袜套持续外展牵引法整复难复性肩关节脱位

1988年1月～1999年6月,我们应用袜套持续外展牵引法,成功整复难复性肩关节脱位32例.其中2例来院就诊时间超过48小时. 1 临床资料 本组32例,男27例、女5例,年龄18～62岁.前脱位31例,后脱位1例,就诊时间6～58小时不等.其中18例在院外多次复位失败而转入我院就诊.14例为在我院采用Hippocrates及Kocher等方法复位失败者.32例中合并肱骨大结节骨折3例,同侧肋骨骨折2例,伤前患有冠心病者4例.     

重组人表皮生长因子凝胶对动物腹部手术切口抗张力强度影响的实验研究

目的 :探讨重组人表皮生长因子 (rh EGF)凝胶对动物腹部手术切口的修复作用。方法 :实验分两部分进行。第 1部分 :SD大鼠 90只 ,随机分为 3组 (切口内外用药组、切口外部用药组和空白基质对照组 ) ,每组 30只 ,每日切口处涂药 1次。术后第 4、5、6、8、10日每组分别处死 6只动物 ,取切口处皮肤进行拉力试验并进行病理组织学检查。第 2部分 :实验用小型猪 6头 ,设 4个用药组 (切口内外用 rh EGF凝胶组、外用 rh EGF凝胶组、外用 rh EGF水剂组和空白基质对照组 ) ,采用自身对照 ,用药方法同上 ,术后第 5、7、9日各处死 2只动物 ,取切口处皮肤同上法测定和检查。结果 :rh EGF凝胶外部用药组两种动物切口处皮肤抗张力强度及拉伸率在不同的用药时间内较空白基质对照组均明显增强 (P<0 .0 5或 P<0 .0 1) ;内外用药组的抗张力强度明显低于外部用药组 (P<0 .0 5或 P<0 .0 1) ,且切口处炎性细胞弥漫性浸润 ,并见异物巨细胞反应 ;外用 rh EGF水剂组抗张力强度和拉伸率与 rh EGF凝胶内外用药组相当 ,但低于 rh EGF凝胶外部用药组。结论 :rh EGF凝胶可明显增强动物手术切口皮肤抗张力强度 ,提高手术切口的愈合质量 ,加速手术切口的愈合。rh EGF凝胶不同的用药方式及 rh EGF不同的剂型对动物皮肤切口抗张力强度有一定     

Effect of ciprodex on graft healing in tympanoplasty

The present study was conducted to evaluate whether the administration of ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex)-soaked gelfoam during tympanoplasty has adverse effects on graft healing. Records of patients who had undergone tympanoplasty with Ciprodex-soaked gelfoam packing placed in the middle and external ear canal were reviewed. The time to heal for each patient and the number of postoperative perforations/complications were recorded. Sixty-four charts met the inclusion criteria. Most procedures were primary type I tympanoplasties with temporalis fascia grafts. Healing of the tympanic membrane was documented in 95.3% of patients, and mean time to healing was 49 d. Two patients who underwent revision tympanoplasty failed to exhibit healing at any visit after surgery. Postoperative complications were infrequent. Patients with Ciprodex-soaked gelfoam packing placed during tympanoplasty showed an overall rate of healing of 95%. Although this study is limited by its retrospective design, the data suggest that the use of Ciprodex during tympanoplasty has no detrimental effect on postoperative graft healing.     

自体邮票植皮术联合冲洗治疗在烧伤患者中的疗效观察

目的分析自体邮票植皮术联合冲洗治疗在深度烧伤患者中的治疗效果。 方法选取新疆医科大学第八附属医院2015年1月至2019年1月收治的68例大面积烧伤患者,随机数字表法分为2组：对照组与观察组,每组34例。对照组Ⅰ期行清创削痂手术、自体邮票植皮术治疗;观察组在此基础上每日联合进行创面冲洗治疗持续至自体邮票植皮术手术前夕,后行邮票植皮术,观察2组手术时间,Ⅰ期创面愈合率、康复率,以及创面分泌物细菌培养阳性率,术后3、7、15 d植皮成活率以及创面愈合时间,评估患者治疗前、治疗后3个月以及治疗后6个月视觉模拟评分法(VAS)评分。数据比较采用t检验。 结果观察组手术时间[(70.31±7.69) min]略长于对照组[(66.52±8.41) min],差异无统计学意义(t＝1.939, P>0.05),观察组Ⅰ期创面愈合率、康复率[(77.34±7.05)%、(74.27±5.84)%]明显高于对照组[(65.61±6.92)%、(63.41±3.35)% ],且创面分泌物细菌培养阳性率[(21.19±4.42)%]低于对照组[(64.36±11.25)%],差异均有统计学意义(t＝ 6.924、9.406、20.826, P<0.05)。术后3、7、15 d,观察组植皮存活率[(34.11±5.26)%、(59.31±4.72)%、(3.19±1.42)%]均高于对照组[(28.64±11.45)%、(51.74±5.68)%、(64.71±8.25)%],差异均有统计学意义(t＝2.531、5.977、3.717,P<0.05),且观察组创面愈合时间[(3.19±1.42) d]短于对照组[(5.36±2.25) d],差异有统计学意义(t＝4.756, P<0.05)。治疗前2组VAS评分差异无统计学意义P>0.05),治疗后3个月、6个月,观察组VAS评分[(5.41±0.34)、(3.35±1.09)分]分别低于对照组[(6.15±1.28)、(4.37±1.24)分],差异均有统计学意义(t＝3.258、3.603,P<0.05)。 结论大面积烧伤患者应用邮票植皮术联合进行创面冲洗治疗可有效改善手术指标,提高植皮存活率,对疼痛缓解也有一定帮助。     

防疤烧伤膏对大鼠伤口愈合的影响

目的：观察防疤烧伤膏对大鼠创面修复的影响。方法：采用大鼠皮肤切割伤模型。创面外用防疤烧伤膏，并采用碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF)和空白处理作为阳性和阴性对照。透明膜标记称量法和注水法记录伤后3d,7d和14d创面面积和伤腔容积，伤后7d和14d取创面组织进行组织学检查。结果 防疤烧伤膏能够减轻伤口炎症反应，促进坏死组织脱落，缩短伤口愈合时间。结论：外用防疤烧伤膏对创面修复有促进作用。     

改进烧伤创面处理方法对提高延迟复苏患者治愈率的作用

目的研究烧伤创面处理方法的改进与提高延迟复苏患者治愈率的关系,旨在进一步提高烧伤延迟复苏患者的治愈率。方法将72例延迟复苏的严重烧伤患者分两组,即1990-01~1995-12(常规组)和1996-01~2001-12(综合组),总结综合组中早期削(切)痂治疗、创面外用碱性成纤维因子(bFGF)或表皮生长因子(EGF)及提高供皮质量的研究等对提高延迟复苏患者治愈率的作用。结果综合组治愈率明显提高,创面基本愈合时间,深Ⅱ度、浅Ⅱ度、供皮区创面愈合时间及住院时间缩短,创面供皮速度加快,主要内脏器官并发症发生率及脓毒症发生率下降,血清肿瘤坏死因子(TNF)水平下降(P<0·01~0·05)。结论早期削痂、外用bFGF或EGF及正确处理头皮烧伤、提高头部等部位的供皮速度等均是提高烧伤治愈率的关键。     

Early mechanical stimulation only permits timely bone healing in sheep

Bone fracture healing is sensitive to the fixation stability. However, it is unclear which phases of healing are mechano‐sensitive and if mechanical stimulation is required throughout repair. In this study, a novel bone defect model, which isolates an experimental fracture from functional loading, was applied in sheep to investigate if stimulation limited to the early proliferative phase is sufficient for bone healing. An active fixator controlled motion in the fracture. Animals of the control group were unstimulated. In the physiological‐like group, 1 mm axial compressive movements were applied between day 5 and 21, thereafter the movements were decreased in weekly increments and stopped after 6 weeks. In the early stimulatory group, the movements were stopped after 3 weeks. The experimental fractures were evaluated with mechanical and micro‐computed tomography methods after 9 weeks healing. The callus strength of the stimulated fractures (physiological‐like and early stimulatory) was greater than the unstimulated control group. The control group was characterized by minimal external callus formation and a lack of bone bridging at 9 weeks. In contrast, the stimulated groups exhibited advanced healing with solid bone formation across the defect. This was confirmed quantitatively by a lower bone volume in the control group compared to the stimulated groups.The novel experimental model permits the application of a well‐defined load history to an experimental bone fracture. The poor healing observed in the control group is consistent with under‐stimulation. This study has shown early mechanical stimulation only is sufficient for a timely healing outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1790–1796, 2018.