同基因异体皮肤移植在危重烧伤病人治疗中的应用

目的：探讨同基因异体皮临床应用效果。方法：经术前准备，l例严重烧伤病人双手背深度创面切痴后，用同卵孪生子异体皮覆盖；其余切痴创面植自体微粒皮加大张同种异体皮。结果：双手背植皮区未现察到排斥现象，而其余植皮区异体皮则最终排斥。结论：同基因异体皮移植后，皮片可长期存活。     

瘢痕疙瘩家系Fas基因的突变：2个家系10份标本分析

目的:观察瘢痕疙瘩家系样本中Fas基因有无突变,探讨Fas基因突变在瘢痕疙瘩形成中的意义。方法:实验于2005-01/05在上海基康公司完成。①标本来自南方医科大学南方医院整形外科2005年收集的A和B两个瘢痕疙瘩家系,所有参与观察的家系成员均签署知情同意书。②采用聚合酶链反应及基因测序技术,分别以A家系两例患者的瘢痕疙瘩组织为观察对象,以其周围正常皮肤及外周静脉血作为自身对照;其配偶的外周静脉血作为正常对照。并以B家系中两例患者的外周静脉血作为不同家系间的对照。共取10份样本,4份组织样本,6份静脉血标本。检测10份样本中Fas基因外显子1～9的基因序列。结果:①基因测序发现所检测的10个瘢痕疙瘩家系标本Fas基因的1～8外显子均未发现突变。②2份瘢痕疙瘩组织标本在第9外显子编码区的11bp,53bp两个位点上存在单个碱基的基因突变或多态性改变。结论:瘢痕疙瘩Fas基因外显子9区段的基因结构异常极有可能造成Fas蛋白的功能改变,从而导致身体局部瘢痕疙瘩的形成。     

动脉闭塞性脉管炎围介入护理干预

目的探讨脉管炎围介入护理干预方法,为临床工作提供参考。方法及时施行介入治疗来迅速改善患肢血运,提高病患的生存质量。结果本组20例经介入治疗后配合相应的护理措施,患者临床症状明显改善,患肢皮温升高,间歇性跛行消失或行走距离明显延长,静息痛消失,溃疡快速愈合,足背或胫后动脉搏动可及。结论做好围手术期护理干预,可减轻患者痛苦。     

扩大范围注射类固醇激素治疗瘢痕疙瘩疗效观察

1临床资料选择2006-10／2008-05小面积瘢痕疙瘩应用得宝松注射液扩大范围注射治疗患者35（男17,女18）例,年龄13—47（平均29．7）岁,病程3mo～9a,平均14．7mo．其中皮损继发于痤疮后5例,外伤后3例,烫伤、注射预防针、虫咬伤后5例,手术后2例．瘢痕疙瘩均在2．0cm×2．0cm～8．5cm×6．5cm之间．皮损位上臂15例,前胸20例,其中5例手术切除后复发,经外用药物.     

胰岛素样生长因子I和单纯疱疹病毒胸苷激酶基因共转染优化创面愈合的研究

Objective To study the effect of cotransfection of genes of insulin-like growth factor I (IGF-I) and herpes simplex virus thymidine kinase (HSV-tk) on wound healing. Methods Thirty male Wistar rats were inflicted with 30% TBSA full-thickness scald. They were then divided into A group (4. 6 μg pcDNA3.1/IGF- I + Lipofectmine 2000 + saline) , B group (3.6 μg pcDNA3. 1/HSV-tk + Lipo-fectmine 2000 + saline) , C1 group and C2 group (2. 3 μg pcDNA3.1/IGF-I + 1. 8 μg pcDNA3. 1/HSV-tk + Lipofectmine 2000 + saline) , and D group (3.0 μg pcDNA3. 1 + Lipofectmine 2000 + saline) according to the random number table, with 6 rats in each group. The above-mentioned mixtures were subcutaneously injected into left back of each rat the moment after injury and on post scald day (PSD) 7, 14, 21 , and 28. Gancyclovir (2.5 mg/100 g) was hypodermically injected into rats in C2 group on PSD 29, 30, 31, 32. Changes in body weight of rats were measured. Wound healing rates were calculated. On PSD 35, the expressions of IGF- I gene in local wound and liver tissue were determined with immunohistochemical staining. The serum expression of IGF- I was determined with radioimmunoassay. Expression of HSV-tk gene in local wound was determined with RT-PCR. Apoptosis of fibroblast in C1 and C2 groups was observed under transmission electron microscope. Data were processed with one-way analysis of variance and Turkey method. Results Body weight of rats in A, C1, and C2 groups increased from PSD 7 through 35, and the difference between former three groups and B, D groups was statistically significant (with F value respectively 2.764, 4.519, 5.009, 13.449, 5.877, P values all below 0.05). Wound healing rates of rats in A, C1, and C2 groups were higher than those in B, D groups (with F value respectively 5.286, 100. 880, 152.380, 127.850, 147. 750, P values all below 0.05). IGF-I gene was positively expressed in wound fi-broblast in A, C1 and C2 groups, but negatively in liver tissues of all the rats. There was no significant statistical difference among groups in serum content of IGF-I [from (1185 ± 170) to (1270 ± 130) ng/mL, F = 0. 355, P =0. 838]. HSV-tk gene was positively expressed in rat skin tissue in B, C1 and C2 groups. Fi-broblast apoptosis was observed under transmission electron microscope in C2 group, but it was not observed in C1 group. Conclusions Cotransfection of pcDNA3.1/IGF- I and pcDNA3.1/HSV-tk mediated by li-posome can promote wound healing, and inhibit the scar proliferation to some extent.     

重度下睑凹陷性畸形的修复

目的 探讨颞浅筋膜瓣在重度下睑凹陷性畸形修复中的应用效果.方法 设计以颞浅动脉为蒂的颞浅筋膜瓣,转移矫正下睑凹陷性畸形.结果 9例患者,术后组织瓣成活良好,凹陷处填充效果满意.随访6个月至1年,8例下睑外形好,1例复发下睑凹陷.所有病例头、面部瘢痕不明显,颞部供区毛发生长良好.结论 应用颞浅筋膜瓣转移矫正重度下睑凹陷性畸形具有操作简便、供区隐蔽、矫形效果好等优点,是修复重度下睑凹陷性畸形的理想方法.     

激素对皮瓣金属硫蛋白表达及存活的影响

目的探讨地塞米松对随意皮瓣术后皮瓣组织中金属硫蛋白（MT）表达及皮瓣成活率的影响。方法雄性健康SD大鼠40只．体重300～350g（60～80日龄）,随机分组。实验组术前24h和12h腹腔注射地塞米松（0．8mg·kg^-1·次^-1）,对照组使用0.9％氯化钠注射液。在大鼠背部肉膜下形成超长随意皮瓣。测激光多谱勒血流相对值（LDF）。术后第3天取材进行HE染色光镜检查,Western blot法检测皮瓣组织中MT的表达,免疫组化法测定半胱天冬酶-3（caspase-3）的水平。术后第9天统计皮瓣存活率。结果实验组（MT）表达水平（3．19±0.97）显著高于对照组（1．87±0．14）（P〈0．01）。实验组caspase-3表达水平（1．19±0．23）显著低于对照组（2．17±0．43）（P〈0．01）。实验组皮瓣的存活比率（69．08％±3．62％）显著高于对照组（60．15％±2．99％）（P〈0．01）。实验组LDF下降少,恢复快（P〈0．01）。结论地塞米松可促进大鼠随意皮瓣成活,上调MT的表达水平及抑制皮瓣组织细胞凋亡可能是其机制之一。     

指尖断指再植12例疗效观察

目的：探讨指尖断指再植术。方法：临床对12例17指指尖断指进行再植术。年龄3岁2月－45岁、食、中、环指1例，中、环指3例，拇指3例，示指3例，小指2例。按田万成分类法，I型10指，Ⅱ型5指，Ⅲ型2指。切割切9例13指，冲床伤1例2指，电锯伤1例1指，钢丝勒伤1例1指。完全离断11例16例，不全离断1例1指。吻合指动脉弓10指16条血管，吻合指动脉弓分支7指7条血管，吻合掌侧皮下静脉7指7条，动静脉转流建立静脉回流1例1指，未史合静脉者10指，吻合两条神经者12例16指，共吻合神经33条。结果：成活15指，部分成活1指，坏死1指。随访12例，随访2个月－2年。14指外观丰满、色泽、温度正常，指甲生长良好，指手两点分辨觉4－7mm，外观良好，功能正常。结论：指尖再植通过吻合血管建立组织循环，能获得良好的外形和功能恢复，应力争再植，对特殊职业者和年轻患者最具意义。     

多层螺旋CT三维重组技术在颈椎损伤中的应用

目的:探讨多层螺旋CT(MSCT)三维重组诊断颈椎复杂骨折的临床应用价值。方法:对31例颈椎外伤的患者行多层螺旋CT扫描,薄层重建后利用工作站行多平面重组(MPR)或曲面重组(CPR)、表面遮盖法(SSD)、容积再现(VR)和透明化X线模拟投影技术(4D)的三维重组。结果:SSD、VR和4D对于颈椎较大、移位较明显的骨折显示较好,图像立体感强,直观;MPR可以较全面、细致地显示骨折、移位情况。本组三维重组CT图像清晰、立体、直观地显示31例患者骨折的部位、范围、骨块的移动方向和距离,使得治疗中得以正确地选择接骨板及其放置位置和切口位置。结论:恰当地运用多层螺旋CT图像重组功能,可清晰显示颈椎的空间解剖关系,较为全面、直观、准确地显示骨折情况,对手术方案的设计与实施具有积极的指导意义。