人工硬脑膜材料的生物相容性

背景：目前研究应用的硬脑膜修补材料主要有自体组织修补材料、同种异体材料、异种生物材料和人工合成材料。 目的：评价修复硬脑膜缺损各种修补材料的性能和应用,寻找合理的硬脑膜修补材料。 方法：以 “硬脑膜,材料”中文关键词,采用计算机检索中国期刊全文数据库2000-01/2010-12中相关硬脑膜缺损修补材料学研究及各种材料在硬脑膜缺损修补临床应用情况的文章。 结果与结论：目前国内使用自体组织、同种异体材料、异种生物材料和人工合成材料等硬脑膜修补材料分别存在着来源困难、易粘连、不易保存、不易消毒或生物相容性差等缺点,自体组织修补材料在可利用的情况下仍为首选,其中异种生物材料因其良好的生物相容性及理化特性成为目前临床应用最广泛的硬脑膜修补材料。虽然异种生物材料是目前临床上大量使用的硬脑膜修补材料,但由于其存在各自不可避免的缺点,硬脑膜修复材料仍需进一步开发。     

创伤性腹壁缺损修补材料的生物相容性及其应用

背景：近年来修复腹壁缺损的方法有了改进与创新,生物材料的应用使腹壁缺损的修复效果有所改观,明显降低了各种腹壁疝的复发和巨大缺损修复后腹壁疝的发生。 目的：评价不同腹壁缺损修补材料临床应用的效果及修补后与宿主的生物相容性。 方法：以 “腹壁缺损,修补,聚丙烯补片,硅胶膜,黏膜,移植,相容性”为中文关键词,“abnormal wall defect; repair; polypropylene patch, silica gel, mucous membrane, transplant, compatibility”为英文关键词,采用计算机检索2005-01/ 2010-10相关文章。纳入与创伤性腹壁修复材料学相关及不同修补材料在腹壁缺损中应用的文章。 结果与结论：目前临床上用于修复腹壁缺损的材料比较多,曾经尝试过多种腹壁修复材料,主要有以下两类：生物性材料包括自体组织(如阔筋膜、肌皮瓣、自体真皮等)、同种异体组织(如羊膜、硬脑膜等)、异种异体组织(如猪心包膜、膈肌、牛腹膜等)。非生物性材料包括金属网织物(如银、铂合金、不锈钢等)、高分子化合物(如Malex,Teflon,Dacron等)。膨体聚四氟乙烯是目前应用较多的腹壁修补材料,但其抗感染能力较差,一旦感染往往需要移去补片。因此寻找优良的生物、植物材料或自体、异体复合材料势在必行。     

通过穿孔改变组织的内生长及扩张聚四氟乙烯的固定:大鼠实验研究

较大范围的腹壁损伤修复对于外科医生来讲一直是一个疑难问题,虽然应用了许多不同的修补材料,但要达到标准理想的修补材料至今还未发现,最近报道采用扩张聚四氟乙烯(cPTFE)作为腹壁缺损的重建。临床研究表明该材料接近理想的修补材料。可是临床实验又提出了绷带-补片界面突出,这种疝是由于缺乏胶原纤维组织向补片内生长的结果。为了防止这种并发症,本文作者运用两种方法评价胶原     

不同颅内植入材料对脑损伤修复的影响

背景：有关脑损伤修复移植物选择尚有争议, 迄今还没有一种材料能在理化性质方面完全替代颅骨。 目的：归纳分析不同颅内植入材料对脑损伤修复的影响及其性能评价。 方法：以“颅脑损伤、复合材料、生物材料、损伤修复”为中文关键词,以“Traumatic brain injury,Compound material,Biological material,Damage repair”为英文关键词,采用计算机检索中国期刊全文数据库、PubMed数据库(1993-01/ 2010-11)相关文章。纳入颅脑损伤-损伤修复材料等相关的文章,排除重复研究或Meta分析类文章。 结果与结论：共入选24篇文章进入结果分析。常用的颅骨缺损的修补材料主要有3 大类:自体和异体骨移植、非金属材料、金属代材料。自体和异体骨移植成形不很理想,存在免疫排斥和坏死吸收。以钛网边作为修复材料,应用三维重建技术的数字化颅骨塑形技术,缩短了手术时间、减少了相应并发症,实现了个体化配置修补颅骨缺损,是一种较为理想的颅骨修补材料。钛合金具有良好的生物相容性,强度高,不老化,密度轻,置入后不影响CT/MRI、脑电图等检查,且置入后成纤维细胞可长入钛网的微孔,使钛网与组织融为一体,明显减少并发症的产生,是目前较为理想的修补材料。     

CRTER杂志普外科方面生物材料研究的发稿方向:本刊学术部

<正>○普外科防腹腔粘连用透明质酸钠凝胶安全性○非吸收性生物材料修补伴创面污染的腹壁切口疝和缺损○脐尿管肿瘤切除应用生物材料○生物型补片与聚丙烯补片修补家猪腹壁缺损的对比研究     

西京医院生物移植材料研究有突破

西京医院生物移植材料研究有突破第四军医大学西京医院胃肠外科卜建石副教授和顾宝清教授共同研制的猪心包膜生物移植材料，为６例患者进行腹壁大面积缺损修复，全部获得成功，为生物材料在人体中的应用闯出了一条新路。腹壁创伤性大缺损在战伤、平时，肿瘤切除或其他情况...     

纳米银-猪小肠黏膜下层与聚丙烯网片修复兔腹壁损伤对比

背景：因为自体取材修复腹壁缺损是以伤治伤,而且取材有限,限制了临床应用,因此寻找理想的腹壁替代材料至关重要。 目的：比较复合修复材料纳米银-猪小肠黏膜下层与聚丙烯网片在腹壁缺损中的应用效果。 方法：大耳兔制备兔腹壁损伤实验模型后随机数字表法分为2组,实验组应用复合材料修复腹壁缺损;对照组应用聚丙烯网片修复腹壁缺损。观察修复后动物一般恢复情况,于修复后1,2,4个月进行腹壁抗张强度测定、腹腔内粘连评分以及组织学检测。 结果与结论：相同时间点实验组粘连度显著低于对照组(P < 0.05);各组4个月腹腔粘连度均较1个月增加(P < 0.05)。两组抗拉力强度修复后4个月均高于修复后1个月(P < 0.01);实验组修复后1,2个月抗拉力强度高于对照组(P< 0.05),到第4个月时,修补处强度几乎相等(P > 0.05)。提示两种修复材料均具有良好的修复能力,修复后均能维持足够的腹壁抗张强度。但复合材料在组织相容性、抗腹腔粘连方面优于聚丙烯网片。自制的纳米银-猪小肠黏膜下层补料无细胞毒性,作为组织工程材料修复腹壁损伤具有可行性。     

运动性关节软骨缺损支架材料的选择及其生物相容性

背景：骨软骨支架是用于承载细胞,供细胞黏附、生长、增殖、分化的载体。 目的：总结运动性关节软骨缺损支架材料的应用进展及其生物替代材料的生物相容性。 方法：以“关节软骨,生物材料,工程软骨,支架材料,生物相容性”为中文关键词,以“ tissue enginneering ,articular cartilage,scaffold material”为英文关键词,采用计算机检索维普数据库、PubMed数据库1993-01/2010-11相关文章。纳入与有关修复关节软骨损伤、生物材料、支架材料、生物相容性等相关的文章。以20篇文献为重点对运动性关节软骨缺损修复用的生物材料的生物相容性进行了讨论。 结果与结论：天然软骨支架材料因其具有细胞识别信号,故生物相容性好,细胞黏附率高,但力学性能较差。有些人工合成材料生物相容性不理想、亲水性差、对细胞吸附不足,人工合成高分子聚合物生物相容性良好。复合支架利用不同生物材料的优点克制材料的局限性制备理想的复合支架,其混合比例、混合技术还有待进一步研究。目前尚无一种材料完全满足组织工程的要,通过材料制备技术的改进或将几种不同材料的复合,材料的性能会不断的提高。     

不同生物材料修复跟腱损伤的应用

背景：构建组织工程化肌腱的关键是寻找适于肌腱细胞黏附、生长及功能分化的支架材料。 目的：评价不同生物材料在跟腱损伤修复中的效果。 方法：以“生物材料,跟腱,修复” 为关键词在万方数据库中检索1985-01/2011-01关于生物材料治疗跟腱缺损的文章。 结果与结论：陈旧性跟腱断裂难以自行愈合及修复,易遗留疼痛及功能障碍。长期以来,不少学者对跟腱缺损的治疗进行了较多的研究,从自体肌腱移植、同种异体肌腱移植到人工肌腱移植、组织工程肌腱移植等,实践证明这些方法手段都存在一定的优点和缺点。虽然肌腱组织工程中支架材料的研究与应用已经取得了一些成功,但是目前应用的材料或存在生物相容性问题、降解性问题或存在力学性能差、难加工成型等缺陷,与理想的支架材料还存在很大差距。     

不同来源蚕丝蛋白修复骨软骨组织缺损的效果比较

背景：目前还没有研究比较不同种属来源蚕丝蛋白修复骨软骨的效果。 目的：观察桑蚕和柞蚕来源蚕丝蛋白支架材料修复骨软骨缺损的效果差异。 方法：取新西兰兔20只,制备单侧膝关节骨软骨缺损模型,随机分为5组：其中1组不植入任何材料,作为空白对照;实验1组将3层桑蚕丝蛋白支架粘在一起,充填于缺损处;实验2组将1个包被转化生长因子β3的桑蚕丝蛋白支架与2个包被骨形态发生蛋白2的桑蚕丝蛋白支架粘在一起,充填于缺损处;实验3组将3层柞蚕丝蛋白支架粘在一起,充填于缺损处;实验4组将1个包被转化生长因子β3的柞蚕丝蛋白支架与2个包被骨形态发生蛋白2的柞蚕丝蛋白支架粘在一起,充填于缺损处。术后8周,取关节骨软骨修复区行组织病理学观察,检测Ⅰ型和Ⅱ型胶原蛋白表达。 结果与结论：实验1组胶原蛋白广泛分布于缺损区全层;实验2组胶原纤维在修复区表面呈平行分布,在中间和底部呈垂直顶部的方向分布;实验3组在修复区表面可见胶原;实验4组在支架表面和底部可见软骨样细胞有成团分布。4个实验组修复区Ⅰ型胶原蛋白呈强阳性表达;实验1组、实验2组修复区Ⅱ型胶原蛋白呈微弱表达,实验3组、实验4组修复区Ⅱ型胶原蛋白呈强阳性表达。表明两种蚕丝蛋白均能修复骨软骨缺损,桑蚕丝蛋白倾向于形成骨组织,柞蚕丝蛋白倾向于形成软骨组织。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程      

The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

The anterior abdominal wall integument is frequently used in a range of reconstructive flaps. These tissues are supplied by the deep and superficial inferior epigastric arteries (DIEA and SIEAs) and the deep and superficial superior epigastric arteries (DSEA and SSEAs). Previous abdominal wall surgery alters this vascular anatomy and may influence flap design. One hundred and sixty‐eight patients underwent abdominal wall computed tomographic angiography (CTA) for preoperative imaging. Fifty‐eight of these patients had undergone previous abdominal surgery, and were assessed for scar pattern and relationship to the course and distribution of all major axial vessels and perforators. Two cadaveric abdominal wall specimens with midline abdominal scars underwent contrast injection of the DIEAs and DSEAs, with subsequent CTA. The course and distribution of all cutaneous vessels were assessed. In all clinical and cadaveric cases, the vasculature of the abdominal wall had been altered by previous surgery. In the clinical cases, vascular architecture was universally altered in the region of the scar, often modifying the filling patterns of the abdominal wall and occasionally precluding the use of an abdominal wall flap. In both cadaveric specimens, regions of non‐filling were evident upon contrast injection, highlighting the angiosomes not supplied by the DIEA or DSEA. Previous abdominal wall surgery necessarily alters the vascular architecture of the abdominal wall, and may alter the source vessels supplying cutaneous tissues. CTA was useful in identifying and delineating these changes, and may be used as a preoperative tool in this role. Clin. Anat. 22:815–822, 2009. © 2009 Wiley‐Liss, Inc.     

生物型补片修补中孕期胎羊腹壁缺损

背景：腹裂在胚胎早期就已出现,由其引起的肠管损伤和功能障碍贯穿胎儿发育的全程。 目的：探讨在中孕期进行宫内手术修补胎羊腹壁缺损的可行性。 方法：取8只妊娠75~80 d的健康单胎妊娠山羊。将其分为两组,拉拢缝合组3只,采用拉拢缝合腹壁的方法修复胎羊腹壁的缺损。生物型膜片组5只,采用两层生物型膜片修补腹壁缺损。两组羔羊自然分娩,对其腹壁进行病理学检查。 结果与结论：拉拢缝合组3只羔羊均顺利娩出,3只羔羊腹壁切口愈合好,瘢痕呈线样,腹内粘连轻。组织切片上见瘢痕轻微。生物型膜片组5只中有1只流产,4只羔羊顺利娩出,4只羔羊腹壁切口愈合好,瘢痕明显,腹内粘连轻。组织切片上主要为纤维结缔组织。结果提示,在中孕期进行胎羊腹壁缺损是完全可行的。胎羊腹壁直接进行缝合者愈合后瘢痕轻微。对于皮肤缺损较大者,生物型修补膜片是一种可行性材料。     

Familial omphalocele: Analysis of risk factors and case report

This is a report of a family with recurrence of omphalocele and apparent autosomal dominant transmission of abdominal wall hernias. Reported cases of familial omphalocele are reviewed and analyzed for risk factors. Familial cases are rarely associated with structural anomalies outside the gastrointestinal tract but often demonstrate vertical transmission that suggests that in certain families omphalocele is due to an autosomal dominant mutation.     

从生物力学角度探讨腹直肌分离

腹直肌分离(diastasis recti abdominis, DRA)是产后并发症之一,常采用腹肌训练的方法促进其康复,但至今没有普遍可接受的训练模式及其相应理论支撑。本文从腹壁生物力学角度对DRA机制和康复效果进行综述,同时也分析了其争议的原因。主要原因包括腹直肌间距(inter-rectus distance, IRD)和腹肌厚度测量方法和测量部位的不统一,以及未能用生物力学方法探讨DRA发生机制等。因此,今后应规范DRA训练方法,研究DRA状态下的腹肌及其腱膜力学特征,为腹肌训练模式提供依据。     

Architectural and morphological assessment of rat abdominal wall muscles: comparison for use as a human model

The abdominal wall is a composite of muscles that are important for the mechanical stability of the spine and pelvis. Tremendous clinical attention is given to these muscles, yet little is known about how they function in isolation or how they interact with one another. Given the morphological, vascular, and innervation complexities associated with these muscles and their proximity to the internal organs, an appropriate animal model is important for understanding their physiological and mechanical significance during function. To determine the extent to which the rat abdominal wall resembles that of human, 10 adult male Sprague‐Dawley rats were killed and formalin‐fixed for architectural and morphological analyses of the four abdominal wall muscles (rectus abdominis, external oblique, internal oblique, and transversus abdominis). Physiological cross‐sectional areas and optimal fascicle lengths demonstrated a pattern that was similar to human abdominal wall muscles. In addition, sarcomere lengths measured in the neutral spine posture were similar to human in their relation to optimal sarcomere length. These data indicate that the force‐generating and length change capabilities of these muscles, relative to one another, are similar in rat and human. Finally, the fiber lines of action of each abdominal muscle were similar to human over most of the abdominal wall. The main exception was in the lower abdominal region (inferior to the pelvic crest), where the external oblique becomes aponeurotic in human but continues as muscle fibers into its pelvic insertion in the rat. We conclude that, based on the morphology and architecture of the abdominal wall muscles, the adult male Sprague‐Dawley rat is a good candidate for a model representation of human, particularly in the middle and upper abdominal wall regions.     

Comparison of small intestinal submucosa and polypropylene mesh for abdominal wall defect repair

Abdominal wall defects are a common medical problem, and inadequate repair methods can lead to serious complications. Abdominal wall reconstruction using autologous tissue, or non-biological, biological, or composite patches is often performed to repair defective areas. In particular, composite patches containing both polymeric and biological materials have gained increasing attention due to their good mechanical properties and biocompatibility. However, it is still unclear whether the quality of repairs using composite patches is superior to that of a biological patch. Based on the limitations of previous studies, we compared small intestinal submucosa (SIS) patches with SIS + polypropylene mesh (PPM) patches for repairing abdominal wall defects in adult beagle dogs. Forty-five female dogs were subjected to surgical resection to produce abdominal wall defects. SIS or SIS + PPM was used as patch for the defects. Morphology, biomechanics, and histological evaluations were performed to evaluate the efficacy and safety of such therapies. Our findings demonstrated that SIS had advantages over SIS + PPM considering biological activity and histocompatibility without increasing the risk of repair failure.     

Evaluation of aortic aneurysm and dissection by abdominal echography

Aortic dissection and aneurysm are related to increased vulnerability of the aortic wall due to arteriosclerosis. Echographic findings of aortic sclerosis include irregularity and strong punctate echoes in the intima and meandering of the aorta. Unruptured abdominal aneurysms are often found incidentally by routine echography. The "maximum diameter" and "increase in the size" of aortic aneurysm on echography are important information closely related to the risk of its rupture. In the evaluation of acute aortic dissection, the flap length indicates the range of dissection. The presence or absence of blood flow in the false lumen must be examined simultaneously using color Doppler echography. Some aortic dissections and aneurysms require emergency treatment on detection, and the evaluation of their images on echography, which is often performed for screening of patients with back or abdominal pain, are important for the determination of the therapeutic approach. In patients who are treated conservatively or observed, echography is very useful for the follow-up. Such patients must also be diagnosed or followed up by combining echography with other imaging techniques depending on the condition and necessary information in each patient.     

Muscle Patterning in Mouse and Human Abdominal Wall Development and Omphalocele Specimens of Humans

Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around the umbilicus are replaced by a translucent membranous layer of tissue. Histological examination of omphalocele development and moreover the staging of normal human abdominal wall development has never been described. We hypothesized that omphalocele is the result of an arrest in the secondary abdominal wall development and predicted that we would observe delays in myoblast maturation and an arrest in secondary abdominal wall development. To look for evidence in support of our hypothesis, we performed a histological analysis of normal human abdominal wall development and compared this to mouse. We also conducted the first histological analysis of two human specimens with omphalocele. In these two omphalocele specimens, secondary abdominal wall development appears to have undergone an arrest around Carnegie Stage 19. In both specimens disruptions in the unidirectional orientation of myofibers were observed in the external and internal obliques, and rectus abdominis but not in the transversus abdominis. These latter findings support a model of normal abdominal wall development in which positional information instructs the orientation of myoblasts as they organize into individual muscle groups. Anat Rec, 2012. © 2012 Wiley Periodicals, Inc.     

暂时性腹腔关闭材料及技术在腹壁缺损中的应用

背景：腹壁缺损是外科治疗的难题之一,设法一期关闭腹腔是外科医生的一项挑战,随着损伤控制外科理念的发展,各种暂时性腹腔关闭技术及材料的出现为该难题提供了有效的治疗方案。 目的：综述暂时性腹腔关闭材料及技术在腹壁缺损中的应用现状。 方法：应用计算机检索Pubmed数据库(1986/2010),以“abdomen,abdominal wall,abdominal injuries/surgery,laparotomy,temporary abdominal closure,patch,vacuum-assited closure,wound healing”为检索词;应用计算机检索中国知网数据库(2005/2010),以“腹部、腹壁、损伤、剖腹术、暂时性关腹、补片、封闭负压引流、创面愈合”为检索词。计算机检索得到278篇文献,排除因研究目的与此文无关,观点落后,重复及类似的研究,保留31篇。 结果与结论：暂时性腹腔关闭在腹壁缺损中已成为一项重要的治疗手段,对改善愈后,提高治愈率有积极的意义。目前应用于暂时性腹腔关闭的材料及技术种类较多,各有利弊及适应证、对于选用何种材料、术式需根据治疗原则及具体病情而定。