微量直流电刺激半月板无血运区裂伤愈合的实验研究

目的　观察微量直流电刺激犬半月板无血运区裂伤修复的组织学特征。方法　将２０ 条成年杂种犬双后肢膝外侧半月板无血运区造成纵形裂伤,每条犬后肢一侧为刺激组,对侧为对照组,用自制微电流刺激器刺激２ 、４ 、８ 、１２ 周后分别取材,行光镜及电镜观察。结果　电刺激２ 周半月板裂伤出现部分愈合,１２ 周完全愈合,而自身对照组均未愈合。结论　电刺激可诱导裂缘纤维软骨细胞分裂增殖;促进毛细血管趋向性增生、胶原合成及排列。半月板无血运区组织细胞并非惰性细胞,采用微量直流电刺激对半月板无血运区裂伤具有明显的促进修复作用。     

电磁技术用于骨科治疗的研究进展

近年来,电磁场生物效应的研究已被我国列为生物物理学方面的重大课题。电磁技术用于骨科治疗的研究横跨电工技术、生物技术和医学领域。早期的医学研究表明低频电磁场能加速骨折愈。     

Approche qualitative de l’éprouvé au Jardin de Soins. Une étude exploratoire en Psychiatrie de l’Adulte

In Adult Psychiatry, the Healing Garden seems today an innovative therapeutic mediation aimed likely take part in the recovery of severe patients. The therapeutic effect would depend on several bound mechanisms, in keeping with our fundamental relation with the natural environment and socio-relational purposes supported by a nonintrusive support of low complexity. Formal scientific clinical studies began in psychiatry in reactive disorders. We want to consolidate the clinical impressions accumulated in practice care in the suffering hospitalized adult of a severe pathology, through a pilot study of a qualitative type using the content analysis of interviews in a short form. The method consists of exploring elements of their comments through a feedback of personal experiences within a small group of patients to identify recurring and shared issues. Then, a structural synthesis of central elements of described experience aims at understanding the patient unique experience meanwhile and perceive the meaning for them. We began the investigation with 7 patients. The clinical evaluation was based on a semi structured interview lasting 20–30 minutes with the help of an interview guide collecting experience. The personal experience of the patient once re-written has been analyzed. The first step of qualitative data confirms the assumption of a device of care supporting the process of recovery, the benefit in a reduction of perception of symptoms of the disease, the impression to get back on their feet, the interest of a differently perceived relation with caregivers, the advantage of a resumption of the power to act, and the recognition of the importance of the support from others. Therefore patients state a re-start of their physical or psychic energy. It can be understood with the support of the group as well as the direct effects of the vegetal, or more, with discovering new possibilities to enable them to rebound back into daily life. Then, they can describe that whenever the caregiver goes to the same level as the patient in charge, and that he agrees to be taught and surprised by what the other knows, he restores on a making-together method a failing self-esteem. This feeling of self-efficiency, highlighted by human interaction with a newly renamed caregiver, enables people to get past feeling stigmatized even if this feeling is unfortunately deeply buried in the person. If the feeling of worthlessness and impossibility to change give way to a slightest action, a dynamic settles down. It enables the patient to get aware that it can act and influence on its environment, like the others. As a result, the feeling of inadequacy decreases and even the slightest result enable to recover self-confidence thanks to a positive environment. It doesn’t take much for them to realize they can act and widen their experience to other areas of their lives. The feeling of the ability to act by themselves comes back. Finally the relationship with others seems a key element in the Healing Garden. It can be shared between peers, between caregivers and patients, between the relationships of these people with the rest of society. The matter is the acceptance of its own abilities even if they are diminished. This perspective cannot be separated from the above mentioned elements: The achievement is team work and overtake individual boundaries. It allows the patient. It is the feedback of society over creation and work performed. The feeling of self-efficiency created by the pride they can feel is reward and may lead to other achievement. To conclude, we propose to consider the thematic emergence of the experience of the concept of vitality as spring action in the real in front of others as echo in a psychopathologic tradition dedicated to the existential comprehension of disorders. The implementation of a healing garden in the psychiatric fields comes as a response of our survey and sustains the patients differently. The originality is in that patients acquire resources from the environment, in a dynamic recovery. So we suggest offering this mediation as soon as possible to curb the spread of their illness. We would like to see this pilot survey taking part in structuring relevant dimensions and new researches.     

加压钢板及螺钉前外侧与内侧入路修复肱骨中下段骨折：疗效及安全性评价

背景：目前对肱骨中下段骨折主要采用复位内固定治疗,内固定入路方式主要有3种：前外侧入路(包括改良上臂前外侧入路)、后侧入路以及内侧入路。目前临床对肱骨中下段骨折的修复入路一直存在争议。 目的：对比加压钢板及螺钉前外侧入路与内侧入路内固定修复肱骨中下段骨折的疗效及安全性。 方法：将重庆市红十字会医院收治的90例肱骨中下段骨折患者按随机数字表法分为两组,每组45例。对照组采用前外侧入路加压钢板及螺钉置入内固定,试验组行内侧入路加压钢板及螺钉置入内固定。比较两组患者手术时间、术中失血量、并发症以及肩关节和肘关节恢复情况。 结果与结论：试验组内固定后术中失血量显著低于对照组(P < 0.05),两组患者手术时间、骨折愈合时间比较差异无显著性意义(P > 0.05)。随访6个月,两组患者肩关节功能Neer评分和肘关节功能Mayo评分比较差异均无显著性意义(P > 0.05)。随访期间两组患者均无切口感染、骨不连、慢性骨髓炎等并发症发生。提示内侧入路与前外侧入路加压钢板及螺钉置入内固定修复肱骨中下段骨折效果相当,且前者术中失血量更少,可有效弥补传统修复方案的部分缺陷,可以考虑作为肱骨中下段骨折内固定的修复入路方式之一。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

锁定加压钢板置入修复Pilon骨折：6个月随访骨折愈合及踝关节功能评价

背景：Pilon骨折的修复方法较多,但效果往往不理想。伴随着科学技术的发展,骨折固定原则的根本性转变以及技术和观念的革新,给Pilon骨折修复带来了新的契机。其中生物学固定技术可尽量减少进一步破坏骨折端骨外膜血供,不扰乱骨折愈合的生物力学环境,是目前研究发展的新趋势。 目的：探讨采用生物学固定技术锁定加压钢板置入内固定修复Pilon骨折的效果。 方法：回顾性分析2008年6月至2013年12月佛山市南海区经济开发区人民医院官窑分院收治应用锁定加压钢板置入内固定修复Pilon骨折76例患者的临床资料,男49例,女27例;年龄19-60岁,平均39.5岁;骨折根据Ruedi-Allgower分型：Ⅱ型54例,Ⅲ型22例。根据生物学固定技术采用锁定加压钢板置入内固定修复Pilon骨折。治疗后定期随访,根据Burwell-Charnley放射学复位标准评定复位质量,复查X射线片观察骨折愈合情况,末次随访时按Baird-Jackson评分标准评定踝关节功能。 结果与结论：76例患者获6-24个月随访。根据Burwell-Charnley放射学复位标准评定复位质量：解剖复位68例,复位可8例。切口一期愈合71例,切口渗液换药后愈合5例,切口一期愈合率达93%。所有患者骨折均愈合,愈合时间4-8.5个月,平均6.25个月。末次随访时踝关节功能按Baird-Jackson评分标准评定：优69例,良5例,可2例。提示采用锁定加压钢板置入内固定修复Pilon骨折具有良好的稳定性,可有效避免破坏骨折端血供,缩短骨折愈合时间,操作简便,对软组织损伤小,是修复Pilon骨折的有效内固定方法之一。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

骨折合并脑外伤时IGF—Ⅱ对骨折愈合的影响

目的测定骨折合并脑外伤后血清胰岛素生长因子2（insulin—like growth-factor2,IGF-Ⅱ）的变化情况,并与单纯脑外伤、单纯骨折病人以及正常人进行对比,分析脑外伤后IGF-Ⅱ浓度变化与骨折愈合之间的关系,以期为临床骨折的治疗提供新的理论依据。方法选择52例住院患者,随机分为四组,每组13例,包括正常组、单纯骨折组、骨折合并脑外伤组及单纯脑外伤组。每例于伤后1、3、7、14d抽取外周静脉血5ml,采血后室温凝固30min,离心1000×G15min,收集分离血清,于-20℃冷冻保存。试验时严格按照IGF-Ⅱ试剂盒使用说明进行操作,计算出所有标本的IGF-Ⅱ的含量,并经统计学分析得出结论。结果单纯脑外伤组和单纯骨折组伤后第3天血清IGF-Ⅱ含量升高,1周时为正常组的2倍,2周时为正常组的3倍。骨折合并脑外伤组伤后第3天血清IGF-Ⅱ含量明显升高,为正常组的2倍,1周时可达5倍,2周时可达到7倍。其与单纯骨折组或单纯脑外伤组比较,差别均有统计学意义（P〈0．05）。结论骨折合并脑外伤病人IGF-Ⅱ含量明显升高,提示IGF-Ⅱ可能加速骨折愈合过程。     

Direct Application of Keratinocyte Growth Factor,Basic Fibroblast Growth Factor and Transforming Growth Factor-α During Healing of Tympanic Membrane Perforation in Glucocorticoid-treated Rats

Peptide growth factors and cytokines modulate both normal and impaired wound healing. Topical application of growth factors in the form of ear drops may counteract impairment of wound healing in the tympanic membrane (TM). We applied keratinocyte growth factor (KGF), transforming growth factor (TGF)- &#102 or basic fibroblast growth factor (bFGF) to the perforated TMs of rats in which healing impairment had been caused by systemic administration of a glucocorticoid. Histologic studies of the injured TM, including anti-5-bromo-2'-deoxyuridine immunohistochemistry, were performed on the third day after wounding. In the control ear, epidermal migration was markedly inhibited by glucocorticoid treatment and no hyperplasia was observed in any layer at the perforation edge. TMs treated with KGF showed marked hyperplasia in the epithelial layer at the perforation edge. In the bFGF- and TGF- &#102 -treated groups, hyperplasia was observed in the epithelial and intermediate layers of the TM near the malleus handle and annulus, while no hyperplasia was seen in any layer at the perforation edge. Only KGF, therefore, improved epidermal migration in the TM, while all the growth factors tested induced hyperplasia in the TM.     

剖宫产术后皮下置引流管对切口愈合的影响研究

目的:探讨剖宫产手术后,在伤口愈合障碍的患者皮下放置引流管对切口愈合的影响。方法:选取存在伤口愈合障碍相关因素的剖宫产手术妇女420例随机平分为两组,每组210例。治疗组,进行腹壁缝合时,在脂肪层放置自制的引流管引流;对照组切口和缝合部位相同,只是不放置引流管。术后比较两组患者切口的愈合情况。结果:治疗组210例患者中,伤口愈合为甲级者176例,乙级30例,丙级4例,没有发生伤口感染的患者;对照组伤口愈合情况,甲级116例,乙级70例,丙级20例,丁级4例;两组比较差异具有显著性(P<0.05)。两组患者进行手术所用的时间和手术完成后住院的天数均无明显差异(P>0.05)。结论:对存在切口愈合障碍相关因素的行剖宫产术的患者,在其皮下置引流管引流可以促进切口的愈合。     

情志因素与消化性溃疡愈合质量的相关性

基于情志因素与消化性溃疡愈合之间的密切关系,消除情志致病的因素,阻断溃疡病的发病和复发环节,探究中西医对消化性溃疡的认识,愈合质量及评价方法,情志因素对消化性溃疡愈合质量的影响。治以疏肝健脾和胃能加强溃疡愈合后的治疗,将能够有效降低消化性溃疡的复发率。