骨折合并脊髓损伤患者血清中转化生长因子β1变化:有利于促进骨折愈合

背景:研究表明,转化生长因子β1在单纯骨折愈合中可发挥重要作用,但在脊髓损伤合并骨折中,转化生长因子β1如何促进骨折愈合未见报道。目的:观察骨折合并脊髓损伤患者的血清中转化生长因子β1水平变化,探讨转化生长因子β1在骨折合并脊髓损伤中的作用机制。方法:收集新疆医科大学第一附属医院脊柱外科及创伤外科从2012年5月至2014年3月间的住院患者28例,并根据是否合并脊髓损伤分为2组,骨折合并脊髓损伤组患者12例、骨折无脊髓损伤组患者16例。分别于伤后第2,7,14,28天空腹时采外周静脉血,并采用酶联免疫法对血清转化生长因子β1质量浓度进行检测。结果与结论:纳入的28例患者中,在损伤第2天,骨折合并脊髓损伤组与骨折无脊髓损伤组血清转化生长因子β1水平差异无显著性意义(P>0.05),在第7,14,28天,骨折合并脊髓损伤组比骨折无脊髓损伤组血清转化生长因子β1水平低(P<0.05)。在骨折合并脊髓损伤组中,血清转化生长因子β1水平从第7天快速升高,至第14天达到高峰,第28天仍然无显著下降。在骨折无脊髓损伤组,第2天升高,第7天升高幅度达到最大,至第28天,升高幅度下降。骨折合并脊髓损伤组血清中转化生长因子β1可发生显著变化,可能与转化生长因子β1在不同时期参与骨折愈合及脊髓损伤修复有关。     

Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team

A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes‐related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty‐three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below‐knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.     

Overview of Surgical Scar Prevention and Management

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

Graphical Abstract

相似文献   

改良美容缝合法对急诊面部皮肤软组织损伤切口愈合、瘢痕产生及美学效果影响

目的:评价改良美容缝合术在急诊面部皮肤软组织损伤患者中的应用效果,观察对术后切口愈合、瘢痕产生及美学满意度的影响.方法:选择我院2018年2月-2019年1月急诊科治疗的65例面部皮肤软组织损伤患者为本次研究对象,患者随机分为对照组32例,观察组33例.对照组开展传统缝合术,观察组开展改良美容缝合术,对比2组患者术后切口愈合、瘢痕产生及美学满意度情况.结果:观察组甲级愈合率63.64%,明显多于对照组31.25%,组间数据比较差异存在统计学意义(P<0.05);观察组患者Ⅰ级瘢痕率57.58%,明显多于对照组31.25%,组间数据比较差异存在统计学意义(P<0.05);观察组术后美学满意度93.94%,明显高于对照组的75.00%,组间数据比较差异存在统计学意义(P<0.05).结论:改良美容缝合法在急诊面部皮肤软组织损伤患者中应用可提升切口愈合效果,减少瘢痕产生,提高患者术后美学满意度,值得临床应用.     

影响人工全膝关节置换皮肤切口愈合因素研究进展

探讨人工全膝关节置换后皮肤切口愈合的影响因素。人工全膝关节置换切口愈合不良是术后常见并发症之一,其常影响到患者术后恢复和手术疗效。其主要与患者自身状况、医师术前准备、术中操作、术后管理等密切相关。目前对人工全膝关节置换后皮肤切口愈合因素研究较多,但所得结果不尽一致。其主要与类风湿性关节炎、糖尿病、营养不良、肥胖、缝合方式、引流管、止血带使用时间、手术入路等有关,这些因素不同程度地影响人工关节置换术后皮肤切口的愈合。     

Donor-site morbidity after harvesting of radial forearm free flaps—comparison of vacuum-assisted closure with conventional wound care: A randomized controlled trial

IntroductionRadial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD).Material and methodsA randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery.ResultsFifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group.ConclusionsOur study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use.     

The effects of ghrelin on colonic anastomosis healing in rats

OBJECTIVES:

In addition to its roles in the stimulation of growth hormone secretion and the regulation of appetite and metabolism, ghrelin exerts immunomodulatory, anti-inflammatory and antioxidant actions in several organ systems. In this study, we investigated the effects of ghrelin on the healing of experimental colonic anastomoses.

METHODS:

Wistar rats were randomly divided into two groups (n = 10 in each). A segment of colon was excised, and an end-to-end anastomosis was performed in the distal colon. The Ghrelin Group received 10 ng/kg/day IP ghrelin for seven days postoperatively, whereas the Control Group received an identical volume of saline. On the seventh postoperative day, the anastomotic bursting pressures and hydroxyproline levels were measured, and adhesion formation around the anastomoses was examined. Histopathological analyses were performed to evaluate inflammatory cell infiltration, fibroblast infiltration, collagen density and neovascularization.

RESULTS:

In the Ghrelin Group, the bursting pressure and hydroxyproline levels were significantly higher than in the Control Group. The adhesion formation scores were lower in the Ghrelin Group than in the Control Group. Although the inflammatory cell infiltration was diminished in the Ghrelin Group, the degrees of fibroblast infiltration, collagen density and neovascularization were not significantly different between the groups.

CONCLUSION:

Our results indicate that ghrelin improves the healing of colonic anastomoses in rats.     

Pinealectomy Does Not Affect the Healing of Experimental Colonic Anastomoses

Gastrointestinal system anastomoses, especially colonic anastomoses, have significant morbidity and mortality despite recent technical improvements. Besides regulating the circadian rhythm, the pineal gland and its main neurohormone product melatonin have widespread actions in the organism. The purpose of this study was to investigate the effects of pinealectomy on the healing of colonic anastomoses. One hundred male albino Wistar rats were used in this study. The rats were separated into three groups: control, pinealectomy, and sham groups. In the control group, only colonic resection and anastomoses were performed. Following pinealectomy, colonic anastomosis was performed 2 weeks later on one half and 2 months later on the other half of the pinealectomy group. Only craniotomy was performed on the sham group, and the rats were separated and evaluated like the pinealectomy group. Colonic anastomoses were evaluated on postanastomotic day 3 and 7 by measuring the bursting pressure and the hydroxyproline levels in the anastomotic segments. There was no difference in the bursting pressure measurements between the groups on both postoperative day 3 and 7. Although hydroxyproline levels were different between groups on both postanastomotic days 3 and 7, it has been observed that neither normal nor anastomotic hydroxyproline levels influenced the anastomotic bursting pressure measurements. The percent deviation from the normal values was compared in the anastomotic segments, and no differences were found regarding the bursting pressure and hydroxyproline levels. It was concluded that pinealectomy has no effect on the healing of colonic anastomoses.     

Ivan Petrovich Pavlov

Twelve African green monkeys were implanted with recombinant human osteogenic protein-1 (rhOP-1) placed on a bovine bone-derived Type I collagen carrier to characterize healing in an ulna segmental bone defect model at 1, 3, 12, and 20 weeks postoperative. Defect healing was evaluated by plain film radiography, computed tomography (CT), magnetic resonance imaging (MRI), bone mineral density (BMD), and histologic analysis. Radiographically, new bone formation was observed as early as 3 weeks postoperative. By 6 weeks, new bone was visible in five of six defects. Increased quantity and mineralization of the new bone were apparent by 12 weeks. Reformation of the medullary cavity with appearance of marrow elements was demonstrated by CT and MRI at 20 weeks. BMD studies revealed a significant increase in the presence of bone with time. Histology at 1 week demonstrated that the implant material was well contained in the defect, and a proliferation of cells occurred at the defect borders. At 3 weeks cell proliferation continued and cell phenotype differentiation was recognized. By 12 weeks substantially less residual carrier was found in the defects, and calcifying tissues with plump chondrocytes, osteoblasts, and immature woven bone were observed. Areas of lamellar and woven bone were identified at 12 weeks, with advanced remodeling and revascularization observed at 20 weeks. The use of osteoinductive implants may provide an alternative to autologous and allogeneic bone tissue in the therapeutic approach to bone defects and promotion of fusion by eliminating the donor site morbidity associated with autogenous bone and the decreased efficacy and potential for disease transmission associated with allogeneic bone.