颌面赝复材料研究进展

综述了目前口腔颌面赝复材料种类、性能要求及各种颌面赝复材料的组成、性能和应用过程,探讨了各种颌面赝复材料的优势及不足,指出目前临床应用的颌面赝复材料以硅橡胶类为主,其中又以中温硫化硅橡胶和室温硫化硅橡胶综合性能较好,应用最为广泛。     

吻合指固有神经背侧支的邻指皮瓣修复手指远端掌侧软组织缺损

目的探讨采用吻合指固有神经背侧支的邻指皮瓣修复手指远端掌侧软组织缺损的疗效. 方法 1996年10月～2004年6月,25例(32指)伴肌腱或骨组织外露的手指远端掌侧软组织缺损患者,其中男18例,女7例,年龄13～45岁.切割伤6例,冲压伤8例,机器绞伤11例.损伤部位:拇指2例,食指8例,中指5例,环指3例,小指2例,食、中指2例,中、环指2例,食、中、环、小指1例.缺损范围:1.5 cm×1.0 cm～4.0 cm×2.1 cm.损伤至就诊时间30 min～48 h.急诊行清创,采用带蒂邻指皮瓣修复,术中同时将指固有神经的背侧支与指神经残端吻合重建皮瓣感觉,术后3周断蒂.供区中厚皮片游离植皮. 结果术后皮瓣及供区均成活,创面Ⅰ期愈合.获随访6～26个月,手指指腹饱满,色泽正常,感觉恢复,两点辨别觉为5～8 mm,均无功能障碍. 结论采用吻合指固有神经背侧支邻指皮瓣修复手指远端掌侧软组织缺损不仅能修复缺损皮肤,且能重建皮瓣感觉,术式操作简便.     

背部供皮区修复大面积皮肤缺损

目的探讨应用背部供皮区修复大面积皮肤缺损的优点。方法对Ⅲ°烧伤、巨大体表肿瘤切除、四肢皮肤撕脱伤及其他原因造成的大面积皮肤缺损的40例患者,根据缺损的部位和大小,用鼓式取皮机在患者背部切取相应的中厚皮片,移植修复缺损。结果术后随访患者1年,所有移植皮片均成活。背部供皮区愈合良好,瘢痕增生轻微,不影响外观。结论于背部取皮其供皮面积大、部位隐蔽,且背部真皮层较厚,取皮后愈合快,愈合后患者能自行平卧加压,避免瘢痕增生。是较理想的修复大面积皮肤缺损的手术方法。     

邻近非主干血管蒂皮瓣移位修复足跟部皮肤缺损

目的探讨足跟部皮肤缺损皮瓣修复的优化选择及临床效果. 方法 2000年2月～2004年4月,应用4种邻近非主干血管蒂皮瓣移位修复足跟部皮肤缺损30例,其中男19例,女11例,年龄8～65岁.致伤原因:车轮绞伤19例,重物压伤5例,电锯伤3例,骨髓炎2例,足跟部鳞状细胞癌1例.皮肤缺损6.0 cm×5.5 cm～16.5 cm×11.0 cm者14例,均合并足后跟或足底皮肤缺损,采用腓肠神经营养血管远端蒂皮瓣及隐神经营养血管远端蒂皮瓣修复,皮瓣切取范围6.0 cm×5.0 cm～18.0 cm×12.0 cm;皮肤缺损2.5 cm×2.0 cm～5.5 cm×4.5 cm者16例,采用足外侧皮瓣及足底内侧皮瓣修复,皮瓣切取范围4.0 cm×3.0 cm～8.0 cm×7.0 cm.供区采用全厚或中厚皮片移植覆盖. 结果术后皮瓣均成活.获随访6～12个月,皮瓣外观良好,无破溃,2例出现胼胝.皮瓣痛觉或触觉部分或完全恢复,两点辨别觉恢复至1.0～3.2 cm.供区外观恢复良好. 结论采用邻近非主干血管蒂皮瓣移位修复足跟部皮肤缺损,具有切取简便、损伤少、不影响患肢血供、可选择性高和可操作性强等优点,是足跟皮肤缺损修复的一种较好选择.     

Fibrous metaphyseal defects — determination of their origin and natural history using a radiomorphological study

The radiomorphological appearance of fibrous metaphyseal defects (FMDs) is demonstrated by long-term follow-up studies. A characteristic radiomorphological course rather than a typical single appearance can be established. These findings correlate well with the duration of these tumor-like lesions; therefore, the radiological findings allow conclusions to be made about the age of a fibrous metaphyseal defect. In addition, the characteristic locations of FMDs will be explained in respect of their origins at insertions of tendons and ligaments.     

筋膜皮瓣治疗小腿顽固溃疡9例报告

本文报道应用小腿后侧筋膜皮瓣治疗9例胫前区顽固性溃疡的经验,一期治愈者8例,二次皮瓣转移治愈者1例。随诊6个月至2年,未见溃疡复发。     

A case-control study of major congenital heart defects in Sweden — 1981–1986

This paper reports the results of a case-control study of major congenital heart defects (CHD) in Sweden. During the period 1981–1986, 1,324 such cases were identified and 2,648 controls were selected. Some common maternal characteristics and exposures were studied using information from prospectively collected data. Possible associations with CHD were found for previous perinatal death, maternal diabetes, epilepsy, hydramnios and disproportion between fetus and pelvis. More specific associations were observed between previous spontaneous abortion, epilepsy, hydramnios and truncus anomalies and between diabetes and septal anomalies. However, no associations were found with involuntary childlessness, contraceptive use, or smoking.Abbreviations ASD atrial septal defect - CHD congenital heart defect - CI confidence interval - CoA coarctation of the aorta - DORY double outlet right ventricle - ECD endocardial cushion defect - HLHS hypoplastic left heart syndrome - IUD intrauterine device - LMP last menstrual period - OC oral contraceptive - OR odds ratio - PDA patent ductus arteriosus - TGV transposition of the great vessels - VSD ventricular septal defect     

带血管蒂足内侧皮瓣修复足后踝皮肤缺损

目的 报告采用带血管蒂足内侧皮瓣修复踝后侧皮肤缺损的结果。方法 在解剖研究的基础上,根据缺损大小沿足内侧轴线设计皮瓣,首先解剖足底内侧血管神经束,再游离深支的内侧支及伴行静脉,沿舟状骨骨膜及胫后肌腱浅层切取皮瓣。结果 11例皮瓣全部成活,皮瓣面积6cm×6cm-7cm×9cm,随访2-4年,外形及功能恢复满意。结论 带血管蒂足内侧皮瓣薄而柔软,特别适用于修复踝关节后侧的皮肤缺损。     

组织工程颅骨缺损修复过程中超微结构观察

目的 用组织工程骨修复SD大鼠颅骨极量骨缺损，并在透射电镜下观察骨修复过程中成骨细胞、血管内皮细胞与陶瓷支架的关系。方法 14只雄性SD大鼠，随机分成实验组和对照组，每组7只。取左侧腔、股骨骨髓，体外诱导培养骨髓基质细胞。实验组将已分化的成骨细胞与含孔磷酸钙陶瓷复合用于修复大鼠自体颅骨极量骨缺损；对照组颅骨缺损处仅置入无细胞的陶瓷材料。分别于术后4、8、12、16、20、24及28周每组各处死1只动物取材，制成脱钙超薄切片，透射电镜下观察成骨细胞、血管内皮细胞与陶瓷残余支架的关系。结果 实验组动物颅骨修复12周前成骨细胞或成骨细胞样细胞毗邻新生小血管、血管内皮细胞存在，16周后成骨细胞转变为骨细胞，并围绕血管被包埋于骨基质及胶原纤维中；陶瓷残余与新生骨间有一条明显的钙化沉积带，大量胶原纤维已伸入到陶瓷支架的纳米级结构中。对照组陶瓷中央部位有大量小血管及血管内皮细胞增生，其周围多为幼稚成纤维细胞，无成骨细胞与血管内皮细胞的依附关系。结论 新型含孔磷酸钙陶瓷作为组织工程细胞支架，其间的纳米级结构有利于骨的再生和血管形成；未见来源于植骨床血管的内皮细胞衍变为成骨细胞。     

Platelet aggregation,disc haemorrhage and progressive loss of visual fields in glaucoma

Platelet aggregationin vitro, deterioration of visual field defects (VFD) and the prevalence of disc haemorrhages (DH) were assessed in 49 patients with primary open angle glaucoma (POAG) and compared with the findings for 67 individuals with suspected glaucoma (GS) in a seven-year follow-up study (range 5.8 to 8.2 years). The percentage patients with spontaneous platelet aggregation (SPA) was higher for POAG patients with visual field deterioration (60%) than both POAG patients without progressive loss of visual fields (12.5%; P<0.005) and those with suspected glaucoma (22.4%; P<0.005). The occurrence of DH was higher among POAG patients with progressive loss of visual field (28%) compared to the GS group (8.4%; P<0.025) and the group of patients consisting of POAG patients without deterioration of VFD and GS (9.9%; P<0.05). DH also occurred more often in patients with low tension glaucoma (41.6%) than in the remaining POAG patients (13.5%; P<0.05). No relation between the patients with SPA and the patients with DH was observed.Abbreviations NPB normal platelet behavior - SPA spontaneous platelet aggregation - DH disc haemorrhage