异种脱细胞真皮与异体巩膜作为HA义眼台包裹材料的实验研究

目的 观察异种脱细胞真皮（acellular xenogenic dermal matrix,X-ADM）和异体巩膜作为羟基磷灰石（hydroxy apatite,HA）义眼台包裹材料,用于实验兔眼的临床表现及病理组织学变化观察.方法 24只纯种新西兰兔,行一只眼的眼球摘除术后,随机平均分为实验组和对照组.于肌锥内分别置入由异种脱细胞真皮及异体巩膜包裹的HA义眼台.术后观察眼部表现,于1、2、4、6、8和12周,连同异种脱细胞真皮或异体巩膜取出义眼台,光镜下观察包裹材料与义眼台的组织病理学改变,包括炎症反应及血管化情况.取4、8和12周标本做透射电镜观察上述组织的超微结构改变.结果 与异体巩膜组相比,异种脱细胞真皮组在同期的成纤维细胞及新生血管的生长更活跃,而且长入较早,新生胶原形成丰富,几乎没有炎症细胞的浸润以及发生排斥反应.结论 异种脱细胞真皮血管化快,免疫原性低,是一种良好的巩膜替代物.     

巩膜四瓣法包裹羟基磷灰石义眼台植入术的临床疗效观察

目的:巩膜四瓣法包裹羟基磷灰石义眼台植入术的临床疗效观察.方法:35例(35眼)患者行眼内容物剜除术后,鼻上下、颞上下方剪开巩膜,将巩膜分成4方瓣,剪断视神经,以视盘为中心,环行剪开后极部巩膜.自后巩膜孔前剪开巩膜近赤道部,巩膜腔后部呈4片张开.结果:术后随访3-27月,患者术后义眼座球体稳固,双眼对称,外观逼真,活动度:内转、外转达10°-15°,上转、下转达10°.无暴露、移位等发生.结论:巩膜四瓣法包裹羟基磷灰石义眼台植入术安全可行,操作简便,并发症少,义眼活动更满意,值得推广.     

羟基磷灰石义眼台巩膜瓣后置入术美容效果分析

目的探讨羟基磷灰石义眼台巩膜瓣后置入术的美容效果。方法眼内容物剜除的患者，采用巩膜后羟基磷灰石义眼台置入术治疗。结果共治疗32例，其中眼球萎缩14例、角巩膜葡萄肿5例、绝对期青光眼3例、新生血管性青光眼3例、眼球破裂伤7例。随访3～12个月，未发现义眼台脱出、移位，置入物性能稳定、可靠，眼睑饱满，义眼活动度良好，美容效果满意。结论羟基磷灰石义眼台巩膜瓣后置入术可达到良好美容效果。     

巩膜转位羟基磷灰石义眼台植入术的应用

羟基磷灰石(hydroxyapatite, HA)义眼台因其具有与人体组织相容性较高、生理排斥反应较小等优点,已广泛地应用于眼部整形和眼窝成形术,而且效果优良[1].但由于HA义眼台植入方法及技巧的不同,导致术后发生了不同的并发症[2].自2001年6月至2006年8月,笔者采用巩膜转位HA义眼台植入术对眼球摘除患者进行美容修复,获得了较好的效果.现报道如下.     

异种肌腱基质材料生物相容性的体外评价实验

目的：通过对制备的异种肌腱基质材料生物相容性的体外实验研究,鉴定其作为软组织修复充填材料的可行性,为进一步试验研究和临床应用提供依据。方法：参照医疗器械生物学评价标准和要求,采用标准的毒理学方法进行急性毒性试验、致敏试验、皮内刺激实验、细胞毒性试验、遗传毒性试验,对制备的异种肌腱基质材料进行评价。结果：急性毒性实验：各组小鼠活动正常,72h小鼠无死亡,各组动物未见中毒症状或不良反应。致敏试验显示材料组和阴性对照组的皮肤反应指数均为0,无致敏性。皮内刺激实验观察显示,材料浸提液和生理盐水处无明显红斑、水肿和皮肤坏死,极轻微刺激。材料的细胞毒性结果示该材料的相对增殖度较高,细胞毒性分级在0-1级。遗传毒性试验指标均达到标准要求,无遗传毒性。结论：异种肌腱基质材料具有良好的生物相容性,满足作为软组织修复充填材料的生物安全性要求,有望成为一种理想的软组织充填材料。     

微囊化新生猪甲状旁腺细胞异种移植的实验研究

目的 探讨微囊化新生猪甲状旁腺细胞异种移植治疗大鼠甲状旁腺功能低下症的效果。方法 应用微囊化技术，制备微囊化（海藻酸钠－聚赖氨酸－海藻酸钠生物微胶囊）新生猪甲状旁腺细胞，32只去甲状旁腺的Wistar大鼠随机分成微囊组、非微囊组、空囊组和对照组，分别移植微囊化新生猪甲状旁腺细胞、甲状旁腺细胞、空微囊及生理盐水。移植后监测血钙及甲状旁腺素水平40周，40周后回收移植物，透射电镜检查。结果 移植后，微囊组大鼠血钙及甲状旁腺素水平恢复到正常范围内，直至观察结束时（40周），透射电镜检查显示移植物存活良好；非微囊组、空囊组和对照组大鼠的血钙及甲状旁腺素水平无改善。结论 微囊化新生猪甲状旁腺细胞异种移植在不用免疫抑制剂情况下，可以在大鼠体内存活，且有功能；海藻酸钠－聚赖氨酸－海藻酸钠生物微胶囊对免疫活性细胞及抗体具有屏蔽作用。     

带蒂肌瓣包裹异种无机骨与自体红骨髓复合物的实验研究

目的 制备带血运并具有新骨组织形成的,来源于异种无机骨与自体红骨髓复合物的肌骨瓣,方法 6月龄新西兰大白兔12只,实验组,每只兔左前肢尺桡骨旁肌肉内植入异种无机骨与自体红骨髓复合物,对照组,右侧相同部位植入单纯异种无机骨,术后2、8、12周进行X线片,大体标本和组织学观察。结果 两组X线片显示植入物呈松质骨样密度,不随植入时间改变,大体观察见植入后2周植入物与肌肉完全融合,包裹有植入物的带蒂肌瓣的血管清晰可见,将此包裹有植入物的带蒂肌瓣游离30分钟后,植入物仍然与周围组织色泽相同,无缺血坏死改变,组织学观察植入后2、8、12周显示植入部位肌肉组织与植入物相连接,但实验组植入后2周,血管进入复合物中,无新骨形成,8周,异种无机骨边缘有较少的新骨形成征象;12周,新骨组织形成明显增多,成骨细胞位于骨的边缘,周围为未分化间充质细胞,血管和骨基质丰富,骨细胞包绕在骨陷窝中,偶尔可见骨髓腔,对照组直至12周,异种无机骨孔隙间仅有带血管的疏松结缔组织无新骨形成,结论 异种无机骨与自体红骨髓复合物植入肌肉内12周可预制成具有血运的、有新骨形成的肌骨瓣。     

异种显微板层角膜移植术的实验研究

板层角膜移植术是目前临床常用的角膜移植手术 ,最大优点是术后排斥反应发生率低和手术不进入前房 ,但由于徒手剖切植片和植床 ,致术后界面瘢痕和散光较重。因此 ,术后视力不佳。显微板层角膜移植术是一种全新的板层角膜手术 ,术后界面瘢痕极轻[1,2 ]。由于手术损伤小、术后反应轻 ,降低了诱发排斥反应的可能性 ,为应用异种角膜材料创造了条件。鉴此 ,我们将异种角膜基质引入该手术 ,设计了异种显微板层角膜移植术 ,并进行了动物实验 ,报道如下。材料和方法一、实验动物及实验分组新西兰白兔 3 0只 ,由中山大学实验动物中心提供。新鲜猪眼球…     

异种脱细胞真皮基质抗原性的实验研究

目的　观察不同方法制备的异种脱细胞真皮基质 (Xeno -ADM )埋植物的抗原性差异。　方法　将猪断层中厚皮片采用胰蛋白酶 +tritonX 10 0等处理 ,制成Xeno -ADM ,分为戊二醛交联的Xeno ADM1组、网状交联的Xeno ADM2 组、未交联的Xeno ADM3 组、动物先用Xeno ADM蛋白致敏后再移植交联的Xeno ADM4组和未交联的异体兔Allo ADM对照组。分别将移植物埋植于 5组共计 2 5只日本白兔的耳部和背部皮下 ,术后 2～ 32周检测兔血清抗ADMs抗体效价 ,并观察移植物大体和组织学变化。　结果　Xeno ADM4埋植物组血清抗Xeno ADM蛋白抗体效价最高 ;排除致敏因素的影响 ,Xeno ADM各组血清抗体滴度依次为 :Xeno ADM3 组 >Xeno ADM2 组 >Xeno ADM1组 (P<0 .0 5～ 0 .0 0 1) ;在Allo ADM组中 ,有 4 0 %的血清样本呈现出抗Allo ADM蛋白抗体阳性。组织学上 ,Xeno ADM移植部位有激烈而持久的炎症反应 ,明显强于Allo ADM异体埋植对照组 ;ADM被降解吸收的程度依次为 :Xeno ADM3 >Xeno ADM2 >Xeno ADM4>Xeno ADM1>Allo ADM (P <0 .0 5～ 0 .0 0 1) ,在交联型ADM组易产生异物巨细胞反应。　结论　Xeno ADM的免疫原性强于Allo ADM ,诱导宿主产生IgG限制的免疫反应 ;大张变性的ADM埋植物能降低抗原 抗体反应 ,减缓炎症免疫反应导致的ADM     

同种异体脱细胞真皮替代同种异体巩膜在眼窝填充中的实验研究

目的 ①了解同种异体脱细胞真皮植入兔眼窝后的组织相容性。②比较两种不同材料包裹羟基磷灰石(hydmxyapatite，HA)植入的结果，包裹材料及HA的血管化进程。方法 随机将24只新西兰大白兔平均分为两组，于球后间隙内分别植入以同种异体巩膜、同种异体脱细胞真皮作为包裹材料的HA，观察大体情况并分别于植入后1、4、8、12周取出，光镜及电镜检查组织学改变。结果 大体显示同种异体脱细胞真皮组植入后无一例出现排斥，但其血管化速度较同种异体巩膜组缓慢。结论 同种异体脱细胞真皮作为包裹材料有较好的组织相容性。并能逐渐引导被包裹材料的血管化。     

Experimental study of apatite cement containing antibiotics

Long-term systemic administration of high concentrations of antibiotics may have adverse effects on local osmolality and on various organs; the potential for such effects provides a rationale for the direct administration of such drugs to local sites. The ideal material for this purpose should contain adequate amounts of antibiotics and be biocompatible, and be capable of filling bone defects. We used an implant material called apatite cement. Compounded with gentamyicin (GM) and poly-l-lactic acid (PLA), this material has excellent biocompatibility. In vitro and in vivo studies of this new compound (52 Japanese white house rabbits) showed that the release of antibiotic was gradual and that an effective drug concentration was maintained for 2 months. Histologic findings revealed new bone formation from 2 weeks after implantation. Thereafter, new bone formation sequentially increased in volume. Within 24 weeks, new bone was identified even inside cracked implants. The implant we developed was composed of bioactive material and delivered antibiotic at a level that exceeded the minimal inhibitory concentration ofStaphylococcus aureus. Our implant appears to stimulate satisfactory bone formation. An abstract of this paper was presented at the 9th International Symposium on Ceramics in Medicine and the 9th Basic Research Session of the Japanese Society of Orthopedic Surgery     

Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique

Screw augmentation with calcium apatite cement (CAC) was used in seven patients with a progressive osteoporotic spinal deformity. Thirty-nine spinal segments (64 screws) were augmented: 15 anteriorly (three patients) and 24 posteriorly (five patients). Dorsally, hemilaminectomy was performed at the level of all augmented screws to rule out CAC leakage. Autogenous bone graft was applied in all patients to induce fusion. Screw augmentation failure occurred in only one patient: 1 of the 16 ventral augmented screws (5.5%) was still loose after the augmentation procedure. In three other patients, 4 out of 48 augmented dorsal screws (5.5%) showed CAC leakage at the pedicle corpus vertebra level. Pedicle wall damage was present at two levels, while at two other levels no wall damage was found during visualization. No CAC-related complications were observed perioperatively. No implant migration was observed, and fusion was observed in all cases at follow-up examination performed at a mean of 32 months after surgery. Received: 29 December 1999 Revised: 30 March 2000 Accepted: 7 April 2000     

Evaluation of a KTP (potassium-titanyl-phosphate) 532 nm laser for endovaporization of choroidal melanomas

BACKGROUND AND OBJECTIVES: The purpose of this in vitro study is to evaluate the use of the KTP (potassium-titanyl-phosphate) 532 nm laser for future use in endovaporization of large choroidal melanomas. STUDY DESIGN/MATERIALS AND METHODS: A KTP 532 nm green laser coupled to a 0.3 mm fiberoptic probe was used to perform in vitro studies on human cadaver eyes and on one enucleated melanoma eye. The specimens were examined by histological staining (Masson-Trichrome) and scanning electron microscopy (SEM). RESULTS: Histological analysis of sclera, choroid, retina, and melanoma revealed different zones of collateral thermal tissue damage. These zones were analyzed quantitatively. We determined the best suitable laser parameters and the time for sclera penetration. CONCLUSIONS: The KTP-laser showed good potential in intraocular vaporization of choroidal melanomas. However, great differences in laser absorption between sclera and melanoma can cause significant complications such as perforation.     

Influence of disodium (1-hydroxythylidene) diphosphonate on bonding between glass-ceramics containing apatite and wollastonite and mature male rabbit bone

Summary It has been reported that bioactive glass-ceramics containing crystalline oxy- and fluoroapatite [Ca₁₀(PO₄)₆(O,F₂) and wollastonite (CaSiO₃), chemical composition: MgO 4.6, CaO 44.9, SiO₂ 34.2, P₂O₅ 16.3, CaF₂ 0.5 in weight ratio] bond to bone tissue through the formation of an apatite (a calcium and phosphorus-rich layer) on the ceramic surface. In this study, the influence of disodium (1-hydroxythylidene) diphosphonate (DHTD) on the bonding between bone and glass-ceramics containing apatite and wollastonite was investigated. Rectangular ceramic plates (15 mm x 10 mm x 2 mm, abraded with #2000 alumina powder) were implanted into the tibial bone of mature male rabbits. DHTD was administered daily by subcutaneous injection to groups 1–5: group 1–4 at doses of 20, 5.0, 1.0, and 0.1 mg/kg body wt/day for 8 weeks; and group 5 at a dose of 5 mg/kg body wt/day for 4 weeks. Group 6 was given injections of saline as a control. At 8 weeks after implantation, the rabbits were killed. The tibiae containing the ceramics were dissected out and used for a detachment test. The failure load, when an implant became detached from the bone, or when the bone itself broke, was measured. The failure loads for groups 1–6 were 0 kg, 0 kg, 8.08±2.43 kg, 7.28±2.07 kg, 5.56±1.63 kg, and 6.38±1.30 kg, respectively. Ceramic bonding to bone tissue was inhibited by a higher dose of DHTD (groups 1 and 2). In groups 3–6, SEM-EPMA showed a calcium-phosphorus-rich layer (Ca-P-rich layer) at the interface between the ceramic and bone tissue. However, at higher doses (5 and 20 mg), the Ca-P-rich layer was not observed on the surface of the glass-ceramic. DHTD suppressed both the formation of the Ca-P-rich layer on the surface of galss-ceramics and also apatite formation by bone. Thus, bonding between the Ca-P-rich layer of glass-ceramics and the apatite of bone tissue did not occur. This study verified that the apatite crystals in bone tissue bonded chemically to the Ca-P-rich layer on the surface glass-ceramics. The organic matrix (osteoid) did not participate in the bonding between bone and glass-ceramics.     

Experimental study using PTFE (Goretex) patches for replacement of the oesophageal wall

BACKGROUND: The purpose of this study was to evaluate tolerance and integration of expanded polytetrafluoroethylene patches used to replace loss of a fragment of the complete oesophageal wall in rats of the Wistar strain. METHODS: The experiment was performed on 10 Wistar rats. Those surviving the experiment were killed 7-28 days after surgery. RESULTS: None of these animals showed signs of peritonitis. The patch was not visible macroscopically. After examination under the microscope, we observed that the material had undergone phagocytosis by macrophages, and there was scar tissue covering the epithelium. CONCLUSION: It is possible to successfully suture a polytetrafluoroethylene patch to the oesophageal wall in Wistar rats as a prosthetic replacement of a wall fragment.     

A combination of wrapping and clipping using a collagen-impregnated dacron fabric (Hemashield)

BACKGROUND: We describe techniques combining wrapping and clipping using a collagen-impregnated Dacron knitted fabric (Hemashield) for accidental arterial perforations and broad-based aneurysms. The results of these techniques in seven patients are presented. METHODS: Clip-reinforced wrapping was performed to obtain hemostasis in two patients with arterial perforations and in a patient with a ruptured broad-based aneurysm in the internal carotid artery. Clipping of the broad neck of the aneurysm and wrapping with Hemashield (wrap-clipping) was performed in four patients with unruptured aneurysms (one internal carotid artery, two middle cerebral artery, one basilar artery). RESULTS: In the three patients treated with clip-reinforced wrapping, complete hemostasis was obtained just after clip application. In the patient with a ruptured broad-based aneurysm, postoperative angiography demonstrated that the dome of the aneurysm was well compressed. In the four patients treated with wrap-clipping, postoperative angiography revealed successful clipping of the broad neck of the aneurysm. CONCLUSION: In this early experience, there were no problems in the use of Hemashield for clip-reinforced wrapping or wrap-clipping.     

应用异种脱细胞真皮的眼睑原位重建术的实验研究

目的探讨应用异种(猪)脱细胞真皮施行兔眼睑原位重建术后的组织相容性,比较异种(猪)脱细胞与异体巩膜替代睑板后的组织转归。方法采用兔眼睑缺损动物模型,随机分别给予异种(猪)脱细胞真皮、兔异体巩膜施行眼睑原位重建术。活体观察动物术后和移植物情况,于术后1、2、4、6、8和12周,取带植片的眼睑,光镜下观察替代材料和自体睑板交界处的组织病理学改变,包括炎症反应、纤维血管化情况和融合情况;取4、8和12周标本做透射电镜观察上述组织的超微结构改变。结果光镜和电镜下二者反应类似,差异无统计学意义。组织学检查显示异种脱细胞真皮引起的免疫和炎症反应轻微。结论异种(猪)脱细胞真皮在植入兔眼睑后有较好的组织相容性,并可引导新生胶原的生长,起到替代睑板的作用。