复合真皮下血管网薄皮瓣30例应用

探讨对功能和外形修复要求较高部位的较大面积皮肤缺损的修复方法。通过２０个颈肩部和４５个腹腰部共６５个真皮下血管网薄皮瓣修复颈部和上肢创面的应用,３０例获得成功,表明复合真皮下血管网薄皮瓣对较大面积的皮肤缺损有较理想的修复效果。     

Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia

Since many years the importance of a weakness of the soft tissue for the development of hernias is discussed controversially. The tensile strength of the tissue is supposed to depend largely on the varying proportion of type I collagen with its high tensile strength and the immature type III collagen. Their relation is regulated by several collagenases, mainly matrix metalloproteinases-1 and -13 (MMP-1 and MMP-13), whereas fibronectin plays a key role for the adherence of cells within the extracellular matrix. The aim of this study was to investigate whether an alteration in type I and type III collagen synthesis, amounts of MMP-1 and MMP-13 and the expression of fibronectin were associated with the development of inguinal hernia. We analysed the hernial sac of patients with indirect (n = 9) and direct (n = 7) inguinal hernias and peritoneum in controls (n = 7) by immunohistochemistry and Western blot analysis. The results showed that the ratio of relative amount of I/III collagen was markedly decreased in patients with either indirect or direct hernias as compared with controls (p < 0.001) with a concomitant increase in type III collagen synthesis. MMP-13 was expressed neither in the hernial sac nor in the peritoneum of the controls, but the positive reactions of MMP-1 were found in the surface of the subserosa of the hernial sac in patients with indirect or direct hernias without any difference compared to controls. Furthermore, the relative amount of fibronectin in patients with either indirect or direct hernias is not significantly different from controls (p > 0.05). In regard to the known alterations of the collagen metabolism in fascia and skin of hernia patients the changed collagen I/III ratio with its increase of type III collagen in hernial sacs support the presence of a systemic disturbance of collagen metabolism. The absence of changes of the expression of collagenases (MMP-1, MMP-13) and the constant levels of fibronectin underline the central role of collagen synthesis for the development of indirect or direct hernias.     

Expression of the extracellular matrix proteins collagen I, collagen III and fibronectin and matrix metalloproteinase-1 and -13 in the skin of patients with inguinal hernia

Although abnormal collagen metabolism has been ascribed an important role in the high recurrence rates after surgical hernia repair, knowledge on tissue sampled in the region affected by inguinal hernias is poor. In the present study, we determined collagen type I and type III in the skin of adult patients with indirect and direct inguinal hernias by both immunohistochemistry and Western blot analysis. In addition, we quantified the immunohistochemical expression of fibronectin and matrix metalloproteinase (MMP)-1 and -13. The results indicated that the ratio of collagen type I/III was significantly decreased in the skin of patients with either indirect (n = 9) or direct hernia (n = 7), with a concomitant increase in collagen type III (p < 0.001 vs. controls, n = 7, without affection of the inguinal region). There was no significant difference between patients with indirect and direct hernia (p > 0.05). MMP-13 was not expressed in any of the skin samples investigated, whereas MMP-1 was found in the epidermis. Fibronectin was predominantly detected at the epidermal-dermal junction. MMP-1, MMP-13 and fibronectin levels were significantly different between patients and controls (p > 0. 05). We conclude that in contrast to the unchanged expression of fibronectin and MMP-1 and MMP-13, the decreased ratios of collagen tpye I/III with the basically increased amount of collagen type III could be of significant importance for the pathophysiology of hernias. The specific ratio collagen I/III probably reflects the altered structural integrity and mechanical stability of the connective tissue in both indirect and direct hernias. Moreover, our findings stress that hernias should be regarded as the manifestation of a systemic disease in the inguinal region with a genetic background, explaining the high recurrence rates after repeated suture repair, as well as the usefulness of surgical meshes in this clinical setting.     

Gardner综合征(附一家族12例10年随访分析)

目的通过对一家族患Gardner综合征患者的10年追踪观察，了解本病的动态变化。方法一家族四代12例患者，男女各6例c.年龄最人者74岁，最小者9岁，平均38岁。检查方法采用结肠气钡双对比造影、纤维结肠镜、X线平片及人体实体摄影。结果出现三联症者8例（66.7％），出现二联症者4例（33.3％）．10年追踪观察，其中4例（33．3％）因结肠息肉发生癌变而死亡，息肉癌变的部位均发生在直肠与乙状结肠．死亡年龄最大74岁，最小35岁。结论本病结肠息肉癌变率很高，30岁以后即可发生，60岁以卜为高峰期.结肠息肉预防性切除仍是最好的治疗方法。     

大鼠肝硬变门脉高压性瘀证舌脉诊变化的实验研究

用复制的肝硬变门脉高压性瘀证大鼠模型,以探索舌脉变化与合深静脉压、门脉压、门脉血流量之间的关系.结果实验组大鼠形成坏死后肝硬变,以假小叶Ⅲ期病变为主;舌深静脉压力升高,与门脉压升高呈正相关;门脉血流量明显减少,与对照组比较P<0.01.认为肝硬变门脉高压性瘀证的舌脉粗张与细络瘀血主要是因门脉血经门—腔侧支循环回流入上腔静脉,引起上腔静脉阻力增大,压力增高,导致舌的静脉系统回流受阻,舌深静脉压力升高所致.     

12 840例小儿麻痹后遗症外科治疗统计分析

目的 :探讨我国现存小儿麻痹后遗症病人的年龄结构、医疗需求、手术类别及外科治疗的有关问题 ,为此类患者的治疗提供参考。方法 :回顾性分析了 1985年 9月～ 2 0 0 3年 5月之间手术治疗的小儿麻痹后遗症 12 840例 ,实施手术 3 15 62次。从病人初次手术年龄、手术部位、下肢瘫痪情况、步态及手术类别进行统计归类。结果 :首次手术年龄 2 5岁以下者 1172 1例 ,占同期病例总数的 91 2 9% ,其中下肢髋部手术占总手术的 15 2 8% ,膝部占 3 0 19% ,踝足占 48 73 % ,下肢均衡术占5 14 % ,上肢手术占 0 5 %。结论 :现存的小儿麻痹后遗症 70 %以上年龄 <3 5岁 ,5 0 %以上的农村患者既往未实施过正确的矫形手术治疗。对中国遗留的百万小儿麻痹后遗症进行系统的现代矫形外科治疗 ,仍是骨科界的一项艰巨任务