新鲜人羊膜微粒与自体微粒皮混合移植对创面愈合的实验研究

目的观察新鲜人羊膜（简称羊膜）微粒混合自体微粒皮促进大鼠创面愈合的作用。方法在24只SD大鼠背部切取4 cm×4 cm全层皮肤,切下的皮肤用取皮鼓反向切取0.15 mm厚皮片,用微量电子天平称量0.1 g制作微粒皮,称取0.2 g、0.4 g羊膜制作羊膜微粒。按移植治疗方法的不同随机分为3组,即自体皮组、治疗1组、治疗2组,每组8只。①自体皮组,用0.1 g自体微粒皮治疗;②治疗1组,用0.1 g自体微粒皮混合0.2 g羊膜微粒治疗;③治疗2组,用0.1 g自体微粒皮混合0.4 g羊膜微粒治疗。移植术后第21、28天,对各组大鼠创面进行大体观察、组织病理检查并测定创面愈合率和收缩率。结果①移植后21天：3组未愈创面为肉芽组织,有少量渗出,3组创面收缩均不明显;与自体皮组比较,治疗1组、2组创面愈合面积大。创面愈合率：治疗2组大于治疗1组（P〉0.05）,治疗1、2组大于自体皮组（P〈0.05）。创面收缩率：治疗2组小于治疗1组（P〉0.05）,治疗1、2组小于自体皮组（P〈0.05）。组织学观察3组表皮层增生,真皮层毛细血管丰富,表-真皮连接处可见乳头,但自体皮组真皮层内成纤维细胞和毛细血管明显,胶原纤维排列稍乱,并有少量炎症细胞浸润。②移植后28天：治疗1组、2组创面基本愈合或痊愈,自体皮组创面愈合面积增大,裸露创面为肉芽组织且渗出较多,治疗1组、2组较自体皮组收缩小。与自体皮组比较,治疗1组、2组表皮层明显增厚,真皮层胶原纤维排列整齐,表-真皮交接处有明显钉突形成。创面愈合率：治疗2组大于治疗1组（P〉0.05）,治疗1、2组大于自体皮组（P〈0.05）。创面收缩率：治疗2组小于治疗1组（P〉0.05）,治疗1、2组小于自体皮组（P〈0.05）。组织学观察自体皮组真皮层内毛细血管较丰富,可见炎症细胞浸润,成纤维细胞增生明显。结论羊膜微粒与自体微粒皮混合移植可以促进创面愈合。

Effects of Mixed Skin Grafting with Fresh Human Amniotic Particles and Autologous Microskin on Wound Healing in Rats

Objective To observe the role of mixed skin grafting with fresh human amniotic granules and allogenous microskin on promoting wound repair.Methods Full thickness skin（4 cm×4 cm） were cut from the back of 24 SD rats.The rats were divided into 3 groups with 8 rats in each group.Allogenous microskin group was transplanted with 0.1 g allogenous microskin.Treatment group 1 and 2 were grafted with mixed autologous microskin and fresh human amniotic granules with the ratio 1∶2（0.1 g∶0.2 g） and 1∶4（0.1 g∶0.4 g）.Twenty-one and 28 days after skin grafting,the wound healing status in general was observed and histological examination was performed.The rates of wound healing and contraction were measured.Results ① 21 days after surgery,the healing rates of treatment group 1 and 2 were higher than that in allogenous microskin group.In all the groups,the wound contraction was not obvious,the wounds were covered by granulation tissue,a little transudation was observed,epidermal cells were proliferous,and the blood capillaries were rich in dermis.But in allogenous microskin group,fibroblasts and blood capillaries were greater in dermis than the two treatment groups,the arrangement of collagen fibers was inordinate,and a few inflammatory cells were infiltrated.Wound healing rates： treatment group 2 treatment group 1（P0.05）,treatment group 1 and 2 allogenous microskin group（P0.05）.Wound shrinking rates：treatment group 2 treatment group 1（P0.05）,treatment group 1 and 2 allogenous microskin group（P0.05）.②28 days after surgery,the wounds were well-healed in two treatment groups.The healiing rate of allogenous microskin group were higher than that 21 days after surgery,the exposed wounds were covered by granulation tissue,and abundant transudation was observed.The shrink degree was less in two treatment groups than that in the allogenous microskin group.In two treatment groups,epidermal hyperplasia was greater than that in the allogenous microskin group,the collagen fibers lined up in order in dermis,and the joints of epiderma and dermis had obvious spikes.In allogenous microskin group,the blood capillaries were rich in dermis,the inflammatory cells were infiltrated,and the proliferation of fibroblasts was obvious.Wound healing rates： treatment group 2 treatment group 1（P0.05）,treatment group 1 and 2 allogenous microskin group（P0.05）.Wound shrinking rates：treatment group 2reatment group 1（P0.05）,treatment group 1 and 2 allogenous microskin group（P0.05）.Conclusion Mixed skin grafting with fresh human amniotic amniotic particles and autologous microskin can promote wound healing.