去细胞羊膜负载毛囊干细胞修复裸鼠全层皮肤缺损

目的利用去细胞羊膜负载毛囊干细胞修复裸鼠全层皮肤缺损。方法体外分离和培养人毛囊干细胞,取经慢病毒介导的绿色荧光蛋白（pGC FU-GFP-Lentiviru）标记后第4代毛囊干细胞接种于去细胞羊膜上;负载后第7天,HE染色光学显微镜观察细胞黏附生长情况。于18只C57BL/6裸鼠背部制作全层皮肤缺损创面,并根据不同的处理方式分为实验组（将负载毛囊干细胞的去细胞羊膜植入裸鼠全层皮肤缺损创面）、去细胞羊膜移植＋干细胞注射组（将去细胞羊膜覆盖创面后羊膜下注射5×106毛囊干细胞）和去细胞羊膜移植组（去细胞羊膜单独移植）,每组6只。分别于移植后第7、14、21、28天,测量各组创面面积并计算创面收缩率。移植后第28天,荧光显微镜观察创面组织绿色荧光蛋白（GFP）表达,HE染色光学显微镜观察新生皮肤结构特征。结果去细胞羊膜负载毛囊干细胞后第7天,HE染色光学显微镜观察发现,细胞连接成片状覆盖于去细胞羊膜表面。实验组和去细胞羊膜移植＋干细胞注射组移植后各时点的创面收缩率均显著小于去细胞羊膜移植组（P〈0.05）。移植后第28天,荧光显微镜观察显示实验组创面表皮层GFP表达阳性;HE染色光学显微镜观察发现实验组创面组织表皮层明显增厚,有类似毛囊样结构生成。结论去细胞羊膜负载毛囊干细胞可用于修复裸鼠全层皮肤缺损。     

人头皮毛乳头细胞体内诱导毛囊形成的实验研究

目的 探讨人头皮毛乳头细胞和毛囊上皮细胞在体内的相互作用，了解毛乳头细胞在体内诱导毛囊形成和调控毛囊生长发育的能力，为毛囊细胞移植奠定实验基础。方法 人头皮毛乳头细胞和毛囊上皮细胞共同移植到无胸腺裸鼠体内，在不同时相取材进行组织切片。H—E、角蛋白免疫组织化学染色。结果 毛乳头细胞和毛囊上皮细胞在体内相互作用，首先形成不规则的混合细胞团、逐渐发展到排列规则、最终形成完整的毛囊结构，并且在移植腔上方的裸鼠皮肤内形成了毛囊结构。这些结构表达毛囊特有的角蛋白。结论 培养的毛乳头细胞与毛囊上皮细胞在裸鼠体内能形成完整的毛囊结构，同时也能诱导裸鼠角质形成细胞、形成毛囊结构。     

头皮缺损97例治疗分析

目的探讨头皮撕脱伤及头皮烧伤后头皮缺损治疗的方法及效果。方法回顾本院1994年8月—2007年12月对97例头皮撕脱伤及头皮烧伤后头皮缺损的治疗情况,对颅骨外露、颅骨全层烧伤等采用颅骨钻孔、培育肉芽组织、中厚皮片移植,皮管带蒂皮瓣移植,局部转移皮瓣移植,皮肤扩张器应用后皮瓣转移等消灭头皮缺损。结果颅骨外露宜采用颅骨钻孔、肉芽生长后再行中厚皮片移植,孔径1～2mm,孔间距1～1.5mm;颅骨坏死宜采用局部皮瓣移植或皮管带蒂皮瓣移植;颅骨外有帽状腱膜等软组织存在,可直接用中厚自体皮移植,但无头发。皮肤扩张器扩张正常头皮后再转移皮瓣移植消灭颅骨外露,虽然治疗疗程长,但毛发正常生长,外观好。结论头皮撕脱伤的不同病例,应采用不同的治疗方法,才能达到最好的治疗效果。     

Secondary and Delayed Bone Grafting in Alveolar and Anterior Palatal Clefts

BackgroundSurgical repair with suitable bone graft / substitutes plays an important role in rehabilitation of individuals with residual anterior palatal or alveolar defects associated with an oronasal fistula.Methods52 cases were treated by secondary or delayed bone grafting of the alveolar defects in isolation or associated with defects of the anterior palate from July 2002 - Nov 2004. Dimension and the extent of the defects were assessed with the help of radiographs & maxillofacial CT. Cephalometric analysis, presurgical orthodontics and dentofacial orthopedics preceded surgical repair with cancellous graft from the iliac crest, followed by post surgical orthodontics and prosthetic rehabilitation.ResultSatisfactory results were achieved in 49 cases with three cases showing failure of graft acceptance. Postoperative clinical and radiological evaluation for all the patients was done at an interval of one, three and six months. Bone density and trabeculation was comparable to the adjacent bone within six months.ConclusionRecreating the bony continuity of the maxillary arch followed by orthodontic correction of dental discrepancies achieves a comprehensive orthosurgical correction.     

汗腺剥脱时保护浅层毛囊对腋臭术后皮片坏死的影响

目的探讨汗腺剥脱的同时注意保护浅层毛囊对预防腋臭术后皮片坏死的效果。方法根据腋毛区范围大小,在腋窝中部顺皮肤皱襞分别设计1～2条长2～3 cm的切口,皮下分离腋毛区及区外1 cm区域,去除汗腺,尽量保护浅层毛囊,保留真皮下血管网,切口间断缝合,皮片引流,弹性绷带适当加压包扎。结果本组共51例102侧,术后切口均一期愈合,未发现切缘糜烂及皮片坏死,随访0.5～1年,瘢痕不明显。结论汗腺剥脱的同时注意保护浅层毛囊可有效预防腋臭术后皮片坏死,提高手术效果。     

前路病灶清除后路椎弓根固定治疗腰椎结核

目的探讨前后路联合Ⅰ期手术治疗腰椎结核的效果。方法采用后路椎弓根钉内固定同时前路病灶清除及椎间植骨融合治疗腰椎结核患者43例。术后随访12~33个月,平均(20±2)个月。在X线片上测量术前、术后后凸角度(Cobb角),观察植骨融合情况,应用Frankel分级评分评估神经恢复情况。结果平均手术时间(3.0±0.5)h,术中平均出血(600±50)mL。43例患者术后切口均甲级愈合,未发生感染现象,未见窦道形成。植骨块均骨性融合,局部无复发,术后X线片显示后凸畸形角度矫正10°~25,°平均(14±2)°,随访1 a以上至植骨块融合时,角度丢失0°~3°,平均(2±1)°,所有患者均未发生后凸畸形加重。15例有神经症状患者术后均有一定程度的恢复。结论前后路联合Ⅰ期手术治疗腰椎结核可以促进植骨融合和神经功能恢复,防止后凸畸形,临床疗效满意。     

Single stage craniofacial reconstruction for fronto-nasal encephalocele and hypertelorism in an adult

The fronto-nasal type of fronto-ethmoidal encephalocele is one of the more common subtype of anterior encephaloceles. We discuss different aspects and difficulties in the management of fronto-nasal encephalocele in a 30-year-old woman. Fronto-nasal encephaloceles present a difficult scenario in adults, mainly due to large gliotic herniating brain tissue, large bony and dural defect, increase in the size of paranasal sinuses, and scars from previous surgeries. However, all difficulties can be overcome after applying the principles of craniofacial reconstructions, i.e. correction of bone defect with autologus split calvarial graft, dural closure with autologous pericranial graft and correction of hypertelorism.     

基础护理认同教育的实践与评价

目的 评价开展基础护理认知教育的实施效果.方法 在全院范围内开展护理人员基础护理认同教育,并于基础护理认同教育前、基础护理认同教育后2次发放调查问卷,了解全院护士对基础护理的认知度并进行对比分析.结果 开展系列基础护理认同教育活动近1年后,在协助病人洁面梳头、足部清洁等基础护理中的生活护理等项目,护士认为应该由护士承担的百分比有所提升,认为应当由家属承担的百分比有所下降,差异有统计学意义.结论 开展基础护理认同教育对提高基础护理认知度有一定的促进作用,但仍存在基础护理内涵认识上的误区,继续强化基础护理认知教育是十分必要的.     

The textual research on the evolution of the toothbrush shape in ancient China

Archaeological discovery demonstrates that the ancient plant hair brush first appeared in the Tang dynasty. According to the evolution of the shape of the head and handle of the toothbrush in ancient times, we can divide the evolution of the shapes into three major stages of development: (1) the Tang and the Five dynasties; (2) the Liao, Song, Jin, Yuan dynasties; (3) Ming, Qing and the Republic periods. The toothbrush heads and handles had no significant differences during the Tang and the Five dynasties. However, the shapes of them in the Liao, Song, Jin, Yuan dynasties are somewhat different. In the Ming and Qing and the republic of China periods, the shape of toothbrush head and handle had further refinement. Recently, some scholars raised doubts about the "plant hair toothbrush doctrine". They believe that the archaeological bone graft handle brush was used to wipe hair oil or clean water when washing and dressing. However, according to shape and function and ancient literature records, the archaeological bone graft handle brush should be a plant hair toothbrush used to clean and protect teeth.     

早期保守磨削痂延期植皮治疗颜面部煤尘燃爆深度烧伤

目的探讨预防颜面部煤尘燃爆深度烧伤后严重毁容的治疗方法。方法对12例煤尘燃爆颜面部深度烧伤患者，早期采用保守磨削痂、延期植皮和双眼睑早期减张、扩张创面立即植皮的处置方式进行治疗。结果本组12例患者于伤后3周内创面全部愈合。随诊3个月，未发现明显瘢痕增生和畸形，面部表情自然，情绪表达充分。结论应用早期保守磨削痂延期植皮的方法，可促进全颜面创面尽快修复，减少瘢痕增生和颜面畸形的发生。     

内窥镜下结合自制拉钩经前路治疗单节段腰椎结核

目的探讨自制拉钩系统联合内窥镜技术治疗单节段腰椎结核的可行性及疗效。方法 2007年9月~2010年1月共收治单节段腰椎结核患者34例。均采用自制微创拉钩并联合应用内窥镜技术,经小切口行椎管微创减压,取髂骨植骨,再结合前路钉棒内固定。术后常规抗结核治疗18个月,评估腰椎前路固定术后脊柱畸形矫正度、患者神经功能康复状况、植骨融合、结核有无复发,及术后并发症发生情况。结果术后随访2~4.5年,平均2.7年,无1例因并发症死亡,畸形矫正满意,内固定系统无松动、断裂,脊髓神经功能有不同程度的恢复,植骨融合无结核复发患者。患者术后及随访时的后凸角、侧凸角与术前比较,差异均有统计学意义（P〈0.05）;患者术前、术后的神经功能状况比较,差异有统计学意义（P〈0.05）。结论单节段腰椎结核采用内窥镜下结合自制拉钩经前路手术治疗微创安全可靠,对脊髓减压充分彻底,可矫正畸形,重建脊柱的稳定性,促进神经功能恢复。     

经椎弓根漏斗＋蛋壳技术刮除病灶植骨内固定治疗脊柱结核的方法探讨

目的：探讨经椎弓根漏斗＋蛋壳技术刮除病灶的方法,并对此手术的优缺点及并发症进行分析。方法：对脊柱结核29例选择性的使用漏斗技术经后路椎弓根刮除病灶,使椎体呈蛋壳样,再植骨,内固定治疗。结果：本组病例手术伤口均一期愈合,无窦道形成及感染,无脊髓神经损伤,术后随访平均（12-30）个月,所有病例植骨均融合,内固定无松动断裂,腰腿痛症状完全缓解,可正常行走,脊柱畸形矫正良好,复发率低。结论：脊柱后路经椎弓根漏斗＋蛋壳技术可彻底清除椎体内病灶、置内固定简单并具有很高的安全性及准确度。手术操作时间短、出血少,术后患者康复快。     

复方ANBP对小鼠皮肤移植创面愈合的疗效观察

目的观察复方ANBP[由仙鹤草(Agrimonia eupatoria, A),藕节(Nelumbo nucifera Gaertn, N),乳香(Boswellia carteri, B)和蒲黄(Pollen Typhae, P)组成]对皮肤移植创面愈合的促进作用。方法选用40只雌性C57BL/6小鼠,制成背部直径1.2 cm圆形全层皮肤缺损小鼠模型,后进行自体原位皮肤移植术,随机分为对照组和实验组,实验组给予复方ANBP粉末敷于皮肤移植区,对照组不予处理。通过肉眼、HE染色观察比较两组皮肤移植区14 d及21 d时皮肤愈合情况,计算创面愈合率并进行统计学分析。结果 (1)皮肤移植14 d、21 d后,实验组小鼠创面愈合率高于对照组(P<0.05)。(2)HE染色结果:皮肤移植14 d,实验组较对照组皮肤移植交界处平坦、表皮嵴浅且连接紧密;皮肤移植区表皮层变薄、新生毛囊数量较多且发育良好。皮肤移植21 d,实验组较对照组皮肤移植交界处皮下组织紧密呈更强的收缩感;皮肤移植区毛囊更成熟、发育趋于完善,出现了明显的毛干、皮脂腺等皮肤附属器。结论复方ANBP能够加快皮肤移植区与周围皮肤衔接,加速皮肤移植愈合,促进皮肤附属器发育及皮肤塑形,提高愈合质量。     

Giant urethral diverticulum -- repair augmented with bovine pericardium collagen matrix graft and tension-free vaginal tape

A 44-year-old nulliparous woman was diagnosed with a giant urethral diverticulum. Surgical excision of the diverticulum was done. The urethral defect was closed with 2-0 vicryl sutures. A piece of bovine pericardium collagen matrix graft was placed over the fascial repair. A tension-free vaginal tape (TVT) sling was then placed over the graft. Concomitant anti-incontinence procedure can be combined with diverticulum repair.     

改良Jones装置与口外弓法推磨牙向远中临床比较

目的：探讨改良Jones装置与口外弓2种方法推磨牙向远中的临床疗效．方法选择20例轻中度前牙拥挤的安氏Ⅱ类错病,介于拔牙和不拔牙矫治的边缘,所有病例随机分配在2个组,分别采用改良Jones装置法和口外弓法2种方法推磨牙向远中,在治疗前后进行X线头影测量和模型测量分析．结果2组磨牙远中移动效果均比较明显,但在移动速度、前牙覆盖及第一磨牙的倾斜度的统计分析差异有统计学意义（P〈0.05）．结论2种方法都可有效的推上颌磨牙向远中移动,但口外弓法需要患者很好配合且矫治力不能持续发挥作用,导致临床疗效不稳定;而改良Jones装置能更快速、有效地推动上颌磨牙远中移动,且不依赖患者的配合,值得在临床推广．     

人体蠕形螨感染的皮肤组织病理学观察

目的:观察人体蠕形螨感染所致皮肤组织病理学改变。方法:收集7例面部皮肤标本经HE染色后在显微镜下观察。结果:在患者面部皮损处扩大的毛囊和增生的皮脂腺中检查出大量蠕形螨成虫、若虫和虫卵。人体毛囊蠕形螨多寄生于毛囊的根部或毛囊周围组织内,被寄生的毛囊均有不同程度的扩张,虫体周围常可见淋巴细胞为主的慢性炎症细胞浸润,毛根角质化较常见。人体皮脂蠕形螨寄生部位为皮脂腺体及导管部,可见腺细胞增生而失去正常结构,但较少有炎症细胞浸润,导管部有轻度扩张。结论:人体蠕形螨寄生与皮肤组织病理学改变有密切关系。     

皮瓣移植术修复手指创面的急诊护理

目的 :介绍 6 5例 71指急诊手外伤患者 ,在急诊缝合室采用血管神经蒂皮瓣去修复手指创面的治疗和护理效果 ;方法 :急诊清创要彻底 ,用指根阻滞麻醉 ,游离的皮瓣设计合理 ,血供可靠 ,术毕将伤指固定功能位 ,定时换药检查 ,早期行全段手指功能锻炼是不可偏废的重要环节 ;结果 :术后随访 48例 5 1指 ,随访时间 2～ 6个月 ,皮瓣恢复及伸屈功能正常 ,无残端 ,触温感良好 ;结论 :急诊直接行手指创面皮瓣移植术治愈率高 ,节省费用 ,操作简便     

先天性手畸形的矫正失误分析

目的：提高对先天性手畸形的手术成功率。方法：应用显微外科技术，采用各类皮瓣移植术、松解术、植皮术、切除矫形术等对先天性手畸形进行矫正。结果：对先天性手畸形组成的认识失误，对先天性手畸形分类的认识失误，对先天性手畸形的手术失误。结论：并非每一个畸形手都需要手术治疗。没有确实的术前方案不能治疗手畸形。如果手术会进一步丧失功能比手术得不到肯定的功能改善危害更大。     

Reconstruction of large limb bone defects with a double-barrel free vascularized fibular graft

Background The use of a free, vascularized fibular graft is an important technique for the reconstruction of large defects in long bones. The technique has many advantages in strong, tubular bones; a more reliable vascular anatomy with a large vascular diameter and long pedicle is used, minimizing donor-site morbidity. Due to limitations in both fibular anatomy and mechanics, they cannot effectively be used to treat large limb bone defects due to their volume and strength.
Methods From 1990 to 2001, 16 clinical cases of large bone defects were treated using vascularized double-barrel fibular grafts. Patients were evaluated for an average of 10 months after surgery.
Results All the patients achieved bony union; the average bone union took 10 months post surgery, and no stress fractures occurred. Compared with single fibular grafts, the vascularized double-barrel fibular grafts greatly facilitate bony union and are associated with fewer complications, suggesting that the vascularized double-barrel fibular graft is a valuable procedure for the correction of large bone defects in large, long bones in addition to enhancing bone intensity.
Conclusions The vascularized double-barrel fibular graft is superior to the single fibular graft in stimulating osteogenous activity and biological mechanics for the correction of very large bone defects in large, long bones. Free vascutarized folded double-barrel fibular grafts can not only fill up large bone defects, but also improve the intensity margin. Therefore, this study also widens its application and enlarges the treatment targets. However, in the case of bone deformability, special attention should be paid to bone fixation and protection of donor and recipient sites.     

面部年轻化手术186例评析

我们首次将上、下眼睑整容术、面颈部除皱术合称为面部年轻化手术。6年中为186例患者施术,优良率达87％。本文就如何根据不同面型选择相应手术方法,提出我们的经验和体会。