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指甲和甲床的再生和修复

周围神经延长及相关研究进展综述

重组合人工骨的研究进展

周围神经缺血再灌注损伤

TREATMENT OF FINGER INJURIES WITH SILVER SULPHADIAZINE

On the basis of the experimental study, 48 cases of finger injuries were treated with 2% silver sulphadiazine. The largest surface area of the wound was 5cm×2.5cm and the smallest being 0.3cm×0.3cm. The patients were follwed up for an average of 5.6 months. All of the wounds were completely healed under treatment without infection or necrosis. The wounds healed with a minimum of 7 days and amaximum of 25 days, with an average of 14.25 days. Experimental study and the clinical materials demonstrated the same results that silver sulphadiazine would reduce infection and inflammatory reaction, minimizing scar formation, and enhancement of granulation formation and epithelization. This method of treatment had theadvantages of being simple, low cost and early return to work.

EFFECTS OF VASCULAR ENDOTHELIAL GROWTH FACTOR GENEACTIVATED MATRIX ON REPAIR OF SCIATIC NERVE DEFECTS IN RATS

Objective To evaluate an effect of the vascularendothelial growth factor (VEGF) geneactivated matrix (GAM) on repair of the sciatic nerve defect in rats. Methods The peripheral nerve extracellular matrix（ECM） was harvested by the chemical extraction from 30 SD rats. The VEGF-GAM comprised of ECM and the plasmids encoding VEGF. Thirty adult Wistar rats were made as a model of the asciatic nerve defect and were randomly divided into the following 3 groups(n=10): Group A (VEGF-GAM conduits), Group B (ECM conduits),and Group C (autografts). At 12 weeks, the rats from each groupwere subjected to an inspection for the walking tract analysis and electrophysiological and histomorphological studies.Results The VEGF DNA could be retained in GAM, promoting the transgene expressing in the sciatic nerve, and more importantly, in the axotomized neurons in the spinal cord for 12 weeks. The motor neuron recovery rate in Group A (79.13％±2.53％) was similar to that in Group C (75.26％±4.48％, Pgt;0.05), but significantly better than that in Group B (56.09％±1.89％, Plt;0.01). The number of the regenerationaxons in the distal sciatic nerve in Group A (13 463±794/mm2) was significantly lower than that in Group C (16 809±680/mm2, Plt; 0.01), but significantly higher than that in Group B (10 260±1 117/mm2,Plt;0.01). The motor nerve conduction velocity in Group A (16.44±1.65 m/s) was significantly lowerthan that in Group C (23.79±2.75 m/s, Plt;0.01), but significantly higherthan that in Group B (12.8 ±1.42 m/s, Plt;0.01). The recovery rate of thegastrocnemius muscle wet weight in Group A (71.40％±3.05%) was significantlylower than that in Group C (87.00％±1.87％,Plt;0.01), but significantly higher than that in Group B (50.00％±4.90％, Plt;0.01). The sciatic nerve function index in Group A （39.37%±4.81%） was significantly lower 〖KG6〗than that in Group C (26.27%±2.71%, Plt;0.01), but significantly higher than that in Group B (4693％±296％, Plt;0.01). Conclusion The results indicate that VEGF-GAM as a bridge can promote the functional recovery of the defected sciatic nerve in rats, but the effect is not so good as that by autografts.

扩大颈前路椎管减压治疗脊髓型颈椎病

探讨扩大颈前路椎管减压治疗脊髓型颈椎病的临床疗效。 方法 2002 年2 月－ 2006 年8 月，收治脊髓型颈椎病患者45 例，采用扩大颈前路椎管减压、自体髂骨植骨、钛板内固定术治疗。其中男28 例，女17 例；年龄55 ～ 77 岁，平均61.5 岁。病程6 ～ 45 个月，平均19.2 个月。单节段36 例，双节段9 例，其中相邻节段不稳11 例。JOA 脊髓功能评分为（10.60 ± 0.32）分，其中5 ～ 8 分24 例，9 ～ 12 分18 例，13 ～ 16 分3 例。 结果 所有患者围手术期安全。未发生椎动脉损伤、神经损伤、脑脊液漏、血肿、感染、钛板螺钉折断、植入物滑脱等并发症。45 例获10 ～ 51个月随访，平均24.6 个月。植骨均于术后6 ～ 9 个月骨性融合，融合率100%。JOA 脊髓功能评分为（15.20 ± 0.17）分，其中5 ～ 8 分3 例，9 ～ 12 分10 例，13 ～ 16 分28 例，17 分4 例，与术前比较差异有统计学意义（P lt; 0.01）。 结 论 扩大颈前路椎管减压治疗脊髓型颈椎病具有操作简便、减压彻底、并发症少、临床效果满意等优点。

EFFECT OF SUBCUTANEOUS IMPLANT OF PERIPHERAL NERVE ALLOGRAFT ON SCIATIC NERVE REGENERATION IN RATS

OBJECTIVE: To study the effect of subcutaneous implant of peripheral nerve allograft on sciatic nerve regeneration in rats. METHODS: Out of 30 male Wistar rats, 6 were donors and 24 were divided randomly into 2 groups. In experimental group (group A, n = 12), a 15 mm segment of sciatic nerve harvested from donors was separately inserted into subcutaneous compartment on the right thigh; two weeks later, the segment of sciatic nerve in subcutaneous compartment was removed and transplanted into a 10 mm sciatic nerve defect of left, which was made immediately. In the control group (group B, n = 12), a 10 mm sciatic nerve defect was made and immediately repaired in situ on the left thigh. The regeneration of sciatic nerve was examined histologically (after 2, 4, 8, and 14 weeks) and electrophysiologically (after 14 weeks of operation). RESULTS: After 2 weeks of operation, the inflammatory reaction was a little ber in group A than in group B. After 4 weeks, the intensity of the inflammatory reaction was similar between two groups; some collagen fibers proliferated. After 8 weeks, the inflammatory reaction ended and the collagen fibers proliferated obviously. After 14 weeks of operation, the structure of epineurium was in integrity and there was no obvious difference in perineurium and endonurium between two groups. A large number of myelinated nerve fibers and a small number of unmyelinated nerve fibers regenerated. The structure of myelin sheath was in integrity. The number and size of regenerated axon had no significant difference between two groups(P gt; 0.05). The conduction velocity, the peak value and the latent period of motor nerve were no significant difference between two groups (P gt; 0.05). CONCLUSION: The allograft of sciatic nerve inserted into subcutaneous compartment can promote nerve regeneration.

REPAIR OF EARLY AVASCULAR NECROSIS OF FEMORAL HEAD BY USING DEPROTEINIZED BONE WITH VASCULAR ENDOTHELIAL GROWTH FACTOR GENE TRANSFER IN RABBITS

Objective To explore a new method of treating early avascular necrosis of femoral head (AVNFH). Methods Sixty-nine New Zealand adult rabbitswith a mean weight of 2.8 kg after AVNFH presenting were randomly divided into three groups. In group A, deproteinized bone(DPB) combined with the recombinant plasmid pcDNA3.1/vascular endothelial growth factor 165(VEGF165) was implanted in the drilled channel of the necrotic femoral head. In group B, only DPB was implanted. In group C, channel was drilled without DPB or plasmid implanted. Femoral head specimens were obtained 3 days, 1, 2, 4, 8 and 16 weeks after operation. The expression of VEGF165 was examined by RT-PCR, Western blot and immunohistochemical techniques. X-ray testedbone formation generally. Angiogenesis and repair of the femoral head were observed by histological and histomorphometric analysis. Results In group A, the expressions of VEGF165 mRNA and protein were detected 3 days postoperatively, reached apex 1 week and lasted more than 3 weeks after implantation. The ratios of IOD of collagen type Ⅰ were 0.29±0.11, 0.55±0.13 and 0.67±0.10 IOD/μm2 respectively at 2, 4 and 8 weeks postoperatively and the ratios of IOD of new capillary vessels were 0.33±0.10and 0.57±0.16 IOD/μm2 respectively at 2, 4 weeks postoperatively in group A, showing statistically significant difference (Plt;0.01) when compared with groups B and D. X-ray test indicated much bone callus formed early. Conclusion Transfection of the VEGF165 gene can enhance local angiogenesis at early stage andDPBVEGF165 compound can improve bone formation. Deproteinized bone combined with VEGF165 gene provides a potential method for therapy of osteonecrosis.

Application of Artificial Vertebral Body of Biomimetic NanoHydroxyapatite/Polyamide 66 Composite In Anterior Surgical Treatment of Thoracolumbar Fractures

Objective To study the clinical effects of the artificial vertebral body of the biomimetic nanohydroxyapatite/polyamide 66 (nHA/PA66) compositefor the structural reconstruction and the height restoring of the vertebral body in the thoracolumbar fractures by the anterior surgical procedures. Methods From December 2003 to January 2006, 42 patients with thoracolumbar fractures received the anterior surgical procedures to decompress and reconstruct the spinal vertebral structure with the artificial vertebral body of the nHA/PA66 composite. Among the patients, there were 28 males and 14 females, aged 1767 years, averaged 43.6 years. The thoracolumbar fractures developed at T12 in 5 patients, at L1 in 17, at L2 in 14, and at L3 in 6. The height of the anterior border of thevertebral body amounted to 29%-47% of the vertebral body height, averaged 40.6%.The Cobb angle on the sagittal plane was 2138° averaged 27.6°. According tothe Frankel grading scale, the injuries to the nerves were as the following: Grade A in 7 patients, Grade B in 19, Grade C in 8, Grade D in 6, and Grade E in 2. Results All the 42 patients were followed up for 625 months. Among the patients, 36 were reconstructed almost based on the normal anatomic structure, and 6 were well reconstructed. The mean height of the anterior border of the vertebralbody was 40.6% of the vertebral body height before operation but 91.7% after operation. And the reconstructed height of the vertebra was maintained. The mean Cobb angle on the sagittal plane was 27.6°before operation but 13.4° after operation. All the patients had a recovery of the neurological function that had a 1grade or 2grade improvement except 7 patients who were still in Grade A and 2 patients who were in Grade D. The implant was fused 35 months after operation. No infection, nail break, bar/plate break or loosening of the internal fixation occurred. Conclusion The artificial vertebral body of the biomimetic nHA/PA66 composite can effectively restore the height and the structure of the vertebra, can be fused with the vertebral body to reconstruct the spinal structural stability effectively, and can be extensively used in the clinical practice.