Prospective observational study comparing burn surgeons’ estimations of wound healing after skin grafting to photo-assisted methods

IntroductionAppropriate graft healing after split-thickness skin graft and early recognition of complications (graft loss) are critical to burn patient management. Larger mesh ratio expansions and Meek micrografting may pose a greater challenge in estimating the percentage of wound healing. This study looks at the reliability of photograph assessments and the concordance of bedside evaluation to photograph assessments of wound healing after skin grafting.MethodsThree assessment methods for percentage of wound healing after skin Grafting were assessed: (1) clinicians’ bedside rating, (2) clinician assessment of high-definition photographs, and (3) digital image analysis through color subtraction using Adobe Photoshop. We compared each method using a mixed-effects model on absolute agreement using intra-class correlation (ICC) and Bland Altman (BA) plots.ResultsFourteen burn patients were enrolled with 38 grafted wounds (100 sites). Bedside assessments had a mean ICC of 0.64 (compared to digital image analysis) and 0.69 (compared to photo assessment), with a wide range on BA-plots. Inter-rater reliability of photo assessment was excellent (0.96) among six clinicians. Repeated photo-assisted assessments had good intra-rater reliability (ICC: photo assessment: 0.88; digital analysis: 0.97).ConclusionsBedside wound healing assessments show variability; photograph documentation of sequential wound progression could supplement active clinical management or studies for more reliable assessments.     

自体角膜缘干细胞移植术治疗翼状胬肉疗效观察

目的: 探讨自体角膜缘干细胞移植术治疗翼状胬肉的临床疗效。方法: 选取84例(98眼)翼状胬肉患者, 随机分为A、B 2组。A组42例(50眼)予以常规单纯翼状胬肉切除术治疗, B组42例(48眼)予以翼状胬肉切除联合自体角膜缘干细胞移植术治疗, 比较2组患者术后复发率、治愈率、角膜创面上皮愈合时间及术后不良反应。结果: B组复发率4.2%, 低于A组的20.0%(P<0.05), B组角膜创面上皮愈合时间(4.1±1.9)d, 少于A组的(6.9±2.3)d(P<0.01);B组患者术后明显不适者2例(4.2%), 少于A组的13例(26.0%)(P<0.01)。结论: 翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉可有效提高治愈率并促进角膜创面上皮愈合, 降低复发率, 患者术后不良反应轻, 值得临床应用推广。     

泪道重建手术中修复材料的应用及研究进展

对于各种病因导致的严重泪道结构损伤或缺失,选择最佳的治疗方案是临床难题之一。当泪道系统难以再通或者无法修复时,可选择泪道旁路手术,以期建立一条新的通道。目前临床上重建泪道系统的材料,大多选用人工泪管或自体组织移植,两者各有利弊。近年来,随着分子生物学和组织工程技术的发展,一些新型材料不断被发明,并被应用于临床,为泪道阻塞性疾病的治疗带来了新材料和新思路。     

不同植入体置入内固定在胸腰椎结核治疗中的应用

目的：探讨一期病灶清除后前路或后路应用不同植入体内固定治疗胸腰椎结核的临床效果。 方法：以 “胸腰椎结核,内固定,钛网,自体骨,骨水泥,前后路”为中文关键词;以:“thoracolumbar spinal tuberculosis;internal fixation;titanium mesh;autogenous bone;cement;anterior and posterior” 为英文关键词,采用计算机检索2007-01/2010-05相关文章。纳入与一期病灶清除前路或后路内固定治疗胸腰椎结核的相关文章;排除重复研究或Meta分析类文章。以30篇文献为主重点探讨了不同植入体内固定治疗胸腰椎结核的临床效果。 结果：目前内固定材料均以钛合金为主,再加前或后路的植骨融合,是治疗胸腰椎结核的主要方法,其优点在于钛合金具有良好的组织相容性和耐腐蚀性,不易发生异物反应。而结核菌在金属表面形成的多糖膜相对薄弱,抗结核药物和患者自身免疫机理仍能够发挥作用,病灶处植入固定物引起感染扩散的可能性较小。但无论是哪种植入体都存在内固定材料长期摩擦刺激血管和内固定物松动、脱落等并发症。 结论：随着内固定材料和内固定技术的发展,大量的临床应用已经证明脊柱结核患者使用内固定的安全性和有效性,而一期重建脊柱的稳定性是提高脊柱结核手术效果的重要因素之一。低磨损、高相容性的内固定植入体是提高治疗质量的重要因素,从而能够更好地延长假体使用寿命。     

Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases

The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte implantation. The success of mosaicplasty procedures in the knee has led to its application to other surfaces, including the talus, tibial plateau, patella, and humeral capitellum. In this report, we present two cases of a chondral defect to the femoral head after a traumatic hip dislocation, treated with an osteochondral autograft (OATS) from the ipsilateral knee, and the inferior femoral head, respectively, combined with a surgical dislocation of the hip. At greater than 1 year and greater than 5 years of follow-up, MRI studies have demonstrated good autograft incorporation with maintenance of articular surface conformity, and both patients clinically continue to have no pain and full active range of motion of their respective hips. In our opinion, treatment of osteochondral defects in the femoral head surface using a surgical dislocation combined with an OATS procedure is a promising approach, as full exposure of the femoral head can be obtained while preserving its vasculature, thus enabling adequate restoration of the articular cartilage surface.     

两种不同移植物重建膝前交叉韧带的临床疗效比较

[目的]探讨自体髌腱与深低温冷冻同种异体髌腱重建膝关节前交叉韧带的临床疗效差异。[方法]72例ACL断裂患者于术前应用电脑随机抽样方法分为两组:A组36例为自体髌腱组,B组36例为单纯深低温冷冻保存同种异体髌腱组。两组病例均由同一术者采用标准关节镜技术完成前交叉韧带重建。通过一般情况比较、轴移试验、Lachman试验、Daniel单腿水平跳跃试验、IKDC评分、Lysholm-Tegner运动水平评分及KT-2000检测评价临床疗效。[结果]70例患者获得随访,平均随访时间A组(36例)39.5个月、B组(34例)36.3个月,2例失访。A组发生术中髌骨骨折1例、术后髌前痛2例,B组出现迟发感染1例。A组平均手术时间较B组长,术后发热天数较B组短。两组住院时间无差异。A、B两组轴移试验、Lachman试验及KT-2000检测的差异无统计学意义。A、B两组ACL重建失败率分别为8%、9%,差异无统计学意义。两组间Daniel单腿水平跳跃试验、IKDC评分及Lysholm-Tegner运动水平评分的差异无统计学差异。[结论]单纯深低温冷冻同种异体髌腱与自体髌腱相比较,重建前交叉韧带的术后短期疗效接近,可作为自体移植物重建前交叉韧带的一个良好的移植替代物。     

Link钢板并植骨治疗复杂胫骨平台骨折

目的探讨Link胫骨上段解剖钢板并植骨治疗复杂胫骨平台骨折的手术方法及疗效分析。方法本院2004年3月至2009年5月共收治复杂胫骨平台骨折18例,按Schatzker分型属型Ⅳ型4例、Ⅴ型8例、Ⅵ型6例,均行切开复位、自体植骨、Link钢板内固定。结果所有病例均获5～18月的随访,根据Rasmussen膝关节功能评分标准,优11例,良4例,可2例,差1例,优良率为83.3%。结论 Link钢板加植骨治疗复杂胫骨平台骨折,对加快骨愈合,防止胫骨平台塌陷,便于早期开展功能锻炼,预防关节僵硬和创伤性关节炎有显著疗效。