目的:探讨新的构建心脏解剖系统的方法,为影像医学、心脏手术和解剖学教学提供参考。方法: 对VHP数据集心脏断面图像进行连续追踪观察,对分割结果进行三维重建;利用Maya三维动画软件对重建心脏进行修正以及对心脏供血过程进行动画设定。结果: VHP心脏断面图像清晰,可清楚显示心脏各部分组织,心脏重建图像质量高,心脏供血过程动画准确、生动。结论:研究采用传统编程技术与Maya三维动画软件相结合进行三维重建的新方法,实现了基于VHP数据集的心脏解剖系统的构建,为影像医学和心脏手术提供了解剖学参考,也为解剖学教学提供了新的教学软件。
Objective To investigate the clinical characteristics of unstable pelvic fractures and to find out an alternative for the treatment. Methods From October 2000 to June 2004, fifty-six patients with unstable pelvic fractures were treated by open reduction and pelvic-reconstructed plate fixation to recover the anatomical structure of pelvis and acetabulum. According to Tile classification, 33 cases were type B (15 cases were Tile B1, 11 cases were Tile B2, 7 cases were Tile B3); 23 cases were type C (10 cases were Tile C1, 8 cases were Tile C2, 5 cases were Tile C3). Results The 56 cases were followed up 12 to 68 months(26 months in average).All cases with fractures got healed during 3 to 6 mouths. According to the Majeed evaluation, 40 cases were excellent, 11 cases were good, 4 cases were fair, and only one case was a failure. The rate of excellency and goodness was 91.07%.The pelvic abnormity was rectified; partial patients felt light pain in iliac scar. Conclusion The choice of the proper operative approach and pelvic-reconstructed plate fixation by allowingfor fracture classification is a good and dependable means for treating unstablepelvic fractures.
Objective To evaluate the advantages and disadvantages of vascularized free peroneal composite flaps for reconstruction of oral and maxillofacial defects. Methods From November 1999 to December 2002, 28 cases of oral maxillofacial defects were reconstructed with vascularized free peroneal composite flaps, with fibulacutaneous flap in 21 cases and with fibulamyocutaneous flap in 7 cases. Three cases received insertion of dental implants into the fibula flap. The flap size was 3.0 cm×5.5 cm to 8.0 cm ×12.0 cm; the fibula length was 5.5 cm to 16.0 cm. Results Of the 28 flaps reconstructed, 24 survived,3 necrosed partially and 1 necrosed completely. All the 5 implants survived andachieved good bone integration in 3 cases. Twenty-six cases were followed up 1-36 months with an average of 18.5 months, the facial appearance and the vocal function were satisfactory in 23 cases. Conclusion Vascularized peroneal flap has many advantages and is one of the optimal flaps for reconstruction of oral maxillofacial defects.
Objective To discuss the definition of complicated giant cell tumor of the bone and retrospectively analyze the treatment protocols and their therapeutic results so as to provide a clinical basis for reducing the postoperative recurrence of this kind of tumor. Methods From April 2001 to April 2005, 22patients (11 males and 11 females, aged 15-66 years) with complicated giant cell tumor of the bone were treated by the marginal or wide excision. The tumor was located in the distal femur in 10 patients, the proximal tibia in 5, theproximal femur in 2, the proximal humerus in 2, the hip bone in 2, and the distal radius in 1. The Campanicci′s grading system was used and the patients were grouped as follows: Grade Ⅱ in 4 patients, and Grade Ⅲ in 18. The functional results of the patients were assessed by the clinical examination. The reconstruction methods were used in the forms of osteoarticular allografting (14 patients) and total arthroplasty (8 patients). Results The analysis on the follow-up (6-48 months, averaged 23 months) of the 22 patients revealedthat the complicated factors were as follows: the tumor breaking through the cortex with an extraosseous mass; the tumor having pathologic fracture; the tumor representing more biologically-aggressive lesions; and the tumor having one or more local recurrences. Two patients (9%) had a local recurrence respectively 8 and 11 months after operation, but improved respectively by limb amputation and radiotherapy. Total arthroplasty achieved a better articular function than osteoarticular allografting. All the patients with osteoarticular allografts showed various degrees of the bone union of the allograft with the host bone. Conclusion The marginal or wide excision of this kind of complicated giant cell tumor of the bone combined withosteoarticular allograft or total arthroplasty can reduce the local recurrence of the tumor and achieve a certain degree of the articular motion function.
Objective To evaluate the effect of reconstruction withautograft implantation in total hip arthroplasty(THA) with regional acetabular deficiency. Methods From 1991 to 2000, 39 cases of THA with acetabular deficiency were conducted. Autogenous bone implantation was used to reconstruct the deficient acetabulum. Of the 39 patients, 25 were males and 14 were females. The age ranged from 34 to 62(45.2 on average). There were21 cases of developmental dysplasia resulted deficiency, 14 cases of fracture of femoral neck complicated with head necrosis(10 hips) and fracture of acetabulum(4 hips). The resected femoral heads or autologous ilium were made the wedgeshaped graft and implanted into the deficient acetabulum, which included 12 cases with cement THA and 27 with cementless THA.Of all the cases, 24 were followed up 2 to 10 years(6.7 years on average). Harris scores before operation were 18 to 50(38.1 on average). Results The limbs were lengthened by 2.4 cm on average. No serious complications were observed in these patients. Comparedwith the scores before the operation, the average Harris scores after the operation were 92.1(Plt;0.01)and 86.3(Plt;0.05) in the one-year and the latest follow-up respectively. The rates for the good were 91.7% and 83.3% in the one-year and the latest follow-up respectively.Conclusion The acetabular reconstruction with autograft in THA will bring better stability in those patients with acetabular deficiency. It is of significance in maintaining a long-term function in the replaced hip.
Objective To evaluate the results of chest wallreconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. Methods From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years.The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiationnecrosis 1 and skin cancer 1. The number of rib resected was 2~7 ribs (3.6 in average). The defect was 20~220 cm2 (97.1 cm2 in average). Concomitant resectionwas done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction alone(latissimus dorsi+greater omentum, latissimusdorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone(Prolen web), and simultaneous BR and STR were performed in 19 patients(latissimus dorsi, pectorails major, latissimus dorsi+fascia lata, and Prolene web). Results Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6~57 months with a median of 22 months. Conclusion A favorable clinical outcome can be achieved by CWR for the patients with hugechest wall defects that result from resection of chest wall tumors.