富血小板血浆联合人工真皮/自体超薄皮片治疗难愈性创面

目的：探讨富血小板血浆（platelet?rich plasma,PRP）联合人工真皮/自体超薄皮片治疗难愈性创面的临床疗效。方法：以2017—2019年南通大学附属医院烧伤整形科收治的年龄18~70周岁难愈性创面患者24例作为研究对象,随机分为对照组（人工真皮+自体超薄皮片）及观察组（富血小板血浆联合人工真皮+自体超薄皮片）,每组12例。所有患者入院后积极术前准备,在全身状况稳定的情况下对难愈性创面进行彻底清创、止血,观察组行富血小板血浆联合人工真皮支架移植覆盖清创后的肌腱、骨骼外露创面,对照组仅行人工真皮支架移植。2周后行自体超薄皮片移植手术,术后定期换药直至创面愈合。比较两组创面愈合时间和创面愈合后1个月、3个月创面温哥华瘢痕评分（Vancouver scar scale,VSS）情况。结果：观察组创面愈合时间［术后（11.50±0.58）d］相比对照组［术后（13.25±0.58）d］缩短（P＜0.05）。创面愈合后1个月,观察组相比对照组VSS评分明显降低［（5.33±0.33）分vs.（7.75±0.48）分,P＜0.01］;创愈后3个月随访,观察组VSS评分明显低于对照组［（1.83±0.37）分vs.（4.58±0.29）分,P＜0.01］。结论：富血小板血浆联合人工真皮/自体超薄皮片治疗难愈性创面能促进创面愈合、减少色素及瘢痕形成、提高创面愈合质量。     

溪黄草规范化种植技术的初步研究

<正>溪黄草为唇形科植物线纹香茶菜lsodonlophanthoides(Buch.-Ham.ex D.Don)H.Hara的干燥全草。主产于长江以南的湖南、四川、云南、江西、广东、广西等地区。具有清热利湿、退黄祛湿、凉血散瘀的功效,用于治疗急性黄疸型肝炎、急性胆囊炎、痢疾、肠炎等病症,是我国南方地区治疗     

IN VITRO TISSUE CUL,TURE STUDY ON GIANT CELL TUMOR OF BONE

In vitro tissue culture of 22 giant cell tumors (GCTs) of the bone in 19 cases was undertaken. Primary growth was successful in all. 11 were Grade I tumors, 10 Grade n and l Grade III. The average survival of the 3 grades of GCTs was in order 167.3, 219 and 625 days. Of these, 6 were postoperative recurrent GCTs, their life span ranging from 198 t0 6.25 days. It is apparent that the higher the pathologic grade of GCT, the longer the survival of cultured cells. Recurring tumors also manifested more active growth po- tential. This lends support to the view that the existing pathologic grading remains valuable for clinical reference. Multinucleated giant cell usually survived 3 weeks, occasionally 3 months. Growth of the stromal cells maint.ained from 5 weeks t0 8 months. The circumstantial evidence indicates that the stromal cells, not the giant cells, should be considered as the offending neoplastic invader.     

骨巨细胞瘤组织块的冻存与复温培养观察

体外培养是研究骨巨细胞瘤的重要途径之一,目前肿瘤组织的来源主要依靠数量有限的新鲜手术标本,这就限制了有计划地进行经常研究。同时,这种肿瘤的巨细胞在体外培养中不能长期存活,其间质细胞经过反复传代培养,生物学特性也能发生变化,因而有必要寻找一种能保存新鲜标本中各种细胞成分及其生物学特性的方法。     

局限性腕骨融合术新型内固定方式的探讨——四角腕骨融合器

目的:研发新型四角腕骨融合器。方法:根据所测国人头、月、三角和钩骨关节有关数据设计草图,选用钛合金制出粗样,然后置入新鲜尸体腕关节标本模拟四角腕骨融合术,修改后制作成品。结果:四角腕骨融合器的钢板部分由锥形板和相连的中心圆桶状结构组成。锥形板开有4个螺钉孔,各通过一根松质骨螺钉与4块腕骨固定,中心圆桶状结构中空可供植骨,外侧面制有螺纹与腕骨紧密咬合,同时制作了配套工具。结论:四角腕骨融合器可使4块腕骨间的固定强度大大提高,并可防止融合体向关节中心的旋转和塌陷,是局限性腕骨融合术中新型、可靠的内固定方式。     

Biomechanical and clinical study on screw hook fixation after direct repair of lumbar spondylolysis

Objective : To evaluate the biomechanical effect and clinical results of hook screw fixation after direct repair of lumbar spondylous defects in the pars interarticularis. Methods: L2-L6 spines of 8 fresh-frozen and thawed calf cadavers were used for mechanical testing. Bilateral spondylous defects were created in the L4 vertebra. The intervertebral rotation ranges between L4 and L5 were scanned and computerized in various states of motion, such as flexion/extension, lateral bending and torsional loadings applied on the intact spine and the spondylous spine when the spondylous spine was fixed with modified Scott' s fixation, hook screw fixation and Buck ' s fixation sequentially and respectively. Between July 2002 and February 2004, 14 young male patients (aged 15-31 years) suffering from symptomatic lumbar spondylolysis were treated with TSRH hook screw fixation after direct repair of the defects. MacNab criteria were used to assess their pre-and post-operative status. Results: Each fixation technique could significantly increase the intervertebral rotational stiffness and made the stiffness return to nearly the intact level. Hook screw technique provided more rotational stability than the others. Hook screw and Buck' s techniques provided more flexion/extension stability than modified Scott' s technique. Neither complication nor instrumental failure was observed in this study. The mean follow-up period was 21 months. All the patients except one acquired union during the follow-up period. Thirteen patients had a“good”or“excellent”result according to MacNab criteria. Conclusions: Hook screw fixation shows biomechanical advantages and is safe and effective for young patients with lumbar spondylolysis.     

思密达等三联治疗反流性食管炎疗效观察

目的 :观察思密达、西沙比利、雷尼替丁联合治疗反流性食管炎的疗效。方法 :将 74例反流性食管炎患者随机分为治疗组及对照组各 37例。治疗组给予思密达、西沙比利、雷尼替丁联合治疗 ;对照组给予西沙比利、雷尼替丁治疗。比较两组疗效。结果 :治疗组治愈 32例 ,显效 3例 ,有效 2例 ,无效 0例 ;对照组治愈 9例 ,显效 5例 ,有效 10例 ,无效 3例。经统计学处理 ,治疗组疗效优于对照组 ,有显著性差异 ( P<0 .0 1)。结论 :思密达、西沙比利、雷尼替丁联合治疗反流性食管炎疗效显著 ,且明显优于西沙比利合雷尼替丁联合治疗的疗效。     

富血小板血浆结合自体网状皮移植治疗Ⅲ度烧伤创面的临床研究

目的：探讨富血小板血浆结合自体网状皮移植治疗Ⅲ度烧伤创面的临床疗效及应用价值。方法：选取2016年10月—2018年2月南通大学附属医院收治的Ⅲ度烧伤创面切痂自体网状中厚皮移植患者50例,随机分为观察组及对照组,每组各25例。所有患者在Ⅲ度烧伤创面切削痂后,观察组行富血小板血浆+自体网状中厚皮移植,对照组仅行自体网状中厚皮移植,术后定期创面换药,记录创面愈合时间、术后第7、11天创面愈合率、术后第2、6个月植皮区温哥华瘢痕评分量表（VSS）评分。对所得结果进行统计学分析。结果：与对照组相比,观察组患者创面愈合时间明显缩短［术后（8.60 ± 0.37）d vs. 术后（10.68 ± 0.39）d,P＜0.01］;术后第7天创面愈合率,观察组为（93.69 ± 1.34）%,对照组为（87.58 ± 1.16）%,两组间比较差异明显（P＜0.01）;术后第11天创面愈合率,观察组为（99.67 ± 0.23）%,对照组为（97.22 ± 0.96）%,两组间差异有统计学意义（P＜0.05）。术后2个月观察组VSS评分（4.04 ± 0.20）分,对照组（6.64 ± 0.22）分;术后6个月观察组VSS评分（1.80 ± 0.16）分,对照组（4.24 ± 0.19）分,观察组得分均明显低于对照组（P＜0.01）。结论：富血小板血浆结合自体网状皮移植能显著加快Ⅲ度烧伤创面的愈合,减少瘢痕生长,在Ⅲ度烧伤创面治疗中具有非常重要的临床应用价值。     

颊脂垫部分摘除术的临床体会

目的：探索一种简单安全有效的颊脂垫摘除术。方法：对30例颊脂垫肥大患者行颊脂垫摘除术,其中28例采用口内小切口径路行颊脂垫摘除术,2例在行面部除皱术的同时行颊脂垫摘除术。结果：对30例患者术后随访1年,其中29例对面型改善效果满意,1例经再行下颌角肥大截除术后亦获满意疗效。结论：口内小切口径路行颊脂垫摘除术是一种理想的颊脂垫摘除手术方法,具有简便性、安全性、微创性、显效性,且并发症少,恢复快,符合美容手术原则。     

强脉冲光治疗烧伤后色素沉着45例效果观察

目的评价强脉冲光治疗烧伤后色素沉着的效果。方法烧伤后色素沉着门诊患者45例,应用强脉冲光治疗,使用能量密度约25焦耳/cm2,刮除冷凝胶后检查治疗区域,行光脉冲相邻发射直至覆盖整个治疗部位。结果行6～31个月的随访,按疗效判定标准进行评判,治愈10例,显效18例,有效11例,无效6例,总有效39例(86.67%)。1例患者在治疗过程中局部出现数枚小水疱,后愈。未见其它明显不良反应。结论强脉冲光治疗烧伤后色素沉着安全有效。