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颌下颈前Ⅲ度烧伤早期脱痂修复一例

APPLICATION OF FASCIOCUTANEOUS FLAP IN REPAIRING Ⅲ° BURN WOUND IN FACIO-CERVICAL REGION

OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.

甲状腺癌术后乳糜瘘的观察与护理

【摘要】　目的　总结甲状腺癌行颈廓清术并发乳糜瘘的治疗及护理方法。　方法　2008年8月-2009年10月，对8例甲状腺癌行颈廓清术发生乳糜瘘患者，采用局部加压包扎，引流管接负压器充分引流或手术缝扎乳糜管等治疗，并进行心理护理、营养指导、引流管监护、并发症的预防等专科护理和基础护理。　结果　4例患者经保守治疗、4例患者采用手术缝扎乳糜管，治愈出院。　结论　对甲状腺癌颈廓清术后并发乳糜瘘患者，采取适当的治疗方法及正确的护理措施，能促进患者尽快早日康复出院，缩短住院时间和减少经济负担。

颈动脉海绵窦漏致低灌注性视网膜病变一例

原发性颈面部恶性淋巴瘤化学治疗的临床分析

【摘要】目的 观察原发性颈面部恶性淋巴瘤手术前后化学治疗（化疗）的治疗效果。方法 回顾性分析18例颈面部恶性淋巴瘤患者的发病年龄和临床表现。结果 18例患者中,2例1.5、2.0年死亡,随访失访1例。存活的15例患者中,2、3年的4例,3、4年的4例,4年以上的7例。结论 恶性淋巴瘤的治疗主要以化疗为主,且以联合化疗效果最佳；手术前后化疗对恶性淋巴瘤的近期临床疗效满意。

Significance of LCT Joint HighRisk HPV Testing for Followup after CIN Treatment

摘要:目的: 探讨联合LCT和高危型HPV检测对CIN宫颈治疗后的随访意义。 方法 :对200例LCT异常,高危型HPV阳性,阴道镜活检证实为CIN1~3的患者行LEEP治疗或宫颈冷刀锥切,治疗后进行严格随访,包括LCT和高危型HPV检测,阳性病例行组织学检查。 结果 :(1)所有病例经治疗后均无病变残留,其治愈率为100%。(2)从治疗后3个月起,CIN1组高危型HPV转阴率为100%。在随访的第3个月和6个月,CIN2~3组高危型HPV转阴率分别为7317%和9085%,显著低于CIN1组,差异有统计学意义(〖WTBX〗P ＜005)。(3)从随访12个月起,一直有2例病例持续HPV阳性,均为CIN3患者,但LCT和阴道镜检查未发现细胞学异常,继续随访。 结论 :CIN治疗后高危型HPV的转阴时间及转阴率与CIN的级别有关;高危型HPV持续阳性,但LCT和阴道镜检查无异常者可继续严格随访;LCT联合高危型HPV检测是CIN治疗后临床追踪随访的有效手段。Abstract: Objective: To investigate the Significance of LCT joint highrisk HPV testing for followup after CIN treatment. Methods : 200 cases that highrisk HPV infection were tested by realtime PCR and CIN1~3 were confirmed with LCT and colposcopy biopsy were considered. The patients were treated with LEEP treatment or cold knife conization. After treatment, all cases were strictly followed up with LCT and HPV test, and the patients with positive results were examined by histology. Results : 1) After treatment, there was no residual disease in all cases, the cure rate was 100%. 2) From 3 months after treatment, highrisk HPV negative rate was 100% in CIN1 cases. While at 3rd and 6th month after treatment, highrisk HPV negative rate in CIN2~3 cases were 7317% and 9085%, which were significantly lower than those in CIN1 cases,the difference was statistically significant. 3) From the 12th monthafter treatment, there are still two cases of sustained highrisk HPV positive but normal with LCT and colposcopy biopsy. All cases are still strictly followedup. Conclusion : After treatment, the negative rate and time of highrisk HPV concerned with the grade of the CIN; the patients with persistent positive highrisk HPV, but without abnormalities detected by LCT and colposcopy biopsy could continue to strictly follow up; LCT joint highrisk HPV detection is an effective clinical means for followup after CIN treatment.

ONE-STAGE OPERATIVE TREATMENT OF ATLANTO-AXIAL INSTABILITY WITH STENOSIS OF LOWER CERVICAL LEVEL OF SPINAL CANAL

To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.

THE APPLICATION OF TRANSPOSITION OF PECTORALIS MAJOR MUSCLE OR MYOCUTANEOUS FLAP IN THE REPAIR OF LONG STANDING WOUND OVER THE MANDIBULO CERVICO THORACIC AREA

The pectoralis major muscle or myocutaneous flap is characterized by its easy dissection and free rotation, as well as abundance of blood supply and tissue mass of the flap, so that it was often used in repairing the wound over the mandibulo-cervico-thoracic area. From 1989 to 1996, 11 cases with long-standing wound of this area were difficult to repair with the traditional method, but were treated with transposition of this type of myocutaneous flap. The myocutaneous flap was applied in 8 case and muscle flap in 3 case. The flap area ranged from 12 cm x 8 cm to 26 cm x 18 cm. All the flaps survived, and excellent results were achieved. The technique and design of the operation were reported in details. It was concluded that the process was easy to perform, and the flap had abundant blood supply and high resistance to infection.

Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury

ObjectiveTo explore the effectiveness of functional reconstruction of hand grasp and pinch by tendon transfers in patients with cervical spinal cord injury.MethodsBetween July 2013 and January 2016, tendon transfer surgery were performed in 21 patients (41 hands) with cervical spinal injury that motion level was located at C6 to reconstruct hand grasp and pinch function. There were 18 males and 3 females with a mean age of 42.3 years (range, 17-65 years). Nineteen patients were with complete spinal cord injury [American Spinal Injury Association (ASIA) grading A], 1 patient was with central cord syndrome whose bilateral hands were completely paralyzed and lower limbs were normal (ASIA grading D), and 1 patient was with cervical spondylotic myelopathy (AISA grading D). The time from injury to hospitalization was 12-22 months (mean, 16.8 months). According to the International classification of surgery of the hand in tetraplegia (ICSHT), there were 6 cases of grade O3, 10 of grade O4, 3 of grade OCu5, and 2 of grade O5. The surgery was divided into two stages with an interval of 6-11 months. At the first stage, grip function was reconstructed in all patients by transfering the extensor carpi radialis longus from radialis side to palmar side through subcutaneous tunnel, and braided and sutured with the flexor pollicis longus and flexor digitorum profundus. At the second stage, the lateral pinch function of the thumb and index finger was reconstructed by braiding and suturing the radial half of the extensor carpi ulnaris (the patients graded as ICSHT O3) or pronator tere (the patients graded above ICSHT O3) with extensor pollicis longus and abductor pollicis longus. The grasp force, the thumb and index finger lateral pinch force, and the maximum fingertips distance between the thumb and index finger were measured at preoperation and at different time points after operation. The modified Lamb and Chan questionnaire, based upon the activities of daily living, was used to evaluate the hand function of all patients at 6 months after sencond stage surgery.ResultsThere was 1 patient with elbow skin lesion, 1 patient with wrist stiffness; both of them recovered after corresponding treatment. All the 21 patients were followed up 15-32 months (mean, 19.6 months) without wound infection, tendon adhesion, tendon rupture, and other complications. The grasp forces of all patients were significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the first stage surgery when compared with preoperative value (P<0.05); and no significant difference was found between different time points after operation (P>0.05). The thumb and index finger lateral pinch force and the maximum fingertips distance between the thumb and index finger of all patients were also significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the second stage surgery when compared with preoperative values (P<0.05); and no significant difference was found between different time points after operation (P>0.05). And there was no significant difference of above indexes between the patients graded as ICSHT O3 and above ICSHT O3 (P>0.05). The functional outcome was good in 19 cases, fair in 1 case, and poor in 1 case according to modified Lamb and Chan questionnaire at 6 months after second stage surgery.ConclusionTendon transfer can significantly improve the hand function and the quality of life of the patients with complete cervical spinal cord injury.

PREVENTION AND TREATMENT OF EARLY POSTOPERATIVE COMPLICATIONS OF ANTERIOR CERVICALSPINAL SURGERY

Objective To study the prevention and management of early compl ications associated with anterior cervical spinal surgery. Methods From November 1998 to December 2006, 363 cases were treated with anterior cervicalsurgery, including 268 males and 95 females aged 17-79 years．In these cases, 224 suffered from cervical spondylosis, 39 from cervical disc herniation, 87 from cervical trauma, 9 from cervical tumor and 4 from cervical tuberculosis. Forty-eight cases with anterior cervical surgery were fused by autogenous il iac bones, 132 cases with anterior cervical surgery were fused by autogenous il iac bones and anterior cervical spine locking plates, and 183 cases with anterior cervical surgery were fused by titanium mesh cage and anterior cervical spine locking plates. Results A total of 282 cases were followed up for 3 months to 5 years with the average of 1 year and 11 months. Twenty-three compl ications associated with surgery were found, with an incidence of 8.16%. Three cases of transient superior laryngeal nerve palsy recovered within 3-7 days after the restriction of l iquid diet and fluid replacement. Two cases of recurrent laryngeal nerve palsy recovered by 3-month pronunciation practice. One case of spinal cord injury was treated with medicine for dehydration and anti-inflammation, and was restored to preoperative muscle power of inferior extremity after 6 months. Two cases of CSF leakage were cured with moderate local compression and meticulous water-tight wound closure. Among the 10 patients with compl ications of internal fixation, one suffering mild dysphagia was reoperated, while the others were treated with cephal-cervico-thorax plaster external fixation and recovered with sol id fusion within 3-18 months. Among the 4 cases with cervical hematoma, 1 died of wrong rescue procedures and 1 was infected. Conclusion Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach and skilled surgical technique are essential for preventing the early postoperative compl ications of anterior cervical spinal surgery．