Combination of a new composite biocampatible skin graft on the neodermis of artificial skin in an animal model

Introduction: There have been very limited and inconsistent attempts at combining the cultured epidermal autograft (CEA) with the neodermis of artificial skin (Integra). The reasons for this remain unknown. The basement membrane proteins of conventional CEA sheets are easily damaged by the dispase treatment during the harvesting of the CEA from the culture flask. The damage of the basement membrane proteins may affect the anchorage of CEA onto the neodermis of Integra. A new Composite Biocompatible Skin Graft (CBSG) was recently developed. Methods: Composite biocompatible skin graft consists of autologous keratinocytes cultivated on a pliable hyaluronate‐derived membrane (Laserskin) which has been pre‐seeded with allogenic dermal fibroblasts. Basement membrane proteins of CBSG are protected from the dispase treatment because the keratinocytes are directly seeded onto Laserskin. The engraftment of CBSG was evaluated on 20 wounds of 10 rats. Integra was grafted on two freshly excised full‐thickness wounds (3 cm in diameter) in the dorsum of each animal. A polypropylene ring was applied to each wound to prevent the migration of epithelium from the edges. Composite Biocompatible Skin Graft was used to cover the neodermis of Integra after the silicone membrane was removed 14?21 days postgrafting. Results: Fourteen (70%) of 20 skin biopsies taken at day 21 from the centre of the grafted wounds revealed regenerated epithelium. Conclusion: A feasible delivery system of cultured keratinocytes onto the neodermis of Integra is demonstrated in this animal ­experiment.     

人工股骨头置换治疗高龄股骨颈骨折

1996年12月~2002年6月,我院应用人工股骨头置换术治疗80岁以上股骨颈骨折患者21例,效果满意。1材料与方法1.1病例资料本组21例,男4例,女17例,年龄80~89岁。其中2例脑血管疾病后轻度偏瘫。健侧发生股骨颈骨折。材料选用常州市康辉医疗器械有限公司产双极人工股骨头。1.2治疗方法     

颈椎前路椎间融合术与人工椎间盘置换术联合椎间融合术治疗连续双节段颈椎病的中长期疗效对比

目的 :比较前路颈椎椎间融合术(anterior cervical discectomy and fusion,ACDF)与颈前路人工椎间盘置换联合颈椎椎间融合(Hybrid手术)治疗连续双节段颈椎病的中长期疗效。方法:回顾性分析2007年1月~2012年3月在我科行ACDF及Hybrid手术治疗的连续双节段颈椎病患者,资料完整且随访时间60个月者共68例,其中ACDF 39例(ACDF组),Hybrid手术29例(Hybrid组),两组患者年龄、性别构成比、随访时间、手术节段等均无统计学差异。比较两组术前及末次随访时的JOA评分、颈椎功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)、颈椎整体活动度、C2-C7颈椎曲度、相邻节段活动度、相邻节段退变情况等。结果:两组患者手术时间、出血量和术后引流量均无统计学差异;末次随访时的JOA、NDI及VAS评分均较同组术前有显著性改善(P0.05),两组间同时间点比较均无统计学差异(P0.05)。末次随访时根据Odom标准,Hybrid组的优良率为93.1%,ACDF组为92.3%,两组比较无统计学差异(P0.05);两组C2-C7曲度较术前均有所恢复,Hybrid组较ACDF组改善更好(P0.05);Hybrid组整体颈椎活动度及相邻节段活动度较术前无明显差异(P0.05),ACDF组颈椎活动度较术前明显降低(P0.05)、相邻节段活动度明显增加(P0.05);颈椎X线片评估相邻节段退变发生率无统计学差异(Hybrid组17.2%vs ACDF组20.5%,P0.05);末次随访时Hybrid组人工间盘置换节段异位骨化发生率为34.5%(10/29),其中Mobi-C假体发生率为41.2%(5/12),Pro Disc-C假体发生率为29.4%(5/17)。结论 :Hybrid手术治疗双节段颈椎病5年以上随访临床疗效及安全有效性与ACDF相当,但Hybrid手术可以更好地重建颈椎曲度,减少邻近节段代偿性活动的同时保持颈椎活动度。     

小切口股骨头置换术治疗高龄股骨转子间骨折

正2009年1月~2016年4月,我科采用转子股骨柄股骨头置换术治疗16例高龄股骨转子间骨折患者,效果良好,报道如下。1材料与方法1.1病例资料本组16例,男9例,女7例,年龄76~91岁。骨折按EvansJensen分型:Ⅲ型10例,Ⅴ型6例。均采用转子股骨柄型双极人工股骨头置换。伤后至手术时间3~7 d。1.2治疗方法腰硬联合麻醉或全身麻醉下手术。患髋后外侧切口,通过大     

多次精液优化对IUI成功率的影响

目的探讨多次精液优化对宫腔内人工授精(IUI)成功率的影响。方法回顾分析我院生殖医学中心41例多次精液优化人工授精周期,分析多次精液优化对妊娠率的影响。结果 41例多次精液优化人工授精周期妊娠率为29.27%,对照组为11.62%,两组临床妊娠率比较,差异有统计学意义(P<0.05)。结论多次精液优化人工授精是一种可以提高人工授精周期妊娠率的方法,具有积极的临床意义。     

The clinical application effects of artificial dermis scaffold and autologous split-thickness skin composite grafts combined with vacuum-assisted closure in refractory wounds

To investigate the clinical application effects of artificial dermis scaffold and autologous split-thickness skin composite grafts combined with vacuum-assisted closure (V.A.C) in refractory wounds. A retrospective analysis was performed on 70 patients with refractory wounds admitted to the First Affiliated Hospital of Soochow University from June 2019 to December 2021 (44 males and 25 females, with an average age of 49.3 ± 21.4 years). There were 26 patients with chronic ulcers; 3 patients with cancerous wounds; 16 patients with hot crush injuries; and 25 patients with traumatic wounds, including 21 cases of hands, 33 cases of feet, 6 cases of upper limbs, and 10 cases of lower limbs. The patients were divided into an artificial dermis scaffold group (35 patients, including 21 males and 14 females, aged 49.5 ± 21.3 years) and a skin graft group (35 patients, including 23 males and 11 females, aged 49.1 ± 21.5 years). In the artificial dermis scaffold group, after debridement, the artificial dermis scaffold was transplanted for approximately 2 weeks until the wound surface was well vascularized, after which the autologous split-thick skin graft was transplanted. Negative pressure wound therapy was performed throughout the treatment. In the skin grafting group, after debridement, the autologous split-thickness skin graft (aSTSG) was transplanted, and negative pressure wound therapy was performed continuously. The wound healing rate; skin graft survival rate; postoperative wound infection; exudative fluid volume; subcutaneous haematoma; hospitalisation time; hospitalisation cost; Vancouver Scar Scale (VSS) score, used to evaluate the scar of the recipient area at 6 months after the operation; and the sensory disorder grading method, used to evaluate the sensory recovery of the recipient area, were compared between the two groups. All 70 refractory wounds healed. In the artificial dermis scaffold group, the skin graft survival rate was 90% (86%–95%), the hospitalisation time was 38 (29–45) days, the hospitalisation cost was 148 102 (118242–192327) yuan, and the VSS score was 1.9 ± 1.3. There were significant differences in skin graft survival rate (70% [60%–80%]), length of hospital stay (21 [14–28] days), hospitalisation cost (76 201 [39228–135 919] yuan) and VSS score [6.1 ± 3.6] between the skin graft group and the artificial dermis scaffold group (P < .05). The skin graft survival rate, scar hyperplasia and sensory recovery of the recipient area in the artificial dermis scaffold group were better than those in the skin graft group, but the hospitalisation time was relatively longer, and the hospitalisation cost was relatively higher. Wound healing rate, postoperative wound infection, exudate volume, and subcutaneous haematoma of patients in the two groups were similar, and there were no significant differences (P > .05). The artificial dermis scaffold and composite transplantation of autologous aSTSG with V.A.C can promote painless wound healing and improve the skin survival rate, skin colour and lustre, and flexible smooth texture and is conducive to less scar hyperplasia and postoperative functional exercise and recovery. This method provides a reasonable and effective scheme for the treatment of clinical refractory wounds.     

人工材料在嵌顿及绞窄性造口旁疝修补术的应用

目的探讨嵌顿、绞窄性造口旁疝开放式人工材料修补术的合理性与评价。方法回顾性分析我院2006年3月至2007年9月采用一期人工材料修补治疗嵌顿、绞窄性造口旁疝6例的临床资料。结果全组患者无死亡及腹腔感染。腹膜前用聚丙稀补片修补1例，发生切口感染，20d后取出补片，行原位腹腔内无张力造口旁疝修补术治愈。1例发生切口脂肪液化，经短时间换药治愈。无其他术后并发症。手术时间120—160min，平均130rain；住院时间12—35d，平均17d；术后随访时间3—21个月，平均为11个月，未见早期复发。结论选择性应用人工材料疝修补治疗嵌顿、绞窄性造口旁疝是安全可行的。     

应用分子吸附循环系统治疗急性肝功能衰竭的经验

目的 探讨急性肝功能衰竭患者等待肝移植期间应用分子吸附循环系统的治疗效果.方法 本组共有16例急性肝功能衰竭患者在等待肝移植期间接受了分子吸附循环系统治疗.结果 16例患者经治疗临床症状及体征明显改善:凝血酶原时间、总胆汁酸、丙氨酸转氨酶、天冬氨酸转氰酶、肌酐和血氨水平明显降低(P＜0.05);肿瘤坏死因子α、一氧化氮和白细胞介素10等细胞因子水平有所下降,但无统计学意义(P＞0.05);序贯性脏器衰竭评估的计分由9.91±1.09降至6.64±1.76,Glascow昏迷评分由7.29±2.06升至13.26±2.14.16例患者中14例成功过渡到肝移植治疗,13例痊愈出院.治疗成功率为81.25%.结论 分子吸附循环系统是治疗肝功能衰竭安全而有效的辅助方法,帮助急性肝功能衰竭患者顺利渡过肝移植等待期.     

Effects of CO2 pneumoperitoneum on blood flow vol-ume of abdominal organs of rabbits with controlled hem-orrhagic shock and liver impact injuries

Objective: To investigate the effects of CO2 pneumo-peritoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock model and liver impact injuries.Methods: After controlled hemorrhagic shock and liver impact injuries, the rabbit model was established. Eighteen rabbits subjected to hemorrhagic shock and liver impact inju-ries were divided into 3 groups randomly according to the volume of lost blood: light hemorrhagic shock (blood loss volume was 10%, 6 ml/kg), moderate hemorrhagic shock (20%, 12 ml/kg) and severe hemorrhagic shock (40%, 22 ml/kg). Intraabdominal pressures of CO2 pneumoperitoneum was 10 mmHg. Color-labeled microspheres were used to mea-sure the blood flow volume of the liver, kidney and stomach before pneumoperitoneum at 30 minutes and 2 hours after pneumoperitoneum and 30 minutes after deflation. And the mortality and hepatic traumatic condition of rabbits were recorded.Results: Of the 18 rabbits, there were 9 with liver impact injuries at Grade Ⅰ, 8 at Grade Ⅱ and Ⅰ at Grade Ⅲ (according to AIS-2005). The mortality rate in light hemorrhagic shock group was 33.33%, and that in moderate or severe hemor-rhagic shock group was 100% within 30 minutes and 2 hours after pneumoperitoneum, respectively. The blood flow vol-ume in the organs detected decreased at 30 minutes under pneumoperitoneum in light and moderate hemorrhagic shock groups. At the same time, the blood flow volume of the liver in moderate hemorrhagic shock group decreased more sig-nificantly than that in light hemorrhagic shock group.Conclusions: The blood flow volume of abdominal organs in rabbits is decreased obviously under CO2 pneumoperitoneum, with fairly high mortality rate. It is be-lieved that CO2 pneumoperitoneum should cautiously be used in abdominal injury accompanied with hemorrhagic shock, especially under non-resuscitation conditions.     

腹腔镜手术中突然无CO_2的应急处理

目的:探讨腹腔镜术中突然无CO2时使用自行设计的应急腹腔充气装置向腹腔充气继续施行手术的可行性。方法:使用本装置建立空气气腹与常规CO2气腹行腹腔镜动物实验,观察建立的手术空间及使用钩状电极时的火花情况,监测动物在麻醉、充气、手术过程中脉搏(pulse,P)、动脉血氧饱和度(SpO2)的变化及术后生存情况,取得一定经验后应用于临床。结果:动物在麻醉、术中、术后半小时P、SpO2的变化曲线一致,能建立足够的手术空间,使用钩状电极切割时无爆炸,火花不明显,术后动物生存良好。使用本装置完成1例腹腔镜异位妊娠取胚术,手术顺利,术中血压(blood pressure,BP)、P、SpO2平稳,术后6h患者BP、P、SpO2正常。结论:腹腔镜术中突然无CO2时用自行设计的应急腹腔充气装置是安全的,具有一定的实用性与可操作性。