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PLATYSMA MYOCUTANEOUS FLAPS IN RECONSTRUCTION OF ORAL DEFECT CAUSED BY TUMOR RESECTION

Oral carcinoma；Platysma myocutaneous flap；Defect repair

APPLICATION OF HALO-VEST IN STABLE RECONSTRUCTION OF UNSTABLE UPPER CERVICAL SPINE

Objective To evaluate the clinical effect of Halo-vest in treatment of unstable upper cervical spine. Methods From March 1997 to October 2002, 16 cases of unstable upper cervical spineswere treated and immobilized by Halovest, aged from 14 to 53 years. There were 3 cases of isolated Jefferson fractures, 4 cases of isolated Hangman fractures and 1 case of Anderson type Ⅱ fracture. The 8 cases were immobilized for 3-4 months by Halovest. There were 3 cases of old odontoid fractures with dislocations treated by occipitocervical plate fixation and fusion, 1 case of C1 malignant tumor by posterior resection and internal fixation, 2 cases of C2 malignant tumor by anterior resection, fusion, and internal fixation; these cases were immobilized by Halo-vest during surgery. There were 1 case of C2,3 tuberculosis were treated by anterior debridement and fusion, and 1 case of gooseneck deformity by anterior decompression, fusion and screw fixation after resection of C2-7 , the 2 cases were immobilized for 3 months by Halo-vest.Of 16 cases, there were 8 cases accompanied with spinal cord syndrome. Results Fifteen cases were followed up 6 months to 5 years. Anterior arch ununion and posteriorarch osseous healing occurred in 1 case of Jefferson fracture. Other fractures and embedded bones became osseous fusion. One case of C2 malignant tumorrecurred 8 months after operation. Spinal cord syndrome of all patients disappeared. Conclusion Halo-vest immobilization is an effective method for conservative treatment and stable reconstruction of unstable upper cervical spine.

一期人工全髋关节置换治疗髋臼骨折合并股骨头颈骨折

目的  总结髋臼骨折切开复位内固定、一期人工全髋关节置换治疗髋臼骨折合并股骨头或颈骨折的临床疗效。  方法   2005 年 1 月－ 2008 年 12 月，采用髋臼骨折切开复位内固定、一期人工全髋关节置换治疗髋臼骨折合并股骨头、颈骨折 6 例。男 5 例，女 1 例；年龄 45 ～ 65 岁。高处坠落伤 2 例，车祸伤 4 例。均为新鲜闭合骨折。受伤至入院时间为 2 h ～ 2 d。其中 2 例合并股骨颈头下型骨折，4 例合并髋关节后脱位及股骨头骨折，2 例合并颅脑损伤。   结 果  手术时间50～90 min，术中失血量400～800 mL，术中输压积红细胞2～4 U。术后切口均Ⅰ期愈合，无感染、血栓形成等并发症发生。5 例患者获随访，随访时间 9 ～ 36 个月，平均 20 个月。髋臼骨折于术后 8 ～ 16 周达骨性愈合，无感染及假体松动发生。末次随访髋关节功能根据 Harris 评分为 75 ～ 95 分，获优 1 例，良 2 例，中 2 例。  结论  一期髋臼骨折内固定、人工全髋关节置换治疗髋臼骨折脱位合并股骨头、颈骨折，可减少股骨头缺血性坏死、创伤性关节炎等并发症，避免二次手术，缩短住院时间。

ABSTRACTSTREATMENT OF OLD FRACTURE OF FEMORAL NECK BY TRANSPOSTION OF FASCIA-LATA-ILIAC BONE AND ITS PERIOSTEUM COMPOSITE CRAFT WITH ITS VASCULARPEDICLE OF DEEP LATERAL FEMORAL CIRCUMFLEXAPTERY

ransopition of vascularized fascia-lata-iliac bone with its periorteum composite graft was used inthe treatment of 20 cases of old fractures of femoral neck. Because the vascular bundie containing thedeep lateral femoral circumflex artery needed not to be dissected during operation, it reduced thechance to irritate the blood vessel and the implantation of the vaseularized composite graft with itsporicateum which wrapped around the neck of femur, it would improve the blood circulation of the femur and the fracture site, thus enhancing the fracture healing and giving the chance to prevent the development of avascular necrosis of femoral head.

The Value of Ultrasonic Examination in Evaluating the Relativity of Hypertension with Intimamedia Thickness of the Carotid and Femoral Arteries and the Blood Flow Parameters

目的:探讨颈动脉(CA)、股动脉(FA)的内—中膜厚度(IMT)及其血流参数对高血压病的诊断价值。方法:对52例原发性高血压病患者利用高频超声进行CA、FA的IMT检查,并与45例正常对照组结果进行对比研究。结果:高血压组的受检者CA、FA的内中膜厚度较正常对照组的明显增厚,差异有统计学意义(Plt;0.01)。高血压组的受检者CA、FA内径较正常对照组增宽,有显著性差异(Plt;0.01)。高血压组与正常对照组的血流速度测量:高血压组CA、FA平均流速(MV)、加速度时间(AT)明显低于正常对照组,差异有统计学意义(Plt;0.01)。高血压组的CA收缩/舒张期血流速度比值(S/D),搏动指数(PI)、阻力指数(RI),均高于正常对照组,差异有统计学意义(Plt;0.01〉。高血压组的FA收缩/舒张期血流速度比值(S/D)、搏动指数(PI)、阻力指数(RI)与正常对照组比较差异无统计学意义。高血压组与正常对照组钙斑形成比较差异有统计学意义(Plt;0.01)。结论:高血压病的CA、FA内—中膜及血流参数均有不同程度改变,超声检查对临床预警和防治具有重要意义。

Correlation between combined deflection angle classification adduction typing and complications after internal fixation of adduction femoral neck fracture

Objective To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. MethodsThe clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. Results The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients’ CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion (P>0.05), but correlated with the incidence of osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P>0.05). Conclusion CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.

Comparative study of surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma

ObjectiveTo explore the safety, effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma (PTC) by video-assisted lateral neck dissection (VALND) or open lateral neck dissection (OLND).MethodsThe clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. The data of 94 cases in the VALND group (n=47) and the OLND group (n=47) were finally included in this study, and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.ResultsThere were no statistical differences of lateral metastatic lymph node numbers, operative time, postoperative drainage volume, drainage tube removal time and postoperative hospitalization days between the two groups (P>0.05). The lateral retrieved lymph node numbers, intraoperative blood loss, the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group (P<0.05). There was no significant difference of surgical complications between the two groups (P>0.05).ConclusionWithout sacrificing surgical safety and effectiveness, VALND has better cosmetic effect and less neck trauma than OLND, which is worthy of clinical application and promotion.

带旋髂深血管蒂髂骨及髂骨膜瓣移位治疗中青年股骨颈骨折

目的 总结带旋髂深血管蒂髂骨及髂骨膜瓣移位治疗中青年股骨颈骨折的手术方法及临床疗效。 方法 2003 年4 月－ 2007 年3 月，收治22 例中青年股骨颈骨折患者。男12 例，女10 例；年龄25 ～ 53 岁，平均42 岁。均为闭合性骨折。致伤原因：交通事故伤18 例，高处坠落伤4 例。受伤至手术时间5 h ～ 43 d。新鲜骨折20 例，陈旧性骨折2 例。骨折部位分型：头下型10 例，经颈型12 例。骨折Garden 分型：Ⅲ型6 例，Ⅳ型16 例。术前Harris 髋关节功能评分（22.80 ± 8.75）分。采用带旋髂深血管蒂髂骨及髂骨膜瓣移位加空心加压螺钉治疗。 结果 术后1 例供区伤口伴液化渗出，经换药治愈；其余切口均Ⅰ期愈合。术后患者均获随访，随访时间20 ～ 60 个月，平均42 个月。21 例股骨颈骨折愈合，愈合时间3 ～ 6 个月，平均3.5 个月；1 例骨折不愈合并股骨头缺血性坏死，于术后6 个月行人工全髋关节置换术。术后14 个月Harris 评分为（86.40 ± 7.95）分，与术前比较差异有统计学意义（P lt; 0.05）。 结论 带旋髂深血管蒂髂骨及髂骨膜瓣治疗中青年股骨颈骨折可改善骨折端血运，促进骨折愈合，减少股骨头坏死的发生。

Application of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia

Objective To investigate the efficacy and safety of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia. Methods This study used a prospective randomized controlled study approach. A total of 60 day surgery patients requiring hysteroscopic surgery under general anesthesia admitted to Weifang People’s Hospital between October and December 2020 were randomly selected. All patients were divided into trial group and control group by completely random number table method, with 30 patients in each group. The trial group received paracervical block combined with total intravenous anesthesia with alfentanil, and the control group received total intravenous anesthesia with alfentanil. The general condition, operation time, recovery time, intraoperative propofol dosage, postoperative pain score, intraoperative motion response and postoperative nausea and vomiting incidence were compared between the two groups. Results There was no significant difference in age, body mass index and incidence of comorbidities between the two groups (P>0.05). There was no significant difference in the operation time, recovery time, pain score at 2 hours after operation, and incidence of nausea and vomiting between the two groups (P>0.05). In the control group, the dose of propofol [(34.07±12.67) vs. (28.33±9.10) mL], the pain score on awakening (1.50±0.78 vs. 0.77±0.50), and the incidence of body movement response (20.0 % vs. 0.0%) were higher than the trial group (P<0.05). Conclusion The use of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia can reduce the amount of propofol during the operation, reduce postoperative pain, and reduce perioperative adverse reactions, which has a good efficacy and safety.

双侧颈胸皮瓣在颌颈部瘢痕挛缩整复中的应用