四种中药对骨愈合过程中相关基因表达的影响

目的:探索中药水蛭、海螵蛸、阿胶、骨碎补在骨折愈合过程中的干预作用,了解它们各自的调节靶点,探索建构其基因组学的途径。方法:通过在大鼠胫骨打孔的方法建立单因素干扰模型,并将300只大鼠随机分为正常组、模型组和给药组(分别用4种中药给药),每组50只,分别在实验的第4、7、14、21、28天不同时间点采用原位杂交方法对各类mRNA的变化进行动态观察,分析骨愈合过程中Ⅰ、Ⅱ、Ⅲ型前胶原mRNA、转化生长因子TGF-β1mRNA、骨形态发生蛋白BMP-2mRNA以及血管内皮生长因子VEGF-mRNA的表达情况。结果:不同中药对不同基因的作用不同,作用的时间点不同,作用强度也存在差异。其中海螵蛸在骨折早期对Ⅰ、Ⅲ型前胶原mRNA、VEGF-mRNA、BMP-2mRNA的表达升高,后期Ⅱ、Ⅲ型前胶原mRNA表达水平下降,VEGF-mRNA、TGF-β1mRNA表达量维持于较高水平;骨碎补组较模型组在BMP-2mRNA、TGF-β1mRNA、Ⅰ型前胶原mRNA的表达上差异有显著性统计意义;阿胶对骨愈合早、中期Ⅰ、Ⅱ、Ⅲ型前胶原mRNA和TGF-β1mRNA的表达与模型组比较差异存在显著性统计意义;水蛭对VEGF-mRNA的表达具有一定的促进作用。结论:海螵蛸、水蛭对血管形成有促进作用,阿胶、骨碎补和海螵蛸对骨折软骨形成早期具有促进骨诱导的作用,并对成骨细胞的增殖及合成活性有较大影响。     

The effect of sucralfate,an agent for gastroprotection on the healing of split thickness skin graft donor sites

Skin is the most commonly used tissue for the transplantation. A meticulous care of the donor site is needed to prevent scarring, delayed healing, and pain. Various agents and dressing materials have been reported to help healing of skin graft donor sites. Sucralfate is an extensively used agent, which provides acute gastroprotection and acceleration of chronic ulcer healing. In this study, we assessed the effects of topical sucralfate on the healing of the split thickness skin graft donor sites in a prospective comparative way. The study was carried out on 32 randomly chosen patients undergoing surgery for various causes and requiring split thickness skin graft resurfacing. The upper halves of the skin graft donor sites on the thighs were simply covered with paraffin gauze and the lower half was covered with sucralfate-soaked paraffin gauzes. The day of full epithelization varied from 6 to 9 days and 8–12 days on the sucralfate-applied areas and on the control sites, respectively. The mean value of the healing was 7.01 days in the studied lower halves and 10.8 days in the upper halves. The healing rate was strikingly faster and less painful on the sucralfate-applied areas. We were able to discharge patients earlier than usual, and patients’ comfort increased. It seems that sucralfate is a promising topical agent to increase the healing rate and decrease the incidence of associated problems such as pain and hypertrophic scar.     

The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon

The current study was performed to understand the relationship between graft length placed within the bone tunnel and intraosseous graft healing in anterior cruciate ligament (ACL) reconstruction. Twenty-four adult beagle dogs were divided into two groups of 12 animals each. In each animal, ACL reconstruction using a 4-mm diameter autogenous flexor tendon graft was done in the left knee. In groups I and II, the graft having a length of 15 and 5 mm, respectively, was placed within the tibial tunnel. The proximal end of the graft was placed through the over-the-top route in all animals. In each group, five animals were sacrificed immediately after surgery, and the remaining seven were sacrificed at 6 weeks postoperatively. Biomechanical and histologic evaluations were performed. In pull out testing, the ultimate failure load and the linear stiffness of the graft-tibia complex harvested at 6 weeks were significantly greater than those harvested at the time-zero period. There were no significant differences in those parameters between groups I and II at 6 weeks. In each group, the perpendicular collagen fibers connecting the tendon to the bone tunnel wall were observed only in the narrow area located close to the intra-articular tunnel outlet. In conclusion, excessively long placement of the flexor graft within the bone tunnel does not result in an additional increase of anchoring strength and stiffness of the graft in ACL reconstruction.     

碱性成纤维细胞生长因子（bFGF）加速猪背部创伤修复的实验研究

实验采用猪背部创伤模型，观察重组的碱性成纤维细胞生长因子（ｂＦＧＦ）对创伤修复的作用。在无菌条件下用特制打孔器在猪背部切割皮肤，形成２．５ｃｍ２的园型创面。将１５０个创面分成５组，分别以ｂＦＧＦ（６０ｕ／ｃｍ２创面），ｂＦＧＦ（（６０ｕ／ｃｍ２创面）加ＳＤ－Ａｇ、ＳＤ－Ａｇ、生理盐水以及不治疗等方法处理，每间隔一天换药一次。实验结果表明，ｂＦＧＦ具有显著促进肉芽组织生长、加速创面再上皮化率以及增加创面愈合组织抗张力强度等作用。ＦＧＦ显著促修复效应的确切机制尚不完全清楚，可能包括直接与间接效应两方面。     

一次手术法对自制两段式种植体种植效果的实验研究

本实验用自制纯钛两段式种植体,以一次手术法植入到狗的下颌前磨牙区,观察5个月,结果表明,观察期间内牙龈无炎症,种植体稳固,X线片显示种植体周围无透射区,镜下可见种植体表面与牙龈之间形成上皮附着样结构,与骨组织之间大多呈骨性愈合。提示了两段式种植体有两种设计和手术方式可供选择。骨内部分在开放的环境中也可达到骨性愈合。     

Quality of ulcer healing influences the relapse of gastric ulcers in humans

The usefulness of dye-contrast endoscopy for the evaluation of the quality of gastric ulcer healing and the prediction of relapse was investigated. Sixty consenting patients whose ulcers healed during 3 months of treatment underwent endoscopy for the identification of the pattern of mucosal regeneration. Patients were monitored for relapses for up to 18 months after antiulcer therapy had ended. The pattern of regeneration was flat in 24 patients, nodular in 25 and intermediate in 11. Internal hypoechoic areas seen by endoscopic ultrasonography were less common and histological maturity was better in the patient group with the flat pattern compared with the patient group with the nodular pattern of mucosal regeneration. Prostaglandin E, synthesis was highest in the group with the flat pattern of mucosal regeneration and the relapse rate was lowest in this group. We conclude that the evaluation of the quality of ulcer healing is possible and that findings in individuals may aid the prediction of relapse for particular patients.     

Effect of hyaluronan on the healing of partially ruptured anterior cruciate ligament of rabbits

The midportion of the anterior cruciate ligament (ACL) of rabbits was partially transected, and the effect of hyaluronan (HA) on its healing was determined. A 1% solution of HA (HA group) or physiological phosphate-buffered saline (control group) was administered intraarticularly, at 0.1 ml/kg body weight, once a week from 1 week after the operation. Two, 4, and 6 weeks after the initiation of HA administration, the ACLs were examined grossly, histologically and immunohistochemically. At 2 weeks, the lacerated portions were completely covered with scar-like tissue in both groups. These tissue areas were smaller in the HA group than in the control group. Histologically in the HA group, the regularity of collagen fibers (indicating the maturity of regenerated collagen fibers) had increased compared to findings in the control group, and the number of fibroblastic cells decreased gradually at a significantly faster rate. The number of inflammatory cells and blood vessels decreased gradually in both groups, with these values being lower in the HA group at each time point but not significantly so. Immunohistochemical examination of the repaired tissue revealed strong staining with anti-chondroitin sulfate proteoglycan antibody in the HA group 2 weeks after the first HA administration. The staining gradually became reduced, with the rate of reduction being faster in the HA group than in the control group. The stimulation of chondroitin sulfate proteoglycan production and the faster reduction of it in the HA group suggests that HA facilitated tissue repair and inhibited the formation of scar tissue.     

The effect of placental removal method on the incidence of postcesarean infections

OBJECTIVE: Our purpose was to determine whether the incidence of postoperative endometritis and wound infection is associated with the method of placental removal at the time of cesarean section.STUDY DESIGN: Parturients undergoing cesarean delivery were prospectively randomized to have the placenta removed manually or spontaneously. Patients were excluded from participation if they had received intrapartum prophylactic antibiotics or had been determined to have chorioamnionitis. After delivery of the infant women in the manual group had the placenta extracted by the primary surgeon, whereas women in the spontaneous group had the placenta delivered by gentle traction on the umbilical cord. All study subjects received perioperative prophylactic antibiotics. The primary outcome variable was a postcesarean infection, defined as postcesarean endometritis or wound cellulitis requiring drainage and antibiotic therapy.RESULTS: A total of 333 women were enrolled in the investigation, with 165 assigned to the manual removal group and 168 allocated to have spontaneous removal. There were no statistically significant differences in mean gestational age, frequency or duration of ruptured membranes, frequency or duration of labor, or mean number of vaginal examinations between the two study groups. Postoperative infections occurred in 25 of 168 (15%) women in the spontaneous delivery group compared with 44 of 165 (27%) women in which the placenta was manually extracted (relative risk 0.6, 95% confidence interval 0.4 to 0.9, p = 0.01). Subset analysis of patients delivered with ruptured membranes similarly demonstrated a statistically significant reduction in the incidence of postoperative infections with spontaneous placental removal compared with manual extraction (20% vs. 38%, relative risk 0.5, 95% confidence interval 0.3 to 0.9, p = 0.02). There was a similar trend toward a reduction in postdelivery infections associated with spontaneous placental removal in women with intact membranes; however, this difference did not attain statistical significance.CONCLUSIONS: Spontaneous delivery of the placenta after cesarean delivery is associated with a decrease in the incidence of postcesarean infections. (Am J Obstet Gynecol 1997;176:1250-4.)     

Periradicular healing in response to Diaket root-end filling material with and without tricalcium phosphate

The healing of the periradicular tissues was evaluated when the polyvinyl resin Diaket with and without tricalcium phosphate was used as surgical root-end filling material. Non-surgical root canal treatment was performed on 56 mandibular premolar roots in mongrel dogs. Following root-end resection, root-end cavity preparations were filled with Diaket, the comparative material, or Diaket in combination with tricalcium phosphate, the experimental material. Postsurgically, healing of the tissues adjacent to the filling materials and in the surrounding surgical site were evaluated at 30 and 60 days. There was virtually no statistically significant difference between the experimental and comparative group at or within the 30- or 60-day period with regard to inflammation, connective tissue formation, root-end encapsulation, cementum formation, or bone apposition. Findings suggest that cementogenesis occurred over both materials. The overall healing of the periradicular tissues was favourable.     

实验性骨折愈合中骨吸收活动的超微结构观察

将50只家兔造成实验性桡骨骨折,分批取骨痂标本,用光镜和电子显微镜观察表明,在骨折愈合过程中,破骨细胞是骨吸收的主要执行者,巨噬细胞能吞噬死骨,但不能吸收骨质。