Objective To investigate the clinical value of occlusal guide plate combined with intermaxillary fixation screw in mandibular defect repair with free fibular flap. Methods Between August and December 2011, 7 patients with mandibular tumor were treated, including 5 cases of ameloblastoma and 2 cases of gingival cancer. Of 7 patients, 4 were males and 3 were females, aged 32-65 years (median, 50 years). Occlusal guide plate was prepared and the implanted position of intermaxillary fixation screws was determined preoperatively. Hemimandibulectomy was performed in 5 cases, half mandibular segmental resection with condyle reservation in the other 2 cases. The free fibular flaps of 11-13 cm in length were harvested for repairing mandibular defects. When the free fibular flaps were fixed, the occlusal guide plate and intermaxillary fixation screws were utilized to restorate the occlusal relation. The donor site was sutured directly. Results The average operation time was 9.5 hours (range, 7-12 hours). All free fibular flaps survived completely. All incisions at the donor site and recipient site healed by first intention. All patients were followed up 10-14 months with an average of 12.3 months. All patients had symmetrical face, good occlusal relation, normal mouth opening, and normal mandibular lateral movement, and no pain of bilateral temporomandibular joints occurred. Panoramic tomography showed good mandibular contour and the suitable emplacement of fibular flaps postoperatively. No tumor recurrence occurred during follow-up period. Conclusion When repairing the mandibular defect with free fibular flap, occlusal guide plate with intermaxillary fixation screw contributes to simplifying operation, accurate recovery of the appearance and occlusal relation, and improving the oral comfort level postoperatively.
Objective To observe the effect of continuous elastic outside distraction on the change of collagen content in female mini pig’s ni pples and their supporting tissues, and to investigate the mechanism of continuous elastic outside distraction correcting inverted ni pples. Methods Three 3-month-old female mini pigs (weighing 18.5-22.0 kg), which had 12 nipples, were employed. Four nipples of each minipig were not treated as control group (n=12), and the other nipples were continuously distracted with inverted nipple correction instruments as experimental group (n=24). The nipple specimens were harvested at 2, 4, 8, and 12 weeks after distraction and HE staining was performed to observe the change oftheir tissue structure. And saturated picric acid sirius red staining was used to observe the distribution and content of collagen types I and III, image analysis software for quantitative analysis. Results The control group had normal structure of epidermis at all time points. In experimental group, the epidermis thickened; basal cells, fibroblasts, and capillary significantly prol iferated along with the times; and the content and the density of collagen types I and III increased gradually. There were significant differences in collagen type I at 4, 8, and 12 weeks, and in collagen type III at 2, 4, 8, and 12 weeks between 2 groups (P lt; 0.01). There were significant differences in the ratio of collagen type I to III at 2 and 4 weeks between 2 groups (P lt; 0.05). Conclusion Continuous elastic outside distraction can increase the quantity of collagen types I and III in the tissue, the thickness of the dermis, and the height of the nipple, which may be one of key mechanisms of correction the inverted nipple by continuous elastic outside distraction.
【Abstract】 Objective To evaluate the effectiveness of HA mixed with adenovirus mediated rhBMP-2 gene (AdvrhBMP-2) transferred BMSCs of goats on distraction osteogenesis. Methods Nineteen adult goats were used for the experiment,no matter they were male or female, and the weight of the goats were 15-20 kg. The 10 mL marrow was obtained from theil iac crest of each goat. The BMSCs was expanded and passaged conventionally. The 3th BMSCs was infected by Adv-rhBMP-2 at 200 multipl icity of infection (MOI). The 1×108 infected BMSCs were digested by 0.25% trypsin and collected, then mixed with HA. The right tibia lengthening models were developed, and mixture with BMSCs was injected in the osteotomy position. The goats were divided randomly into 4 groups according to the material injected in operation, group A: Adv-rhBMP-2/BMSCs/HA (n=6); group B: Adv-rhBMP-2/BMSCs (n=5); group C: Adv-β-gal/BMSCs/HA (n=4); group D: sham without any injections (n=4). After a seven-day latency period following ostectomy, distraction was carried out at a rate of 1 mm/day for 4 weeks. Roentgenography was practiced in 5, 8 and 12 weeks. After 12 weeks, the goats were sacrificed and dual-energy X-ray absorptiometry (DXA), biomechanical test and histology results were studied. Results After five and eight weeks surgery, X-raytest showed the distraction callus was more in group A and B than group C and D, and the radiographic score was significantly higher in group A and B than in the other two groups(P lt; 0.05); after 12 weeks surgery, the continued callus was formed in the distraction defects in all groups. DXA showed the mean bone mineral content of distraction callus in group A, B, C, D was (4.175 ± 1.921), (2.600 ± 0.638), (2.425 ± 0.826) and (1.175 ± 0.574) g, and the mean bone mineral density was (0.612 ± 0.196), (0.630 ± 0.159), (0.450 ± 0.166) and (0.266 ± 0.113) g/cm2. The group A and B was significantly higher than group C and D (P lt; 0.05).Biomechanical test showed the maximum loading of group A, B, C, D was (490.20 ± 155.08), (350.59 ± 80.48), (221.95 ± 68.79) and (150.65 ± 92.29) N, and elastic modulus was (178.24 ± 105.80), (105.88 ± 27.09), (81.18 ± 48.67) and (50.35 ± 47.64) MPa. The group A was significantly higher than in group C and D (P lt; 0.05). Histology observation revealed abundant bone formation in the distraction defects in group A, and the bone trabecula was arranged longitudinal and netl ike. Histomorphology analysis revealed the bone volume in group A, B, C, D was 72.35% ± 5.68%, 67.58% ± 7.42%, 49.63% ± 4.87% and 38.87% ± 2.35%, and the bone formation was significantly greater in group A compared with group D (P lt; 0.05). Conclusion HA mixed with rhBMP-2 modified BMSCs can accelerate distraction osteogenesis in goats.
To find new technique for repair of peripheral nerve defect, the nerve elongation repair technique was adopted. Two cases with nerve defect were treated by this method. One was a 12 year old male, the defect length of right radial nerve was 7.2 cm at the elbow. The other one was a 28 year old male, the defect length of left ulnar nerve the was 5 cm at elbow. In this method, the nerve was elongated by slow stretch from distal and proximal end of the ruptured nerve. After a few days, the nerve was repaired by direct suture. After operation, the function of nerves were recovered in 119 days and 114 days respectively. Follow-up for 5 years, the function of the effected limbs were recovered to the normal side. It was concluded that: (1) the peripheral never can be elongated by slow stretch; (2) to stretch the nerve end in a rubber tube can prevent adhesion and connective tissue blocking; (3) strength and supporting point of stretching should be designed carefully.
目的:探讨陈旧性髌骨骨折的最佳治疗方案。方法:我院1997.1～2007.12收治陈旧性髌骨骨折患者20例,均采用术前髌骨牵引、股四头肌锻炼,术中髌前纵形S切口、改良张力带固定骨折块,配合关节腔注射玻璃酸钠,术后早期行患肢CPM机功能锻炼。结果: 所有患者均获得随访,随访时间1.5～3.5年,平均2.2年。患者术后X片髌骨骨折块对位良好、关节面平整。术后切口甲级愈合,下床时间2d～21d,平均6.5d。骨折愈合时间3.0～6.5月,平均4.2月。术后1.5年膝关节HSS功能评分:优8例,良8例,可3例,差1例,优良率80%。结论: 术前牵引、术中正确处理骨折、术后术后早期锻炼等综合治疗陈旧性髌骨骨折疗效显著。