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中华整形外科杂志
中华整形外科杂志

曹谊林

双月刊

1009-4598

cjpls@cma.org.cn

010-88960006

100144

北京市石景山区八大处路33号

中华整形外科杂志/Journal Chinese Journal of Plastic SurgeryCSCD北大核心CSTPCD
查看更多>>1985年创刊，中华医学会主办。本刊是中国协和医科大学整形外科研究所出版的整形外科专业学术期刊。以整形外科、烧伤外科、显微外科、骨科、口腔科、耳鼻喉科、眼科、泌尿外科、皮肤科等学科临床医师及科研工作者为读者对象，刊登对整形外科发展具有导向性、指导性的评论和文件，报道整形外科领域先进的科研成果和诊疗经验，以及对整形外科临床有指导作用、与整形外科临床密切结合的基础理论研究。主要栏目有：论著、工作研究、经验交流、病例报告、技术改进、综述、讲座、警钟等。本刊被多家国内外生物医学期刊数据库和医学文摘所收录。
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    下颌骨外板矢状劈开自体骨充填术矫正半侧颜面短小

    归来牛峰俞冰刘剑锋...
    249-257页
    查看更多>>摘要：目的 探讨采用矢状劈开患侧下颌骨外板并植入健侧切取的下颌骨外板修复重建半侧颜面短小的新方法。 方法 回顾性分析2006年3月至2023年3月，中国医学科学院整形外科医院颅颌面外科收治的半侧颜面短小患者临床资料。术前根据临床表现和影像学检查结果进行诊断和手术设计。所有病例均在全身麻醉下完成手术。经口内入路将患侧下颌骨外板劈开，然后根据术前设计采取健侧适当形态和大小的下颌骨外板植入劈开的骨间隙并采用钛合金小夹板予以坚强内固定。术后随访患者的并发症发生、面部形态改善情况及患者对手术效果满意度，满意度评分为1～5分，分数越高表示越满意。在术前、术后即刻和术后远期(末次)随访时拍摄照片并分析畸形严重程度。将患者术前、术后即刻、术后远期随访CT数据以Dicom格式导入Surgicase Proplan医学三维图像工作站后，利用Segmentation功能重建下颌骨，测量术前、术后即刻和术后远期随访的下颌骨厚度，对其测量值比较采用重复测量方差分析，多重比较采用LSD检验；用多样本Kruskal－Wallis秩和检验对畸形矫正外观满意度评分进行统计分析，以P<0.05为差异具有统计学意义。 结果 共纳入39例患者，女13例，男26例，年龄(22.2±4.56)岁(15～27岁)。所有患者术后随访(45.56±39.41)个月(6～153个月)，植入的下颌骨外板与邻近骨组织结合良好，并获得下颌角区以及下颌骨体部明显的增宽效果。39例中，1例术后1年感染，钛板外露，经过清创并取出固定的小夹板以后愈合；其余患者面部形态均得到明显改善。35例患者对手术效果满意，3例非常满意，1例对术后1年感染不满意，但是对手术效果满意。术前与术后即刻、术后远期随访的患侧下颌骨厚度测量值分别进行两两比较，差异均有统计学意义(P均<0.05)；患者畸形矫正外观满意度术前评分[2.0(1.5，2.0)分]、术后即刻评分[4.0(4.0，4.0)分]及术后末次随访评分[4.0(4.0，4.0)分]比较，差异有统计学意义(P<0.01)。其中，术前评分与术后即刻、术后末次随访的评分分别比较，差异均有统计学意义(P均<0.01)；术后末次随访与术后即刻评分比较，差异无统计学意义(P>0.05)。 结论 下颌骨外板矢状劈开符合下颌骨解剖学特点并为自体骨的植入和愈合提供了良好条件。健侧下颌骨外板的切取，在充填患侧增加厚度的同时，缩小健侧下颌角区厚度，从而有效矫正下颌骨不对称畸形。该方法操作简单，并发症少，效果良好，是矫正半侧颜面短小的理想治疗手段之一。 Objective To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side. Methods From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups (P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant(P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up (P>0.05). Conclusion The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.

    下颌骨颜面发育不全下颌骨重建骨移植骨生成下颌骨外板下颌骨外板矢状劈开半侧颜面短小

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    虚拟手术联合三维打印导板在下颌骨良性肿瘤切除和颌骨缺损修复重建中的应用

    付坤高宁杨雷雷刘康彦...
    258-263页
    查看更多>>摘要：目的 探讨虚拟手术联合三维(3D)打印导板在下颌骨良性肿瘤切除和颌骨缺损修复重建中的应用效果。 方法 2013年6月至2020年12月，郑州大学第一附属医院口腔颌面外科行数字化技术辅助下颌骨良性肿瘤切除，同期游离腓骨肌皮瓣修复重建颌骨缺损患者全部纳入该研究，临床资料不全者排除。根据是否在术中使用下颌骨和腓骨截骨导板，分为导板组和非导板组。导板组术前3D打印下颌骨及腓骨截骨导板，术中使用导板完成肿瘤切除和腓骨塑形操作，非导板组仅依据虚拟手术方案和预成钛板完成相应操作。记录腓骨瓣制备情况、手术时间、腓骨瓣临床成活情况，术后1周颌面部螺旋CT影像评价腓骨骨段间及腓骨与下颌骨间密合程度、预成形钛板与腓骨及下颌骨间密合程度和髁状突位置，术后半年视觉模拟评分法(VAS)调查患者术后面部外形满意度。采用SPSS 21.0软件对数据进行统计学分析，手术时间、术后面部外形评价比较采用独立样本t检验，髁突位置、腓骨及下颌骨段间密合程度、钛板与骨段密合程度比较采用卡方检验，P<0.05为差异有统计学意义。 结果 共纳入30例患者，男性17例，女性13例，中位年龄24岁(16～64岁)。腓骨瓣制备过程顺利，术中所需腓骨长度(14.1±1.9)cm(5.7～18.1 cm)，腓骨塑形段数(2.9±0.6)段(2～4段)。12例下颌骨缺损以单层腓骨修复，7例以血管化折叠腓骨修复，11例以血管化复合非血管化腓骨修复。导板组与非导板组手术时间比较[(335.9±64.0)min vs.(470.7±140.5)min],差异具有统计学意义(P<0.05)。术后随访9～23月，平均11个月，所有腓骨瓣均成活。术后1周颌面部螺旋CT影像评价腓骨骨段间、腓骨与下颌骨间密合程度、预成形钛板与腓骨及下颌骨间密合程度及髁状突位置较好的患者，导板组分别为15例、15例和13例，非导板组分别为10例、13例和11例。导板组与非导板组腓骨骨段间及与下颌骨间密合程度比较(15/15 vs. 10/15)差异具有统计学意义(P<0.05)。术后半年2组患者对术后面部外形均比较满意，导板组与非导板组VAS评分比较[(9.6±0.5 )分vs.(9.3±0.5 )分]，差异无统计学意义(P>0.05)。 结论 虚拟手术联合3D打印导板可以进一步缩短手术时间，提高下颌骨良性肿瘤切除颌骨缺损游离腓骨瓣修复重建的精准度。 Objective To explore the potential of integrating virtual surgery with three-dimensional (3D) printed guides in the surgical management of mandibular benign tumors and subsequent reconstruction of bone defects. Methods A retrospective analysis was conducted on the clinical data of patients who underwent computer-assisted resection and vascularized fibular flap reconstruction for benign mandibular tumors at the Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, from June 2013 to December 2020. According to the utilization of guide plates for mandibular and fibular osteotomy during surgical procedures or not, the patients were categorized into two cohorts: a guide plate cohort and a non-guide plate cohort. In the guide plate group, custom-designed gudie plates based on virtual surgical plans were fabricated using 3D printing technology and employed intraoperatively In the non-guide plate group, surgery was exclusively performed based on virtual surgical plan and prebent titanium plate without any supplementary plating. The measured outcomes included fibular flap osteotomy, operation duration, and clinical flap survival. Computed tomography images obtained one week post-surgery were utilized to assess the intersegmental commissure degree between fibular segments as well as between fibular segments and mandible, commissure degree between fibular segments and prebent titanium plate, and condyle position. The satisfaction of patients with their facial appearance was evaluated 6 months after the surgery using a visual analogue scale. Statistical analysis was conducted using SPSS 21.0 software. Independent sample t-tests was utilized to compare the duration of operation and and postoperative evaluation of facial appearance, the Chi-square tests was utilized for condyle position, commissure degrees among interactions involving fibular segments, prebent titanium plates, bone segments(P<0.05 denoted statistical significance). Results A total of 30 patients were enrolled, comprising 17 males and 13 females, with a median age of 24 years (16-64 years). The preparation process of fibular flaps proceeded smoothly. The required length of fibula was measured as (14.1 ± 1.9) cm (5.7-18.1 cm), while the number of fibular segments ranged from 2 to 4, averaging at approximately 2.9 ± 0.6. The mandibular defects were repaired using a single-layer fibula in 12 cases, a vascularized folded fibula in 7 cases and a combination of vascularized and non-vascularized fibula in 11 cases. The operation time for the guide plate group was recorded as ( 335.9 ± 64.0) min (240-433 min), while it was observed to be (470.7 ± 140.5 ) min (280-680 min) for the non-guide plate group.The postoperative follow-up duration ranged from 9 to 23 months, with an average period of 11 months. All fibular flaps demonstrated clinical survival. The number of patients with good commissure degree between fibular and mandibular segments, between prebent titanium plate and fibular and mandibular segments and the position of condyle were 15, 15 and 13 cases in guide plate group, 10, 13 and 11 cases in non-guide plate group respectively. The statistical analysis revealed a significant difference (P<0.05) in the degree of commissure between the fibular and the mandibular segments (15/15 vs. 10/15) in the two groups. Both groups exhibited high levels of satisfaction regarding their postoperative facial appearance at the 6 months follow-up, observed to be 9.6±0.5 and 9.3±0.5 respectively, and the statisticla analysis revealed non-significant difference (P>0.05). Conclusion The integration of virtual surgery with 3D printed guide plates can effectively reduce operative time and improve precision in the repair and reconstruction of free-fibular flaps following resection of benign tumors of the mandible.

    骨重建打印,三维计算机辅助手术下颌骨游离组织瓣手术时间虚拟手术

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    数字化外科用于上颌Le FortⅠ型分块骨切开术的效果及精确度评价

    魏一源孙晓爽赵庆吴一凡...
    264-272页
    查看更多>>摘要：目的 探讨数字化外科导板和板引导下的Le FortⅠ型分块骨切开术的精确度及手术效果。 方法 回顾性分析2014年1月至2019年6月，在四川大学华西口腔医院正颌与关节外科行Le FortⅠ型分块骨切开术的患者临床资料。根据术前手术方案设计方法分为数字化外科组和传统模型外科组。通过对数字化外科组术前设计模型及术后模型的拟合比对、定量分析评价虚拟手术设计的精确性，分析传统模型外科组及数字化外科组的上颌骨术前术后在三维方向上的手术位移量、术后并发症发生情况，以及患者术后半年满意度调查。使用SPSS 22.0进行统计分析，对数字化外科组术前设计模型与实际术后模型之间的线性距离和角度采用配对t检验，数字化外科组和传统模型外科组患者各个标志点术前术后在三维方向上的位移量采用独立样本t检验，并对2组术后并发症发生比例采用Pearson卡方检验，以P<0.05为差异有统计学意义。 结果 共纳入221例患者，数字化外科组129例，男35例，女94例，年龄为(24.5±6.5)岁；传统模型外科组92例，男28例，女性64例，年龄为(27.7±5.4)岁。数字化外科组中术前设计模型与实际术后模型之间线性距离差为(1.23±0.35)mm，角度差为2.48°±0.31°。术后平均随访9个月，2组患者上颌骨术前、术后在三维方向上的手术位移量测量中，数字化外科组与传统模型外科组右上颌尖牙牙尖点、左上颌第1磨牙近中颊尖点(U3R、U6L)在垂直方向上的位移量分别比较[(6.72±1.57) mm vs.(4.07±2.14) mm、(4.73±2.07) mm vs.(1.62±1.82) mm]，差异均有统计学意义(P均<0.05)。数字化外科组除1例牙根损伤外，无其他严重并发症发生；传统模型外科组则出现3例腭瘘，4例牙根损伤，2例骨不连，其手术并发症发生比例明显高于数字化外科组[(9.8%，9/92) vs.(0.8%，1/129)]，差异有统计学意义(P<0.05)。数字化外科组术后94.5%(122/129)的患者满意度评分>3分，传统模型外科组术后有89.1%(82/92)的患者满意度评分>3分，2组患者对手术效果都很满意。 结论 相对于传统模型外科，在数字化导板及板指导下，Le FortⅠ型分块骨切开术精确度高，术后效果好，能有效减少手术并发症的发生。 Objective In this retrospective study, the accuracy and outcomes of segmental Le Fort I surgery with the aid of 3D-printed surgical templates and occlusal splints and dental model surgery were evaluated. Methods Clinical data of patients receiving segmental Le Fort I surgery in the Department of Orthognathic and Temporo-Mandibular Joint Surgery of West China Stomatological Hospital of Sichuan University from January 2014 to June 2019 were retrospectively analyzed. The accuracy of virtual surgical planning(VSP) and the difference between VSP and dental model surgery were evaluated by postoperative complications, color distance maps, and quantitative accuracy analysis.The amount of surgical displacement of the maxilla in the three-dimensional direction before and after surgery, the occurrence of postoperative complications and the patients'satisfaction survey were analyzed in both groups. Pairedt-tests were used for the linear distance and angle between the preoperative design model and the final virtual surgery model in the digital surgery group. Independent samples t-test was used for each marker point’s preoperative and postoperative displacements in the three-dimensional direction between the digital surgery group and the dental model group. The proportion of postoperative complications in the 2 groups was tested using the Pearson chi-square test, and the difference was considered statistically significant at P<0.05. Results There were 129 patients in the digital surgery group, 35 males and 94 females, aged (24.5±6.5) years, and 92 patients in the dental model surgery group, 28 males and 64 females, aged (27.7±5.4) years.The overall mean linear difference was 1.23±0.35 mm, and the overall mean angular difference was 2.48°±0.31°. The vertical displacement of U3R, U6L in the digital surgery group was (6.72±1.57)mm and (4.73±2.07)mm. The vertical displacement of U3R, U6L in the group of dental model surgery was (4.07±2.14)mm and (1.62±1.82)mm.The significant deviation difference in U3R-Y and U6L-Y between two groups could be detected. The complications in two groups showed a significant difference. Except for one case of root injury, there was no serious complication recorded in the digital surgery group. However, there were three cases of palatal fistulas, four cases of root injury and two cases of bone dehiscence in the dental model group. 94.5% of patients in the digital surgery group are satisfied with the surgical results, while 89.1% in the dental model group. Conclusion Compared with dental model surgery, segmental Le Fort I surgery is highly accurate under the guidance of surgical templates and occlusal splint which has better postoperative results and effectively reduces the occurrence of surgical complications.

    外科手术,计算机辅助牙颌面畸形LeFortⅠ型分块骨切开术虚拟手术传统模型外科数字化外科导板三维分析

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    数字化技术辅助设计腓骨瓣修复上颌骨肿瘤切除后缺损

    高宁谢卫红付坤刘康彦...
    273-277页
    查看更多>>摘要：目的 探讨数字化技术辅助设计腓骨瓣修复上颌骨肿瘤切除后缺损并行种植义齿修复的治疗效果。 方法 回顾性分析2018年3月至2020年10月于郑州大学第一附属医院口腔颌面外科就诊的上颌骨良性肿瘤患者资料。术前采用数字化技术模拟肿瘤切除和腓骨重建，打印模型并制作导板，同时在模型上预成形钛板和手工塑形个性化钛网，术中根据截骨导板切除病变组织，依据手术计划和塑形导板引导腓骨塑形，使用游离腓骨瓣联合个性化预成形钛网重建上颌骨缺损。骨移植后6～9个月置入Straumann种植体，种植后3～4个月进行上部烤瓷冠修复，以恢复咬合关系和咀嚼功能。术后对面部外形、咀嚼功能和种植体周围炎进行随访。 结果 共纳入12例患者，男7例，女5例，年龄20～55岁，中位年龄36岁。其中骨化纤维瘤3例，成釉细胞瘤7例，牙源性黏液瘤2例。根据James Brown分类法，Ⅱb型4例，Ⅱc型3例，Ⅱd型3例，Ⅲb型2例。12例患者的肿瘤切除和腓骨重建手术过程顺利，游离腓骨瓣全部成活，患者颌面部对称，种植修复后咬合关系良好，咀嚼和吞咽功能恢复正常。种植后随访12～48个月，平均26个月，开口度2.8～3.3 cm，未见明显种植体周围炎。 结论 采用数字化技术辅助设计腓骨瓣修复上颌骨肿瘤切除后缺损并进行种植义齿修复，不仅能较好地恢复患者的面部外形，而且能重建患者的咬合关系和咀嚼功能。 Objective To investigate the therapeutic effect of digital technology assisted design of fibula flap for the repair of maxillary tumor defect and implant denture. Methods A retrospective analysis was performed in patients with benign maxillary tumors who were admitted to Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou Universityfrom March 2018 to October 2020. Before the surgery, the virtual tumor resection, fibula reconstruction and stereomodels were printed for the fabrication of fibular osteotomy guide plates.And titanium plates were prefabricated with the stereomodels. Personalized titanium meshes were prebent manually. During the operation, the tumor was removed according to the osteotomy guide plate.The fibula was reshaped according to the surgical plan and the guide plate.And maxillary defects were reconstructed using the fibular flap combined with a prebent personalized titanium mesh.Straumann implants were implanted 6-9 months after bone grafting.The upper porcelain crown was repaired 3-4 months after implantation to restore the occlusal relationship and masticatory function. The facial appearance, masticatory function and peri-implant inflammation were followed up. Results A total of 12 cases were included in this study, 7 males and 5 females, aged 20-55 years, with a median age 36 years old. Among them, there were 3 cases of ossifying fibroma, 7 cases of ameloblastoma, and 2 cases of odontogenic myxoma.According to the James Brown classification, there were 4 cases of Type Ⅱb, 3 cases of Type Ⅱc, 3 cases of Type Ⅱd, and 2 cases of Type Ⅲb. Tumor resection and fibula reconstruction went smoothly in 12 patients and all the free fibular flaps survived 14 days after surgery. The patients had maxillofacial symmetry, good occlusal relationship after the implant repair, and normal chewing and masticatory functions, after 12-48 months of follow-up, with an average of 26 months. The mouth opening reached 2.8-3.3 cm, without obvious peri-implantitis. Conclusion The use of digital technology to design fibula flap to repair the defect after maxillary tumor resection and implant denture can not only restore the patients’ facial contour, but also restore their occlusal relationship and masticatory function.

    上颌骨上颌肿瘤腓骨牙种植数字化技术

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    颧骨颧弓肥大临床再认识及基于脂肪技术的治疗新思路初探

    张军王志强沈志伟吴乐昊...
    278-285页
    查看更多>>摘要：目的 对基于以骨骼测量为参数建立的传统颧骨颧弓肥大概念进行重新认识，并探讨利用脂肪技术对软组织塑形来治疗颧骨颧弓肥大的美学效果。 方法 回顾性分析2017年5月至2022年5月锦州医科大学附属第一医院和北京美莱医疗美容医院利用脂肪技术治疗的颧骨颧弓肥大求美者临床资料。术前求美者取端坐位，从侧面分别测量两侧的颧部最高点到颞部最低点的距离(颧颞值)。根据颧颞值将颧骨颧弓肥大分为轻度(6～<10 mm)、中度(10～<13 mm)及重度(≥13 mm)。利用脂肪技术对颧骨颧弓皮下脂肪垫吸脂塑形，对颞部和(或)颧弓下凹陷进行脂肪移植填充塑形。同时在面部美学设计理念指导下，把侧面部轮廓修饰成平滑曲线，内移颧部高光点。部分患者接受脂肪填充塑形增加额部、眉弓及颏部的向前凸度，增加面部中轴线的长度等，以达到视觉上缩小颧骨颧弓肥大的效果。术后6个月随访时分别对医生和求美者独立进行满意度调查。采用配对t检验进行术前和术后颞颧值差异的比较。 结果 共纳入655例颧骨颧弓肥大求美者，均为女性，年龄(28.1±4.9)岁(18～59岁)；轻度肥大376例，中度肥大244例，重度肥大35例。所有求美者均接受了颧部吸脂塑形术和颞部脂肪移植术；260例求美者接受了颧弓下凹陷脂肪填充术；289例求美者接受了额部和(或)"苹果肌"、鼻部和下颏部的脂肪填充塑形，以调整面部凸出度或面长度。其中，有5例中度肥大者、11例重度肥大者接受了2次治疗，其余求美者均只接受1次治疗。术后随访6～12个月，平均8个月。术后6个月随访时，求美者和医生满意率调查结果显示：轻度肥大者和医生的满意率均超过95.00%，中度肥大者均超过90.00 %，重度肥大者均在75.00%以上。轻、中、重度肥大求美者的术前和术后6个月的颧颞值改变均有统计学意义(P均<0.05)。 结论 (1)"高颧骨"外观与骨骼和软组织因素均有关，将颧骨颧弓肥大定义为颧部肥大可能更为准确。根据颧颞值将颧部肥大划分为轻度、中度和重度3种类型有利于开展个性化治疗。(2)对颧部肥大患者，采用造型艺术设计理念利用脂肪技术对面部进行软组织塑形，能获得理想的美学效果。该方法与传统颌面外科技术相比具有风险小、损伤轻微、术后恢复快及并发症少等优点。 Objective To recognize of prominent zygoma based on bone measurement and evaluate the aesthetics effectiveness of the facial soft tissues remodeling for prominent zygoma with adipose technology. Methods Clinical data of patients with prominent zygoma treated by facial soft tissues remodeling with adipose technology in the First Affiliated Hospital of Jinzhou Medical University and Beijing Mei-Lai Medical Cosmetology Hospital from May 2017 to May 2022 were retrospectively analyzed. Before operation, all patients were seated in vertical position. The distance between the highest point of the zygomatic region and the lowest point of the temporal region in horizontal plane was measured with (namely zygomatic temporal value). The cases were divided into three levels: mild (6-<10 mm), moderate(10-<13 mm) and severe(≥13 mm) according to the zygomatic temporal value. Then adipose technique was used to reduce the subcutaneous fattissue thickness of zygomatic arch, and the temporal and (or) subzygomatic depression were filled with processed granular fat. At the same time, under the guidance of facial aesthetic design, the zygomatic highlight point was moved inward and the length of the central axis of the face was increased. Moreover, the forward convexity of forehead, eyebrow arch and chin were increased by fat grafting for some of these patients. The application of the aforementioned methods were to achieve visual reduction of zygomatic arch hypertrophy. The satisfaction of patients and doctors were independently investigated in six months after operation. The difference of zygomatic temporal values before and after operation was compared by pairedt-test. Results A total of 655 patients with prominent zygoma were enrolled, all were female, aged (28.1±4.9) years old(18-59 years old), including 376 patients with mild hypertrophy, 244 patients with moderate hypertrophy and 35 patients with severe hypertrophy. All the patients underwent zygomatic liposuction and temporal fat transplantation. 260 cases of patients received subzygomatic depression filling. A total of 289 patients were filled with fat in forehead and(or) "apple muscles", nose and chin to adjust the protrusion or length of the face. Among them, 5 patients with moderate hypertrophy and 11 patients with severe hypertrophy received two treatments, and the rest of the patients received one treatment. All patients were followed up for 6 -12 months, with an average of 8 months. The satisfaction of patients and doctors was more than 95.00% in mild hypertrophy, more than 90.00% in moderate hypertrophy, and more than 75.00% in severe hypertrophy. There were significant differences in zygomatic temporal value preoperative and postoperative 6 months for patients with mild, moderate and severe hypertrophy (all P<0.05). Conclusion The appearance of high cheekbones is associated with both skeletal and soft tissue factors. Therefore prominent zygomatic region is more accurate compared with prominent zygoma. According to zygomatic temporal value, it is divided into three types: mild, moderate and severe. Under the guidance of the facial aesthetic theory, prominent zygoma can be effective treated and ideal aesthetic effects can be obtained with adipose technology through the adjustment to soft tissue. Compared with traditional maxillofacial surgery, this method has obvious advantages, such as low risk, slight injury, rapid recovery and fewer complications.

    颧骨颧骨颧弓肥大颧骨复合体肥大脂肪移植脂肪技术

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    梳子瓣技术和步序设计理念在整形美容与修复重建中的应用

    高玮林晓曦邹运仇雅璟...
    286-292页
    查看更多>>摘要：目的 探讨梳子瓣技术和步序设计理念在整形美容与修复重建手术中的应用效果及适用性。 方法 回顾性分析2018年1月至2022年12月上海交通大学医学院附属第九人民医院应用梳子瓣技术行整形美容与修复重建手术患者的临床资料。梳子瓣技术在应用过程中遵循步序设计的理念，即分步、按序进行术前、术中的设计和调整，将设计与手术步骤相结合。其主要操作包括：沿目标区域边缘设计切口并切开，在目标区域基底部广泛分离形成组织瓣，垂直于切缘方向对组织瓣按序裁切并临时缝合固定，边裁切边固定，期间可对切口张力和局部外观进行调整，整个组织瓣分割后形成梳子样外观，沿着临时固定点对整个梳子瓣进行切除，精细缝合切缘，最后拆除临时缝线。术后对患者手术切口愈合情况、并发症等进行观察，对患者面部恢复情况和手术效果进行随访。 结果 共纳入6例患者，男3例，女3例，年龄2～58岁。其中1例行眉下切口上睑提紧术及睑缘切口下睑成形术，1例行中下面部除皱术，1例行厚唇修薄及右面部抽脂术，1例行面部先天性黑色素痣切除术，1例行眉部先天性黑色素痣切除术，1例行面部皮瓣修整术。患者术后切口均一期愈合，未出现手术相关并发症。术后随访3～18个月，患者面部均恢复良好，对手术效果均表示满意。 结论 将梳子瓣技术及歩序设计理念应用于整形美容与修复重建手术中，可精细调整切缘的对合，使切口张力均匀分布，降低术后切口瘢痕形成及外观畸形的风险；其临床应用范围广泛，有较好的适用性。 Objective To explore the clinical outcome and applicability of the comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery. Methods The clinical data of patients who underwent plastic aesthetic and reconstructive surgery with the comb flap technique in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022 were retrospectively analyzed. The application of the comb flap technique follows the concept of stepwise design, that was, preoperative and intraoperative design and adjustment were carried out step by step and in sequence, and the design was combined with the surgical procedure. Its main operations included: an incision was designed along the edge of the target area, the tissue flap was widely separated at the base of the target area. The tissue flap was cut in sequence perpendicular to the cutting edge and temporarily sutured and fixed, the edge was cut and fixed. During the operation, the tension of the incision and the local appearance could be adjusted. The incisal edge was finely sutured, and the temporary suture was finally removed. The healing of surgical incision and complications were observed after the operation, and the facial recovery and surgical effect were followed up. Results Six patients were enrolled, including 3 males and 3 females, aged from 2 to 58 years. One patient underwent upper eyelid tightening and lower eyelid blepharoplasty through subeyebrow incision. One patient underwent middle and lower face rhytidectomy. One patient underwent thick lip thinning and right facial liposuction. One patient underwent facial congenital melanocytic nevi resection. One patient underwent eyebrow congenital melanocytic nevus resection. One patient underwent facial flap repair. All patients had primary healing of incision, and no surgery-related complications occurred. All patients were followed up for 3 to 18 months, and all patients were satisfied with the surgical effect. Conclusion The application of comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery can delicately adjust the alignment of the incision margin, make the tension evenly distributed, and reduce the risk of scar formation and deformity after the operation. It has a wide range of clinical applications and good applicability.

    外科皮瓣美容外科整形外科梳子瓣步序设计

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    超声与MRI诊断纤维脂肪性血管性病变的效能比较

    胡文笳魏帆王朝晗郑玉琳...
    293-299页
    查看更多>>摘要：目的 对比纤维脂肪性血管性病变(FAVA)的超声与MRI诊断效能。 方法 回顾性分析2011年1月至2021年10月于河南省人民医院行超声和MRI检查的疑似FAVA患者的临床资料。分析超声和MRI的影像学表现及特征并将影像结果与病理结果进行对比。评价超声和MRI诊断FAVA的效能指标采用敏感度、特异度、阳性预测值、阴性预测值和符合率。采用配对χ2检验(McNemar检验)比较超声、MRI及两者联合诊断符合率，P<0.05为差异有统计学意义。 结果 共纳入50例患者，男24例，女26例，年龄(16.2±10.5)岁(1～50岁)。FAVA患者43例，非FAVA患者7例。超声诊断FAVA的敏感度、特异度、阳性预测值、阴性预测值和符合率分别为83.7%、71.4%、94.7%、41.7%和82.0%；MRI诊断FAVA的敏感度、特异度、阳性预测值、阴性预测值和符合率分别为69.8%、85.7%、96.8%、31.6%和72.0%；两者联合诊断FAVA的敏感度、特异度、阳性预测值、阴性预测值和符合率分别为90.7%、71.4%、95.1%、55.6%和88.0%。超声诊断的符合率高于MRI，差异无统计学意义(χ2＝1.41，P＝0.235)。两者联合诊断符合率高于超声(χ2＝0.71，P＝0.401)，高于MRI(χ2＝4.00，P＝0.039)，后者差异有统计学意义。 结论 超声与MRI对FAVA均有较高诊断价值，两者联合诊断可提高术前诊断符合率。 Objective To compare the diagnostic efficacy of ultrasound and MRI in fibro-adipose vascular anomaly (FAVA). Methods The clinical data of patients with suspected FAVA who underwent ultrasound and MRI examinations at Henan Provincial People’s Hospital from January 2011 to October 2021 were retrospectively analyzed. The imaging findings from ultrasound and MRI were analyzed, and then compared with the pathological findings. To evaluate the diagnostic efficacy of ultrasound and MRI in diagnosing FAVA by assessing sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate. Paired χ2 test (McNemar test) was used to compare the coincidence rate of ultrasound and MRI, as well as their combined diagnosis. A significance level of P < 0.05 was considered statistically significant. Results A total of 50 patients were included in the study, comprising 24 males and 26 females, with their ages ranging from 1 to 50 years and an average age of (16.2 ± 10.5) years. Pathology confirmed 43 FAVA patients and 7 non-FAVA patients. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of ultrasound in the diagnosis of FAVA were 83.7%, 71.4%, 94.7%, 41.7%, and 82.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of MRI in the diagnosis of FAVA were 69.8%, 85.7%, 96.8%, 31.6%, and 72.0%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of FAVA were 90.7%, 71.4%, 95.1%, 55.6%, and 88.0%, respectively. The diagnostic accuracy of ultrasound was higher than that of MRI, but the difference was not statistically significant (χ2 = 1.41, P = 0.235). The coincidence rate of combined diagnosis was higher than that of ultrasound (χ2= 0.71, P = 0.401) and MRI (χ2= 4.00, P = 0.039), with a statistically significant difference. Conclusion Both ultrasound and MRI are highly valuable in diagnosing FAVA. The combined usage of ultrasound and MRI can enhance the accuracy of preoperative FAVA diagnosis.

    磁共振成像超声声像图纤维脂肪性血管性病变血管瘤脉管畸形

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    多元组织移植在眼睑分裂痣整形外科修复中的应用

    罗思思卢晓昭杨喆马宁...
    300-306页
    查看更多>>摘要：目的 探讨多元组织移植在眼睑分裂痣手术治疗的临床效果及策略。 方法 回顾性分析2005年1月至2022年1月，于中国医学科学院整形外科医院尿道下裂整形中心就诊的眼睑分裂痣患者临床资料。手术分为4种。(1)直接切除缝合术；(2)单纯游离植皮术：根据缺损大小，上睑及下睑创面以中厚或全厚皮片覆盖；(3)眼轮匝肌肌皮瓣联合游离植皮术：上睑缺损及下睑近缘处缺损以皮片移植，下睑缺损以同侧眼轮匝肌蒂颞区皮瓣修复；(4)眼轮匝肌为蒂的颞区扩张皮瓣联合游离植皮术：手术分两期，一期手术于患侧颞区置入扩张器，二期手术取出扩张器后，行眼睑病变组织切除，再形成外眦眼轮匝肌眶部为蒂的岛状皮瓣，旋转180°后覆盖下睑缺损，上睑及下睑近睑缘处缺损仍以皮片移植。通过门诊、电话及微信随访患者术后面部外观及眼部运动等情况。采用SPSS 22.0统计软件进行分析，计量资料以±s表示，组内术前及术后颜面部修复重建术后疗效评估标准建议(A&F)评分比较采用配对t检验，P<0.05为差异有统计学意义。 结果 共纳入34例患者，男18例，女16例，年龄(17.7±15.3)岁(2～33岁)。眼睑分裂痣面积为0.3 cm×0.2 cm～14.0 cm×14.0 cm。直接切除缝合术6例，其中同时行重睑术2例，术后A&F评分(4.54±1.32)分较术前(3.28±0.98)分提高，差异无统计学意义(P>0.05)；单纯游离植皮术10例，术后A&F评分(5.13±1.59 )分较术前(2.25 ±1.59 )分高，差异无统计学意义(P>0.05)；眼轮匝肌肌皮瓣联合游离植皮7例，术后A&F评分(5.54±1.46)分较术前(2.18±1.61)分明显提高，差异有统计学意义(P<0.05)；眼轮匝肌为蒂的颞区扩张皮瓣联合游离植皮术11例，术后A&F评分(4.95±0.60)分较术前(2.18±1.48)分提高，差异无统计学意义(P>0.05)。所有患者切口均一期愈合，皮片或皮瓣成活良好，眼睑功能正常。28例患者获得8～81个月随访，其中3例术后继发下睑外翻畸形，3例切口及植皮区黑痣复发，2例植皮区色素沉着较明显，1例继发重力性上睑下垂，其余患者修复效果满意；6例因联系方式变更失访。 结论 眼轮匝肌肌皮瓣联合游离植皮在中到大面积眼睑分裂痣的整形外科修复中可获得更稳定的效果。上睑及下睑近睑缘处以游离植皮修复，下睑以皮瓣移植修复，更加符合上下睑的生理状态，不同的组织移植方式联合，可使面部容外形更美观。 Objective To investigate the clinical efficacy of different surgical approaches for repairing eyelid coloboma. Methods Patients with the divided nevus of eyelid treated at Hypospadias Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2005 to January 2022 were included. The surgeries were categorized into 4 types. (1) Direct excision and suture. (2) Local skin grafts: covering the defect with split- or full-thickness skin grafts according to the size of the defect on the upper and lower eyelids. (3) Combined skin grafts with orbicularis oculi myocutaneous flap: grafting skin flaps for defects on the upper eyelid and near the lower eyelid, and temporal area skin flaps based on the same side orbicularis oculi muscle pedicle for lower eyelid defects. (4) Temporal area expanded flap based on the orbicularis oculi muscle combined with skin grafts: the surgery was divided into two stages, the first stage involves the placement of an expander in the temporal area of the affected side, and the second stage involves the removal of the expander, excision of eyelid lesion tissue and formation of an island-shaped skin flap with the orbital part of the orbicularis oculi muscle pedicle as the pedicle, which was rotated 180° to cover the lower eyelid defect. Defects near the upper and lower eyelid margins were still covered with skin grafts. Follow-up was conducted through outpatient visits, telephone calls, and WeChat messaging to assess facial appearance postoperatively. SPSS 22.0 statistical software was used for analysis, and the measurement data were expressed as Mean±SD, the count data were expressed as percentage, and the comparison of preoperative and postoperative was calculated by aesthetic and functional status of facial soft-tissue deformities (A&F scores) within the group was performed by pairedt-test, the difference was considered statistically significant at P<0.05. Results A total of 34 patients were included average age was 17.7±15.3 years. The size of the lesions varied from the smallest nevus measuring 0.3 cm × 0.2 cm and the largest measuring 14.0 cm × 14.0 cm. Direct excision with suturing was performed in 6 cases, among which 2 cases received simultaneous double eyelid surgery, the postoperative A&F score (4.54 ± 1.32) was higher than the preoperative (3.28 ± 0.98) score, the difference was not statistically significant (P>0.05). The skin graft was performed in 10 cases, the postoperative A&F score (5.13 ± 1.59) was higher than the preoperative (2.25 ± 1.59), the difference was not statistically significant (P>0.05). The skin graft combined with using orbicularis oculi muscle skin flap was performed in 7 cases, the postoperative A&F score of our patients (5.54 ±1.46) was significantly higher than the preoperative (2.18 ±1.61 ), the difference was statistically significant (P<0.05). The skin graft combined with the expanded temporal area flap based on the orbicularis oculi muscle was performed in 11 cases, the A&F score of our patients after repair (4.95 ±0.60) was improved compared with the preoperative (2.18±1.48) score, and the difference was not statistically significant (P>0.05). Twenty-eight patients were followed up for 8 to 81 months while 6 cases lost due to change of contact information, among whom three developed secondary ectropion of the lower eyelid, three experienced recurrence of nevi in the incision and grafting area, two exhibited significant pigmentation in the grafting area, and one developed secondary ptosis of the upper eyelid, while the rest of the patients were satisfied with the repair results. Conclusion Surgical excision is the only effective treatment for eyelid cleft nevi with different clinical presentations. Covering defects on the upper and lower eyelids with different tissue transplantation method can disperse the entire nevus, resulting in more stable long-term repair effects and a more natural appearance. The combination of an orbicularis muscle flap and a free skin graft provides more stable result in the plastic surgery of medium to large eyelid split nevi. Free skin grafting of the upper and lower lids near the margins, and flap grafting of the lower lids are more consistent with the physiological state of the upper and lower lids, and the combination of different tissue grafting method can make the appearance of the face more reasonable.

    眼睑先天性分裂痣组织移植皮瓣外科治疗

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    丹参酮ⅡA磺酸钠减轻过氧化氢诱导的人脐静脉内皮细胞焦亡

    潘筱云陶先耀糜菁熠毛栋...
    307-317页
    查看更多>>摘要：目的 探讨丹参酮ⅡA磺酸钠(STS)对过氧化氢(H2O2)诱导后人脐静脉内皮细胞(HUVECs)焦亡的影响及其可能机制。 方法 2021年11月至2022年9月，采用无锡市第九人民医院保存的HUVECs细胞株作为研究对象，实验分为4组：空白对照组(正常条件)、空白＋STS组、H2O2组、H2O2＋STS组。待细胞长至80%融合度时，H2O2组和H2O2＋STS组加入500.00 μmol/L H2O2诱导3 h，去除含500.00 μmol/L H2O2的培养基之后，空白＋STS组和H2O2＋STS组加入5.00 μg/ml STS与HUVECs共培养24 h。通过CCK-8实验检测不同浓度(0、0.05、0.50、5.00、50.00、500.00 μg/ml)的STS对HUVECs增殖的影响，TUNEL染色检测DNA损伤阳性细胞，实时荧光定量PCR(RT-PCR)检测炎症小体核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)的表达来确定H2O2诱导焦亡的最适浓度。检测试剂盒检测H2O2诱导后活性氧自由基(ROS)表达。细胞划痕实验和基质胶体外成管实验探究STS对焦亡状态下HUVECs迁移能力和成管能力的影响。RT-PCR和Western blotting检测NLRP3、Caspase-1、白细胞介素-18、白细胞介素-1β的基因和蛋白表达。不同时点浓度比较采用重复测量方差分析，2组间数据比较采用t检验，多组间数据比较采用单因素方差分析，P<0.05为差异有统计学意义。 结果 50.00 μg/ml以下的STS对HUVECs的增殖无影响，500.00 μmol/L H2O2诱导HUVECs焦亡效果最佳。TUNEL染色显示，与空白对照组相比，H2O2组TUNEL阳性细胞率显著升高，差异有统计学意义(P<0.01)，与H2O2＋STS组TUNEL阳性细胞率的差异无统计学意义(P>0.05)。ROS检测结果显示，与H2O2组比，H2O2＋STS组细胞内ROS明显降低，差异有统计学意义(P<0.01)。细胞划痕和体外成管实验显示，与空白对照组相比，H2O2组细胞迁移率和成管能力明显减弱，差异均有统计学意义(P均<0.01)，与H2O2＋STS组差异均无统计学意义(P均>0.05)。RT-PCR和Western blotting结果显示，H2O2＋STS组与H2O2组比较，细胞焦亡相关因子表达降低，差异有统计学意义(P<0.05)。 结论 STS可通过抑制ROS的过量产生，促进细胞焦亡诱导后HUVECs的细胞迁移和管样形成，减轻H2O2诱导的HUVECs细胞焦亡，从而促进血管生成。 Objective To investigate the effect of sodium tanshinone ⅡA sulfonate (STS) on pyroptosis of human umbilical vein endothelial cells (HUVECs) induced by H2O2 and its possible mechanism. Methods From November 2021 to September 2022, HUVECs were used as the research subjects at Wuxi Ninth People’s Hospital. The experiment was divided into four groups: the blank control group (normal condition), blank + STS group, H2O2 group and H2O2 + STS group. When the cells reached 80% fusion, 500.00 μmol/L of H 2O2 was added to H2O2 group and H2O2 + STS group for 3 hours, and then the medium containing 500.00 μmol/L H 2O2 was removed. After that, the blank+ STS group and the H2O2+ STS group were each supplemented with 5.00 μg/ml of STS and co-cultured with HUVECs for 24 hours. CCK-8 was used to assess the impact of STS at various concentrations (0.00, 0.05, 0.50, 5.00, 50.00, 500.00 μg/ml) on the proliferation of HUVECs. DNA damage-positive cells were detected with TUNEL staining. The expression of NOD-like receptor protein 3 (NLRP3) was detected using real-time PCR (RT-PCR) to investigate the optimal concentration of pyroptosis induced by H 2O2. A detection kit was used to measure the expression of reactive oxygen species (ROS) induced by H2O2. The effect of STS on the migration and tube formation of HUVECs during pyroptosis was examined using a cell scratch test and a matrix gel tube formation test. The expressions of NLRP3, caspase-1, interleukin-18, and interleukin-1β were detected using RT-PCR and Western blotting. Repeated measures ANOVA was used to compare the concentrations at different time points,t-tests were used to compare data between two groups, and one-way ANOVA was used to compare data between multiple groups. P<0.05 was considered statistically significant. Results STS below 50.00 μg/ml had no effect on the proliferation of HUVECs, while 500.00 μmol/L H 2O2 had the most significant effect on inducing pyroptosis in HUVECs. TUNEL staining showed that compared with the control group, the number of TUNEL-positive cells in H2O2 group was significantly increased, and the difference was statistically significant (P<0.01). However, there was no significant difference in the number of TUNEL-positive cells in the H2O2+ STS group (P>0.05). The results of ROS detection showed that compared with the H2O2 group, intracellular ROS levels in the H2O2+ STS group was significantly decreased, and the difference was statistically significant (P<0.01). Cell scratch and tube formationin vitro experiments showed that compared with the control group, cell mobility and tube formation ability were significantly decreased in the H2O2 group (all P<0.01), and there was no statistical significance in the H2O2+ STS group (all P>0.05). RT-PCR and Western blotting results showed that, compared with the H2O2 group, the expression of pyroptosis-related factors in the H2O2+ STS group was significantly decreased (all P<0.05). Conclusion STS can inhibit the excessive production of ROS, promote the cell migration and tubular formation of HUVECs after pyroptosis induction, and alleviate H2O2-induced pyroptosis of HUVECs, thereby promoting angiogenesis.

    人脐静脉内皮细胞细胞焦亡丹参酮ⅡA磺酸钠血管生成

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    基于临床真实场景的新型显微外科模拟训练平台的初步教学应用效果

    崔蕾韩岩王昱婷张泽亚...
    318-324页
    查看更多>>摘要：目的 探讨基于临床真实场景的新型显微外科模拟训练平台的有效性。 方法 该研究为前瞻性研究，2020年1月1日至2023年1月1日选取解放军总医院第一医学中心整形修复科和中国医学科学院整形外科医院在读硕士研究生为受训对象，给予基于临床真实场景的新型显微外科模拟培训。该训练平台由研究小组设计，装置构成包括：(1)血液灌注系统，用于模拟活体动物血管；(2)内限制挡杆系统，用于模拟在深部腔隙中操作；(3)外限制挡杆系统，用于模拟困难体位下的操作；(4)蠕动平台系统，用于模拟呼吸运动影响下的显微操作。将受训者完全随机分配入对照组(传统显微外科进阶训练组)和实验组(使用该模拟训练装置进行进阶训练)。经过4周的显微外科培训，受训者被安排进行2次操作技能考核，第1次考核使用活体动物模型，进行鼠尾动脉的端对端吻合，第2次考核在真实病例中进行游离背阔肌肌皮瓣动脉的端对端吻合。采用显微外科GRS评分量表和手术时间作为评价指标比较2组的显微外科技能训练效果。GRS评分量表包括灵活性、视觉空间能力、手术流畅程度、判断力4项，评分越高表明该项技能掌握越好。卡方检验分析2组受训者性别的差异。采用Mann－Whitney U检验比较2组的GRS分数，采用独立t检验分析2组受训者年龄、手术时间。P<0.05为差异统计学意义。 结果 共纳入18名受训者，其中对照组10名，男6名，女4名，年龄(27.80±1.87)岁；实验组8名，男4名，女4名，年龄(28.10±1.56)岁。2组受训者的年龄、性别分别比较，差异均无统计学意义(P均>0.05)。在第1次(活体动物模型)考核中，对照组和实验组的GRS量表各项目评分、手术时间差异均无统计学意义(P均>0.05)。但在第2次(真实病例)考核中，实验组的GRS量表各项目评分明显高于对照组，实验组手术时长较对照组更短，差异均具有统计学意义(P均<0.05)。 结论 与传统的显微外科培训方法相比，使用基于临床真实场景的新型显微外科培训平台进行显微操作训练，可以有效缩短学习曲线，使受训者更快地掌握复杂的显微操作技能。 Objective A microsurgical simulation training device based on real clinical scenes was designed and its effectiveness was tested. Methods From January 1, 2020 to January 1, 2023, postgraduate students in the Plastic and Reconstructive Surgery Department of the First Medical Center of PLA General Hospital and the Plastic Surgery Hospital of Chinese Academy of Medical Sciences were enrolled in this prospective study. The simulation training device consists of four parts: (1)Blood perfusion system, which is used to simulate living animal blood vessels.(2)The inner baffling rod system, which is used to simulate the operation in deep cavity.(3) The exterior baffling rod system, which is used to simulate the operation in difficult positions.(4) A pulsating platform system is used to simulate microsurgery under the influence of respiratory movement. Preliminary verification of the effect of the simulated training device was as follows: Surgeons with no experience in microsurgery were completely randomized assigned to the control group (traditional microsurgery training group) and the experimental group (training group using the simulated training device). After 4 weeks of microsurgical training, the trainees were assigned to perform two surgical skill assessments, the first using a live animal model for end-to-end anastomosis of rat tail arteries, and the second assessment using end-to-end anastomosis of free latissimus dorsi flap arteries in a real case. The performance of the two groups was compared by using operation time and microsurgical GRS score scale including four items of dexterity, visuospatial ability, operative flow and judgment. Chi-squared test was used to analyze gender between the two groups. GRS scores between the two groups were compared by the Mann-Whitney U test. Participants’ ageand operation time between the two groups was compared by independent t-test. P<0.05 was considered statistically significant. Results A total of 18 trainees were enrolled, including 10 in the control group, 6 males and 4 females, with an average age of (27.80±1.87) years. There were 8 subjects in the experimental group, 4 males and 4 females, with an average age of (28.10±1.56) years old. There were no significant differences in age, gender and other baseline characteristics between the two groups (P>0.05). There was no significant difference in GRS score and operation time between the control group and the experimental group (P> 0.05) in the first assessment. However, in the second assessment of real cases, the GRS score of the experimental group was significantly higher than that of the control group(14.25 vs. 5.70), and the operation duration of the experimental group was also shorter than that of the control group, and the difference was statistically significant[(100.37±24.65 ) min vs. (105.60±22.84) min] (P<0.05). Conclusion Compared with traditional microsurgery training methods, using microsurgery training devices based on clinical real scenes can effectively shorten the learning curve and enable trainees to master complex micromanipulation skills more quickly.

    显微外科手术手术血管吻合模拟训练教学材料装备设计

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