Clinical analysis of mandibular reconstructions using synthetic bones based on three-dimensional printing technology in 149 cases / 上海交通大学学报（医学版）

Objective-To assess the clinical value of the computer-assisted three-dimensional reconstruction technique design and evaluate the climcal experience of manufacture artificial bone precision to repair the mandibular defect.Methods· From 2001 to 2016,163 computer-assisted reconstruction surgeries had been performed in Craniofacial Department,Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine.During six months followup,the measurement data was conducted and compared with three-dimensional CT result.Random measurement of the three key anatomical points pre-and post-operative carried out with statistical error was used to evaluate the accuracy of computer-assisted three-dimensional reconstruction in mandibular defects repairation and to investigate the clinical application value of the operation time and postoperative complication rate.Results· From July 2001 to July 2016,a total of 163 patients underwent computer-assisted three-dimensional reconstruction of artificial bone repair for mandibular defects;149 patients met the statistical criteria in which preoperative design and postoperative actual effect's average distance error (1.27±0.15) mm,operation time (2.5±1.2) h.Conclusion· Threedimensional design of artificial bone to repair the mandibular defect is a valuable technology,by relying on quantitative design and preoperative simulation to simplify the difficulty and improve the accuracy of surgery.The patients showed high satisfaction rate with low surgical complications and long-term efficacy.

Trifocal distraction osteogenesis for reconstruction of skull defect

OBJECTIVE@#To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment.@*METHODS@#Six labrador dogs were selected in this study and divided into observation group and control group randomly. Each group contained 3 dogs. Skull segmental defects models were established by surgery, and dogs in bservation group received trifocal distraction osteogenesis treatment. Bone density was observed and compared between two groups during treatment.@*RESULTS@#There were no significant difference in bone density between two groups on th 1st day (P>0.05). The bone density of observation group on the 30th day, and 60th day were higher than that of control group (P<0.01).@*CONCLUSIONS@#Trifocal distraction osteogenesis has significant clinical effect, and it would be widely used in clinical treatment.

Changes of different section area at different parts of upper-airway after Le Fort III osteotomy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effects of Le Fort III osteotomy and midface distraction osteogenesis (DO) on the upper-airway narrow.</p><p><b>METHODS</b>Since 2000, 11 cases (10 cases of Crouzon syndrome and 1 case of Apert syndrome) with severe midface deficiency were treated with Le Fort III osteotomy and midface DO. The section area of different parts of upper-airway were tested by computer assistants image measurement preoperatively and postoperatively. Some patients received sleep function monitoring.</p><p><b>RESULTS</b>The face appearance and the function of upper-airway improved significantly after Le Fort III osteotomy and Midface DO. The section area at the level of posterior nasal spine and uvula increased obviously after treatment (P < 0.05), however the section area at the level of epiglottis and separation between airway and esophagus were not obviously enlarged (P > 0.05).</p><p><b>CONCLUSIONS</b>Midface DO after Le Fort III osteotomy can effectively improve the upper-airway narrow, especially the upper part from uvula.</p>

Experience of midfacial distraction osteogenesis in upper airway stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of upper airway stenosis after Le Fort III osteotomy and midfacial distraction osteogenesis (DO).</p><p><b>METHODS</b>Eleven cases (age, 5-16 yrs) with severe midface dysostosis complicated with exophthalmos, anterior crossbite and upper airway stenosis were treated by using Le Fort III osteotomy and midfacial DO from August 2000 to February 2007. The 3D reconstruction of the upper-airway from CT data was used to evaluate the upper airway volume before and after the operation. And meanwhile polysomnography was carried out to demonstrate the upper airway functional changes.</p><p><b>RESULTS</b>There was a 64.3% mean increase [mean, (9.13 +/- 6.94) ml, P < 0.05] in upper airway volume in the 11 cases after the operations. It showed that there was significant improvements in the indexes of polysomnography after the operations, such as apnea and hypopnea index, average SaO2, minimum oxygen saturation and snore index.</p><p><b>CONCLUSIONS</b>The Le Fort III osteotomy and midfacial distraction osteogenesis can efficiently relieve the symptoms of upper-airway stenosis in severe midfacial dysostosis.</p>

Surgical correction of craniofacial dysostosis with midface distraction osteogenesis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of distraction osteogenesis on correction of craniofacial dysostosis.</p><p><b>METHODS</b>Le Fort III osteotomy was applied through coronal route on patients with craniofacial dysostosis such as Crouzon and Apert syndrome. The procedures included disconnecting the skeletal midface from base of cranium, setting up a RED II distraction device, and directing the device bars. The distraction was started 5 days after the surgery, with a rate of 1 mm forward per day. When midface approaching the right position, i.e. a slightly over correction of occlusion was reached, stopped distraction and kept the device for 2 - 4 months.</p><p><b>RESULTS</b>Eight cases completed all the therapy. The average blood lose was 300 ml and the average operation time was 3.5 hours. The midface had been moved averagely 9 mm forwardly and 1.5 mm downwards. The features had been improved obviously and the occlusion reached nearly normal. No serious complications occurred except for 1 case of seroma and 1 case of infection around pin on scalp. No recurrence was found in the 5 months of follow-up.</p><p><b>CONCLUSIONS</b>Midface distraction osteogenesis is propitious to teenage or severe cases of craniofacial dysostosis.</p>

Clinical study on the therapeutic effects and mechanism of progesterone in the treatment for acute severe head injury / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of Progesterone (PG) on the patients with acute severe traumatic brain injury, and investigate it's neuroprotective mechanisms.</p><p><b>METHODS</b>Fifth-six patients with acute severe traumatic head injury were divided randomly into two groups: 26 cases were treated with PG and 30 cases were control. Neurological outcome of the patients were assessed using Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), verbal and motor functions scale and Karnofsky Performance Scale (KPS). The serum concentrations of PG, TNF-alpha and 15-F(2t)-isoprostane were measured at day 1, 5 and 10 after trauma.</p><p><b>RESULTS</b>In the two groups, There were no significant difference in the mortality, GCS of acute healing phase, GOS and verbal and motor functions at 10th days after treatment (P>0.05); After follow-up for 3 months, GOS, verbal functions and KPSin the PG treatment group were better than those in the control group (P<0.05); In addition, there was no difference of motor functions in the two groups (P>0.05). At 5th day after trauma, serum 15-F(2t)-isoprostane and TNF-alpha levels increased in the control group, but decreased at 10th day after trauma. Compared with the control group serum PG levels increased, serum 15-F(2t)-isoprostane and TNF-alpha levels reduced significantly in the PG treatment group at 5th and 10th day after injury (P<0.05).</p><p><b>CONCLUSION</b>It indicated that successive early application of PG will benefit the patients with acute severe head injury by improving the recovery and reducing the disability, which may be related to its alleviating inflammatory and lipid peroxidation response.</p>

Surgical correction of craniofacial dysostosis with midface distraction osteotogenesis / 中华整形外科杂志

<p><b>OBJECTIVE</b>Correction of craniofacial dysostosis with midface distraction osteotogenesis.</p><p><b>METHODS</b>Le Fort III osteotomy has been employed through coronal route on patients with midface craniofacial dysostosis such as Crouzon and Apert syndrome. Then a REDII distraction device was set up, and the device bars directed. The distraction begins 6.4 days after the surgery, with a rate of 1 mm per day. When midface approaching the right position, i.e. an slightly over correction of occlusion is reached, the distraction stops and the device is held for the next 2-4 months.</p><p><b>RESULTS</b>There are 8 cases completed all the therapy with an average age of 11.9 years old. The midface had been moved averagely 9.7 mm forwards and 1.6 mm downwards. The features had been improved obviously and the occlusions reach nearly normal. The exophthalmos reduced from 20.3 mm to 11.9 mm. In cephalometry, SNA was averagely enlarged 9 degrees, and ANB enlarged 8.8 degrees. The snore during sleeping was also improved in 87.5% cases. No serious complication had occurred except minor one such as 1 case of seroma and 1 case of infection around pin on scalp. According to 5 months averagely follow-up, there is no recurrence in our list.</p><p><b>CONCLUSIONS</b>Midface distraction osteotogenesis is propitious to teenage or severe cases of craniofacial dysostosis.</p>