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异体手移植1例:法国里昂经验
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作者 Jean-Michel Dubernard Xavier Martin +5 位作者 Marwan Dawhara Guillaume Herzberg Earl Owen Hari Kapila Nadey S Hakim Marco Lanzetta 郑小飞 《中国创伤骨科杂志》 CSCD 2000年第2期90-95,共6页
背景 联合应用最新免疫抑制剂治疗下的动物异体肢体移植的长期存活以及自体肢体再植令人鼓舞的结果使我们相信人体异体手移植将会成活。方法 1998年9月,我们将一位脑死亡的男性的手和前臂远端移植到一位因创伤致前臂远端1/3截肢的48岁... 背景 联合应用最新免疫抑制剂治疗下的动物异体肢体移植的长期存活以及自体肢体再植令人鼓舞的结果使我们相信人体异体手移植将会成活。方法 1998年9月,我们将一位脑死亡的男性的手和前臂远端移植到一位因创伤致前臂远端1/3截肢的48岁男性患者。供者的手臂用4℃ UW器官保存液灌注后,肘上5cm截肢并置于冰箱中运输。同时解剖供体和受者的手臂,辨别各自的解剖结构,使有活力的结构准确相配。移植过程中包括骨的固定、动静脉的吻合(缺血时间12.5小时)、神经吻合、肌肉和肌腱的缝合和皮肤的覆盖。免疫抑制剂包括抗胸腺细胞蛋白、FK506、霉酚酸和强的松。维持治疗包括FK506、霉酚酸以及强的松。随访包括常规移植后的实验室检测、皮肤活检、增强理疗和心理支持治疗。结果 术后早期过程十分平静,未发生外科并发症。患者能很好地耐受免疫抑制剂。术后8~9月发现有轻度的皮肤排斥反应的临床和组织学表现。加大强的松的剂量(20mg/天至40mg/天)以及局部免疫抑制剂霜剂应用后临床和组织学表现消失。增强理疗使运动功能获得令人满意的进展。感觉的恢复(Tinel征)十分理想,已达到腕横纹(20cm)。术后100天时正中神经和尺神经的感觉已恢复到手掌,至少24cm。手掌的深压觉存在而无触觉。结论 异体手移植技术上是可行的。现有? 展开更多
关键词 异体移植 手缺失 手移植
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Osmic acid staining of myelin sheath in normal and regenerated peripheral nerves 被引量:2
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作者 卫丽萍 何风春 +3 位作者 陈逊文 卢士璧 Marco Lanzetta Robbert De Iongh 《Chinese Journal of Traumatology》 CAS 2007年第2期86-89,共4页
Objective : To introduce a practical, economical, and time-saving method to stain (with osmic acid) the myelin sheath in normal and regenerated peripheral nerves. Methods: A total of 12 Sprague Dawley rats, weighi... Objective : To introduce a practical, economical, and time-saving method to stain (with osmic acid) the myelin sheath in normal and regenerated peripheral nerves. Methods: A total of 12 Sprague Dawley rats, weighing 250-320 g ( mecan = 276 g ± 38 g ), were divided into two groups: a normal nerve group (n = 6 ) and a regenerated nerve group ( n = 6 ). In the normal nerve group, the ventral and dorsal roots of L4 to L6 and their sciatic nerves were harvested for histological analysis. While in the regenerated nerve group, the right sciatic nerves were severed and then repaired with an epineurial microsuture method. The repaired nerves were harvested 12 weeks postoperatively. All the specimens were fixed in 4 % paraformaldehyde and transferred to 2 % osmic acid for 3-5 days. Then the specimens were kept in 75% alcohol before being embedded in paraffin. The tissues were cut into sections of 3 ten in thickness with a conventional microtome. Results: Under a light microscope, myelin sheaths were clearly visible at all magnifications in both groups. They were stained in clear dark colour with a light yellow or colorless background, which provided high contrast images to allow reliable morphometric measurements. Morphological assessment was made in both normal and regenerated sciatic nerves. The ratios of the myelin area to the fibre area were 60. 28 % ± 7.66 % in the normal nerve group and 51. 67% ± 6. 85% in the regenerated nerve group, respectively (P〈0.01). Conclusions: Osmic acid staining is easy to perform and a very clear image for morphometrical assessment is easy to obtain. Therefore, it is a reliable technique for quantitative evaluation of nerve morphology. 展开更多
关键词 Peripheral nerve REGENERATION Myelinsheath STAINING Osmium Tetroxide
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Long-term result of guided nerve regeneration with an inert microporous polytetrafluoroethylene conduit
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作者 何风春 范清宇 +4 位作者 Timothy R Cushway Robbert De Iongh Marco Lanzetta Pierluigi Tos Earl R Owen 《Chinese Journal of Traumatology》 CAS 2003年第3期145-151,共7页
Objective: To evaluate the long term outcome of Polytetrafluoroethylene (PTFE) conduit in nerve repair and to provide more evidence in view of its potential application to achieve a satisfactory functional recovery in... Objective: To evaluate the long term outcome of Polytetrafluoroethylene (PTFE) conduit in nerve repair and to provide more evidence in view of its potential application to achieve a satisfactory functional recovery in clinical settings. Methods: Thirty six Wistar rats had their right sciatic nerve transected and were repaired with either conventional microsuture technique (Control group, n=18) or a PTFE conduit with a gap of 5 mm left between the nerve stumps (PTFE group, n=18). At 6 and 9 months after the operation, electrophysiological assessment and measurement of gastrocnemius muscle weight were conducted and morphology of the regenerated nerves were studied with image analysis. Results: At 6 months postoperatively, the nerve conduction velocity recovered to 60.86 % and 54.36 % (P> 0.05 ), and the gastrocnemius muscle weight recovered to 50.89 % and 46.11 % (P> 0.05 ) in the Control group and the PTFE group respectively. At 9 months postoperatively, the recovery rate was 65.99 % and 58.79 % for NCV (P> 0.05 ), and 52.56 % and 47.89 % for gastrocnemius muscle weight (P> 0.05 ) in the Control group and the PTFE group respectively. Regenerated nerve fibers in the PTFE group had a regular round shape with no fragmentation, wrinkling or splitting of the myelin sheath. Image analysis revealed that the ratio of the myelin area to the total fiber area was larger at 9 months than at 6 months in both groups (P< 0.01 ). Conclusions: Microporous PTFE conduit may be an alternative for nerve repair allowing of guided nerve regeneration and functional recovery with no obvious adverse effect at long term. 展开更多
关键词 Nerve regeneration Polytetrafluoroethylene POLYMERS Myelin sheath
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