颧颞部骨折术后并发颞部凹陷的临床回顾性研究

目的:分析不同颧颞部骨折性质与颞部凹陷的相关性,评价颧颞部骨折术后并发颞部凹陷的防治效果。方法:对105例颧颞部骨折病例进行回顾性分析,52例患者行颞部凹陷修复术,采用头皮冠状切口,应用钛网修复颞部凹陷,术后通过长期随访评价治疗效果。结果:陈旧性骨折颞部凹陷的发生率显著高于新鲜骨折,但治疗后颞部外形均有明显改善。结论:钛网植入能有效地修复颧颞部骨折术后并发的颞部凹陷,但应把握手术时机及治疗方法。     

颧颞部骨折术后并发颞部凹陷的临床回顾性研究

目的：分析不同颧颞部骨折性质与颞部凹陷的相关性,评价颧颞部骨折术后并发颞部凹陷的防治效果。方法：对105例颧颞部骨折病例进行回顾性分析,52例患者行颞部凹陷修复术,采用头皮冠状切口,应用钛网修复颞部凹陷,术后通过长期随访评价治疗效果。结果：陈旧性骨折颞部凹陷的发生率显著高于新鲜骨折,但治疗后颞部外形均有明显改善。结论：钛网植入能有效地修复颧颞部骨折术后并发的颞部凹陷,但应把握手术时机及治疗方法。     

颧骨复合体骨折手术治疗的临床研究

目的：观察和对比头皮冠状切口及小切口联合入路在各种颧骨复合体骨折治疗中的效果。方法：分析2002年～2005年于我院口腔颌面外科救治的62例颧骨复合体骨折病人手术入路及临床效果。结果：根据不同类型的骨折,选择不同术式和切口,术中患者使用微型钛板行坚固内固定,术后均达到面形及功能的恢复。结论：对于大部分颧骨复合体骨折可以采用小切口的单独或联合入路进行治疗,对于颧骨体颧弓粉碎性骨折及陈旧性骨折应采用头皮冠状切口加必要的辅助切口。     

两种联合切口手术治疗眶- 上颌- 颧骨复合体骨折的对比研究

目的:对比研究冠状-睑下缘-口内联合切口手术与冠状切口联合口腔前庭沟切口手术治疗眶-上颌-颧骨复合体骨折的治疗效果。方法:选取2006年10月～2010年12月眶-上颌-颧骨复合体骨折患者136例,69例患者行冠状-睑下缘-口内联合切口手术,67例行冠状切口联合口腔前庭沟切口手术,分别命名为A组和B组,比较两组患者治疗效果,治疗效果用甲级、乙级和丙级表示。结果:A组治疗效果甲级、乙级、丙级分别为65.2%、30.4%、4.4%,B组治疗效果甲级、乙级、丙级分别为46.3%、29.8%、23.9%,A组治疗效果优于B组;A组术后并发症少于B组。结论:冠状-睑下缘-口内联合切口手术比冠状切口联合口腔前庭沟切口手术更好地治疗眶-上颌-颧骨复合体骨折,治疗效果好,并发症少,能更好地实现颧骨复位。     

两种联合切口手术治疗眶-上颌-颧骨复合体骨折的对比研究

目的：对比研究冠状-睑下缘-口内联合切口手术与冠状切口联合口腔前庭沟切口手术治疗眶-上颌-颧骨复合体骨折的治疗效果。方法：选取2006年10月-2010年12月眶-上颌-颧骨复合体骨折患者136例,69例患者行冠状-睑下缘-口内联合切口手术,67例行冠状切口联合口腔前庭沟切口手术,分别命名为A组和B组,比较两组患者治疗效果,治疗效果用甲级、乙级和丙级表示。结果：A组治疗效果甲级、乙级、丙级分别为65．2％、30．4％、4．4％,B组治疗效果甲级、乙级、丙级分别为46．3％、29．8％、23．9％,A组治疗效果优于B组;A组术后并发症少于B组。结论：冠状-睑下缘-口内联合切口手术比冠状切口联合口腔前庭沟切口手术更好地治疗眶-上颌-颧骨复合体骨折,治疗效果好,并发症少,能更好地实现颧骨复位。     

冠状- 睑下缘- 口内联合切口手术治疗眶- 上颌- 颧骨复合骨折

目的:探讨经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折坚强内固定术的临床应用价值。方法:回顾性分析69例患者经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折解剖复位,钛板坚强内固定。结果:69例均一期愈合,68例治疗效果优良,1例治疗效果欠佳;2例轻度睑外翻,两周后恢复正常,无额纹变浅、面神经损伤等其他并发症。结论:冠状-睑下缘-口内联合切口具有切口隐蔽、面部疤痕不明显、显露充分、并发症少等优点,是治疗眶-上颌-颧骨复合骨折的良好手术进路。     

冠状-睑下缘-口内联合切口手术治疗眶-上颌-颧骨复合骨折

目的：探讨经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折坚强内固定术的临床应用价值。方法：回顾性分析69例患者经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折解剖复位,钛板坚强内固定。结果：69例均一期愈合,68例治疗效果优良,1例治疗效果欠佳;2例轻度睑外翻,两周后恢复正常,无额纹变浅、面神经损伤等其他并发症。结论：冠状-睑下缘-口内联合切口具有切口隐蔽、面部疤痕不明显、显露充分、并发症少等优点,是治疗眶-上颌-颧骨复合骨折的良好手术进路。     

背侧单切口与桡尺侧双切口钢板内固定治疗尺桡骨中上段双骨折

目的:研究成人尺桡骨中上段双骨折使用背侧单切口与桡尺侧双切口钢板内固定的治疗效果。方法:选择我院2011年3月至2014年7月行双钢板治疗成年尺桡骨中上段双骨折患者41例,其中手术入路选择背侧单切口患者25例,选择背侧双切口患者16例。比较两种手术方式的临床效果。结果:背侧单切口入路组患者在手术出血、切口长度等方面要优于背侧双切口组(P0.01);两组在术前时间、骨折愈合时间方面未见明显差异(P0.05)。单切口组的疼痛VAS评分在术后1周和术后12周时要优于双切口组(P0.05);单切口组的膝关节HSS评分在术后1周时要优于双切口组(P0.01),而在术后12周时两组未见明显差异(P0.05)。结论:选择背侧入路单切口和双切口双钢板治疗尺桡骨中上段双骨折均有较好的临床效果,而背侧单切口入路,手术操作相对简单易行,创伤较小,术后恢复较好。     

快速成型技术在手术治疗跟骨关节内骨折中的应用

目的:跟骨解剖形态复杂、结构不规则,骨折多累及关节面,且致伤后关节面压缩、塌陷、粉碎严重,传统手术术区显露较局限,骨折复位较困难,关节面复位精度不高,手术时间较长,致残率高。探讨快速成型技术治疗跟骨关节内骨折的应用价值。方法:将2012年1月~2013年1月期间收治的30例SandersⅢ-Ⅳ跟骨骨折患者根据入院顺序随机均分为试验组和对照组两组,对试验组患者采用计算机辅助技术行跟骨骨折的三维重建解剖学模型,快速成型制作出与实体1:1大小的跟骨模型。依此对跟骨骨折做出明确的诊断、分型,制定手术方案,术前模拟手术,指导手术治疗,将术中指标与未模拟手术的对照组指标进行比较。结果:试验组和对照组的手术时间分别为(53.3±5.0)min和(71.4±4.9)min,两组间差异有统计学意义(P0.05)。试验组和对照组术中出血量分别为(47.3±6.8)mL和(51.3±8.4)mL,两组间差异无统计学意义(P0.05)。试验组术后功能评分:优良率88.2%,而对照组为88.9%,两组间差异无统计学意义(P0.05)。结论:快速成型技术能够向术者直观、立体的展示骨折的形态,使术者准确评估骨折情况,弥补术区切口显露局限的不足,提高复位精度,缩短手术时间,减少术中创伤,降低致残率,对跟骨骨折的治疗有很强的指导意义、应用前景广阔。     

俯卧位后外侧入路联合内侧切口治疗三踝骨折35 例的临床疗效评价

目的:探讨在俯卧体位下采用后外侧入路联合内侧切口治疗三踝骨折方法的临床疗效及安全性。方法:选择2014年1月~2015年1月在我院治疗并由同一治疗组医生采用俯卧体位下治疗的三踝骨折患者35例,治疗外踝骨折时将钢板置于腓骨后侧或外侧,使用钢板或螺钉对后踝骨折进行固定,2枚拉力螺钉固定内踝。观察术后切口及骨折愈合、踝关节功能恢复情况。术后定期随访,采用AOFAS踝-后足评分标准对踝关节功能进行评价。结果:手术时长50~142 min,平均90 min,1例患者内侧切口出现局部红肿,抬高患肢及定期换药后局部红肿好转,未出现明显切口感染征象。2例病人术后出现足背部麻木,分别在术后6周、9周时消失。随访时间6~18月,平均随访15个月。术后3月X线显示所有病人骨折线模糊,骨痂生长良好,按美国足踝外科协会踝-后足评分系统评分:优28例,良5例,可2例,优良率94.29%。结论:在俯卧体位下采用后外侧切口治疗三踝骨折可一次性复位、固定后踝和外踝骨折,联合内侧切口可在一个体位下完成三踝骨折的手术,缩短手术时间,对软组织破坏少,骨折可获得解剖复位,术后踝关节功能恢复佳,可降低因反复翻身而污染术野的概率。     

The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozygomatic deformities

Collapse of the zygomatic arch following trauma results in inadequate anteroposterior projection of the zygomatic body and an increase in facial width. Accurate assessment of the position of the zygomatic arch in relation to the cranial base posteriorly and the midface anteriorly is the key to the acute repair of complex midfacial fractures and the secondary reconstruction of posttraumatic deformities of the orbitozygomaticomaxillary complex. Loss of projection of the zygomatic arch may occur with injuries confined to the orbitozygomaticomaxillary region or in association with complex midfacial fractures. A safe anatomic approach to the zygomatic arch allows exact anatomic restoration of the zygomatic arch using miniplates and screws and results in the reconstruction of an outer facial frame with a correct anteroposterior projection and facial width. The zygomatic arch injury is diagnosed using axial CT scanning. Three-hundred and seventeen arches have been exposed through a coronal incision following acute trauma and 47 arches have been exposed in patients requiring late correction of a posttraumatic orbitozygomaticomaxillary deformity. Permanent palsy to the frontal branch of the facial nerve has occurred in one patient following the exact definition of the anatomy of this region.     

Infracture technique for reduction malarplasty with a short preauricular incision

The infracture technique for reduction malarplasty has been widely used as an aesthetic surgical procedure in northeast Asia. Since 1988, the authors' original method of infracture technique was performed through the combined approach of intraoral and temporopreauricular incision, which may leave a rather long scar on the temporal region. To shorten the external scar, a new technique using a short preauricular incision instead of a long temporopreauricular incision was developed. From September of 2000 to June of 2001, this new approach was applied to 142 patients for correction of prominent zygoma. In this procedure, anteriorly, incomplete fracture of the zygomatic body was performed through an intraoral approach for bending inward. Posteriorly, full-thickness cutting of the zygomatic arch was performed through a preauricular incision. Then, lateral bulging of the zygomatic arch was reduced with infracturing, and the infractured site was fixed in a new position with a microplate and three screws. The advantages of this technique are reduction of the operation time, reduction of the length of the external scar, and reduction of postoperative edema around the operative region. With this combined approach, the authors were able to sufficiently expose the zygomatic arch and body and able to change the lateral convex arch into a concave one. Under direct vision, the authors could effectively and precisely perform the infracture technique through a much shorter preauricular incision that did not result in a long, conspicuous external scar.     

Endoscopically assisted malarplasty: one incision and two dissection planes

Asian society is uniquely concerned about the distinctive facial features associated with malar prominence. Various methods of reduction malarplasty have been developed and are currently being applied. In this study, a new approach to malarplasty was experimentally assessed between December of 1999 and August of 2001. After having received careful observations of their facial features and full counseling sessions, 32 patients were selected. These patients had three distinctive characteristics: (1) severe zygomatic arch prominence and normal zygomatic body prominence, (2) desire for only a reduction of the lateral prominence, and (3) desire for a less invasive surgery. Through a short incision in the temporal area, the authors performed the dissection as two different planes. Endoscopic dissection between the superficial layer of deep temporal fascia and the temporoparietal fascia to the zygomatic body and blunt dissection under the deep layer of the deep temporal fascia to the zygomatic arch were performed. Complete osteotomy of the zygomatic arch and an incomplete osteotomy of the zygomatic body were then performed with a reciprocating saw. Finally, the zygomatic arch for the zygoma infraction was pressed manually. The major advantages of this procedure are its simplicity and the short operation and recovery time, with little bleeding and edema.     

Intraoral approach for reduction malarplasty: a simple method

Young Korean women with prominent zygoma may experience stress in daily life because the Oriental physiognomy often associates prominent zygoma with bad luck. Moreover, prominent zygoma in a wide Oriental face has the effect of making a person appear older and stubborn. Zygomatic reduction is often necessary to relieve stress from self-consciousness about facial appearance and to obtain younger and softer features. As such, most zygomatic procedures are cosmetic; therefore, an entirely intraoral approach with no skin incision is desirable. The current operative method of zygomatic reduction consists of two steps. The zygomatic body and arch are exposed through a mucoperiosteal incision from the maxillary canine to the first molar area. The first step is to grind and file the zygomatic body. The second step is made on the zygomatic arch. Using an oscillating saw, a partial-thickness osteotomy is made just posterior to the orbital rim, and a full-thickness osteotomy is made just anterior to the articular tubercle of the zygomatic arch. Light pressure on the posterior part of the arch produces a greenstick fracture of the anterior osteotomy site and a complete fracture of the posterior osteotomy site, resulting in inward repositioning of the zygomatic arch. This method of zygomatic reduction is simple, easy, effective, and leaves no conspicuous scars on the face.     

Surgical treatment of thyrotoxic exophthalmos

Conservative treatment of thyrotoxic exophthalmos has not given satisfactory results. Our observations, modifications of the standard surgical technique, and the results of orbital decompression for this condition are presented. Through a transverse incision close to the lower eyelid margin, the floor and the lateral orbital wall are explored. The posterior part of the orbital floor and the zygomatic part of the lateral orbital wall, as well as the periorbital fat, are removed. Through an incision made over the medial margin of the orbit, the medial orbital wall is explored and its ethmoidal part is removed. By the same approach, further retrobulbar fat is removed. Through an upper eyelid incision, fat is removed from the eyelid region and the levator aponeurosis is divided. This produces satisfactory symmetrical decompression of the orbit with good correction of exophthalmos and a significant decrease in the signs and symptoms of this condition.