Objective To investigate the application of the fibrous envelope of tissue expanders for the tension reduction. Methods Between June 2005 and May 2011, 21 patients with facial scar were treated with skin soft tissue expansion. There were 6 males and 15 females, aged 19-33 years (mean, 24.5 years), including 19 cases of hypertrophic scar and 2 cases of atrophic scar with disease duration of 1-31 years. The scars ranged from 4 cm × 2 cm to 25 cm × 10 cm. The tissue expander was implanted under normal skin adjacent to lesions in the first stage. And the post-expanded skin flap was designed as advance flap or transpositional flap as supplement in the second stage. Fibrous envelope at the base was fixed to the periosteum or fascia nearby first, and then sutures were used between envelopes at the base and on the skin flap or to the dermis of the skin flap to keep the mouth and lower eyelid in proper position. It reduced the tension of incision and maintained the contour of the face and neck. Results After the first stage operation, 2 cases had replaced expanders because of infection and leakage. No complication of infection or hematoma occurred after the second stage operation. The patients were followed up 1-18 months (mean, 10.2 months); of them,12 were followed up more than 1 year. No secondary deformity (deviation of mouth angle, eyebrows pulling, or eyelid ectropion) occurred. The flaps had good appearance and color. The satisfactory results were achieved. Conclusion In skin soft tissue expansion of the face, the fibrous envelopes at the base could reduce the tension of the incision and prevent the deformity of the mouth and lower eyelids.
【Abstract】 Objective To review the progress of autologous fat grafting of the face and outline different arguments in this field. Methods Recent literature concerning autologous fat grafting of the face was reviewed and analyzed. Results The applications and techniques for autologous fat grafting have been matured increasingly. It not only can adjust the proportion of facial contours, restore tissue volume, but also can improve the local skin texture. Reliable clinical results have achieved in facial augmentation and rejuvenation. Although there are arguments about donor site, harvesting technique, processing technique, and grafting technique, the basic principle is the same. Conclusion From the perspective of evidence-based medicine, clinicians are rich in clinical experience, but objective evidence is insufficient. So further researches should be carried to look for scientific evidences.
A combined rotational flap was used to repair large scar on the face. The flap was removed from the lateral part of the neck, face and postaural region, between the zygmatic arch and clavicle. The dissection was carried out on the superfic ial of SMAS and platysmus M. Twentysix (12 males and 14 females) were reported. The age ranged from 5 to 28 years. The flap was survived completely in 19 cases. Small area at the margin of the flap was necrotic, which was reducing appeared in the postaural cular region in 6 cases. By reducing the size of the postaural cual component of the flap, necrosis never occured. Among these cases, 11 were followed up for 6 to 14 months. The results were satisfactory. The combined flap was classified as randomized flap because it had no axial and it could be used to cover a large area of skin defect. The color, thickness and quality of the flaps were all close to the normal facial skin. It was considered especially suitable for repair the large wound on the medial twothirds of the cheek.
ObjectiveTo compare and observe the curative effect of different body positions after pars plana vitrectomy (PPV) combined with inert gas filling for rhegmatogenous retinal detachment (RRD). MethodsA retrospective clinical study. From October 2019 to September 2021, 192 eyes of 192 RRD patients who were diagnosed and received PPV combined with inert gas filling in Qingdao Eye Hospital of Shandong First Medical University were included in the study. Best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fundus photography, optical coherence tomography, and B-mode ultrasonography were performed in all affected eyes. The BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the post-operative position requirements, the affected eyes were divided into the face-down positioning group and the adjustable positioning group, with 97 eyes in 97 patients and 95 eyes in 95 patients, respectively. Age (Z=0.804), course of disease (Z=－0.490), eye type (χ2=0.175), logMAR BCVA (Z=－0.895), intraocular pressure (Z=0.178), lens status (χ2=1.090), number of detached clocks (Z=0.301) and macular involvement (χ2=0.219), number of holes (Z=－1.051) and number of lower holes (χ2=0.619) were compared, there was no significant difference (P＞0.05). The gender composition ratio was compared, and the difference was statistically significant (χ2=5.341, P＜0.05). The follow-up time after surgery was more than 3 months. The retinal reattachment rate in one operation, the improvement of BCVA and the incidence of complications were observed. The independent sample Mann-Whitney test was used for the comparison of continuous variables between groups; the χ2 test was used for the comparison of categorical variables. ResultsIn the face-down positioning group and the adjustable positioning group, retinal reattachment in one operation was performed in 92 (94.8%, 92/97) and 89 (93.7%, 89/95) eyes, respectively; logMAR BCVA was 0.45±0.34, 0.41±0.21. There was no significant difference in the retinal reattachment rate in one operation (χ2=0.120, P=0.729) and logMAR BCVA (Z=－0.815, P=0.416) between the two groups. After surgery, the intraocular pressure increased in 11 (11.3%, 11/97) and 5 (5.3%, 5/95) eyes in the face-down positioning group and the adjustable positioning group, respectively; the secondary epimacular membrane was 2 (2.1%, 2/97), 3 (3.2%, 3/95) eyes. There was no significant difference in the incidence of elevated intraocular pressure and secondary epimacular membrane between the two groups after surgery (χ2=2.320, 0.227; P=0.128, 0.634). ConclusionIt is safe and effective to adopt adjustable positioning after PPV combined with inert gas filling for RRD, which is equivalent to the effect of face-down positioning.
To evaluate the safety and efficacy of one-level posterior lumbar interbody fusion(PLIF) combined with Prospace and facet fusion using local autograft. Methods Clinical and radiographic data of 76 patients treated by this technique was reviewed from May 2002 to December 2004. Of them, there were 52 males and 24 females, with an average age of 53.2 years (2381 years), including 60 cases of degenerative disc disease, 9 cases of failed back surgery syndrome and 3 cases of spondylolysis. The disese courses were 1.2-8.7 years (mean 3.6 years). The levels of PLIF were:L 2,3 in 2 cases, L 3,4 in 7, L 4,5 in 54, L 5/S 1 in 10, L 4/S 1 in 1 and L 5,6 in 2. After decompression，Prospace was inserted into interbody space bilaterally，and located in disc space 4 mm beyond the rear edge ofthe vertebral body. Local laminectomy autograft was packed both laterally into and between 2 implants. Then the remanent local autograft was placed over facet bed. Pedicle screws were used after insertion of Prospace. Clinical results wereevaluated by the JOA score. Disc height ratio and lumbar lordosis angles were measured on lateral radiographs. Fusion status was determined by evidence of bridge trabeculae across facet joint and interbody space on CT scan without mobility in lateral dynamic X-rays, and no radiolucent gap between Prospace and endplate. Paired t test was used for statistical analysis. Results Mean blood loss and operative time was 384 ml and 178 minutes, respectively. The average JOA score at final follow-up (26.1±2.7) was significantly improved when compared with that of preoperation (14.5±4.0, P＜0.05), with a mean recovery rate of JOA score 81.1% (37.5%-100.0%). The fusion rate was 974%(74/76). Mean disc height ratio and the involved segmental lordosis angle were increased from preoperative 0.27± 0.07 and 5.8±2.2° to 0.33±0.06 and 11.3±2.0° respectively at the final followup, and the differences were significant (P＜0.05). There were no devicerelated complications. Conclusion This surgical technique combined with Prospace interbody device is a safe and effective surgical option for patients with onelevel lumbar disorders when PLIF is warranted.
ObjectiveTo evaluate the feasibility and effectiveness of one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. MethodsBetween January 2010 and December 2014, 32 cases of lumbosacral spinal tuberculosis (L4-S1) were treated by one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation. There were 20 males and 12 females, aged 17-62 years (mean, 43 years). The disease duration was 12-48 months (mean, 18 months). The involved segments included L5, S1 level in 19 cases and L4, 5 level in 13 cases. The effectiveness was evaluated by Oswestry disability index (ODI) and imaging parameters (lumbar-sacral angle correction and Bridwell classification and CT fusion criteria) after operation. ResultsThe operation was successfully completed in all patients; the average operation time was 180 minutes, and the average intraoperative blood loss was 400 mL. All cases were followed up 12 to 67 months (mean, 15.6 months). At last follow-up, common toxic symptom of tuberculosis disappeared, and no internal fixation failure occurred. Neurological function was recovered to normal in 7 patients with neurological symptoms, and American Spinal Injury Association (ASIA) scale was improved to grade E from grade C (2 cases) and grade D (5 cases) before operation. At 1 year and last follow-up, the ODI scores were significantly improved when compared with preoperative score (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P>0.05). The lumbarsacral angle was significantly increased at 7 days, 1 year and last follow-up when compared with preoperative one (P < 0.05), but there was no significant difference between different time points after operation (P>0.05). The bone graft fusion time was 9-24 months (mean, 12 months). At 1 year after operation and last follow-up, X-ray Bridwill bone fusion rates were 87.50% (28/32) and 93.75% (30/32) respectively, and CT fusion rates were 87.50% (28/32) and 90.63% (29/32) respectively; and there was significant difference in interbody fusion between at 1 year and last follow-up (P < 0.05). Drug resistance was observed in 4 cases; Bridwill gradeⅢand gradeⅣfusion was shown in 3 cases and 1 case after adjusting the anti-tuberculosis scheme after 1 year. ConclusionOne-stage posterior retaining part facet joint in laminectomy and debridement can effectively clear the tuberculose focus, intervertebral bone graft combined with short segment pedicle screw fixation can maintain postoperative spinal reliable stability and get satisfactory bone fusion rate, so it is an effective method for the treatment of lumbosacral tuberculosis.
ObjectiveTo investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. MethodsA retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3, 4 in 32 cases, L4, 5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was 1ess than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared;according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. ResultsAt L4, 5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P<0.05), more serious facet joint degeneration was observed in group C;no significant difference was found in facet joint degeneration at L3, 4 (P>0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P>0.05) except for PT (P<0.05). ConclusionPI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4, 5 and L5, S1;PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.
ObjectiveTo evaluate the effectiveness of double pedicled flap and technique of geometric broken line (GBL) for primary repair of serious dog bite wound. MethodsBetween October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34.5 years (range, 8-68 years), and with a mean disease duration of 4 hours (range, 30 minutes to 24 hours). The defect ranged from 1.7 cm×0.5 cm to 15.0 cm×8.0 cm, with the mean depth of 0.5 cm (range, 0.3-0.8 cm). Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage (VSD) was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1.7 cm×1.5 cm to 18.0 cm×15.0 cm. The donor site was sutured directly. VSD was used for 3 days after operation. ResultsAll flaps survived and wound healed, and donor site incision healed well, with invisible scar. All patients were followed up 6 months to 8 years (mean, 4 years). The wounds were repaired well, and the patients had good facial appearance. No rabies attack was observed during follow-up. ConclusionIt is an ideal repair method to chose double pedicled flap and technique of GBL for primary repair of dog bite wounds. Satisfactory cosmetic appearance can be obtained.
Objective To analyze the biomechanical changes of the adjacent cervical facet joints when the angled cervical prosthesis is replaced. Methods A total of 400 northwestern people were involved, with an age of 40 years or older.The cervical vertebra lateral X-ray films were taken, and the cervical angles were measured by professional computer aided design software, then the cervical intervertebral disc prosthesis with 10° angle was designed. The finite element models of C4，5and C4-6 segments with intact cervical discs were developed; the C4，5 disc was replaced by the cervical prosthesis with 0° and 10° angle respectively; and then all models were subjected to axial loading, flexion/extension, lateral bending, and torsion loading conditions; the stress effects on adjacent facet joints after replacement were observed by comparing with that of the intact model. Results The cervical angles were (9.97 ± 3.64)° in C3，4, (9.95 ± 4.34)° in C4，5, (8.59 ± 3.75)° in C5，6, and (8.49 ± 3.39)° in C6，7, showing no significant difference between C3，4 and C4，5, C5，6 and C6，7 (P gt; 0.05) and showing significant differences between the other cervical angles (P lt; 0.05). When C4，5 model was axially loaded, no significant difference in equivalent shearing stress were observed in intact, 0°, and 10° groups; at flexion/extension loading, the stress was biggest in intact group, and was smallest in 10° group; at lateral bending, the stress got the high rank in intact group, and was minimum in 10° group; at torsion loading, the stress state of 10° group approached to the intact one condition. When C4-6 model was loaded, the facet joint stress of the replaced segment (C4，5) decreased significantly at axial loading, flexion/extension, and lateral bending; while no obvious decrease was observed at torsion loading; the stress of the adjacent inferior disc (C5，6) decreased significantly at axial loadingand lateral bending condition, while less decrease was observed at torsion loading, no significant change at flexion/extension condition, it approached to that of the intact one. Conclusion The finite element analysis reveals that the biomechanical properties of 10° designed prosthesis is approximate to that of the intact cervical disc, thus the 10° designed prosthesis can meet the requirements of biomechanical function reconstruction of the cervical spine.
Objective This is a meta-analysis of the efficacy of noninvasive ventilation (NIV) with helmet compared to NIV with face mask in patients with acute respiratory failure (ARF). Methods " Helmet, face mask or facial mask” and " mechanical ventilation or noninvasive ventilation” were used as key words both in Chinese and English to search all the trials in PubMed, OVID, Embase, Scopus and Cochrane Library, websites, reference lists of articles, CNKI and Wanfang Database from inception to December 2016. Two reviewers independently assessed the methodological quality of the trials and extracted information. Revman 5.3 was used for data analysis. Results Ten randomized controlled trials (RCTs) and six case-control trials were included. NIV with a helmet reduced the intubation rate (OR=0.35, 95%CI 0.24 to 0.51, P<0.000 01), in-hospital mortality rate (OR=0.51, 95%CI 0.34 to 0.76, P=0.001), and NIV-related complications (OR=0.10, 95%CI 0.06 to 0.15, P<0.000 01) compared to NIV with face mask. There was no significant difference in gas exchange between two groups. In the subgroup analysis, types of ARF and ventilation mode did not affect the intubation rate and the complications relevant to NIV, but NIV with helmet mainly decreased the in-hospital mortality of the patients with hypoxemic ARF or pressure support ventilation. Conclusions NIV with a helmet can decrease the endotracheal intubation rate, in-hospital mortality, and NIV-related complications of the patients with ARF. And helmet is as effective as face mask in improving the gas exchange. However, larger or multicenter RCTs are needed to analyze the role of NIV with a helmet in this condition.