骨间前血管前臂背侧皮神经营养血管皮瓣的临床应用

目的：报道改进前臂背侧皮神经营养血管逆行皮瓣的手术方法及临床效果。方法：对腕背以远的皮肤缺损创面，设计以骨间前血管腕背支为血管蒂，沿前臂背侧皮神经营养血管轴切取皮瓣逆向转位修复。结果：临床应用8例，皮瓣全部皮活。随访6－12个月，皮瓣质地优良，外形与功能恢复满意。结论：该皮瓣切取方便，血供可靠，不累及前臂主要血管，适于修复虎口、腕背及手背等处较大面积的皮肤软组织缺损。     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

皮神经营养血管对扩大穿支蒂皮瓣存活面积的实验研究

Objective To study the effects of nerocutneous vessels on perforator flap blood supply and survival area. Methods Thirty SD rats were randomly divided into 3 groups. The study of the vasculature and nerve disposition of rat dorsum was performed with 10 rats of one group. According to the study,a distal rectangle neurocutaneous flap based on deep circumflex iliac artery perforator, 10 cm long and 3 cm in the width, was elevated on the rest rats, and sutured back to the original situation. The axis of the experimental group's flap paralleles the posterior median line,while the control group flap's angulated about 30° with it. The blood flow of the flap was assessed by fluorescein angiography on the 1st and 7th day after surgery. The surviving rate and the capillary density of flap were assessed on the 7th day after surgery. Results The rat deep circumflex iliac perforator artery was a constant perforator artery, with an nutrition area about 4 cm× 3 cm. The dorsal cutaneous nerves run along the dorsomedian line, nourished by rich vessels. The blood perfusion 1st day after surgery was 42.85% in the experimental group, 37.94% in the control group(P ＞ 0.01 ).On the 7th day, it was 84.07% in the experimental group, 58.55% in the control group (P＜ 0.01). The mean survival rate of the experimental group was 83.93%, higher than control group's 59.95% (P＜0.01),and the density of the blood vessels was higher in experimental group than control group's. Conclusion The neurocutaneous vessels can improve the flap survival condition, which make the perforator flap bigger and safer.     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.     

埃罗替尼和塞来昔布协同抑制胆管癌细胞生长

目的:观察表皮生长因子受体(EGFR)酪氨酸激酶抑制剂埃罗替尼(erlotinib)与环氧合酶(COX-2)抑制剂塞来昔布(celecoxib)对胆管癌细胞生长的协同抑制作用。方法:采用甲基噻唑基四唑(MTT)比色法检测胆管癌细胞株QBC939增殖,流式细胞术检测用药前、后细胞凋亡和细胞周期的变化,逆转录聚合酶链反应(RT-PCR)、Western印迹方法观察用药前、后细胞中COX-2、EGFR下游信号及凋亡、细胞周期相关基因蛋白表达的变化。结果:QBC939细胞表达COX-2 mRNA和EGFR mRNA及相应蛋白。埃罗替尼、塞来昔布抑制QBC939细胞增殖,促进细胞凋亡,诱导细胞周期阻滞于G0/G1期。同时,塞来昔布增强了埃罗替尼抑制细胞生长、诱导细胞凋亡的作用。联合用药显著降低p-MAPK、p-Akt及PGE2表达。结论:塞来昔布和埃罗替尼均可抑制胆管癌细胞的生长,而联合用药具有协同作用,能同时阻断EGFR和COX-2信号通路。在胆管癌治疗中具有一定应用前景。     

胰岛素泵和甘精胰岛素在2型糖尿病患者围手术期的疗效及费用的比较

目的:比较胰岛紊泵和甘精胰岛素在2型糖尿病(T2DM)患者围手术期控制血糖选标时间及低血糖的发生率及费用的差别.方法:将80例围手术期T2DM患者分为胰岛素泵治疗组(CSII组)42例,甘精胰岛素治疗组(G组)38例.比较各组患者血糖达标时间及低血糖的发生率及费用的差别.结果:CSII组和G组在血糖达标时间及低血糖发生率上无明显差别,而G组在费用方面明显低于CSII组.结论:胰岛素泵及甘精胰岛素在T2DM患者围手术期均能安全、有效、快速、平稳降低血糖,且甘精胰岛素费用较低.     

腓骨短肌转移治疗跟腱修复术后再断裂

[目的]总结以腓骨短肌转移治疗跟腱修复术后再断裂的手术方法和效果。[方法]本组患者共11例,男10例,女1例。年龄26～51岁,平均37.5岁。外院予行初次手术时均为新鲜闭合性断裂,所用术式包括腓肠肌腱瓣翻转缝合1例和直接端端缝合10例。初次修复术后因皮肤坏死、功能操练不当或再次受伤而发生再断裂。再断裂至再次手术的时间为1～3周。再次手术时均采用腓骨短肌转移修复跟腱;1例局部皮肤坏死者予以清创、跟腱修复并游离移植股前外侧皮瓣覆盖创面。术后6周依次采用长腿石膏前托、长腿管型石膏、短腿管型石膏固定;积极而循序渐进地进行功能操练。[结果]所有病例术后随访12～18个月,平均14个月。手术切口均顺利愈合,1例游离移植皮瓣完全存活。2例术后发生足部外侧感觉减退,术后2～3周恢复。所有患者均未发生跟腱的再次断裂及足内翻畸形。根据Arner/Lindholm跟腱修复疗效标准进行评定,优6例,良4例,差1例,优良率为90.9%。[结论]腓骨短肌移植可以填补跟腱缺损,同时保证修补部位的力学强度和愈合,从而利于术后功能操练的顺利进行,并且对踝关节的外翻功能不会造成明显损害,是治疗跟腱修复术后再断裂的良好选择。     

妊娠期妇女甲型H1N1流感15例临床分析

甲型H1N1流感是一种由新型流感病毒感染所致的急性呼吸道传染病,传染性强,病情进展迅速.妊娠妇女作为甲型H1N1流感重症病例的高危人群,更应引起重视.为尽快了解其相关特性,总结防治经验,笔者对温州市第二人民医院收治的15例甲型H1N1流感妊娠期妇女进行了分析.     

双极射频在前交叉韧带重建中的应用

目的:探讨关节镜下双极射频在前交叉韧带重建术中的应用。方法:在关节镜下应用双极射频对16例前交叉韧带重建术中的移植物进行皱缩,男12例,女4例;年龄18～46岁,平均31岁。单纯前交叉韧带损伤5例,合并半月板损伤10例,合并后交叉韧带损伤1例。术中和术后对所有病例观察随访,记录临床检查结果和Lysholm评分。结果:术中可见应用双极射频处理后的韧带逐渐收缩变短,韧带张力明显提高,麻醉状态下抽屉试验和Lachman试验均呈阴性。术后随访6～13个月,平均9.5个月,膝关节主观和客观稳定性均明显改善,Lysholm评分从术前(51.7±3.9)分提高到(86.2±3.5)分(P<0.01)。结论:关节镜下应用双极射频在前交叉韧带重建术中对移植物进行皱缩,可使重建韧带收缩变紧,提高关节的稳定性。     

无头加压空心螺钉治疗舟状骨骨折的早期疗效

目的总结无头加压空心螺钉治疗舟状骨骨折的手术方法及疗效。方法 2009年12月-2010年5月,采用切开复位无头加压空心螺钉内固定治疗29例舟状骨骨折患者。男19例,女10例;年龄18～66岁,平均42岁。根据Herbert-Fisher分型:B1型10例,B2型12例,B3型5例,B4型2例。受伤至手术时间2～7 d,平均4 d。结果术后患者切口均Ⅰ期愈合。22例获随访,随访时间6～12个月,平均9个月。X线片检查示术后40～80 d骨折达骨性愈合,平均60 d。1例B4型患者于术后6个月影像学检查确诊为舟状骨缺血性坏死。末次随访时腕关节功能较术前显著改善。Mayo腕关节功能评分,获优14例,良6例,中2例。结论 无头加压空心螺钉加压固定稳定牢靠,是治疗舟状骨骨折的有效方法之一。