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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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    小耳畸形治疗虚实交互辅助系统HE-01的构建及辅助耳廓再造术的可行性研究

    王爽顾勤浩何乐人姜栋文...
    131-142页
    查看更多>>摘要：目的 构建基于HoloLens的小耳畸形治疗虚实交互辅助系统HE-01，并验证其辅助耳廓再造术的可行性。 方法 以2021年8至9月于中国医学科学院整形外科医院招募的6名健康志愿者(男3名，女3名，平均年龄20.5岁)和6例小耳畸形患者(男3例，女3例，平均年龄7.6岁)为研究对象。运用Mimics Research 21.0和3-matic research软件构建虚拟耳廓三维模型，基于HoloLens和咬合夹板导航标记装置构建HE-01。通过志愿者重复试验评价HE-01的注册精准度、跟踪延迟度及不同颜色(红色、绿色、蓝色和皮肤色)虚拟耳廓导板的显示效果，通过小耳畸形患者重复试验明确操作流程并验证HE-01应用于耳廓再造术的可行性。 结果 成功构建HE-01并明确操作流程。志愿者重复试验显示，HE-01在不同角度下注册精准度均较高，6名志愿者12侧耳廓不同方向(耳廓前－60°、－30°、0°、30°、60°方向)的重合误差率均在2.3%～2.4%[小于正常人双侧耳廓大小的差距(2.7%)]；跟踪延迟度低(6名志愿者均小于0.1 s)；绿色和红色的虚拟耳廓导板显示效果较佳。小耳畸形患者重复试验显示，HE-01可应用于耳廓再造术，导航标记装置佩戴无明显并发症，具有可重复性和稳固性。 结论 本研究完成了基于导航套装、CT数据与HoloLens的增强现实辅助耳廓再造的概念设计，HE-01具有良好的注册精准度、跟踪速度和显示效果，为进一步的软件开发及临床转化做了良好铺垫。 Objective To construct a virtual-real interactive system HE-01 for the treatment of microtia based on HoloLens and verify the feasibility of applying HE-01 in ear reconstruction. Methods Six volunteers (3 males and 3 females, average age: 20.5 years old) and six patients with microtia(3 males and 3 females, average age: 7.6 years old) were recruited from Plastic Surgery Hospital of Chinese Academy of Medical Sciences from August to September 2021. The Mimics Research 21.0 software and 3-matic research software were used to construct a virtual three-dimensional auricle model. Based on HoloLens and occlusal splint navigation marker device, the virtual-real interactive system HE-01 for the treatment of microtia was constructed. The registration accuracy, tracking delay and display effect of different colors (red, green, blue and skin color) of HE-01 were evaluated through repeated experiments of volunteers. The operation process was defined through repeated experiments of patients and the feasibility of applying HE-01 in auricular reconstruction was verified. Results HE-01 was built successfully and the operation flow was clear. The experiment of six volunteers (12 ears) showed a high registration accuracy (average error rate 2.3%-2.4%, less than 2.7% of the bilateral auricle size difference of normal people), low tracking delay (six volunteers were all less than 0.1 s), and best green and red display effect of virtual auricle guide under different angles (-60°, -30°, 0°, 30°, 60°). Experiments of patients with microtia showed that HE-01 could be applied to auricular reconstruction, and there were no obvious complications in wearing the navigation marker device, which had repeatability and stability. Conclusion This study has completed the conceptual design of augmented-reality assisted auricular reconstruction based on navigation device, CT data and HoloLens. HE-01 has good registration accuracy, tracking speed and display effect, laying a good foundation for further software development and clinical transformation.

    先天性小耳畸形耳廓增强现实影像导板HoloLens

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    改良皮肤微小三角瓣联合口轮匝肌瓣功能性分区重建修复单侧不完全性唇裂

    刁建升何林余学元刘翔宇...
    143-150页
    查看更多>>摘要：目的 探讨应用改良皮肤微小三角瓣联合口轮匝肌瓣功能性分区重建的方法修复单侧不完全性唇裂的临床效果。 方法 回顾性分析2020年4月至2023年2月西安交通大学第一附属医院整形美容颌面外科收治的单侧不完全性唇裂患儿临床资料。参考上唇健侧解剖结构标记手术定点，采用短直线结合微小三角瓣法设计皮肤切口：沿人中嵴方向设计短直线切口，于患侧红唇缘上方皮肤设计微小三角瓣，插入对侧唇峰处，降低患侧唇峰，延长人中嵴。将口轮匝肌分割为5个肌肉瓣分3区进行重建，恢复上唇与鼻底亚单位结构，重建唇珠、人中嵴结构，纠正向健侧偏斜的鼻小柱，抬高鼻基底。术后从主观评价和客观测量2个方面对手术效果进行评价：(1)主观评价，由未参与手术的2位整形外科医师通过患儿术前和末次随访时的照片，对手术后瘢痕情况、唇弓连续性、唇峰高度、鼻底宽度、鼻孔对称性和人中嵴高度进行总体效果评分，外形较差为1分，一般为2分，满意为3分。(2)客观测量，由未参与手术的1位整形外科医师通过Image-Pro Plus 6.0软件测量双侧红唇厚度、双侧唇峰口角距、双侧人中嵴长度、双侧鼻翼唇峰距、双侧鼻底宽度，计算非对称率(|健侧数值－患侧数值|/健侧数值×100%)，数值越接近于0，表示两侧差异性越小、越对称。采用描述性方法进行统计分析，非正态分布的计量资料用M(Q1，Q3)表示。 结果 共纳入32例单侧不完全性唇裂患儿，其中男19例，女13例，年龄3个月至1岁6个月。患儿术后切口均一期愈合，无局部感染、出血、切口裂开等并发症。术后随访6～24个月，患儿红唇形态饱满，连续性良好，唇珠明显，人中嵴结构立体，双侧对称性良好，遗留瘢痕小，修复效果满意。患儿手术效果主观评价平均总体得分为2.66分，其中唇弓连续性得分最高(2.84分)，鼻孔对称性得分最低(2.38分)；客观测量结果显示，双侧鼻底宽度[2.60%(1.02%，7.08%)]与双侧人中嵴长度[3.95%(2.03%，5.98%)]的非对称率最低。 结论 改良皮肤微小三角瓣联合口轮匝肌瓣功能性分区重建的方法能够修复上唇亚单位结构，较好地恢复上唇和鼻基底的对称性，是修复单侧不完全性唇裂的有效方法。 Objective To investigate the clinical effect of repairing unilateral incomplete cleft lip functionally and sub-regionally with modified micro-triangular skin flap and orbicularis oris muscle flaps. Methods A retrospective study was conducted in the patients with unilateral incomplete cleft lip, who underwent repair at Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi’an Jiaotong University from April 2020 to February 2023. Surgical landmarks were fixed according to the anatomical structure of non-cleft side. Short straight skin incisions were designed along the philtral column. A micro-triangular flap was designed above the vermilion margin of the affected lip, which was inserted into the contralateral lip peak to lower the lip peak and lengthen the philtral column. The orbicularis oris muscle was reconstructed with five muscle flaps in three areas to create a good sub-structure of the upper lip and the nasal floor. The vermilion tubercle and philtral column were reconstructed. Deviation of nasal columella was corrected and the nasal floor was elevated. The outcomes were assessed through subjective evaluation and objective anthropometric measurements.(1) Subjective outcomes were assessed by two plastic surgeons together who were not included in this study. The following parameters were assessed: scar appearance, Cupid’s bow continuity, lip pick height, alar base width, nostril symmetry, philtral ridge contour. Each parameter was graded from 1 point (poor), 2 points (average), or 3 points (good). (2) Objective measurements were taken by one plastic surgeon who was not included in this study using the Image-Pro Plus 6.0. Measurements were included bilateral vermilion thickness, bilateral length of lip pick to cheilion, bilateral philtral column length, bilateral length of Cupid’s pick to ala nasi, bilateral alar base width. Asymmetry ratio = |non-cleft counts-cleft counts|/non-cleft counts×100%, and a value closer to 0 would mean the less different, the more symmetrical. Statistical analysis was performed using descriptive methods. Non-normal distributed measurement datas were expressed by M(Q1, Q3). Results A total of 32 patients of unilateral incomplete cleft lip were enrolled, including 19 males and 13 females, aged 3-18 months. All patients were primary healing, and no serious complications (i.e., infection, hematoma, wound dehiscence) occurred. The postoperative follow-up time was 6-24 months. The patients were satisfied with the results, including favorable red lip contour, good continuity, obvious vermilion, cubical philtrum column, good symmetry of bilateral structure and sub-structure and light scar. The overall score of the subjective evaluation was 2.66 points. Cupid’s bow continuity got the highest score(2.84 points), and nostril symmetry got the lowest score(2.38 points). Objective measurements indicated excellent parameters were bilateral alar base width [2.60%(1.02%, 7.08%)] and bilateral philtral length[3.95%(2.03%, 5.98%)]. Conclusion Repairing unilateral incomplete cleft lip functionally and sub-regionally with modified micro-triangular skin flap and orbicularis oris muscle flaps can create a good sub-structure of the upper lip contour, and bring a significant improvement in the upper lip and the nasal floor symmetry, which is an effective method for incomplete unilateral cleft lip repair.

    唇裂修复外科手术微小三角瓣口轮匝肌

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    口腔黏膜预植尿道板分期治疗残废型尿道下裂

    丁园王越顾胜利沈志伟...
    151-155页
    查看更多>>摘要：目的 探讨应用口腔黏膜预植尿道板分期治疗残废型尿道下裂的效果。 方法 回顾性分析2019年3月至2023年3月遵义市第一人民医院小儿外科收治的残废型尿道下裂患儿的临床资料。手术方式均采用口腔黏膜预植尿道板分期治疗，即一期手术行阴茎伸直、口腔黏膜预植尿道板，二期手术行尿道成形。术后随访观察尿道板存活、尿瘘、尿道裂开、尿道憩室、尿道狭窄、阴茎下弯复发、阴茎外观及排尿情况。 结果 纳入12例男性患儿，年龄5岁1个月至14岁，中位年龄8岁2个月。12例患儿入院前有2～4次尿道下裂手术史，平均3.2次，所有病例均伴有中、重度阴茎下弯和包皮缺乏，其中尿道裂开5例，多处尿瘘3例，尿道狭窄4例。所有患儿术后随访6～36个月，平均25个月。一期术后发生预植尿道板部分感染、失活1例，经高压氧治疗及局部换药后愈合；二期术后发生尿瘘2例，经再次尿瘘修补术后治愈；其他患儿无尿道裂开、尿道憩室、尿道狭窄、阴茎下弯复发，阴茎外观无臃肿，尿道开口位于阴茎头正位，呈纵向裂隙状，排尿通畅、尿线连续。 结论 口腔黏膜预植尿道板分期治疗残废型尿道下裂效果满意，是一种安全、可行的有效方法。 Objective To investigate the effect of staged operations with oral mucosa preimplantation urethral plate in the treatment of crippled hypospadias. Methods The clinical records of patients with crippled hypospadias which were treated in the First People’s Hospital of Zunyi from March 2019 to March 2023 were retrospectively reviewed. Staged operations with oral mucosa preimplantation urethral plate were applied to all patients. The survival condition of preimplantation urethral plate, urethrocutaneous fistula, urethral dehiscence, urethral diverticulum, urethrostenosis, residual chordee, the appearance of penis and urinating condition were observed. Results Twelve male children were enrolled, ranging in age from 5 years and 1 month to 14 years, with a median age of 8 years and 2 months. All of these patients had 2 to 4 times of urethroplasty surgeries with an average time of 3.2. All patients suffered from moderate to severe chordee and lack of prepuce, including 5 patients with urethral dehiscence, 3 cases with multiple urethrocutaneous fistulas and 4 cases with urethrostenosis. All patients were followed 6 to 36 months after surgery with an average of 25 months. One patient suffered from infection of preimplantation urethral plate after the first stage operation was cured by hyperbaric oxygen therapy and local dressing. Two patients complained of urethrocutaneous fistula after the second stage operation were cured by fistulectomy. No urethral dehiscence, urethral diverticulum, urethrostenosis or residual chordee was observed in other patients. Penile appearance was not bloated and the longitudinal slit urethral orifice was located in the head of the penis. Urination was smooth and the urine line was continuous. Conclusion Staged operation with oral mucosa preimplantation urethral plate is an effective and safe method for the treatment of crippled hypospadias.

    尿道下裂口腔黏膜预植外科皮瓣

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    鼻鹦鹉嘴样畸形的治疗策略研究

    赵弘历王先成孙杨熊祥...
    156-162页
    查看更多>>摘要：目的 阐述中国人鼻鹦鹉嘴样畸形矫治的手术策略，并评估术后效果。 方法 回顾性分析2021年1月至2022年12月中南大学湘雅二医院整形美容外科收治的鼻鹦鹉嘴样畸形患者资料。根据患者鼻畸形的病因和严重程度，分别通过鼻中隔前脚切除、鼻尖支撑重建、鼻穹窿中段重建、鼻尖上区皮肤切除等方法进行个性化矫治。通过鼻尖上区畸形评分(0～3分，得分越高，畸形越明显)、视觉模拟评分法(VAS)美学评分(0～10分，得分越高，畸形越明显)对患者术前与术后的鼻尖上区美学效果进行评估；通过鼻整形结果评估(ROE)量表对术后鼻功能与美学效果进行患者满意度自评，总分100分，得分越高代表满意度越高。正态分布计量资料以±s表示，采用配对t检验进行分析；非正态分布计量资料以M(Q1，Q3)表示，采用Wilcoxon符号秩检验进行分析。 结果 共纳入53例患者，男7例，女46例，年龄19～45岁，平均29岁。15例患者行初次隆鼻术，38例患者行二次隆鼻术；鼻轻度畸形5例，中度畸形25例，重度畸形23例。术后随访6～17个月，平均9.5个月。患者的鼻尖上区美学效果有明显改善，鼻尖上区畸形评分由术前的2(2，3)分降低至术后的0(0，0)分(Z＝－6.58，P<0.001)，VAS美学评分由术前的(7.47±1.73)分改善为术后的(1.79 ±1.67)分(t＝－25.61，P<0.001)。患者对术后的鼻部功能与美学的满意度较高，ROE量表得分为(82.45±11.55)分；无明显鼻尖下垂、皮肤坏死、明显瘢痕增生等情况发生。 结论 根据鹦鹉嘴样畸形的严重程度和病因选择合适的手术方法进行矫治可获得良好的效果，术后患者鼻尖上区美学效果明显改善，患者满意度高。 Objective To evaluate the effectiveness of surgical methods for correcting pollybeak deformity in Chinese rhinoplasty. Methods A retrospective chart review was conducted for patients who underwent pollybeak correction between January 2021 and December 2022 at the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University. Individualized correction was tailored based on the etiology and severity of the nasal deformity of each patient, involving techniques such as resection of the anterior part of the nasal septum, reconstruction of nasal tip support, reconstruction of the middle part of the nasal vault, and excision of skin in the upper region of the nasal tip. A modified classification system for pollybeak deformity, the supratip fullness rating scale (SFRS), was developed to evaluate supratip fullness (0-3 points, with higher scores indicating more apparent deformity). The patients aesthetic outcomes were assessed by surgeons using the visual analogue scale (VAS) (0-10 points, with higher scores indicating more apparent deformity), and patient self-assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (0-100 points, with higher scores indicating higher satisfaction). The measurement data of normal distribution was expressed as Mean±SD and analyzed by paired t-test the measurement data of non-normal distribution was expressed as M(Q1, Q3) and analyzed by Wilcoxon signed rank test. Results In a cohort study of 53 rhinoplasty patients (7 male, 46 female age range 19-45 years, mean 29 years), comprising 15 primary and 38 secondary surgeries, nasal tip deformities were evaluated. Deformities were classified as mild (5 cases), moderate (25 cases), and severe (23 cases). Over a follow-up period of 6-17 months (mean 9.5 months), significant aesthetic improvements in the nasal tip region were observed. The SFRS scores decreased from 2(2, 3) preoperatively to 0(0, 0) postoperatively (Z = -6.58, P < 0.001), and VAS scores decreased from 7.47±1.73 to 1.79±1.67 ( t = -25.61, P < 0.001). High patient satisfaction was indicated by a mean ROE score of 82.45±11.55. No significant complications, such as nasal tip ptosis, skin necrosis, or scar hyperplasia, were reported. Conclusion Selecting an appropriate surgical method based on the severity and cause of pollybeak deformity can achieve satisfactory outcomes. Post-operative patients exhibit significant aesthetic improvement in the upper nasal tip area, resulting in high patient satisfaction.

    鼻成形术鼻畸形鹦鹉嘴样畸形胡萝卜样畸形中国人群隆鼻术鼻尖上区缝合鼻尖上区皮肤楔形切除

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    一个双侧耳甲腔型小耳畸形家系遗传学及临床表型分析

    钱会利张利难贾阳侯秀英...
    163-168页
    查看更多>>摘要：目的 对1个中国汉族非综合征型双侧耳甲腔型小耳畸形家系进行致病变异检测及临床表型分析。 方法 2022年6至12月于山西医科大学第一医院整形外科收集1个中国汉族非综合征型双侧小耳畸形家系成员的临床资料以及外周血样本，提取先证者DNA利用全基因组测序(WGS)筛选可能的候选变异。采用荧光定量PCR验证候选拷贝数变异(CNV)在先证者及其表型正常的配偶和患病儿子的存在情况，并分析其与表型的相关性。 结果 该家系共4代9人，含4例小耳畸形患者，收集到其中3人外周血样本，分别为先证者、先证者配偶(表型正常)、先证者的儿子(患病)。家系内患者表现为非综合征型双侧耳甲腔型小耳畸形。WGS在先证者检测到HMX1和CPZ基因间区的拷贝数增加，重复区域累及HMX1基因远程增强子进化保守区域(ECR)，该变异存在于先证者及其患病的儿子，其配偶临床表型正常，不存在ECR的CNV改变。 结论 累及HMX1远程增强子ECR的CNV重复可能与该家系的双侧耳甲腔型小耳畸形有关。 Objective To detect pathogenic mutation in a Chinese family affected with isolated bilateral microtia. Methods During 2022 June to December, one Chinese Han family with non-syndromic bilateral microtia was recruited at the First Hospital of Shanxi Medical University. The clinical data and peripheral blood samples were collected from the family members. Whole genome sequencing (WGS) was performed in the proband to screen all candidate variants. Quantitative PCR was applied to identify the candidate copy number variation (CNV) among the proband, the unaffected wife and the affected son to demonstrate the association between candidate variant and phenotype. Results The patients in the family had non-syndromic bilateral concha-type microtia. WGS detected the duplication in the intergenic region of HMX1 and CPZ gene in the proband, which involved the evolutionarily conserved region (ECR). Both the proband and his affected son carried the CNV, while his unaffected wife did not have this variation. Conclusion Duplications involving the long range HMX1 enhancer ECR are associated with the bilateral concha-type microtia in this family.

    先天性小耳畸形耳甲腔型全基因组测序进化保守区域HMX1基因拷贝数变异增强子

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    121例头颈部丛状神经纤维瘤手术治疗患者的回顾性研究

    王薇顾熠辉朱倍瑶谭好...
    169-178页
    查看更多>>摘要：目的 头颈部丛状神经纤维瘤(PNF)的治疗是临床难题，在手术治疗、分类、治疗时机和治疗方法上缺乏共识。通过对头颈部PNF手术治疗患者的临床表现、手术情况、肿瘤复发情况、治疗满意度及生活质量改变的分析，为进一步形成共识提供依据。 方法 通过病历查阅及电话随访的方式，回顾性分析2012年5月至2022年7月上海交通大学医学院附属第九人民医院整复外科因头颈部PNF进行手术治疗的Ⅰ型神经纤维瘤病(NF1)患者资料。完整收集、统计分析患者的临床资料，采用电话随访方式对患者和(或)家属的术后即刻满意度、远期手术满意度，以及标准化生活质量问卷HRQol和PlexiQol进行调查。根据治疗前后生活质量改变和远期手术满意度，将患者分为手术获益组及非获益组，使用单因素及多因素logistic回归分析远期手术获益患者的临床特点。 结果 有完整记录的头颈部NF1入院手术患者共计512例，随访时筛选病史及影像学明确为NF1相关PNF，并取得有效随访的121例患者纳入研究。男70例，女51例，年龄(25.60±12.85)岁，范围7～63岁，其中≤18岁的患者41例，>18岁的患者80例。瘤体以侵袭性生长为主，62.81%(76/121)患者表现出临床功能障碍。41.32%(50/121)患者接受了多次手术治疗，121例患者总计进行了215次手术。手术目的包括改善外观及功能修复，术后并发症发生率为6.05%(13/215)。末次术后随访时间为(51.41±27.66)个月，42.15%(51/121)患者表示术后瘤体有复发。对术后即刻效果比较满意及非常满意的患者占76.03%(92/121)，但在远期随访时满意率降至46.28%(56/121)。≤18岁的患者家属对手术造成的瘢痕不满意比例更高，且有更强的再次手术意愿。瘤体复发与否和手术获益密切相关(OR＝2.32，P<0.05)。进一步分析发现年龄及性别是头颈部PNF复发的危险因素，其中≤18岁的患者复发风险显著高于>18岁患者(OR＝3.49, P＝0.004)，并且7～12岁年龄段患者的末次术后复发率最高，达到68.42%(13/19)；男性患者的复发概率显著低于女性(OR＝0.40, P＝0.026)。 结论 头颈部PNF患者临床表现复杂，临床诊疗应注重充分的术前评估、积极的多学科诊疗协作和综合应用包括手术及靶向药物的治疗方法，以提高安全性及有效性，减少瘤体复发。 Objective The treatment of head and neck in plexiform neurofibroma (PNF) is a major clinical problem, lacking consensus on surgical treatment, classification, operation timing, and treatment method. The purpose of this study was to provide a basis for further consensus formation by analyzing the clinical manifestations, surgical conditions, tumor recurrence, post-operation satisfaction, and changes in quality of life of patients undergoing PNF surgery in head and neck. Methods Through medical record review and telephone follow-up, a retrospective analysis was conducted on neurofibromatosis type 1 (NF1) patients admitted for surgical treatment for PNF patient in head and neck from May 2012 to July 2022 in Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Complete collection and statistical analysis of patients’clinical data, using telephone follow-up to investigate the immediate postoperative satisfaction and long-term surgical satisfaction of patients and/or their families, as well as standardized quality of life questionnaires HRQol(health related quality of life) and PlexiQol(plexiform neurofibroma quality of life). Based on the data about changes in quality of life before and after surgery and long-term surgical satisfaction, patients were divided into surgical benefit and non-benefit groups. Binary and multivariate logistic regression analysis were used to analyze the clinical characteristics of patients with long-term surgical benefit. Results Totally 512 patients with head and neck NF1 were admitted for surgery with complete medical records. 121 patients were identified as NF1 related PNF diagnosed by medical history and radiological examination, and effective follow-up was obtained. There were 70 males and 51 females, aged (25.60±12.85) years old, ranging from 7 to 63 years old, with 41 patients who were ≤ 18 years old and 80 patients over 18 years old. 62.81%(76/121) of patients exhibiting clinical dysfunctions, and the tumor mass were mainly characterized by invasive growth. 41.32%(50/121) of patients underwent multiple surgical treatments, with a total of 215 surgeries performed on 121 patients. The surgical objective included appearance improvement and functional repair. The incidence of postoperative complications was 6.05%(13/215). The follow-up period after last operation was (51.41±27.66) months, and 42.15%(51/121) of patients reported postoperative tumor recurrence. 76.03%(92/121) of patients were satisfied with immediate postoperative result, while the rate decreased to 46.28%(56/121) during long-term follow-up. Family members of patients who were ≤ 18 years old had a higher proportion of dissatisfaction with the scars caused by surgery and a stronger willingness to undergo another surgery. The tumor recurrence was closely related to surgical benefits (OR=2.32, P<0.05). Further analysis found that the gender and age of patients were the main risk factors for the recurrence. The recurrence risk in patients ≤ 18 years old was significantly higher than in that over 18 years old(OR=3.49, P=0.004), and the highest in the 7-12 year-old group, reaching 68.42%(13/19). The recurrence risk in male patients was significantly lower than that in females (OR=0.40, P=0.026). Conclusion The clinical manifestations of PNF patients in head and neck region are complex. Clinical diagnosis and treatment in PNF should focus on the applications in comprehensive method such as full preoperative evaluation, active multi-disciplinary treatment cooperation and combined therapies in order to improve the safety and effectiveness of treatment and reduce tumor recurrence.

    神经纤维瘤,丛状Ⅰ型神经纤维瘤病头颈部肿瘤肿瘤复发

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    遵循"AISS"策略精准治疗躯干部巨大神经纤维瘤

    张璠陈尚雄张彬张家平...
    179-186页
    查看更多>>摘要：目的 以体表肿瘤精准治疗为目标，探讨躯干部位巨大神经纤维瘤的外科治疗策略。 方法 回顾性分析2021年1月至2023年3月陆军军医大学第一附属医院整形外科收治的躯干部巨大神经纤维瘤患者资料，均遵循"AISS"策略进行精准治疗，即：(1)术前储存自体成分血(autologous blood storage)；(2)术前介入栓塞瘤体关键供血动脉(interventional embolization)；(3)术中精准切除瘤体(surgical resection)；(4)反取瘤体断层皮片回植修复继发巨大创面(skin graft)。记录患者术前基线资料、自体成分血存储量、介入栓塞具体血管及方法、术中出血量、术中输血量、围术期并发症等指标，并随访肿瘤复发情况。 结果 共纳入5例患者，男4例，女1例，年龄22～32岁。5例患者瘤体主要位于躯干部(颈、胸、腰、骶尾部)，大小为21 cm×20 cm～76 cm×66 cm。术前完成自体成分血储存800～1 600 ml，术前介入栓塞主要瘤体供血血管包括：胸廓内动脉、肋间动脉、胸廓外动脉、腰动脉、腹壁下动脉、髂腰动脉及髂内动脉。术中出血量150～3 000 ml，输注自体存储血完成手术。所有患者未发生大出血、发热、感染等并发症，1例患者移植瘤体断层皮片小范围成活欠佳，位于双侧髂窝部位，后续通过换药与刃厚皮片移植治愈。术后随访6～24个月，未见瘤体复发。 结论 "AISS"策略不仅能安全、精准地治疗躯干部巨大神经纤维瘤，而且能有效减少术中出血量及并发症，一期修复巨大创面，防止肿瘤复发，提高患者满意度。 Objective To investigate the surgical strategy for giant neurofibromas in the trunk with the goal of precise treatment of superficial tumors. Methods We retrospectively analyzed the patients with giant neurofibroma of the trunk who admitted to the Department of Plastic Surgery, Southwest Hospital of Army Medical University from January 2021 to March 2023. All patients were treated with "AISS" strategy: (1) autologous blood storage (2) interventional embolization of the key blood supply artery of the tumor (3) surgical resection of the tumor (4) skin graft was harvested from the tumor to repair the secondary defect. Patient demographics, autologous blood storage volume, specific blood vessels and methods of interventional embolization, intraoperative blood loss, intraoperative blood transfusion, complications, and tumor recurrence at follow-ups were documented. Results A total of 5 patients were enrolled, including 4 males and 1 female, aged 22-32 years. The tumors size ranged from 21 cm×20 cm to 76 cm×66 cm, which were located in the trunk (neck, chest, waist, sacrococcygeal region). The volume of autologous blood storage ranged from 800 to 1 600 ml before the operation. The main blood supply vessels of the tumor were embolized before the operation, including: internal thoracic artery, intercostal artery, external thoracic artery, lumbar artery, inferior epigastric artery, iliolumbar artery and internal iliac artery. All patients underwent radical resection. The intraoperative blood loss was 150-3 000 ml. Patients were transfused with their autologous blood during the operation. There were no severe intraoperative hemorrhage, adverse effects of blood transfusion or infection were not noted. A small skin graft necrosis was noticed in the bilateral iliac fossa in one patient, which was subsequently resolved through dressing change and blade-thickness skin graft transplantation. No tumor recurrence was found during the follow-up period (6-24 months). Conclusion "AISS" strategy not only safely and accurately treat giant neurofibroma of trunk, but also effectively reduce the intraoperative blood loss and complications, repair of huge wounds in one stage, preventing the recurrence rate of tumors and improving patient satisfaction.

    神经纤维瘤神经纤维瘤病巨大神经纤维瘤AISS策略精准治疗

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    CT血管成像联合彩色多普勒超声设计游离股骨内侧髁骨瓣治疗难治性手舟骨骨折不愈合

    高文华赵书明张路李栋...
    187-194页
    查看更多>>摘要：目的 探讨术前CT血管成像(CTA)联合彩色多普勒超声(CDU)血管定位技术辅助下游离带血管蒂的股骨内侧髁骨瓣的手术方法治疗难治性手舟骨骨折不愈合的临床效果。 方法 回顾性分析2018年1月至2022年6月华北医疗健康集团邢台总医院骨三科应用以膝降动脉为血供的游离股骨内侧髁骨瓣转移修复手舟骨陈旧性骨折合并骨坏死患者病例资料。术前采用CTA联合CDU技术定位膝降动脉，依照定位结果及骨质缺损情况设计股骨内侧髁骨瓣并修复手舟骨陈旧性骨折。采用门诊和电话方式进行随访，依照视觉模拟评分(VAS)评价腕关节疼痛程度，依照改良Mayo评分法评价腕关节功能，手舟骨弓背畸形程度根据舟骨角评价，腕骨间稳定程度根据舟月角评价。正态分布计量资料以±s表示，采用配对样本t检验比较术前CDU测定及术中实际测定的膝降动脉起始处血管管径、起始处至股骨内侧髁下缘距离，并比较手术前后疼痛VAS评分、腕功能Mayo评分、握力、腕关节活动度、舟月角、舟骨角。 结果 共纳入12例患者，其中男9例，女3例；年龄23～56岁，平均36岁；右侧骨折7例，左侧5例；手舟骨腰部骨折8例，近极骨折4例。比较术前CDU测定和术中实际测量的膝降动脉起始处血管管径[(1.7±0.5)mm vs. (1.8±0.7)mm]、起始处至股骨内侧髁下缘距离[(11.9±2.1)cm vs. (12.1±1.9)cm]，差异均无统计学意义(P>0. 05)。术后所有患者均获得6个月～2年随访，平均13个月。全部患者经X线片检查显示手舟骨骨性愈合，平均愈合时间为15周。术后6个月随访时，比较手术前后疼痛VAS评分[(3.7±0.9)分vs. (0.5±0.1)分]、腕功能Mayo评分[(46.1±3.8)分vs. (86.2±6.1)分]、舟月角[(65.3±4.1)° vs. (47.9±3.5)°]、舟骨角[(37.1±3.9)° vs. (22.8±2.3)°]、腕关节屈伸活动度[(79.0±11.7)° vs. (118.5±15.8)°]、握力[(6.7±4.6)kg vs. (26.1±5.3) kg]，差异均有统计学意义(P<0.05)。 结论 游离带血管蒂的股骨内侧髁骨瓣为修复手舟骨陈旧性骨折伴有骨坏死的理想方法之一，术前血管定位技术有效指导了骨瓣设计、切取，保证术中操作快速、准确。 Objective To investigate the surgical method of preoperative computed tomography angiography(CTA) combined with color Doppler ultrasonography(CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion. Methods Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow-up was conducted using outpatient and telephone method. The degree of wrist pain was evaluated using the visual analogue scale (VAS), wrist function was evaluated using the improved Mayo scoring method, the degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data was represented as Mean±SD, and paired sample t-tests were used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results A total of 12 patients were enrolled, including 9 males and 3 females age ranged from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [(1.7±0.5) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [(11.9±2.1) cm vs. (12.1±1.9) cm](P>0.05). All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1), Mayo scores (46.1±3.8 vs. 86.2±6.1), scapholunar angle [(65.3±4.1)° vs. (47.9±3.5)°], scaphoid angle [(37.1±3.9)° vs. (22.8±2.3)°], wrist flexion and extension range of motion [(79.0±11.7)° vs. (118.5±15.8)°], grip strength [(6.7±4.6) kg vs. (26.1±5.3) kg]were compared before and after surgery, the differences were statistically significant (allP<0.05). Conclusion The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.

    手舟骨骨折,不愈合超声检查,多普勒,彩色CT血管成像股骨内侧髁骨瓣

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    激光美容门诊文身状况单中心调查研究

    林莉鄂天宇王熙宁毕辰...
    195-201页
    查看更多>>摘要：目的 了解激光美容门诊寻求去除文身人群的相关状况。 方法 对2021年6月至2022年5月就诊于山东第一医科大学附属省立医院激光美容门诊的寻求去除文身者进行面对面问卷调查。调查内容主要包括：文身受访者的基本信息、文身相关情况、受访者对文身的认知、文身去除需求4大类共30个问题。对问卷作答情况进行统计，并按文身受访者的性别、就诊年龄、文身时受教育程度进行差异性分析。对问卷一般资料进行描述性统计分析；进行各资料构成比的差异性分析时采用Mantel-Haenszel卡方检验或Pearson卡方检验。 结果 共发放150份调查问卷，回收有效问卷142份。文身受访者中男81例，女61例，就诊年龄为(21.8±4.9)岁(13～41岁)。调查结果显示，受访者文身时为未成年人(<18岁)占52.8%(75/142)，97.2%(138/142)受访者文身时年龄<24岁；67.6%(96/142)受访者后悔文身行为；受访者本人要求去除文身占73.2%(104/142)；为谋求个人发展(参军、工作、求学)而去除文身的受访者占68.3%(97/142)；了解文身危害的受访者仅占23.2%(33/142)；文身后发生不良反应的受访者占21.8%(31/142)；文身时隐瞒家人者占82.4%(117/142)；家人认可文身行为仅占25.4%(36/142)。差异性分析显示，受访者的受教育程度与其对文身危害的了解程度未见关联(P>0.05)；受访者去除文身的原因与就诊年龄和性别有关联(P<0.01)；文身面积与受访者性别有关联(P<0.01)，女性受访者更倾向于选择小面积文身；受访者文身年龄与文身时的学历水平有关联(P<0.01)，文身年龄<18岁的比例在文身时初中学历的受访者中最高[76.2%(32/42)]，随着文身时学历的增高，这一比例下降趋势明显。 结论 激光美容门诊寻求去除文身的受访者以青少年群体为主，文身时约半数为未成年人，大多数受访者对文身危害不了解。受访者文身年龄与文身时的教育背景有一定关联。受访者去除文身的原因依性别和年龄的不同而存在一定差异。受访者教育背景与其对文身危害的了解程度无关联。 Objective To understand the relevant situation of people seeking tattoo removal in laser cosmetic clinics. Methods A face-to-face questionnaire survey was conducted among respondents seeking tattoo removal who visited the Laser Cosmetic Clinic of the Provincial Hospital Affiliated to Shandong First Medical University from June 2021 to May 2022. The questionnaire survey content included 4 categories and a total of 30 questions: basic information of the tattoo respondents, tattoo-related situations, respondents’ cognition of tattoos, and tattoo removal needs. The questionnaire responses were statistically analyzed, and differences were analyzed according to the gender, age of the tattoo respondents, and educational level at the time of tattooing. Descriptive statistical analysis was conducted on the general information of the questionnaire Mantel-Haenszel chi-square test or Pearson’s chi-squared test were used for the analysis of the difference in the composition ratio of each data. Results A total of 150 questionnaires were distributed and 142 valid questionnaires were collected. There were 81 male and 61 female tattoo respondents, with an age of (21.8±4.9) years (13-41 years). The result of the survey showed that 52.8%(75/142) of the respondents were minors (<18 years old) at the time of tattooing, and 97.2%(138/142) were <24 years old at the time of tattooing 67.6% (96/142) regretted the act of tattooing 73.2%(104/142) of the respondents themselves asked for the removal of tattoos who removed their tattoos for personal development (joining the army, working, studying) was 68.3%(97/142) only 23.2%(33/142) of the respondents understood the harms of tattoos and 21.8%(31/142) of the respondents suffered from adverse reactions after getting tattoos. The percentage of respondents who hid their tattoos from their family members was 82.4%(117/142) the percentage of respondents whose family members approved of the tattoos was only 25.4%(36/142). Analysis of variance showed that there was no correlation between the education level of the respondents and their knowledge of the tattoo risks(P>0.05) the reasons for removing tattoos were correlated with the age and gender of the respondents at the time of consultation (P<0.01) the size of tattoos was correlated with the gender of the respondents (P<0.01) and the female respondents were more inclined to choose a small tattoo the age of tattooing of the respondents was correlated with the level of education of the respondents when they had tattooed themselves (P<0.01), the proportion of tattoos aged <18 years old was highest among respondents with junior high school education at the time of tattooing [76.2%(32/42)], and this proportion tended to decrease significantly as the education level at the time of tattooing increased. Conclusion The respondents seeking tattoo removal in the laser cosmetic clinic are mainly teenagers. About half of the respondents were minors at the time of tattooing, and most of them were not aware of the tattoo risks. There is a certain correlation between the age of the respondents and their educational background at the time of tattooing. There are certain differences in the reasons for removing tattoos among respondents depending on gender and age. There is no correlation between the educational background of the respondents and their understanding of the tattoo risks.

    文身术问卷调查去除文身青少年

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    使用新型冻存保护剂进行人源脂肪组织冻存及移植的有效性评估

    赵润蕾王关卉儿安阳杨丹丽...
    202-211页
    查看更多>>摘要：目的 探索使用新型冻存剂进行人源脂肪组织冻存及移植的有效性。 方法 标本来源于2022年1至3月在北京大学第三医院成形外科进行吸脂术的健康成年女性，将获得的脂肪组织离心后随机分为9组，分别采用不同的冻存液[A组、B组、二甲基亚砜(DMSO)组]及冻存时长(1、2、3个月组)于液氮中冻存。A组冻存液组分为右旋糖苷40(DEX)＋氨基酸＋维生素＋无机盐，B组冻存液组分为DMSO＋DEX，DMSO组采用传统冻存液，组分及配比为10% DMSO＋20%胎牛血清(FBS)＋70% DMEM-12。采用5 ml冻存管，脂肪∶冻存液＝3∶2，每组冻存6管。脂肪组织复温后，采用HE染色观察组织学形态，采用免疫组化染色进行脂滴包被蛋白(Perilipin)定量分析，通过阳性细胞数量与总细胞数量的比值计算Perilipin阳性率；采用CCK-8法测定脂肪细胞活性。选择健康无特定病原体级裸鼠38只，根据移植脂肪使用不同的冻存保护剂(A组、B组、DMSO组)分为3组，每组各12只，另外2只作为day 0对照组，各组脂肪冻存时间均为3个月。裸鼠腹腔麻醉后，每侧背部注射复温后的冻存脂肪各0.9 ml，分别于移植后1、2、3个月通过MRI扫描及三维软件计算脂肪组织存留率并进行组间比较；小鼠处死后取移植的脂肪组织，采用HE染色和免疫组化染色进行组织形态学观察及Perilipin定量分析。采用GraphPad Prism 8.0软件对数据进行统计学分析，符合正态分布的计量资料以±s表示，整体多组间比较采用重复测量资料的方差分析，同一时间点组间数据比较采用Tukey多重检验。 结果 在液氮中冻存1～3个月后不同冻存液组的脂肪组织形态接近正常新鲜脂肪组织，各组Perilipin阳性率差异无统计学意义(P>0.05)；CCK-8法提示冻存1个月和3个月时DMSO组脂肪细胞活性优于A组和B组(P<0.01)，冻存2个月时DMSO组和B组脂肪细胞活性优于A组(P<0.01)。动物实验中冻存脂肪移植后1～3个月体积存留率各组之间差异无统计学意义(P>0.05)，移植1～3个月后各组脂肪组织出现不同程度局部坏死伴炎症反应，Perilipin阳性率各组之间差异无统计学意义(P>0.05)。 结论 使用新型冻存液冻存脂肪组织的效果与传统冻存液相比未见显著差异，且避免了使用DMSO或FBS作为冻存剂对人体潜在的不良作用，理论上更加安全。 Objective To investigate the effectiveness of new cryoprotective agents in preserving and transplanting human adipose tissue. Methods The adipose tissue samples were obtained from healthy adult females who underwent liposuction at the Department of Plastic Surgery of Peking University Third Hospital from January to March 2022. The adipose tissue samples were centrifuged and then randomly divided into 9 groups. These groups were cryopreserved in liquid nitrogen using different cryoprotective agents [group A, group B, and dimethyl sulfoxide (DMSO) group] and cryopreservation times (1-month, 2-month, and 3-month groups), respectively. The cryoprotective agent formulation in group A was dextrose glycoside 40 (DEX), amino acids, vitamins, and inorganic salts. In group B, the formulation included DMSO and DEX. The ratio of cryoprotective agent in the DMSO group was 10% DMSO, 20% fetal bovine serum (FBS), and 70% DMEM-12. For cryopreservation, 5 ml cryogenic tubes were used with a fat to cryoprotective agent ratio of 3∶2, and each group contains 6 tubes for cryopreservation. After thawing the adipose tissue, HE staining was used to observe the histological morphology. Immunohistochemical staining was employed for the quantitative analysis of lipid droplet-encapsulated protein (Perilipin), and the Perilipin positivity rate was calculated by the ratio of the number of positive cells to the total number of cells. Adipocyte viability was assessed using the CCK-8 method. Thirty-eight healthy, clean nude mice were selected and divided into 3 groups of 12 mice each according to the use of different cryoprotective agents (groups A, B, and DMSO), while the other 2 mice were used as the day 0 control group. The mean fat freezing duration for all groups was 3 months. After nude mice were anesthetized intraperitoneally, 0.9 ml of thawed cryopreserved fat was injected into the dorsum bilaterally. The rate of adipose tissue retention was calculated by MRI scanning and three-dimensional software at 1, 2, and 3 months after transplantation, and compared between the groups. The fat grafts were explanted from the mice after they were sacrificed, and then subjected to histological morphology and quantitative analysis of Perilipin by using HE staining and immunohistochemical staining. GraphPad Prism 8.0 software was used for statistical analysis of the data. The data that conformed to a normal distribution were expressed as Mean ± SD. The overall comparison between multiple groups used analysis of variance for repeated measures. The comparison of data between groups at the same time point used Tukey’s multiple comparison test. Results The morphology of adipose tissue in different cryoprotective agent groups closely resembled that of normal fresh adipose tissue after being cryopreserved in liquid nitrogen for 1-3 months. The difference in the proportion of Perilipin-stained positive cells in each group was not statistically significant (P>0.05). The CCK-8 method indicated that the effect of the DMSO group was superior to groups A and B at 1 and 3 months of cryopreservation (P<0.01), and that the DMSO group and group B were superior to group A at 2 months of cryopreservation (P<0.01). In the animal experiments, there was no statistically significant difference between the groups in the volume retention rate 1-3 months after cryopreserved fat transplantation (P>0.05). Additionally, the adipose tissues in each group exhibited varying degrees of localized necrosis accompanied by an inflammatory reaction 1-3 months after transplantation. There was no statistically significant difference in the Perilipin staining positivity between the groups (P>0.05). Conclusion The use of new cryoprotective agents for cryopreserving adipose tissue does not show a significant difference compared to the traditional cryoprotective agent. However, it is theoretically safer as it avoids the potential toxic effects of using DMSO or FBS on the human body.

    脂肪组织冷冻保护剂二甲基亚砜胎牛血清右旋糖苷

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