超声引导下腰方肌阻滞在全髋关节置换患者中的应用效果分析

目的 分析超声引导下腰方肌阻滞在全髋关节置换患者中的应用效果。方法 选取2019年1月至2021年3月河南省洛阳正骨医院收治的100例拟行全髋关节置换术的髋关节疾病患者作为研究对象,按照随机数表法将其随机分为观察组(50例)和对照组(50例),观察组患者术中采用超声引导下腰方肌阻滞联合全身麻醉、术后行腰方肌阻滞外导管连接自控镇痛泵自控镇痛,对照组患者术中单纯采用全身麻醉、术后行静脉留置针连接自控镇痛泵自控镇痛,对比观察两组患者手术时间、术中出血量、麻醉起效时间、麻醉维持时间以及术后静息和活动时的疼痛程度。结果 观察组患者手术时间及术中出血量与对照组无明显差异(t=0.377、0.375,P=0.707、0.709),麻醉起效时间明显短于对照组(t=17.320,P<0.001),麻醉维持时间明显长于对照组(t=10.080,P<0.001)。术后4、8、12、24 h,观察组患者静息和活动时数字分级评分法(NRS)评分均明显低于对照组(静息时:t=2.116、4.698、2.418、2.296,P=0.037、P<0.001、P=0.017、P=0.024;活动时:t=2.590、2.500、4.892、2.346,P=0.011、P<0.001、P<0.001、P=0.021)。结论 超声引导下腰方肌阻滞可有效缩短麻醉起效时间,延长麻醉维持时间,降低全髋关节置换术后疼痛程度。

Effect of Dermabrasion and ReCell on Large Superficial Facial Scars Caused by Burn, Trauma and Acnes

Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell？. According to the etiology, patients were classified into post-burning group （n=5）, post-traumatic group （n=7） and post-acne group （n=7）. Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score （PSS）, Vancouver Scar Scale （VSS）, and Patient and Observer Scar Assessment Scale （POSAS） of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group （19.6±4.0 days）, post-traumatic group （15.8±2.6 days）, and post-acne group （11.4±3.1 days） varied remarkably （F=7.701, P=0.007）. The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups （P〈0.05）, where the most significant improvement was shown in the post-acne group （P〈0.05）. The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group （all P〈0.05）, where the more significant improvement was also shown in the post-acne group （P〈0.05）. Conclusions The combined treatment of dermabrasion and ReCell has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.

皮神经营养血管皮瓣修复下肢难愈性创面18例

烧（创）伤后骨关节肌腱外露、骨关节手术后钢板外露、慢性溃疡等常发生在四肢远端，治疗难度大，创面不易愈合。2009年1月--2011年12月，笔者单位采用皮神经营养血管皮瓣修复下肢难愈性创面18例，取得良好效果。

Comparative study on effects of burn-blast combined injury and burn-firearm combined injury complicated with seawater immersion on vascular endothelial cells

Objective: To comparatively study the effects and mechanisms of burn-blast combined injury and burn-firearm combined injury complicated with seawater immersion on vascular endothelial cells. Methods: A total of 40 healthy adult hybrid dogs of both sexes, weighing 12-15 kg, were used in this study. Randomly-selected 20 dogs were established as models of burn-blast combined injury (the burn-blast injury group) and the other 20 dogs as models of burn-firearm combined injury (the burn-firearm injury group). Then the wounds of all the dogs were immediately immersed in seawater for 4 hours, and then they were taken out from the seawater. Blood samples were withdrawn from the central vein of the dogs before injury, and at 4, 7, 10, 20, and 28 hours after injury to measure the circulating endothelial cells and the von Willebrand factor. Results: Circulating endothelial cells increased significantly at 4 hours after injury in all the dogs. But they reached peak at 7 hours after injury in the burn-blast injury group and at 28 hours after injury in the burn-firearm injury group. The changes of circulating endothelial cells in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 7, 20, and 28 hours after injury (P<(0.01)). The von Willebrand factor reached peak at 4 hours after injury in the burn-blast injury group and at 28 hours in the burn-firearm injury group. The changes of von Willebrand factor in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 20, and 28 hours after injury (P<(0.01)). Conclusions: In burn-blast injury combined with seawater immersion, the vascular endothelial cells changed most significantly at 4 hours or 7 hours after injury, while burn-firearm injury combined with seawater immersion have the same at 20 hours or 28 hours after injury.

Effects of mesenchymal stem cells transfected with human hepatocyte growth factor gene on healing of burn wounds

Objective： To explore the effects of bone marrow-derived mesenchymal stem cells （BMSCs）transfected with adenoviral vector carrying hepatocyte growth factor （HGF, Ad-HGF） on burn wound healing.Methods： BMSCs from male Wistar rats were separated and purified with Percoll separating medium by density gradient centrifugation and cultured with DMEM containing 20% fetal bovine serum （FBS）. Then BMSCs were transfected with Ad-HGF at the optimal gene transduction efficiency of 100 multiplicity of infection （MOI）. The efficiency of transfection and the expression of HGF in the suspension were detected by flow cytometry and enzyme linked immunosorbent assay （ELISA） respectively. Thirtytwo female rats were subjected to 90℃ water for 12 seconds to induce a partial thickness skin burn. The animals were randomly divided into mesenchymal stem cells （MSCs） treatment group （Group A）, Ad-HGF treatment group （Group B）,Ad-HGF-modified MSCs treatment group （Group C） and saline control group （Group D）. On days 3, 5, 7, 14 and 21 postburn, HE and Sirius red stain were performed to observe the burn wound healing and collagen content. The content of hydroxyproline in wounds was also detected.Transplanted cells and the expression of（sex-determining region Y） SRY gene were detected by in situ hybridization and polymerase chain reaction （PCR）, while the expression of HGF in wound tissues was detected by ELISA.Results： The result of flow cytometry showed that the transfection efficiency was 86.41% at 100 MOI. Compared with the control group, the content of HGF in the supernatant after transfection increased time-dependently and peaked at 48 h, showing significant differences at 24 h, 48 h,72 h and 96 h （P＜0.01 ）. Results of HE stain revealed that the range of re-epidermidalization in Group C was significantly larger than that in other groups in the first week. Three weeks postburn, the epidermis was significantly thicker in Group C than in other groups and the nails of dermis inserted into the derma of burn wounds. Sirius red stain showed that the content of collagen Ⅰ in Group C was much less compared with that in other groups 21 days postburn. In situ hybridization revealed an expression of SRY gene in burned female rats, consistent with the finding of PCR. Immunohistochemistry demonstrated the largest increase of HGF expression in Group C, whose contents of hydroxyproline,however, decreased on day 7 postburn. Compared with other groups, the content of HGF in the wounds of Group C increased obviously on day 14 after transfection （P＜0.05） and there was no significant difference among Groups A, B and D.Conclusion： Our study suggests that transplantation of MSCs modified with Ad-HGF has positive effects on the healing of burn wounds probably through differentiation and release of relevant cytokines.