钢丝Bunnel缝合法修复治疗跟腱断裂

目的探讨用钢丝Bunnel缝合法修复治疗跟腱断裂的手术方法及效果。方法对26例跟腱断裂患者采用钢丝编织缝合牵拉,使跟腱断端部分重叠对合,将钢丝经跟骨穿孔固定于内侧皮下。跟腱断端腱旁组织用可吸收线间断缝合。结果平均随访26个月,根据Arner—Lindholm疗效标准进行评定,优19例（73．1％）,良7例（26．9％）。结论钢丝Bunnel缝合法治疗跟腱断裂是一种方法简便、疗效满意的手术方法。     

肌腱显微缝合的抗拉强度试验

用家兔作试验,切断跟腱后,用改良的Kessler法分别用5/0及7/0尼龙单丝缝线缝合。术后定时取出标本作抗拉强度试验。发现用5/0缝线修复肌腱在术后2周内,抗拉强度显著高于7/0缝线修复组。为临床选用缝线提供了依据。     

带线锚钉与单纯缝线吻合治疗急性跟腱断裂

<正>2013年4月～2016年9月,我科采用带线锚钉或单纯缝线吻合断端治疗24例急性跟腱断裂患者,疗效良好,报道如下。1材料与方法1. 1病例资料本组24例,男21例,女3例,年龄23～60岁。左侧10例,右侧14例。闭合伤21例,开放伤3例。8例跟腱断裂距止点3 cm,断端均不规则; 16例跟腱断裂距止点3～6 cm。带线锚钉+丝线Kessler法缝合9例,单纯缝线吻合15例。受伤至手术时间1～21 d,20例在1周以内,4例超过1周。1. 2治疗方法全身麻醉或腰硬联合     

梗阻性黄疸对胆管损伤修复的影响

为探讨梗阻性黄疸对胆管愈合的影响 ,我们通过建立动物模型 ,从瘢痕形成的角度来观察分析 ,现报道如下。一、材料与方法1.实验对象与分组 :Wistar大鼠 60只 ,随机分为 4组。对照组 (A) 10只 ,直接行胆管切开缝合修补 ;梗黄 3d组 (B)15只、梗黄 7d组 (C) 15只、梗黄 14d组(D) 2 0只 ,分别于结扎胆总管后 3、7、14d行胆道再通及胆管切开缝合修补。2 .动物模型建立 :(1)一期手术结扎胆总管 :乙醚吸入麻醉 ,开腹以 0号丝线结扎胆总管。 (2 )二期手术建立胆管损伤修复模型 :对照组开腹显露胆总管 ,于手术显微镜下 ,横形切开胆总管前壁 ,以11/ 0…     

肌腱周边缝合方法的生物力学研究

目的　比较三种肌腱周边缝合方法 ,即连续法、Cross- Stitch法和 Halsted法的生物力学特性。方法　将 60只新鲜成年猪后蹄 区趾屈肌腱造成切割伤 ,按手术先后随机分成 6组 ,每组 10只。第1～ 3组用 Kessler法进行核心缝合 ,第 4～ 6组用 Tang法进行核心缝合。各组均加用周边缝合修复腱周 :第 1、4组用连续缝合法 ,第 2、5组用 Cross- Stitch法 ,第 3、6组用 Halsted法。术后即刻应用材料力学测定仪测定修复肌腱被拉伸至出现 2 mm间隙时 ,其 2 mm间隙形成负荷及最大负荷 ;并根据位移 -负荷曲线计算其刚度及最大功耗。结果　同一核心缝合法时 ,Halsted法的 2 - mm间隙形成负荷、最大负荷、最大功耗最高 ;Cross- stitch法次之 ;连续缝合法最低。Halsted法的刚度与 Cross- stitch法相近而连续法较差。结论　 Halsted周边缝合法对肌腱抗张能力的作用最大 ,能够满足肌腱手术后早期活动所需的抗张力要求。     

聚羟基丁酸酯可吸收缝线生物相容性的实验室研究

目的：研究聚羟基丁酸酯（Polyhydroxybutyrate,PHB）可吸收缝线的生物相容性。方法：①将成纤维细胞进行体外培养,传代后与PHB可吸收缝线复合培养,设与经聚氰基丙烯酸酯处理过的PHB可吸收缝线复合培养为对照组,观察细胞生长情况;②行扫描电镜检查观察细胞在丝线上的生长情况;③以MTT法检测复合培养后的细胞活性。结果：①实验组细胞生长良好,对照组细胞漂浮,收缩成团;②扫描电镜下见细胞在丝线上贴附生长良好;③MTT法检测实验组对细胞增殖无明显影响。结论：PHB可吸收缝线具有良好的生物相容性。     

两种肌腱缝合方法的对比研究

目的 对两种肌腱缝合方法的生物力学特性进行对比研究,为临床肌腱修复术对缝合方法的选择提供理论依据.方法 收集30根完整的废弃肌腱,随机分为两组,从中间锐性切断.A组:采用新创ZM缝合法缝合肌腱;B组:采用改良Kessler缝合法缝合肌腱,缝合后立即进行生物力学测试.测定2mm间隙形成负荷、最大负荷、最大间隙、断裂方式,计算所修复肌腱的强度,所得数据进行统计学分析.结果 A组的2mm间隙形成负荷为(46.13±1.57)N、最大负荷为(57.18±1.84)N、强度为(8.45±0.34) N/mm,均大于B组的2 mm间隙形成负荷(15.02±0.67)N、最大负荷(28.63±1.95)N、强度(2.47±0.22) N/mm;A组的最大间隙(6.77± 0.29)mm小于B组的最大间隙(11.62± 0.94) mm;A组的缝线抽出率(0)小于B组缝线抽出率(100％).结论 ZM缝合法具有良好的抓持作用和强大的抗张力强度,可以满足屈肌腱修复术后早期无抗阻主动功能锻炼的需要.     

SURGIPRO~*Ⅱ缝线应用于皮内美容切口缝合的临床效果观察

目的:观察SURGIPRO*Ⅱ非吸收性单股聚丙烯惰性缝线应用于皮内美容切口缝合的临床效果。方法:选择2011年1月～12月期间在我院施行手术的符合纳入标准的患者92例,分观察组和对照组,观察组使用5-0/SURGIPRO*Ⅱ非吸收性单股聚丙烯惰性缝线皮内缝合切口,对照组使用4-0/POLYSORBTM可吸收缝线皮内缝合切口,出院后随访6月,对比观察分析两组切口组织的过敏反应、炎性反应、疼痛程度、瘢痕横径、异物反应、切口愈合情况等多项指标。结果:①对照组和观察组初期炎性反应和过敏反应、疼痛程度差异不大,(P>0.05);②7日后对照组有13例患者开始出现缝线异物反应,观察组第5日拆除缝线,患者皮内没有缝线异物残留,切口整齐,切缘对合良好,瘢痕纤细,切口甲级愈合率达100%;对照组的有1例出现缝线异物反应,切口出现红肿、渗液,甲级切口愈合率略微偏低;半年后随访发现,对照组瘢痕横径≥1mm达7例,比观察组高出13.1%。结论:5-0/SURGIPRO*Ⅱ缝线用于皮内美容切口缝合,容易拆除,皮内缝线异物残留时间短,皮肤局部反应小,切口整齐,切缘对合良好,瘢痕纤细,甲级愈合率高,临床应用效果良好。     

抗菌可吸收缝线缝合儿童面部裂伤的美容效果观察

目的:分析抗菌可吸收缝线在儿童面部裂伤美容缝合中的应用效果。方法:选取2017年3月-2017年4月就诊于本院整形外科面部裂伤行清创美容缝合的80例患儿为研究对象,随机分为观察组和对照组,每组40例。两组患儿在完成清创术后,观察组采用抗菌可吸收缝线皮下减张缝合,尼龙线缝合皮肤的美容缝合法;对照组采用丝线皮下减张缝合,尼龙线缝合皮肤。观察两组患儿术后伤口感染、线结反应及瘢痕增生情况。结果:观察组患儿术后伤口感染及线结反应发生率明显低于对照组,差异具有统计学意义(P0.05);但两组患儿术后瘢痕增生发生率未见明显差异(P0.05)。结论:使用抗菌可吸收缝线美容缝合儿童面部裂伤可以有效降低术后伤口感染及线结反应发生率,效果显著,值得临床推广应用。     

可吸收胶原蛋白线在口腔种植修复术切口无张力缝合中的应用价值

目的:比较可吸收胶原蛋白线与丝线编织非吸收性缝线在口腔种植修复手术切口无张力缝合中的临床效果及对患者伤口愈合时间的影响。方法:选取2016年8月-2017年8月在笔者医院门诊行牙齿种植修复术的188例患者为研究对象,采用随机数字法将其分为试验组和对照组,每组94例。试验组采用可吸收胶原蛋白线缝合伤口,对照组采用丝线编织非吸收性缝线缝合伤口。比较两组患者伤口愈合等级、平整率、缝合线完全吸收率、切口愈合时间、疼痛情况及不良反应发生情况。结果:试验组:甲级愈合89例,乙级愈合5例;对照组:甲级愈合74例,乙级愈合19例,丙级愈合1例,试验组患者伤口愈合等级显著优于对照组,差异有统计学意义(P<0.05)。试验组患者牙龈红肿5例,对照组患者牙龈红肿16例,渗血10例,试验组患者牙龈红肿、渗血及总发生情况均显著优于对照组,差异有统计学意义(P<0.05)。术后3、5、7d,试验组患者缝线位点完全吸收率分别为0.00%、11.35%、97.52%,对照组患者缝线位点完全吸收率均为0.00%,试验组患者缝线位点完全吸收率在术后3、5d均显著高于对照组,差异均具有统计学意义(P<0.05)。试验组患者切口平整率为85.11%,对照组患者切口平整率为68.09%,差异具有统计学意义(P<0.05)。试验组患者伤口愈合时间为(5.23±0.31)d,对照组患者伤口愈合时间为(7.57±0.36)d,试验组患者伤口愈合时间显著优于对照组,差异有统计学意义(P<0.05)。术后3、5、7d,试验组患者VAS评分分别为(3.17±1.65)分、(2.04±0.88)分、(1.11±0.56)分,对照组患者VAS评分分别为(4.97±1.74)分、(3.74±1.25)分、(2.73±0.93)分,在各个时间节点,试验组患者VAS评分水平均显著优于对照组,差异有统计学意义(P<0.05)。结论:可吸收胶原蛋白线在口腔种植修复手术切口无张力缝合中的临床效果较丝线编织非吸收性缝线的临床效果更加显著,应用可吸收胶原蛋白缝线能够有效提高患者伤口愈合效果、缩短愈合时间,同时减少不良反应,值得在临床推广应用。     

Fatty acids and osteoarthritis: different types,different effects

While the association between obesity and osteoarthritis used to be solely regarded as a result of increased mechanical loading, systemic factors also likely play a role in the pathophysiology of osteoarthritis. Nutrient excess leading to obesity may result in lipotoxicity, which might be involved in the development of osteoarthritis. The different fatty acid types have distinct effects on inflammation. This review focusses on the currently available studies, summarizing the effects of the different fatty acid types on osteoarthritis and involved joint tissues. In animal studies omega-3 polyunsaturated fatty acids reduced the expression of inflammatory markers, cartilage degradation and oxidative stress in chondrocytes. In contrast, these markers were increased upon omega-6 polyunsaturated fatty acid and saturated fatty acid stimulation. Additionally, a decrease in pain and dysfunction was observed upon omega-3 supplementation in cats and dogs. In line, most human in vitro studies show pro-apoptotic and pro-inflammatory actions of saturated fatty acids. While all polyunsaturated fatty acids reduced markers of oxidative stress, omega-3 polyunsaturated fatty acids additionally decreased prostaglandin production. Human intervention studies with omega-3 polyunsaturated fatty acid supplementation may indicate a beneficial effect on pain and function and might be associated with less structural damage. In contrast, an adverse effect of saturated fatty acids on osteoarthritis has been observed. Monounsaturated fatty acids have been infrequently studied and findings are inconclusive. Existing studies indicate a promising effect of especially omega-3 polyunsaturated fatty acids on osteoarthritis signs and symptoms. However, more human intervention studies are warranted to draw robust conclusions.     

In-hospital cardiac arrest: different wards show different survival patterns

The purpose of the study was to investigate the characteristics and outcomes of in-hospital cardiac arrests that occurred outside of the hospital critical care areas. A prospective register of adult in-hospital cardiac arrests occurring in non-critical care areas of Christchurch Hospital, Christchurch, New Zealand, from January 2001 to December 2004 was compiled. Two-hundred-and-forty-three cardiac arrests were recorded in this period. The overall return of spontaneous circulation was 38.7% (CI 32.6, 44.8) and survival to discharge was 21.0% (CI 15.9, 26.1). Comparison of clinical areas showed that the percentage with successful resuscitation and the percentage with survival to discharge were highest in the cardiology wards (52.2%, 41.3%) and lowest in the medical wards (24.9%, 8.8%). After taking account of rhythm, age, gender and time of day, differences between clinical areas were slightly reduced. Cardiology wards, however, still had a higher resuscitation percentage than medical wards (P = 0.03) and a higher percentage with survival to discharge than all other areas (P = 0.005 overall, P < or = 0.05 for each individual comparison). Reporting of hospital-wide survival rates does not accurately reflect the survival rates in a variety of specific clinical areas. The analysis of outcomes across different clinical areas at Christchurch Hospital revealed differences in outcomes and therefore the clinical experience of staff in those areas. These differences have implications for the resuscitation training of health professionals. The further development of national resuscitation registries may allow more specific analysis of outcomes in different clinical areas.     

Antisperm antibodies bind with different patterns to sperm of different men

Immunologic infertility is an important area of current clinical research. The immunobead test is a laboratory method that identifies the classes of antisperm antibodies and their binding sites on the sperm surface. In this study we have investigated the variability in the pattern of antibody binding to spermatozoa after passive transfer from blood serum. Serum from a single donor containing antisperm antibodies of the IgG class was used in all experiments. The spermatozoa from 27 semen donors were found to differ significantly in the degree and location of immunobead binding after exposure to this serum. There was substantial day-to-day variability in the results for individual semen donors and the overall variability in test results was significantly greater when a number of semen donors was used rather than a single donor. These data suggest that details of antisperm antibody binding after passive transfer from body fluids may depend on the sperm donor. The design of research studies involving antibody transfer must take this source of variability into account.     

不同部位高血压性脑出血不同术式的探讨

目的探讨不同部位高血压性脑出血的有效术式. 方法 2001年1月～2003年8月,对85例不同部位高血压性脑出血采取不同手术方式.40例皮层下、基底节区外侧型未出现脑疝者,采用局麻加强化麻醉下小骨窗开颅血肿清除术;26例基底节区内侧型未出现脑疝者,采用局麻加强化麻醉下头皮小切口颅骨钻孔血肿穿刺抽吸术;11例术前脑疝及6例小脑半球出血者采用静脉全麻,开颅清除血肿;2例脑干出血破入第四脑室者采取侧脑室外引流术,其他部位出血破入脑室加用侧脑室外引流. 结果 85例病死率12.9%(11/85),其中皮层下、小脑、脑干、基底节区外侧型未出现脑疝的病例无死亡;基底节区内侧型病死率29.0%(9/31);11例术前脑疝的病死率45.5%(5/11). 结论皮层下、基底节区外侧型未出现脑疝的病人经局麻小骨窗开颅清除血肿效果显著,小脑出血经积极手术预后良好,基底节区内侧型出血经局麻小切口钻孔抽吸效果较差.     

Fractionating language: different neural subsystems with different sensitive periods.

Theoretical considerations and psycholinguistic studies have alternatively provided criticism and support for the proposal that semantic and grammatical functions are distinct subprocesses within the language domain. Neurobiological evidence concerning this hypothesis was sought by (1) comparing, in normal adults, event-related brain potentials (ERPs) elicited by words that provide primarily semantic information (open class) and grammatical information (closed class) and (2) comparing the effects of the altered early language experience of congenitally deaf subjects on ERPs to open and closed class words. In normal-hearing adults, the different word types elicited qualitatively different ERPs that were compatible with the hypothesized different roles of the word classes in language processing. In addition, whereas ERP indices of semantic processing were virtually identical in deaf and hearing subjects, those linked to grammatical processes were markedly different in deaf and hearing subjects. The results suggest that nonidentical neural systems with different developmental vulnerabilities mediate these different aspects of language. More generally, these results provide neurobiological support for the distinction between semantic and grammatical functions.     

不同腹腔镜手术方式对不同超声分型精索静脉曲张患者治疗疗效的影响

目的 探讨不同腹腔镜手术方式对不同超声分型精索静脉曲张（VC）患者疗效的影响.方法 将接受腹腔镜手术治疗的164例VC患者随机分为A组与B组,每组82例,A组行Palomo术式,B组行Ivanissevich术式.分析所有患者术后精液质量变化情况、手术后近、远期并发症及复发率等指标.结果 在A组与B组内,蔓状静脉丛（PPV）中、重度反流患者术后精液质量均较术前提高（P〈0.05）,而轻度反流患者术后精液质量改善不明显（P＆gt;0.05）;对于PPV重度反流患者,Palomo术式的复发率低于Ivanissevich术式（0.00 vs 13.63%）,而PPV轻、中度反流患者两种术式术后均无复发;PPV轻、中、重度反流患者Palomo术式与Ivanissevich术式近远期并发症差异无统计学意义（P＆gt;0.05）.结论 对于PPV中、重度反流患者,两种腹腔镜手术方式均能改善患者精液质量,为减少复发率,PPV重度反流患者可首选Palomo术式;超声提示PPV轻度反流的VC患者是否需行手术治疗有待进一步研究.