Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

AIM： To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques： combined conjunctival autograft and overlay amniotic membrane transplantation （CAT with AMT）, conjunctival autograft transplantation （CAT） alone and amniotic membrane transplantation （AMT） alone. METHODS： In this retrospective study, 142 eyes of 142 pterygium patients （104 primary, 38 recurrent）who underwent CAT （group A）, AMT （group B） or CAT with AMT （group C） respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS： The number of recurrence post-surgery were 17 （9 from primary, 8 from recurrent; the same description below）, 18 （10, 8） and 2 （1, 1） in groups A, B, and C respectively; dry eyes were 22 （16, 6）, 27 （18, 9） and 7 （3, 4）; conjunctival inflammations were 30 （17, 13）, 27 （16, 11） and 11 （6, 5）. Patients in group C （either pdmary or recurrent or both） mainly showed significantly better results than those in group A or B （P〈0.05） regarding above-mentioned clinical effects. CONCLUSION： Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.

Comparison of the Efficacy of Pterygium Resection Combined with Conjunctival Autograft versus Pterygium Resection Combined with Amniotic Membrane Transplantation

Purpose:To compare the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation in the treatment of pterygium. Methods: A total of 118 cases (133 eyes) were randomly assigned to receive pterygium resection combined with conjunctival autograft (n=81) or pterygium resection combined with amniotic membrane transplantation(n=52)..Corneal wound healing and neovascularization and the presence or absence of conjunctival proliferation and hyperemia were analyzed at 12 months post-operatively. Results: In the conjunctival autograft group, 6 eyes (7.4%) had recurrent pterygium,.while in the amniotic membrane transplantation group, 10 eyes showed recurrence (19.2%,P<0.05,.chi-square)..Patients in the conjunctival autograft group recovered significantly faster compared with those in the amniotic membrane transplantation group. Conclusion:.Patients receiving pterygium surgery combined with conjunctival autograft had lower recurrence rates and experience faster recovery compared with those undergoing pterygium resection combined with amniotic membrane transplantation.

Nerve autografts and tissue-engineered materials for the repair of peripheral nerve injuries: a 5-year bibliometric analysis

With advances in biomedical methods, tissue-engineered materials have developed rapidly as an alternative to nerve autografts for the repair of peripheral nerve injuries. However, the materials selected for use in the repair of peripheral nerve injuries, in particular multiple injuries and largegap defects, must be chosen carefully. Various methods and materials for protecting the healthy tissue and repairing peripheral nerve injuries have been described, and each method or material has advantages and disadvantages. Recently, a large amount of research has been focused on tissue-engineered materials for the repair of peripheral nerve injuries. Using the keywords ＂peripheral nerve injury＂, ＂autotransplant＂, ＂nerve graft＂, and ＂biomaterial＂, we retrieved publications using tissue-engineered materials for the repair of peripheral nerve injuries appearing in the Web of Science from 2010 to 2014. The country with the most total publications was the USA. The institutions that were the most productive in this field include Hannover Medical School （Germany）, Washington University （USA）, and Nantong University （China）. The total number of publications using tissue-engineered materials for the repair of peripheral nerve injuries grad- ually increased over time, as did the number of Chinese publications, suggesting that China has made many scientific contributions to this field of research.

Focus on limbal stem cell deficiency and limbal cell transplantation

Limbal stem cell deficiency(LSCD)causes severe vision impairment and can lead to blindness,representing one of the most challenging ocular surface disorders.Stem cell deficiency can be congenital or,more often,acquired.The categorization of ocular surface transplantation techniques is crucial to achieving treatment homogeneity and quality of care,according to the anatomic source of the tissue being transplanted,genetic source,autologous or allogenic transplantation(to reflect histocompatibility in the latter group),and cell culture and tissue engineering techniques.The aim of this minireview is to provide a summary of the management of LSCD,from clinical characteristics and therapeutic outcomes to the development of novel therapeutic approaches.The manuscript also briefly summarizes recent findings in the current literature and outlines the future challenges to overcome in the management of the major types of ocular surface failure.

Involuntary muscle spasm expressed as motor evoked potential after olfactory mucosa autograft in patients with chronic spinal cord injury and complete paraplegia

Object: The efficacy of olfactory mucosa autograft (OMA) for chronic spinal cord injury has been reported. New activity in response to voluntary effort has been documented by electromyography (EMG), but the emergence of motor evoked potential (MEP) reflecting electrophysiological conductivity in the central nervous system, including the corticospinal pathway, after OMA, and the best indications for OMA, have not been clarified. Here, we report the emergence of MEPs after OMA and offer recom-mendations for appropriate indications based on the presence of involuntary muscle spasm (IMS). We used analysis of MEP to examine the efficacy of OMA for patients with complete paraplegia due to chronic spinal cord injury. To clarify the indications for OMA, we investigated the association of IMS and efficacy of OMA. Methods: Four patients, 3 men and 1 woman, were enrolled. The mean age of the cases was 30.3 ± 9.5 years (range, 19 to 40 years). All 4 cases were American Spinal Injury Association (ASISA) grade A. The mean duration from injury to OMA was 95.8 ± 68.2 months (range, 17 to 300 months). Samples of olfactory mucosa were removed, cut into smaller pieces, and grafted into the sites of spinal cord lesions after laminectomy. Postoperative subcutaneous fluid collection, postoperative meningitis, postoperative nosebleed, postoperative infection in the nasal cavity, impaired olfaction, neoplastic tissue overgrowth at the autograft site, new sensory disturbance, and involuntary muscle spasm were investigated as safety issues. Improvements in ASIA grade, variations in ASIA scores, EMG, SSEP, and improved urological function were evaluated as efficacy indicators. Results: There were no serious adverse events in this series. In 2 of the 4 cases, an improvement in motor function below the level of injury was recognized. In one, the motor score was 50 until 16 weeks after surgery, and it increased to 52 from 20 weeks after surgery. In the other, the motor score was 50 until 20 weeks after surgery, and it increased to 52 at 24 weeks after surgery with a further increase to 54 at 48 weeks after surgery. The emergence of MEP was recognized in the latter case at 96 weeks after surgery. The other 2 cases had no improvement in ASIA motor score. Both of these cases who showed improvements in the ASIA motor scores exhibited relative IMS compared with those who had no ASIA motor score recovery. Conclusions: We recognized the emergence of MEPs in a case with complete paraplegia due to chronic spinal cord injury after OMA. IMS might be a candidate of indication of OMA.

翼状胬肉术后复发的危险因素及治疗的研究进展

翼状胬肉是一种眼科常见病及多发病,术后复发是常见的问题之一,且多次复发可造成睑球粘连、结膜囊狭窄、眼球运动受限等严重并发症。近年来,翼状胬肉术后复发逐渐成为眼科医师关注的焦点。本文系统梳理了翼状胬肉术后复发的危险因素,包括全身及眼部危险因素,翼状胬肉自身相关危险因素,分子生物学、基因、病原微生物相关危险因素等;并阐述了减少翼状胬肉术后复发的治疗策略,如手术的选择,辅助药物、物理治疗策略,中医药治疗策略等。本研究可为眼科医师在临床实践中预防翼状胬肉复发提供一定参考。

自体骨软骨移植术应用于HeppleⅤ型距骨骨软骨损伤患者的效果及对关节功能的影响

目的:研究自体骨软骨移植术应用于HeppleⅤ型距骨骨软骨损伤(OLT)患者中的效果及对关节功能的影响。方法:选取山东国欣颐养集团枣庄中心医院2018年2月—2023年2月收治的86例HeppleⅤ型OLT患者开展研究,以电脑编号奇偶数字法分为Ⅰ组(n=43)及Ⅱ组(n=43)。Ⅰ组用自体骨软骨移植术治疗,Ⅱ组用关节镜下微骨折术治疗。对比两组疗效、关节功能、血清生长因子水平及并发症发生情况。结果:Ⅰ组总有效率高于Ⅱ组(95.35%vs 76.74%)(P<0.05);术后3个月,两组关节功能相关指标均较术前明显升高,且Ⅰ组均高于Ⅱ组(P<0.05);术后3个月,两组血管内皮生长因子(vascular endothelial growth factor,VEGF)、血小板衍生生长因子(platele derived growth factor,PDGF)均升高,Ⅰ组均高于Ⅱ组,转化生长因子-β_(1)(transforming growth factor-β_(1),TGF-β_(1))均降低,Ⅰ组低于Ⅱ组(P<0.05);Ⅰ组并发症发生率低于Ⅱ组(4.65%vs 20.93%)(P<0.05)。结论:自体骨软骨移植术应用于HeppleⅤ型OLT患者中,疗效较佳,可明显改善患者关节功能及血清生长因子水平,降低并发症发生风险。

两种方法治疗原发性翼状胬肉的疗效观察

目的:比较自体结膜瓣移植术(conjunctival autograft transplant,CAT)和角膜缘干细胞移植术(limbal conjunctival autograft transplant,LCAT)治疗原发性翼状胬肉的临床效果。方法:前瞻性、随机、对照病例研究。收集2014-01/2015-01在解放军第四七四医院诊断为原发性翼状胬肉患者共120例120眼,依次纳入本研究,奇数者行CAT,偶数者行LCAT。结果:术后随访1a,完成随访107例107眼,CAT组患者54例54眼,术后复发4眼,复发率7.4%;LCAT组患者53例53眼,术后复发2眼,复发率3.8%。两组间复发率无统计学意义(P=0.678)。结论:CAT组和LCAT组均能有效治疗原发性翼状胬肉,降低术后翼状胬肉复发率,但LCAT是治疗原发性翼状胬肉的最优术式。

大面积Ⅲ°烧伤早期大片自体皮移植与畸形的预防

目的 :探讨大片自体皮移植治疗大面积Ⅲ°烧伤患者及其畸形的预防。方法 :在患者全身情况允许时 (伤后10d左右 )行切痂或削痂 ,做大片自体皮移植。采用同一供皮区和Ⅱ°烧伤初愈区重复大片供皮的技术 ,扩大自体皮源。结果 :12 2例烧伤总面积 5 0 %— 80 %、Ⅲ°烧伤 2 0 %— 5 0 %的患者 ,采用上述治疗 ,皮片存活率为 90 %— 10 0 %。随访 84例植皮区外形接近正常 ,功能良好 ;14例患者留有轻度畸形 ,但采用小手术治疗后畸形得以矫正。结论 :改进取皮技术 ,扩大皮源 ,采用大片自体皮移植 ,皮片存活率高 ,明显缩短了疗程 ,功能与外形好 。

绷带镜在翼状胬肉切除联合结膜瓣移植术后的应用

目的:探讨绷带镜在翼状胬肉切除联合结膜瓣移植术后应用的临床效果。方法:前瞻、随机、对照性病例研究。收集2015-01/2016-01在我院诊断为原发性翼状胬肉拟接受翼状胬肉切除联合结膜瓣移植术患者共110例110眼,奇数者为绷带镜组(在翼状胬肉切除联合结膜瓣移植术后给予配戴绷带镜),偶数组为对照组(仅行翼状胬肉切除联合结膜瓣移植术)。术后1、3、7d时采用VAS视觉模拟量表法评估术后疼痛程度,并观察术后患者角膜刺激症状;术后3d采用角膜荧光染色法检测角膜上皮修复情况;随访患者至术后1a,统计翼状胬肉复发情况。结果:术后1d绷带镜组疼痛评分(4.13±2.06分)较对照组(5.80±1.93分)明显减轻(t=4.391,P<0.001);术后3d绷带镜组疼痛评分(2.09±1.36分)较对照组(3.65±1.65分)明显减轻(t=5.422,P<0.001);术后7d绷带镜组和对照组疼痛评分无统计学差异(t=1.295,P=0.198)。术后1d和3d时,绷带镜组刺激症状均较对照组减轻(P<0.05),而术后7d时绷带镜组与对照组比较无统计学差异(P=0.052)。术后3d时角膜荧光染色面积,绷带镜组(0.33±0.37mm^2)较对照组(2.73±2.21mm^2)明显减小(t=7.921,P<0.001)。术后1a翼状胬肉复发率,绷带镜组与对照组比较无统计学差异(P=1.000)。结论:翼状胬肉切除联合结膜瓣移植术后配戴角膜绷带镜可以有效减轻患者术后疼痛和刺激症状,加速角膜上皮愈合,明显提高患者术后舒适度。

深低温保存角膜缘干细胞活性实验研究

目的 评价深低温冷冻保存兔眼角膜缘干细胞活性。方法 12只 (12眼 )新西兰白兔 ,制备 2mm周边角膜和 2mm球结膜的环形浅层角膜缘植片及角膜干细胞缺乏眼表疾病模型。角膜缘植片通过程序降温仪程序降温后 - 196℃深低温保存 ,30天和 6 0天后行角膜缘自体移植。组化及免疫组化证实深低温保存的角膜缘干细胞活性。结果 角膜干细胞缺乏导致角膜上皮愈合延迟 ,上皮结膜化 ,PAS染色阳性 ,AE5染色弱阳性 ;基质水肿 ,角膜血管化。深低温保存角膜缘干细胞自体移植能促进角膜上皮愈合 ,为角膜表型 ,PAS染色阴性 ,AE5染色阳性。基质水肿逐渐吸收 ,新生血管消退、变细。结论 深低温保存法能保存角膜缘干细胞活性 ;能随时按需为临床提供活性角膜缘材料 ;为深低温保存角膜缘干细胞移植治疗临床眼表疾病提供了实验依据。

自体角膜缘上皮移植术治疗翼状胬肉的临床报告

目的 比较单纯切除术及自体角膜缘上皮移植术治疗中度初发性翼状胬肉的效果。方法 单纯切除组 2 0例 (2 4眼 ) ;自体角膜缘上皮移植组 (简称移植组 ) 18例 (2 2眼 )。结果 移植组 :平均追踪 9 2 4± 2 6 2月 ,复发率 4 5 % ,明显低于单纯切除组 33 33%的复发率 (平均追踪 8 6 8± 2 83月 )。

微波消融治疗前臂甲状旁腺移植组织功能亢进2例并文献复习

目的探讨超声引导下微波消融治疗前臂甲状旁腺移植组织功能亢进的效果及技术安全性。方法 2例曾行甲状旁腺全切除联合自体组织移植术(PTX+AT)并行维持性血液透析的患者,因血清全段甲状旁腺激素(iPTH)水平显著升高及伴发症状加重,确诊为前臂甲状旁腺移植组织功能亢进。对移植物进行多模态高频超声检查并行超声引导下经皮微波消融术治疗,观察患者术后疗效和临床症状。结果超声检查清晰显示2例患者前臂甲状旁腺移植组织的位置、数量、大小、血流灌注状态。测定2例患者各移植组织内iPTH水平后,保留测定值最低的1枚,其余均实施微波消融术,消融治疗均获技术成功。2例患者共消融前臂甲状旁腺移植组织分别为5枚和4枚,最大者分别为15 mm×6 mm和13 mm×5 mm。2例患者微波消融术后1 d移植侧、非移植侧前臂静脉血iPTH水平分别为87.3 ng/L、79.6 ng/L和66.3 ng/L、65.2 ng/L。术后1年随访期间患者钙、磷、碱性磷酸酶水平均下降并持续稳定,骨和关节痛明显缓解,且未出现移植侧前臂皮肤感觉麻木以及指、腕关节的屈伸活动异常。结论 PTX+AT后前臂甲状旁腺移植组织可发生功能亢进,微波消融可有效治疗移植组织功能亢进,其操作简便且安全性高。

羊膜移植术和羊膜联合角膜缘上皮移植术治疗复杂性翼状胬肉

目的 :比较羊膜移植术与羊膜联合自体角膜缘上皮移植术治疗各种复杂性翼状胬肉的疗效。方法 :对 42例 ( 48眼 )复发性翼状胬肉和假性胬肉并睑球粘连患者分别行羊膜移植术 ( 2 0例 ,2 2眼 )和羊膜联合自体角膜缘上皮移植术 ( 2 2例 2 6眼 ) ;术后随访 6～ 12 (平均 8.5 )个月。结果 :术后 2周 ,羊膜联合自体角膜缘上皮移植术组 ,除 2眼外角膜创面完全上皮化 ,达到无瘢痕性愈和 ;而羊膜移植术组有 8眼角膜创面未完全修复 (P <0 .0 5 )。随访 1年 ,羊膜联合自体角膜缘上皮移植术组未见无排斥反应发生和胬肉复发 ,而羊膜移植术组有 3眼出现不同程度胬肉复发。结论 :羊膜联合自体角膜缘上皮移植术较单纯羊膜移植术治疗复发性或假性翼状胬肉 ,能更有效地抑制结膜下纤维增生、重建角膜缘屏障、促进角膜创面修复 ,从而提高治疗效果 ,降低复发率。

一期前路病灶清除椎间植骨联合内固定治疗脊柱结核

目的探讨病灶彻底清除后,自体髂骨块椎间植骨联合前路或后路内固定的效果。方法1999年6月～2004年4月期间一期手术治疗脊柱结核89例,其中前路病灶清除、自体髂骨椎间植骨,前方或侧前方内固定73例;前路病灶清除、自体髂骨椎间植骨,后路内固定16例。术后支具保护6个月,正规抗结核化疗12个月。根据术前、术后及最后一次随访的X线平片分析融合情况和畸形矫正的进展。结果随访1～5年,平均28个月;除2例复发、1例内固定松动、2例出现药物性肝炎、2例出现供骨区严重疼痛外,无其他并发症;88例获骨性愈合,愈合时间3～6个月。平均4个月;术前、术后、最后一次Cobb角分别为35.3°、16.3°、19.5°。结论对合适的病例,该法可有效稳定脊柱、维持其畸形的矫正;达到牢固地融合,临床效果明显。

自体带骨膜髂骨移植治疗Hepple Ⅴ型距骨骨软骨损伤的临床疗效

目的:回顾性分析作者采用自体带骨膜髂骨移植治疗Hepple V型距骨骨软骨损伤的临床疗效。方法:2015~2018年,对17例Hepple Ⅴ型距骨骨软骨损伤患者采用自体带骨膜髂骨移植治疗,其中男性15例,女性2例,平均年龄28.0±6.4岁(21~45岁),14例经内踝截骨,3例采取前内辅助小切口。所有患者术前、术后3个月、6个月和末次随访时均进行功能评分和影像学评估。功能评分包括疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足功能评分,影像学评估包括X线片、计算机断层扫描(CT)及磁共振(MRI)检查。结果:随访时间26.0±5.9个月(15~36个月),术前CT显示囊性变直径为8.2±1.3 mm,深度7.6±0.9 mm,VAS评分由术前6.9±0.9分下降至末次随访时的1.3±0.9分(P<0.01),AOFAS踝关节功能评分由术前53.4±5.5分提高至末次随访时86.5±7.6分(P<0.01),优良率82%。末次随访时CT检查显示囊性变填充良好15例,MRI检查显示修复区软骨面平整13例。结论:自体带骨膜髂骨移植治疗Hepple V型距骨骨软骨损伤可获得满意的临床疗效,影像学证实填充效果良好。

自体角膜缘与结膜移植治疗复发性翼状胬肉

目的比较自体角膜缘与结膜移植治疗复发性翼状胬肉的疗效。方法复发性翼状胬肉病人９４例（１１５眼）随机分为Ａ，Ｂ两组，Ａ组４７例（５６眼），Ｂ组４７例（５９眼）。手术显微镜下切除胬肉后Ａ组行自体角膜缘移植术，Ｂ组行自体球结膜移植术。观察术后植片生长、角膜创面修复、角膜新生血管及胬肉复发率。结果术后植片成活时间３～５天（平均３．７５天）；术后角膜创面修复时间Ａ组较Ｂ组快（Ｐ＜０．０５）。角膜新生血管Ａ组较Ｂ组少。术后１２个月胬肉复发率Ａ组（３．８％）较Ｂ组（２５．９％）低（Ｐ＜０．０１）。结论治疗复发性翼状胬肉自体角膜缘移植较结膜移植疗效好。

自体角膜缘移植羊膜移植治疗翼状胬肉

目的 观察自体角膜缘移植术或/和羊膜移植术治疗翼状胬肉的临床效果。方法 206眼翼状胬肉患者分3组分别采用显微手术切除局部病灶联合自体角膜缘移植术或/和羊膜移植术治疗,并给予定期随访、裂隙灯检查及照相。结果 术后随访3-17月,视力均有所提高,眼表愈合迅速,且复发率低。结论 胬肉切除后联合羊膜移植及自体角膜缘移植术对治疗翼状胬肉,降低术后复发率,恢复和重建眼表很有帮助。

三种不同术式治疗复发性翼状胬肉的疗效观察

目的:评价羊膜移植、自体角膜缘干细胞移植、羊膜移植联合自体角膜缘干细胞移植3种不同术式治疗复发性翼状胬肉的效果。方法:将127例127眼复发性翼状胬肉患者随机分为A,B,C三组,采用不同手术方式。其中A组45例45眼行羊膜移植术;B组40例40眼行自体角膜缘干细胞移植术;C组42例42眼行羊膜移植联合自体角膜缘干细胞移植术。术后随访12～24mo,分析对比3种不同术式的手术复发率。结果:A组10眼复发,复发率为22.2%;B组9眼复发,复发率为22.5%;C组3眼复发,复发率为7.1%。A组与B组比较差异无统计学意义,C组与A,B组比较有显著性差异(P<0.05)。结论:羊膜移植联合自体角膜缘干细胞移植术治疗复发性翼状胬肉术后复发率最低,是治疗复发性翼状胬肉较为理想的手术方式,值得临床推广应用。

自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位16例

目的 ：观察自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位的疗效,评价髋臼骨缺损进行自体骨重建的优越性。方法：自2008年3月至2013年12月采用自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位16例（16髋）,其中男11例,女5例;年龄41~72岁,平均56.3岁;病程3.6~37.2年;交通事故伤12例,坠落伤4例。所有患者进行系统跟踪随访,评定术后1个月髋关节疼痛指标、Harris评分及髋关节总活动度变化。结果：16例（16髋）均获随访,时间11~78个月,平均27.3个月。16例（16髋）术前髋关节总活动度（56.2±23.4）°,VAS评分86.3±7.2,Harris评分32.6±12.6;术后1个月髋关节总活动度（181.8±17.6）°,VAS评分11.1±2.6,Harris评分86.3±7.2,均较术前改善,术后解决了疼痛和髋关节功能受限,假体位置均完好。结论 ：自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位,髋臼的初始稳定性及远期稳定性均较好,自体骨植骨避免了异体骨的并发症,骨源合理利用,价格低廉,减轻了患者负担。