肋骨原发性骨肿瘤的诊断及治疗

目的探讨肋骨原发性骨肿瘤的诊断及手术方式。方法回顾性分析6例（7根肋骨）肋骨原发性骨肿瘤患者的临床特点及手术治疗效果。6例均行手术切除,切除范围：超过肿瘤边缘2 cm离断肋骨,延上一肋骨下缘、下一肋骨上缘切除周围组织。1例用聚丙烯材料行胸廓重建术。结果随访时间1~7年,无1例复发。结论肋骨原发性骨肿瘤手术治疗效果明确,复发率低。     

Functional analysis of CTRP3/cartducin in Meckel's cartilage and developing condylar cartilage in the fetal mouse mandible

CTRP3/cartducin, a novel C1q family protein, is expressed in proliferating chondrocytes in the growth plate and has an important role in regulating the growth of both chondrogenic precursors and chondrocytes in vitro. We examined the expression of CTRP3/cartducin mRNA in Meckel's cartilage and in condylar cartilage of the fetal mouse mandible. Based on in situ hybridization studies, CTRP3/cartducin mRNA was not expressed in the anlagen of Meckel's cartilage at embryonic day (E)11.5, but it was strongly expressed in Meckel's cartilage at E14.0, and then reduced in the hypertrophic chondrocytes at E16.0. CTRP3/cartducin mRNA was not expressed in the condylar anlagen at E14.0, but was expressed in the upper part of newly formed condylar cartilage at E15.0. At E16.0, CTRP3/cartducin mRNA was expressed from the polymorphic cell zone to the upper part of the hypertrophic cell zone, but was reduced in the lower part of the hypertrophic cell zone. CTRP3/cartducin-antisense oligodeoxynucleotide (AS-ODN) treatment of Meckel's cartilage and condylar anlagen from E14.0 using an organ culture system indicated that, after 4-day culture, CTRP3/cartducin abrogation induced curvature deformation of Meckel's cartilage with loss of the perichondrium and new cartilage formation. Aggrecan, type I collagen, and tenascin-C were simultaneously immunostained in this newly formed cartilage, indicating possible transformation from the perichondrium into cartilage. Further, addition of recombinant mouse CTRP3/cartducin protein to the organ culture medium with AS-ODN tended to reverse the deformation. These results suggest a novel function for CTRP3/cartducin in maintaining the perichondrium. Moreover, AS-ODN induced a deformation of the shape, loss of the perichondrium/fibrous cell zone, and disorder of the distinct architecture of zones in the mandibular condylar cartilage. Additionally, AS-ODN-treated condylar cartilage showed reduced levels of mRNA expression of aggrecan, collagen types I and X, and reduced BrdU-incorporation. These results suggest that CTRP3/cartducin is not only involved in the proliferation and differentiation of chondrocytes, but also contributes to the regulation of mandibular condylar cartilage.     

高频超声在隐匿性肋骨骨折诊断中的应用价值

目的探讨高频超声在隐匿性肋骨骨折诊断中的应用价值。方法对42例有胸部外伤史、临床表现及体征均怀疑肋骨骨折的患者同时行高频超声及X线检查,分析高频超声及X线对肋骨骨折的检出情况。结果42例患者通过多次超声及X光片复查最终确诊均有不同程度肋骨骨折,其中高频超声初次检查发现39例患者有肋骨骨折及软组织损伤情况,检出率为93％,骨折断端错位0．5～5．5mm,检出X线胸片未查出的7例骨折;经x线初次检查发现肋骨骨折32例,检出率为82％,骨折断端错位2．0～5．5mm,检出高频超声未查出的骨折1例。两者对肋骨骨折检出率的比较具有高度统计学意义（P〈0．01）。结论高频超声能检出X线检查不能显示的轻微肋骨骨折,对隐匿性肋骨骨折的检出具有重要的临床应用价值。     

耳后推进皮瓣联合肋软骨移植一次性修复部分耳廓缺损

目的：介绍一种一次性修复外伤后部分耳廓缺损的方法。方法：以耳廓缺损缘为蒂形成耳后推进皮瓣,取自体肋软骨雕刻成片状支架与缺损缘拼接,形成耳后筋膜瓣覆盖支架后侧,联合肋软骨供区全厚皮片移植一次性修复部分耳廓缺损。结果：临床应用8例,缺损一次性修复,双侧耳对称,外形满意。结论：联合应用以缺损缘为蒂的耳后推进皮瓣及自体肋软骨移植技术可一次性修复外伤性部分耳廓缺损,具有治疗周期短、效果可靠的特点。     

Original article： Perichondrium/cartilage composite graft for repairing large tympanic membrane perforations and hearing improvement

Background The main risk factors for postoperative failure in tympanoplasties are large perforations that are difficult to repair, annular perforations, and a tympanic membrane （TM） with extensive granular myringitis that require middle ear exploration and mastoidectomy. The aim of this study was to investigate a novel technique of perichondrium/cartilage composite graft for repairing the large TM perforation in the patient of otitis media. Methods Retrospective chart reviews were conducted for 102 patients with large tympanic membrane perforations, who had undergone tympanoplasty from August 2005 to August 2008. Tympanoplasty or tympanomastoidectomy using a perichondrium/cartilage composite graft was analyzed. The tragal or conchal perichondrium/cartilage was used to replace the tympanic membrane in patients. Results Patients aged from 13 to 67 years were followed up in average for 24 months （10-36 months）. Seventy-four ears （72.61%） were used the tragal perichondrium/cartilage as graft material and 27 ears （27.39%） were used the conchal perichondrium/cartilage. Graft take was successful in all patients. Postoperative complications such as wound infection, hematoma, or sensorineural hearing loss were not identified. Nine patients （8.82%） had the partial ossicular replacement prosthesis, 14 patients （13.72%） using the autologous curved incus and 79 patients （77.45%） without prosthesis. Successful closure occurred in 92% of the ears. A total of 85.8% patients achieved a postoperative hearing improvement. Conclusions The graft underlay tympanoplasty using perichondrium/cartilage composite is effective for the majority of patients with large perforation. The hearing was improved even if the mastoidectomy was required in the patients with otitis media with extensive granulation.     

热带沿海地区断指再植的临床研究

目的:观察热带沿海地区断指再植的临床治疗效果,探讨高温高湿高盐环境对断指再植术的影响。方法:2009年4月～2011年10月我科收治58例66指断指患者,断指再植术按清创、骨固定、修复肌腱、吻合血管、吻接神经顺序进行手术,患者术后2周开始进行功能锻炼,4周拔克氏针,同时对存活的断指进行功能评定。结果:所有患者均顺利完成手术,成活60指,坏死6指,成活率为90.9%。远节断指再植术成活率显著高于近节断指再植患者(P<0.05),中节断指再植与近节和远节断指再植成活率差异无统计学意义(P>0.05);离断时间≤断指成活率高于>6h组,其差异具有显著的统计学意义(P<0.05);断指采用低温保存成活率高于采用常温保存组,其差异具有显著的统计学意义(P<0.05);致伤原因的不同导致的断指成活率的差异不具有显著的统计学意义(P>0.05)。结论:热带沿海地区只要离断的手指条件许可,行断指再植术可取得良好的效果,彻底清除是断指存活的基础,对血管的精细吻合是断指存活的关键。     

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

Abstract

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.

Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.

Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.

Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4?±?5.24?dB. The mean ABG was 9.2?±?2.13?dB 1 month postoperatively and 8.5?±?2.26?dB 6 months postoperatively (p?<?.005).

Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn’t require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.     

Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts

Abstract

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient.

Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty.

Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air–bone gap (ABG) gains were compared.

Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3?±?8.32 months, overall mean ABG gain was 11.33?±?8.42?dB. Overall median postoperative ABG value (9?dB) was significantly lower compared to the median preoperative value (24?dB) (p?<?.001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p?=?.04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p?=?.68).

Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.     

牙髓细胞和肋软骨细胞共培养形成组织工程软骨的胶原类型分析

目的 :研究牙髓细胞和肋软骨细胞共培养形成的组织工程软骨的胶原类型。方法 :人肋软骨细胞和牙髓细胞按1∶1的比例用微团法共培养来促进其向软骨细胞分化。应用苦味酸天狼猩红染色,偏正光检测法研究形成的组织工程软骨胶原类型,并与颅颌面区域软骨进行比较。结果:肋软骨细胞和牙髓细胞微团法共培养形成的组织工程软骨中以I型胶原为主,同时包括II和III型胶原纤维,其纤维结构组成与肋软骨、髁突软骨增殖层及颞下颌关节盘的纤维结构相似。结论:肋软骨细胞和牙髓细胞共培养可形成的组织工程软骨,其组织结构与纤维软骨相似。