缺氧缺血型狭长窄蒂皮瓣成活过程中基质细胞衍生因子-1、CD34及微血管密度的表达

目的检测基质细胞衍生因子-1（stromal cell—derived factor-1,SDF-1）、CD34、微血管密度（MVD）在缺氧缺血型狭长窄蒂皮瓣组织的不同时间、不同面积的表达,以及SDF-1在狭长窄蒂皮瓣组织血管新生中的作用。方法在5头家猪两侧背部各制作蒂部长宽比为4：2,携带皮瓣面积分别为2cm×2cm（A组）、3cm×3cm（B组）、4cm×4cm（C组）、5cm×5cm（D组）和6cm×6cm（E组）共5组的窄长蒂皮瓣模型。对5组皮瓣进行大体观察、皮瓣成活情况、光镜下检测MVD、免疫组织化学及酶联免疫技术（ELISA）,检测皮瓣远端组织在术后0、3、5、7、14d时,SDF-1和CD34表达。结果（1）同一组狭长窄蒂皮瓣,随着时间推移,SDF-1、CD34及MVD表达也随之增加,SDF-1在第5天达最高值（A组124．80±4．05,B组137．85±3．03,C组166．53±2．98,D组72．80±2．63,E组62．79±2．20）;CD34在第7天达最高值（A组16．76±0．62,B组17．60±0．72,C组18．48±0．55,D组12．70±0．60,E组11．51±0．70）;MVD在第7天达最高值（A组52．45±2．78,B组59．34±3．12,c组61．14±3．35,D组25．25±3．78,E组24．46±7．46）,随后逐渐下降。（2）不同组狭长窄蒂皮瓣,随着皮瓣面积的增大,SDF-1、CD34及MVD的表达也随之增加,当面积达5cm×5cm时,各项指标不再增加,皮瓣远端出现部分坏死。结论SDF-1对狭长窄蒂皮瓣成活中的新生血管起一定的调节作用。     

一定长宽比狭长窄蒂与任意皮瓣成活面积关系的实验研究

目的 揭示具有一定长宽比例的狭长窄蒂与任意皮瓣成活面积关系. 方法 25头猪被随机分成5组,每组5头,5组皮瓣蒂长宽比分别为0 cm:2 cm、1 cm:2 cm、2 cm:2 cm、3 cm:2 cm、4 cm:2 cm,每个长宽比例的狭长窄蒂均携带5个不同面积的任意皮瓣,分别为2 cm×2 cm、3 cm×3 cm、4 cm×4 cm、5 cm×5 cm和6 cm×6cm,并依次命名为A、B、C、D、E,其中A瓣为B、C、D、E瓣的对照瓣,在每组每只猪的双侧背部均形成A、B、C、D、E皮瓣,顺序随机排列.对每组皮瓣进行大体观察、荧光色素钠染色、ECT血流测定、成活面积分析等. 结果 ①当狭长窄蒂的长宽比例一定时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定界限时皮瓣远端即发生坏死,而成活面积并未缩小;②当皮瓣大小一定,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定界限时皮瓣远端即发生坏死,皮瓣成活面积缩小. 结论 任意皮瓣的蒂部可以设计成狭长状,蒂宽可远远小于瓣宽;一定长宽比的狭长窄蒂所能携带的任意皮瓣成活面积有其最大值,一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.     

一氧化氮合酶和CD34在狭长窄蒂随意型皮瓣中表达与皮瓣成活的关系

目的通过在猪背部设计一定宽长比例的狭长窄蒂所携带不同大小的几组随意型皮瓣,在术后不同时间测定各组皮瓣内一氧化氮合酶（nitri coxide synthase,NOS）和CD34的表达量,并观察皮瓣的成活面积,揭示NOS、CD34表达量与皮瓣成活的关系,以探讨狭长窄蒂皮瓣的成活机制。方法在5只白色实验猪的两侧背部均形成蒂部宽长比皆为2：4的狭长窄蒂皮瓣各5个,其面积分别为2cm×2cm、3cm×3cm、4cm×4cm、5cm×5cm、6cm×6cm,并依次命名为A、B、C、D、E皮瓣。其中A瓣为对照瓣。术后对皮瓣进行大体观察,并分别于术中即刻、术后3、5、7、14d切取皮瓣远端外侧缘组织块,用于测定皮瓣内NOS、CD34表达量,术后14d计算皮瓣存活面积。结果A、B、C组皮瓣NOS、CD34的表达量随皮瓣面积的增大逐步升高,皮瓣完全存活（P〈0．05）;D、E组皮瓣当皮瓣面积达到一定限度时,NOS、CD34表达餐不再随皮瓣面积的增大而升高,表达相对恒定,皮瓣远端部分坏死（P〉0．05）。结论任意型皮瓣的成活与蒂的宽长比没有直接关系。一定宽长比例的狭长窄蒂所携带的随意皮瓣成活面积有其一定限度。     

乒乓球拍样皮瓣成活过程中基质细胞衍生因子-1、CD34的表达

目的 检测基质细胞衍生因子-1(SDF-1)、CDM在乒乓球拍样皮瓣组织不同时间、不同面积的表达,观察SDF-1在皮瓣组织血管新生中的作用.方法 制作乒乓球拍样皮瓣动物模型.对皮瓣进行大体观察、皮瓣成活情况、免疫组织化学及酶联免疫吸附试验(ELISA)技术检测皮瓣远端组织在术后0、3、5、7、14 d时SDF-1、CD34的表达.结果 (1)同一组狭长窄蒂皮瓣,随着时间推移,SDF-1、CD34的表达也随之增加,SDF-1在第5天达到最高值(A组124.80±4.05,B组137.85±3.03,C组166.53±2.98,D组72.80±2.63,E组62.79±2.20),CD34在第7天达到最高值(A组16.76±0.62,B组17.60±0.72,C组18.48±0.55,D组12.70±0.60,E组11.51±0.70),随后逐渐下降.(2)不同组狭长窄蒂皮瓣,随着皮瓣面积的增大,SDF-1、CD34的表达也随之增加,当皮瓣面积达5 cm×5 cm时,各项指标不再增加,皮瓣远端部分坏死.结论 在皮瓣成活过程中SDF-1和CD34的表达呈正相关.

Abstract：

Objective To detect the expression of stromal cell-derived factor 1 (SDF-1), CD34 in the PingPong Racket flap during the survival process, and investigate the role of SDF-1 in flap neovascularization. Methods The PingPong Racket flap animal model was established. The morphology and survival of the flap were observed. The expression of SDF-1 and CD34 in the distal flap was detected by using immunohistochemistry and enzyme-linked immunosorbent assay at 0, 3, 5, 7, and 14 days after operation respectively. Results (1) In the same group of flaps, with prolongation of time, the expression of SDF-1 and CD34 was increased. The expression of SDF-1 reached the peak at the 5th day (group A; 124. 80 ±4.05, B: 137.85±3.03, C: 166.53±2.98, D: 72. 80 ±2.63, E: 62.79±2.20), and that of CD34 reached the peak at the 7th day (group A: 16. 76 ±0.62, B: 17. 60 ±0.72, C: 18.48 ±0.55, D: 12.70 ±0. 60, E: 11. 51 ±0. 70) ; (2) In the different groups of flaps, when the flap area was increased, the expression of SDF-1 and CD34 was increased, and at the area of 5 cm ×5 cm, the flaps had partial necrosis. Conclusion There was a positive relationship between SDF-1 and CD34 in the survival process of the flap.     

猪背部乒乓球拍样任意型皮瓣成活的动物实验研究

目的 探讨乒乓球拍样任意型皮瓣成活面积与窄蒂长宽比例关系.方法 25只猪随机分成5组,在5组猪的背部分别形成不同长宽比例的狭长窄蒂和5个不同面积的任意型皮瓣.对每组皮瓣进行大体观察、荧光色素钠染色、单光子发射计算机断层仪（ECT）血流量测定、成活面积分析等.结果 当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定限度时皮瓣远端即发生坏死,而成活面积并未缩小;当皮瓣面积不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定限度时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 狭长窄蒂任意型皮瓣是一种简便实用的任意型皮瓣,蒂部可以设计成狭长状,蒂瓣的长宽比远小于传统的比例,在一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.     

猪狭长窄蒂随意型皮瓣蒂部不同长宽比例与成活面积关系的研究

目的 探讨狭长窄蒂随意型皮瓣蒂的长宽比例与皮瓣成活面积的关系,为临床应用狭长窄蒂皮瓣提供理论依据.方法 将25只猪随机分成5组,每组5只,5组皮瓣蒂的长、宽比分别为0∶2,1∶2,2∶2,3∶2,4∶2,每个长宽比例的狭长窄蒂均携带5个不同面积的随意型皮瓣,分别为2 cm×2 cm、3 cm×3 cm、4 cm×4 cm、5 cm×5 cm、6 cm×6 cm,并依次命名为A、B、C、D、E,其中A瓣为B、C、D、E瓣的对照瓣,在每组每只猪的双侧背部均形成A、B、C、D、E皮瓣,顺序排列但两侧背部相反.对每组皮瓣进行大体观察、荧光色素钠染色、ECT血流测定、病理学表现和成活面积分析等.结果 ①狭长窄蒂随意型皮瓣和常规随意型皮瓣的成活过程和病理过程是一致的,皮瓣的成活过程并未因蒂部变窄变长而延缓.②当狭长窄蒂的长宽比例不变时,随着皮瓣面积的增加,皮瓣成活面积也随之增大,但达一定界限时皮瓣远端即发生坏死,而成活面积并未缩小.③当皮瓣大小不变,随着狭长窄蒂的长宽比例增加,皮瓣成活面积不受影响,但达一定界限时皮瓣远端即发生坏死,皮瓣成活面积缩小.结论 ①随意型皮瓣的蒂宽可远远小于瓣宽,蒂宽和瓣长比可远小于传统的比例.②随意型皮瓣的蒂部可以设计成狭长状,使整个皮瓣形似"乒乓球拍",更利于皮瓣的旋转.③不同长宽比的狭长窄蒂所能携带的随意型皮瓣成活面积有其最大值,一定范围内增大皮瓣面积或蒂部的长宽比例不会导致皮瓣坏死.

Abstract：

Objective To explore the relationship between the ratio of length to width of slender narrow pedicle and random flap survival area, and to provide a theoretical basis for the clinical application of slender narrow pedicle flaps. Methods 25 pigs were randomly divided into 5 groups, 5 pigs in each group. The ratio of length to width of slender narrow pedicle in 5 groups respectively was: 0∶2 , 1∶2 ,2∶2, 3∶2, 4∶2 . Every ratio's slender narrow pedicle was carrying five different size of random flaps,which were2cm×2cm(A),3 cm×3 cm(B),4 cm×4 cm(C), 5 cm×5 cm(D),6 cm×6 cm(E),respectively. Flap A was control flap. In each group, flap A, B, C, D and E were created in each pigs'bilateral back. The order in both sides back is contrary. The flaps were evaluated with the general observation, fluorescence examination, blood flow ECT test, pathological expression and computerized analysis of survival area. Results ① The living process and pathologic process of traditional flap and slender narrow pedicle flap were consistent. It could not postpone the flap living process when the flap pedicle became long and narrow. ② When the ratio of the length to width of the slender narrow pedicle was constant, along with the flap area increased, the flap survival area also increased, but when the flap reached a certain area , the distal flap would necrosis, the flap survival area would not reduce. ③ When the flap size remained unchanged, along with the ratio of the length to width of the slender narrow pedicle increased, the flap survival area was not affected, but when the ratio of the length to width of the slender narrow pedicle increased to a certain limit, distal flap would necrosis, the flap survival area would reduce.Conclusions ① Pedicle width of random flap can be much smaller than flap width. The ratio of pedicle width to flap length is far less than traditional ratio. ② The pedicle of random flap can be designed as slender shape, so that the whole flap looks like "pingpang bat ", which makes the narrow pedicle flap rotate easily. ③ A certain ratio of the length to width of a slender narrow pedicle has a maximum flap survival area, and increasing the flapsize or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis.     

地拉罗司对成年大鼠狭长窄蒂皮瓣DLL4、CD105表达及血管新生的影响

目的 探讨地拉罗司对成年大鼠狭长窄蒂皮瓣Delta样配体4(DLL4)、CD105表达及血管新生的影响.方法 健康成年SD大鼠20只随机分为地拉罗司组和对照组(n=10).地拉罗司组每只大鼠采用地拉罗司100 mg·kg-1·d-1连续灌胃1周,对照组采用等量生理盐水连续灌胃1周.灌胃停止后,两组每只大鼠背部左右各设计1个蒂部为1 cm×1 cm、瓣部为3 cm×3 cm的狭长窄蒂乒乓球拍样随意型皮瓣模型.手术1周后分别取各个皮瓣蒂部、皮瓣部中间位置组织1 cm×1 cm,以10％甲醛溶液固定,免疫组织化学(SABC法)分别检测CD105和DLL4.结果 地拉罗司组与对照组相比,无论在蒂部或是在皮瓣部,大鼠皮瓣组织内CD105标记的新生血管均增多,DLL4表达的新生血管均减少.两组中,皮瓣部组织中CD105、DLL4标记的新生血管均多于蒂部.结论 地拉罗司促进狭长窄蒂皮瓣中的CD105表达、促进血管新生,并且可能与其抑制皮瓣Notch途径中关键蛋白DLL4的表达有关.     

狭长窄蒂皮瓣在老年人皮肤癌治疗中的应用

目的 探讨狭长窄蒂皮瓣在老年肿瘤切除后软组织缺损修复中的应用及成活机制.方法 设计蒂部位于肿瘤切除后创面旁沿知名或穿支血管走向的狭长窄蒂皮瓣,用于老年人肿瘤切除后软组织缺损的修复.皮瓣切取最大面积12 cm×10 cm,最小3 cm×4 cm,蒂宽1.0～1.5 cm,蒂长2～8 cm.结果 共17例,14例Ⅰ期成活,外形良好,3例因早期包扎不当,延迟愈合.结论 老年人皮肤组织细胞代谢率低,移植后皮瓣组织本身的耐缺血缺氧能力强,设计狭长窄蒂皮瓣修复老年肿瘤切除后软组织缺损,较易成活,且窄蒂狭长,转移容易,皮瓣不臃肿,同时利于肿瘤的早期综合治疗,是老年肿瘤术后修复较理想方法.     

狭长窄蒂皮瓣在面额部皮肤癌治疗中的应用

目的 介绍一种打破常规任意皮瓣长宽比例限制的狭长窄蒂皮瓣在面额部皮肤癌切除后组织缺损修复中的应用,并探讨其成活机制.方法 设计不带知名血管,以耳前或耳后狭长皮肤筋膜或单纯筋膜为蒂的侧颌颈部皮瓣,修复面额部皮肤癌切除后组织缺损26例,其中颞额区皮肤基底细胞癌5例,皮肤鳞状细胞癌6例,面部恶性黑色素瘤1例,基底细胞癌8例,鳞状细胞癌5例,皮肤黏液癌1例.26例皮瓣的蒂部有24例在耳前,2例在耳后;4例仅为筋膜蒂.皮瓣最大10.0 cm×8.0 cm,最小3.0 cm×2.5cm,蒂宽1.0～1.5 cm,蒂长2～6 cm.结果 26例狭长窄蒂皮瓣除5例皮瓣远端淤血,其后渐恢复,其余全部成活,修复后局部外形理想.结论 该狭长窄蒂皮瓣不带知名血管,其长宽比例超过常规任意皮瓣,无需解剖血管,切取容易,蒂部狭长使其旋转和覆盖范围大,供、受区邻近,是修复面额部皮肤癌扩大切除后组织缺损的理想皮瓣.     

隐神经大隐静脉筋膜蒂皮瓣的临床应用

目的探讨不同类型隐神经大隐静脉筋膜蒂皮瓣临床应用的可靠性. 方法 1996年6月～2002年10月,对18例膝、小腿及远端的皮肤缺损创面,根据不同缺损部位分别采用以隐神经大隐静脉筋膜远端蒂皮瓣(11例),近端蒂皮瓣(4例)及交腿皮瓣(3例)移位修复.皮瓣范围4 cm×5 cm～9 cm×20 cm. 结果 17例皮瓣全部成活,1例远端蒂皮瓣因静脉回流障碍致远端1/5坏死.随访6～24个月,皮瓣质地优良,外形与功能恢复满意. 结论隐神经大隐静脉筋膜蒂皮瓣设计灵活多样,切取简便快捷,血供可靠,不牺牲主干血管,是一种修复下肢远端皮肤软组织缺损创面的理想皮瓣,但皮瓣成活面积与胫后动脉皮穿支的关系有待进一步研究.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

三角韧带损伤的手术治疗

[目的]探讨踝关节三角韧带损伤的手术治疗及效果。[方法]2002年4月-2005年4月治疗伴有三角韧带损伤的踝关节骨折40例，均采用切开复位和坚强内固定，并修复重建三角韧带，恢复踝关节内外侧结构的稳定性。下胫腓联合分离仍不稳定者，给予皮质骨螺钉横向内固定。[结果]全部病例得到16个月-3a随访，平均1．5a。按齐氏疗效评定标准：优良30例，可8例，差2例，优良率75％。[结论]强调踝关节骨折切开解剖复位，坚强内固定的同时，应充分重视修复重建三角韧带。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。