1例富血小板血浆治疗外阴Paget′s病术后创面感染的护理体会

总结1例外阴Paget’s病术后创面感染的护理体会,利用伤口评估三角工具对患者创面进行评估,通过使用液体伤口敷料联合银离子敷料控制感染,富血小板血浆技术促进伤口愈合,个体化健康教育提高患者治疗依从性的整体干预方案对伤口进行有效管理,结果显示伤口愈合效果良好。     

Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma

Purpose: The technology of 3D printing (3DP) exists for quite some time, but it is still not utilized to its full potential in the field of orthopaedics and traumatology, such as underestimating its worth in virtual preoperative planning (VPP) and designing various models, templates, and jigs. It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications. Methods: An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation. Virtual preoperative planning and 3DP were used in the management of these fractures. Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data. Results: In all the 91 cases, where VPP and 3DP were used, the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively. Surgical time was reduced, with a better outcome. Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation. The average score of the questionnaire was 4.5, out of a maximum of 6, suggesting a positive role of 3DP in orthopaedics. Conclusion: 3DP is useful in complex trauma management by accurate reduction and placement of implants, reduction of surgical time and with a better outcome. Although there is an initial learning curve to understand and execute the VPP and 3DP, these become easier with practice and experience.     

Plasma rico en factores de crecimiento como tratamiento para agujero macular de espesor total secundario a telangiectasia macular tipo 2

Full-thickness macular hole is a rare complication of macular telangiectasia type 2, and its treatment is still controversial. A patient with a full-thickness macular hole secondary to macular telangiectasia type 2 underwent vitreoretinal surgery with a plasma rich in growth factors membrane in the macular hole. At the sixth month of follow-up, anatomical and functional improvements were achieved, with no adverse effects. Plasma rich in growth factors is a new option, with advantages due to its biological properties that achieves good results in terms of safety and effectiveness in the surgical treatment of macular hole.     

组织工程用于修复慢性牙周组织缺损的动物实验研究

目的:应用细胞型和/或非细胞型组织工程化牙周组织移植修复慢性牙周缺损的动物实验,探讨其用于牙周再生治疗的可行性。方法:人工构建5只成年杂种狗慢性牙周缺损病变模型,分别随机采用:引导组织再生治疗术+富血小板血浆+B ioOss(GTR+PRP+B ioOss)、引导组织再生治疗术+富血小板血浆+B ioOss+自体牙周膜细胞(GTR+PRP+B ioOss+PDLCs)、引导组织再生治疗术+自体牙周膜细胞(GTR+PDLCs)和GTR治疗,其中GTR组6颗牙,其余3组各为8颗牙。12周后作病理切片,HE染色观察牙周组织再生情况。结果:动物实验发现GTR组的新生牙槽骨、牙骨质和牙周组织高度分别为(0.52±0.21)mm、(0.8±0.13)mm、(1.9±0.10)mm。而另外3组的新生牙槽骨、牙骨质和牙周组织高度分别为GTR+PRP+B ioOss组:(1.36±0.17)mm、(1.92±0.18)mm、(2.62±0.16)mm;GTR+PRP+B ioOss+PDLCs组:(1.42±0.22)mm、(2.07±0.19)mm、(2.68±0.20)mm;GTR+PDLCs组:(1.39±0.19)mm、(1.82±0.16)mm、(2.55±0.12)mm,这3组牙槽骨、牙骨质和牙周组织的修复再生效果均明显优于GTR组(P<0.05),而它们之间的差别无显著性。结论:应用GTR技术结合组织工程可显著促进狗牙周组织缺损的再生。     

The treatment of bisphosphonate-associated osteonecrosis of the jaws with bone resection and autologous platelet-derived growth factors

BACKGROUND: Bisphosphonates administered intravenously are used to treat patients with cancer who have hypercalcemia associated with malignant disease, multiple myeloma or metastatic tumors (breast, lung, prostate) in the bones. Bisphosphonates are bone resorption inhibitors and have been associated with osteonecrosis of the jaws. In this article, the authors provide an alternative treatment modality for refractory bisphosphonate-associated osteonecrosis (BON). CASE DESCRIPTION: The authors treated 12 patients with refractory BON and a history of long-term bisphosphonate therapy. Each patient had mucosal ulceration with exposed necrotic bone. The treatment combined bone resection with platelet-derived growth factors (PDGFs). The surgical intervention they used was a marginal resection limited to the alveolar bone. Ten of the patients recovered with complete mucosal and bone healing. CONCLUSION: BON has been shown to be refractory to antibiotics, minor local débridement and 0.12 percent chlorhexidine oral rinse. Treatment of refractory BON with a combination of marginal resection and PDGF has shown favorable results, including complete wound healing in most patients. This modality has been shown to be effective in treating BON and may be a useful alternative to existing treatment strategies.     

Use of platelet-rich plasma in periodontal surgery—a prospective randomised double blind clinical trial

The aim of this prospective controlled randomized clinical trial was to evaluate the additional effect of platelet-rich plasma (PRP) in attachment gain. Twenty-two patients showing contralateral intrabony defects were included. Defects were randomized to beta-TCP (Cerasorb) in combination with PRP (test) or alone (control). Probing pocket depth (PPD), clinical attachment level (CAL), and relative AL (RAL) were assessed at the first, initial, re-evaluation (or basis examinations) and 6 months after surgery. Defect dimensions were recorded at baseline surgery (day 0) and during re-entry surgery (after 6 months), with vertical depth of the defect as primary outcome variable. An early healing index (EHI) was assessed 3 days, 1, 2 and 4 weeks after surgery. Both treatments led to clinical improvements. The median reduction of open vertical depth was 1.9 mm (interquartile intervals, 0.75 and 2.5 mm) at test sites, compared with 2.6 mm (1.8 and 3.5 mm) at control sites (p = 0.19, Wilcoxon). The median reductions of PPD and CAL at the four sites in close proximity to the defect in the interproximal area at test sites were 0.8 and 0.28 mm, and at control sites 0.4 and 0.13 mm, respectively. The EHI showed a reduction from grade 3 after 3 days to grade 1 after 4 weeks. PRP did not improve the results achieved with beta-TCP in the treatment of intrabony defects.