游离背阔肌皮瓣修复四肢肿瘤切除后创面

我院骨科组于1985年5～10月份为4例患下肢高分化低度恶性肿瘤的病人,在化疗的配合下施行肿瘤局部大块切除,吻合血管的背阔肌肌皮瓣移植修复创面等综合治疗,早期获得了满意的效果.4例病人中有2例患小腿软骨肉瘤,1例小腿脂肪肉瘤和1例髋部纤维肉瘤.背阔肌肌皮瓣较适用于修复软组织缺损大的创面,其大而扁平的肌肉部分几乎能完全覆盖缺损,外形亦常较满意.     

覆膜支架治疗Ⅲ型主动脉夹层

目的探讨覆膜支架治疗Ⅲ型主动脉夹层的方法和疗效。方法对14例Ⅲ型主动脉患者行爱膜支架治疗。术前强化CT检查明确诊断。术中先行主动脉造影，明确内膜破口位置，分辨真假腔，然后根据病变血管近端正常血管直径加上其直径的15％～20％选择支架型号。沿腹股沟下方约2cm处横行切开，游离股动脉并切开，插入支架输送器，硝普钠降收缩压至70～90mmHg，于破口位置缓慢释放支架，封闭主动脉内膜破口，重新造影，观察支架位置，是否有内漏．．结果14例均成功植入支架，患者疼痛症状消失。升主动脉造影示真腔扩大，假腔消失12例，小内漏2例（经球囊扩张后仍有）。术后1周，1、6个月行强化CT检查示真腔扩大，假腔内血栓形成并缩小，远断血运改善，无截瘫、左上肢缺血及支架移位等并发症．结论覆膜支架治疗Ⅲ型主动夹脉层创伤小，操做简单，手术死亡率低，并发症少．恢复快，近期效果好．     

A New Harvest Site for Bone Graft in Anterior Cruciate Ligament Revision Surgery

During revision anterior cruciate ligament (ACL) surgery, femoral interference screws frequently require removal. This may lead to significant tunnel widening and possible graft fixation failure as a result. Solutions include drilling the revision tunnel in a different location, using stacked interference screws, or using bone graft to fill the defect. Autogenous iliac crest graft and allograft are both used, but there are significant comorbidities associated with each. We developed a new technique for harvesting autogenous bone graft that avoids many of the complications associated with other graft sources. By use of the existing surgical incision from the initial harvest of the bone–patellar tendon–bone autograft, bone from the medial tibial metaphyseal safe zone is harvested via an OATS tube harvester (Arthrex, Naples, FL). A bone plug 1 mm larger in size than the femoral defect is harvested and arthroscopically inserted via a press-fit technique. At 3 months after bone grafting, patients undergo revision ACL reconstruction. The proximal tibial metaphysis is a safe bone graft harvest site in revision ACL surgery and offers an effective method for filling large bony defects, allowing anatomic reconstruction of the ACL after bone healing has occurred. Furthermore, it eliminates the problems associated with allograft or use of a remote graft donor site.     

心包膜移植在结膜囊成形术中的应用

目的：探讨保存人心包膜移植治疗结膜囊狭窄的临床效果及安全性。方法：对眼球摘除术后伴有结膜囊狭窄综合征的26例26眼，利用心包膜移植行部分结膜囊成形术，术后随访观察3～12个月，平均8个月。结果：24眼（92．31％）在术后30～60天移植的心包膜被结膜覆盖，感染1例（3．85％），结膜囊狭窄1例（3．85％）。结论：保存心包膜移植治疗结膜囊狭窄取材方便，疗效显著，操作简单。     

BKV in Simultaneous Pancreas-Kidney Transplant Recipients: A Leading Cause of Renal Graft Loss in First 2 Years Post-Transplant

With the introduction of more potent immunosuppressive agents, rejection has decreased in simultaneous pancreas/kidney transplant (SPK) recipients. However, as a consequence, opportunistic infections have increased. The purpose of this report is to outline the course of SPK patients who developed polyomavirus-associated nephropathy (PVAN). A retrospective review of 146 consecutive SPK recipients from January 1, 1996 to December 31, 2002 was performed. Immunosuppression, rejection and development of PVAN were reviewed. Nine patients were identified. All received induction with either OKT3 or thymoglobulin. Immunosuppression included tacrolimus/cyclosporine, MMF/azathioprine and sirolimus/prednisone. Two patients were treated for kidney rejection prior to the diagnosis of PVAN. Time to diagnosis was an average of 359.3 days post-transplantation. Immunosuppression was decreased but five ultimately lost function. However, none developed pancreatic abnormalities as demonstrated by normal glucose and amylase. Two underwent renal retransplantation after PVAN diagnosis and both have normal kidney function. PVAN was the leading cause of renal loss in SPK patients in the first 2 years after transplantation and is a serious concern for SPK recipients. The pancreas, however, is spared from evidence of infection, and no pancreatic rejection occurred when immunosuppression was decreased.     

Role of Integrin CD103 in Promoting Destruction of Renal Allografts by CD8+ T Cells

Infiltration of CD8(+)TCRalphabeta(+) T-effector populations (CD8 effectors) into graft epithelial compartments has long been recognized as a key lesion in progression of clinical renal allograft rejection. While the afferent phase of allograft immunity is increasingly well-defined, the efferent pathways by which donor-reactive CD8-effector populations access and ultimately destroy the graft renal tubules (rejection per se) have received remarkably little attention. This is an important gap in our knowledge of transplantation immunology, because epithelial compartments comprise the functional elements of most commonly transplanted organs including not only kidney, but also liver, lung, pancreas, and intestine. Furthermore, there is increasing evidence that attack of graft epithelial elements by CD8-effector populations not only causes short-term graft dysfunction but is also a major contributor to development of chronic allograft nephropathy and late graft loss, which now represent the salient clinical problems. Recent studies of the T-cell integrin, alpha(E)beta(7) (CD103), have provided insight into the mechanisms that promote interaction of CD8 effectors with graft epithelial compartments. The purpose of this communication is to review the known properties of the CD103 molecule and its postulated role in the efferent phase of renal allograft rejection.     

复合珊瑚羟基磷灰石人工骨的研制及其成骨效应

目的 自行研制复合珊瑚羟基磷灰石人工骨并评估其成骨效应。方法 取南海澄黄滨珊瑚碳酸钙在特定条件下经过“热液交换反应”，制成单纯珊瑚羟基磷灰石(coralline Hydroxyapatite，CHA)人工骨，并将其与基因重组骨形态发生蛋白(rhBMP2)和几丁糖复合制成了三种复合珊瑚羟基磷灰石(composite Coralline Hydroxyapatite，CCHA)人工骨，将此三种不同配型的复合人工骨和单纯CHA人工骨分别植入四组24只SD大白鼠肌肉内。手术后2、4、6、8周取材进行组织学观察，计数高倍单位视野内的成骨细胞数量和炎性细胞数量。采用SPSS8.0统计软件处理系统分析。结果 术后各时期取材结果显示：B组(CHA rhBMP2)和D组(CHA rhBM2P 几丁糖)的单位视野内成骨细胞数量明显多于A组(单纯CHA)和C组(CHA 几丁糖)：而C组和D组的单位视野内炎性细胞数量明显少于A组和B组。即D组人工骨的单位视野内的成骨细胞数量多、炎性细胞少。结论 rhBMP2-几丁糖／CHA复合人工骨不但具有显著的成骨诱导作用，还具有炎症反应轻及持续的诱导成骨作用，是一良好的骨移植替代物。