合并肢体畸形的大段骨缺损。畸形处采用线形／楔形截骨。畸形愈合并骨短缩者楔形截骨后进行骨痂牵开骨延长术，骨不连并畸形及短缩者接合点加压与截骨矫形骨段滑移延长同时进行。[结果]矫正股骨短缩畸形7cm1例，胫骨6例，内翻畸形2例，后成角畸形2例，混合畸形2例。平均延长5．3cm（4．5—7cm），平均延长时间3．5个月，平均延长后外固定时间7个月，无神经血管损伤，膝踝关节活动未受影响。[结论]Ilizarov支架、Orthofix LRS、Hybrid固定系统与Orthofix LRS的组合用于骨痂牵开／骨段滑移治疗合并肢体畸形的大段骨缺损均能达到矫形及骨延长的治疗目的。Orthofix LRS及Hybrid固定系统与Orthofix LRS的组合较Ilizarov支架操作简便，安全可靠，患者乐于接受。     

全髋关节翻修术中髋臼骨缺损的分类和重建研究进展

在髋关节翻修术中,髋臼骨缺损的治疗具有相当的挑战性。术前的计划,缺损的辨认和稳固的重建是成功翻修手术的基础。应用自体骨和同种异体骨移植填充骨缺损,目前使用特殊的重建方法行髋臼重建已取得了一定的疗效。临床上髋关节翻修手术越来越多,因此有必要针对髋臼骨缺损建立系统的诊断和治疗程序。本文就髋臼骨缺损的分类和重建进展做一综述。