OBJECTIVE To investigate the effect of percutaneous bone marrow graft for the management of nonunion of tibia. METHODS From March 1996 to June 2000, 56 cases with nonunion of tibia were treated by autogenous bone marrow graft. Among them, there were 38 males and 18 females, aged from 19 to 72 years. A marrow needle was inserted into the site of the nonunion under the X-ray, the autogenous bone marrow was injected into the site of nonunion. Compression bandage and appropriate immobilization material were applied after operation. This procedure was repeated every month, 2 or 3 times was needed. RESULTS 56 patients were followed-up for 4 months to 4 years and 2 months, averaged 2.8 years. Fracture healed in 53 cases and X-ray displayed fracture line disappeared and a great deal of continuous callus formed, and nonunion in 3 cases. CONCLUSION Percutaneous autogenous bone marrow graft can play a role in osteogenesis at the site of nonunion. It is easy to aspirate bone marrow and the operation is simple. It has clinical application value for the satisfactory effect.
Objective To study efficiency of vascularized bone graft combining with reconstituted bone xenograft (RBX) in repairing bone defect and the expression of the vascular endothelial growth factor (VEGF) in serum. Methods From January 1998 to December 2002, 27 cases of bones defects were treated and randomly divided into 3 groups according to different repair materials: group A (the vascularized bone graft-RBX group, n=9), group B (the vascularized bone graft group, n=10)and group C(the RBX group, n=8). The bone defect repair, the bone healing time and the bone graft resorption were observed by radiograph after 3 months, 6 months and 12 months of operation, and the expression of VEGF in serum was assayed with lumino-enzyme immunoassay before operation and after operative 2 weeks, 4 weeks, 6 weeks and 8 weeks respectively. Results The X-ray films showed that the bonehealing was achieved in 8 cases of group A, in 6 cases of group B and in 3 cases of group C after 3 months; in 1 case of group A, respectively in 3 cases of both group B and group C after 6 months. The bone graft resorption was observed in1 case of group B and in 2 cases of group C after 12 months. The serum VEGF values after operative 2 weeks and 4 weeks were higher than those before operation in all of 3 groups(Plt;0.05), and the VEGF values of groups A and B were higher than that group C(Plt;0.05) after 4 weeks. There were no significant differences (Pgt;0.05) in serum VEGF level between postoperative 6, 8 weeks and preoperation in 3 groups. Conclusion The expression of serum VEGF obviously increase in the early period of bone transplanting, it is value of clinical evaluation of reparative efficiency of bone defect.
The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
目的 探讨局部麻醉下行自体疝囊植入法修补腹股沟疝的方法和治疗体会。方法 对36例腹股沟疝患者的临床资料进行回顾性分析，单一采用利多卡因作腹股沟区域阻滞麻醉，并改进利用自体疝囊植入充填封闭内环部及腹股沟管后壁的缺损与裂隙，然后进行常规方法修补缝合。结果 本组36例患者麻醉与手术效果皆满意，平均麻醉时间5min，平均手术时间40min，术中均未再注射止痛药物。患者术后早期切口有饱满、夯实感，疼痛症状较传统手术轻。无伤口瘀血、感染、阴囊血肿或尿潴留等并发症发生。术后6h即可进食，2～5d可下床活动，平均住院时间7d，住院费用较硬膜外麻醉减少20%～30%。经随访1～5年，平均随访3年，无再复发。结论 局部区域阻滞麻醉安全性高，并完全能满足手术需要；而自体疝囊组织为“天然补片”，植入后可充分加强内环部及腹股沟管后壁的强度，愈合后形成较为坚固的纤维组织壁，最大程度地防止疝的形成与复发。麻醉与手术操作相对简单，费用低廉，便于基层医院开展。
Ten cases of neurotmesis of posterior interosseous nerve of the forearm were treated with mierosurgical technique from Aug, 1988 to Oct. 1990, of which, 4 cases by autogenous nerve graft and 6 cases by direct neurosuture. Eight cases have been followed-up from 4 months to 1 year after operation concerning with satisfactory results. Some questions the diagnosis, the points for attention in operation, and the relation of the results and the time when the operation done were discussed. The comparison of the results and the recovery time between the autogenous-nerve graft and direct neurosuture was made.
Abstract In order to find a new method to repair large bone defect, the free periosteum autograft was investigated in experiment, and then the method was used clinically. In the experiment, a 6mm×18mm×5mm bone defect was made at upper end of both tibiae of 42 rabbites. The periosteum of each rabbit was cut into 1mm cubes, and implanted randomly into the tbial bone defect on one side and the other side was used as control. After 2, 4, 8 weeks, the bone defects of each group were examined for bone formation by roentgenography, radionuclide and histology. The results showed that the defects treated by free periosteum autografts healed twice as fast as the controls (its natural healing). The reason probably was that the periosteum provided with many osteogenic cells. On thebasis of these results, 21 cases of bone defects (the largest was 10.5cm×4cm×4cm, the smallest was 2cm×2cm×2cm) including 17 cases of benign bone tumor and4 cases of chronic osteomyelitis, were treated by free periosteum autografts. The defects were all healed, and the function of the joints was restored.
目的:探讨自体血液回收技术对循环、血细胞和凝血功能的影响及应用效果。方法: 选择急诊大失血手术患者27例,采用ZITI-2000型血液回收机回收血液,经过滤、离心、清洗后回输给患者。分不同时点观察HR、SBP、MAP、DBP、SPO2的变化,并监测RBC、Plt、HB、Hct、FIB、PT、APTT的变化。计算输血量和异体输血率。随机选择8例进行回收原血和回输 血血细胞学比较。结果:(1)术前血压较低,心率较快,回输血液后,HR显著降低(Plt;0.01),SBP和MAP显著升高(Plt;0.01)。(2)术前RBC、HB和Hct均低于正常水平,回输后各时点均升高明显(Plt;0.01)。术前FIB和Plt低于正常水平,回输后各时点增高,但无显著意义。PT、APTT无明显变化。(3)回收原血平均每例3735mL,回输血平均每例1589mL,异体输血率为25％。(4)回输血RBC、HB和Hct均显著高于回收原血(Plt;0.01)。结论:自体血液回收技术用于临床安全可靠,能有效维持循环的稳定,对凝血功能无明显影响,节约血源,减少异体输血。
OBJECTIVE: To observe the clinical effect of acellular allogenic dermis with split-thickness autogenous skin graft for coverage of wound. METHODS: Acellular allogenic dermis with split-thickness autogenous skin graft was used to repair 34 wounds of head, neck, trunk and extremities. The area of wounds was from 5 cm x 10 cm to 12 cm x 19 cm. Out of 34 wounds, there were 2 due to old granulation, 4 due to excision of giant pigmented nevus, 6 due to excision of capillary hemangioma of skin and 22 due to excision of scar. RESULTS: All grafts survived and had the smooth surface without obvious pigmentation and with slight wound contraction. CONCLUSION: Acellular allogenic dermis with autologous epithelium for coverage of various wounds is an ideal procedure.
Objective To investigate the clinical application of self-cranial bone powder in one stage cranioplasty．Methods From October 1999 to December 2002,self-cranial bone powder and medical adhesive were used to repair the skull defect, for one stage cranioplasty, caused by operations on cranium in 128 casesof severe dangerous craniocerebral injury, acute intracranial hematome, sick skull and intracranial tumor．The bone growth was observed by CT or X-ray examination 3-24 months after replantation of cranioplasty．Results The decompression and cranioplasty were performed simultaneously, the time prolonged 5-10 minutes than that of routine, the appearance of repaired cranial bone was normal, without concavity and convexity. After 12 months of operation, the replanted bone merged with the normal bone completely, with normal appearance. The operation successful rate was 96.1%(123/125) without any complication. Only fivecases were not better in growing because of less bone powder, but withoutcerebral pulse and defective syndrome. All the cases did not need secondary cranioplasty．Conclusion The effect of cranioplasty with self-cranial bone powder effect is good in taking shape. This new method can avoid the traditional secondary cranioplasty for skull defect and complications．