连续浅缝法修补膜周型室间隔缺损

目的探讨连续浅缝法修补单纯膜周型室间隔缺损(pVSD)法的效果。方法选取2002年1月至2004年10月我院收治的体重10kg以内(≤10kg)50例单纯膜周型室间隔缺损患者,均采用自体心包连续浅缝法修补。结果主动脉阻断时间32±21min(14-52min),体外循环时间56±35min(29-69min)。无°房室传导阻滞发生,9例发生右束支传导阻滞,2例结性心律。2例膜周偏流出道型VSD患者因前上缘残余分流分别为0.4cm和0.3cm,再次手术修补;1例后下缘残留细束样分流,直径0.15cm,随访6个月后自愈;10例膜周偏流出道型VSD患者剪开三尖瓣,8例垂直瓣环,2例平行瓣环;1例三尖瓣中度反流,随访无加重;5例轻度反流,4例轻微反流,随访均无加重;1例心包积液;1例再次进入手术室止血。结论连续浅缝法是修补单纯膜周型室间隔缺损的有效外科纠治方法。     

心脏跳动下修补小儿室间隔缺损的临床研究

目的　探讨在浅低温体外循环心脏跳动下完成小儿室间隔缺损修补术的可行性。方法　 18例小儿室间隔缺损随机分为观察组和对照组 ,观察组在浅低温体外循环心跳下修补室间隔缺损 ,对照组为常规心脏停跳下修补室间缺损。测定心肌同功酶释放和三磷酸腺苷 ,观察左室压力 ,评价术野显露及气栓预防效果等。结果　观察组心肌同功酶释放明显低于对照组 ,三磷酸腺苷含量明显高于对照组 ,心肌超微结构基本正常 ,术中左室压力低于主动脉压力 ,术后无气栓发生。结论　浅低温体外循环心脏跳动下行小儿室间隔缺损修补术能更好地保护心肌。术野显露技术和防气栓的方法简便可行。     

重视神经、内分泌与免疫机制在皮肤修复与再生中作用的研究

目的概述神经、内分泌与免疫学机制的变化对皮肤修复的影响,以及近年来的研究进展,为深入开展这一领域的研究和临床治疗提供依据.方法广泛阅读国内外相关文献,并进行分析、综合,确定神经、内分泌与免疫机制在皮肤修复中的作用.结果皮肤作为神经依赖性器官、内分泌器官及免疫器官,在皮肤损伤修复与再生中发挥重要作用.结论目前对这一领域研究较少,应加强相关基础研究.     

关节镜下应用“微骨折”方法修复关节软骨缺损

目的:探讨关节镜下应用“微骨折”技术对膝关节全层关节软骨缺损修复的效果。方法:对68例全层关节软骨缺损患者进行随机分组:实验组(35例),男17例,女18例,平均年龄35.1岁,采用关节清理后应用“微骨折”技术进行处理,即利用骨刀设计的特性和适度的锤击力量造成软骨下的骨组织微小骨折,刺激软骨生长。对照组(33例),男17例,女16例,平均年龄31.6岁,仅作关节清理术。结果:术后随访6~18个月,平均8.6个月,按Lysholm评分标准,实验组明显优于对照组(P<0.01)。结论:关节镜下应用“微骨折”技术能够显著减轻关节疼痛,增加关节活动度,改善关节功能,是一种简单有效的修复全层关节软骨缺损方法。     

Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: Preliminary assessment in an animal model out to 1 year.

Focal full-thickness cartilage lesions of the human medial femoral condyle (MFC) can cause pain and functional impairment. Affected middle-aged patients respond unpredictably to existing treatments and knee arthroplasty may be required, prompting risk of revision. This study assesses the safety of, and biological and functional response to, a metallic resurfacing implant which may delay or obviate the need for traditional arthroplasty. The anatomic contour of the surgically exposed MFC of six adult goats was digitally mapped and an 11 mm diameter full-thickness osteochondral defect was created. An anchor-based Co-Cr resurfacing implant, matching the mapped articular contour, was implanted. Each goat's contralateral unoperated femorotibial joint was used as a control. Postoperative outcome was assessed by lameness examination, radiography, arthroscopy, synoviocentesis, necropsy, and histology up to 26 (n = 3) or 52 (n = 3) weeks. By postoperative week (POW) 4, goats demonstrated normal range of motion, no joint effusion, and only mild lameness in the operated limb. By POW 26 the animals were sound with only occasional very mild lameness. Arthroscopy at POW 14 revealed moderate synovial inflammation and a chondral membrane extending centrally across the implant surface. Radiographs at POWs 14 to 52 implied implant stability in the operated joints, as well as subchondral bone remodeling and mild exostosis formation in the operated and contralateral unoperated joints of some goats. By POW 26, histology revealed new trabecular bone abutting the implant. At POWs 26 and 52 MFC cartilage was metachromatic and intact in the operated and unoperated femorotibial joints. Proximal tibiae of some operated and unoperated limbs demonstrated limited subchondral bone remodeling and foci of articular cartilage fibrillation and thinning. The chondral membrane crossing the prosthesis possessed a metachromatic matrix containing singular and clustered chondrocytes. Our data imply the safety, biocompatibility, and functionality of the implant. Focal articular damage was documented in the operated joints at POWs 26 and 52, but lesions were much reduced over those previously reported in untreated defects. Expanded animal or preclinical human studies are justified.     

Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques

Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25 women and 28 men, mean age 60.4 (range 28–94) — were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique.     

软骨下骨钻孔术对兔软骨缺损修复的远期效果观察

目的　观察软骨缺损的修复过程 ,比较不同数目钻孔术对软骨缺损修复的远期效果。方法　用中国白兔 4 0只 ,在股骨髁关节面造成 6mm× 8mm全层软骨缺损 ,分别施行 10孔及 5孔钻孔术 ,孔径1mm ,于术后 12周及 13个月取材 ,做组织学及电镜观察 ,并进行评估。结果　 (1) 12周时 10孔、5孔和对照组的修复组织中类透明软骨分别占 70 %、5 0 %、0 % ;13个月时 10孔、5孔和对照组的修复组织中类透明软骨分别占 90 %、10 0 %、0 %。 (2 )修复组织厚度 :12周时 10孔及 5孔组均明显高出毗邻软骨 ,且 10孔明显高于 5孔 ;13个月时 10孔与 5孔无显著性差异 ,且已接近毗邻软骨厚度。 (3)修复组织覆盖缺损的面积 :12周时 10孔 >5孔 >对照组 ;13个月时 10孔与 5孔无显著性差异 ,但二者均明显大于对照组。结论　软骨下骨钻孔对关节软骨缺损修复的远期效果良好 ,能长期适应关节的生理运动和功能负重 ,10孔与 5孔的远期修复效果无显著性差异。     

应用足底内侧皮瓣修复足跟部软组织缺损

目的探讨应用足底内侧皮瓣转移修复足跟部软组织缺损的临床疗效。方法应用足底内侧皮瓣转移修复15例深达跟骨的足跟部软组织缺损。结果15例皮瓣移植后均成活,术后随访3~12个月,所有皮瓣外形和感觉均恢复良好。结论足底内侧皮瓣修复足跟部深度软组织缺损效果较好。     

血管内皮细胞和成纤维细胞混合移植对人工真皮血管化的影响

目的观察同种血管内皮细胞和成纤维细胞移植对人工真皮血管化的促进作用。方法在27只Wistar大鼠背部造成2．5 cm×2．5 cm全层皮肤缺损创面(2处／只),将其分为血管内皮细胞组:将血管内皮细胞混入0．5 ml纤维蛋白胶中,按1．0×105／cm2的密度均匀喷洒于移植床;混合组:将血管内皮细胞和成纤维细胞混入等量纤维蛋白胶后,同前密度喷洒于移植床;对照组:按同样方法喷洒等量纤维蛋白胶。随后各组移植人工真皮,每组9只大鼠18处创面。于移植后5、10 d切取移植的真皮及周围组织行HE、血管内皮生长因子(VEGF)、Masson和墨汁灌注染色,观察新生血管生长情况。于移植后5 d行伊文思蓝灌注,以分光光度计定量检测法测定微血管形成情况。结果移植后5 d,HE、VEGF、Masson和墨汁灌注染色均可见各组移植床有新生血管长入。HE染色见血管内皮细胞组、混合组新生血管数量分别为(14．2±3．6)、(12．1±2．5)条,较对照组[(3．9±1．6)条]明显增多(P<0．05)。移植后10 d,人工真皮内及移植床均有微血管形成,且胶原组织的合成增加。移植后5 d,经伊文思蓝灌注,收集并检测血管内皮细胞组、混合组真皮组织溶出的上清液,吸光度值分别为0．167±0．058、0．155±0．046,均高于对照组的0．066±0．024(P<0．05)。结论同种血管内皮细胞和成纤维细胞移植可促进创面愈合过程中的血管新生,加速人工真皮移植后血管化过程,促进类真皮组织的成熟。     

经导管同期封堵治疗膜周部室间隔缺损合并房间隔缺损

目的　探讨经导管介入同期治疗膜周部室间隔缺损 (VSD)合并房间隔缺损 (ASD)的可行性、方法及疗效。方法　 4例患者 ,年龄为 12～ 2 6岁。术前超声检查提示VSD合并ASD。VSD均为膜周部缺损 ,缺损直径 3～ 6mm ,缺损上缘距主动脉瓣 2～ 6mm。ASD均为继发孔型 ,缺损直径 5～ 8mm。4例患者均于术中先行左心室造影 ,确定VSD适合封堵后 ,先行VSD封堵 ,最后行ASD封堵。结果　 4例患者均经导管一次封堵治疗成功。左心室造影显示VSD呈囊袋型 3例 ,囊袋直径分别为 4、5和 10mm ,封堵器的直径分别为 4、8和 12mm。 1例缺损为管状 ,直径 3.5mm ,用 4mm的封堵器治疗成功。4例患者ASD伸展径为 6～ 10mm ,封堵器直径为 6～ 12mm。所有患者术中及术后无并发症。结论　经导管介入同期封堵治疗膜周部VSD合并ASD具有技术上的可行性、安全性和良好的治疗效果