“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications,which may lead to poor prognosis.AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect.METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery,Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed.All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap.The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed,and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed.RESULTS There were 5 cases of high flow cerebrospinal fluid(CSF)leakage and 7 cases of low flow CSF leakage.Postoperative cerebrospinal fluid leakage occurred in 2 patients(8.3%)and intracranial infection in 2 patients(8.3%),which were cured after strict bed rest,continuous drainage of lumbar cistern combined with antibiotic treatment,and no secondary surgical repair was required.The patients were followed up for 8 to 36 months after the operation,and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up.Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery.CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction

Objective: Laryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection. Methods: Four patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated. Results: The four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months. Conclusion: The combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy.

3D-printed,bi-layer,biomimetic artificial periosteum for boosting bone regeneration

Periosteum,a membrane covering the surface of the bone,plays an essential role in maintaining the function of bone tissue—and especially in providing nourishment and vascularization during the bone regeneration process.Currently,most artificial periostea have relatively weak mechanical strength and a rapid degradation rate,and they lack integrated angiogenesis and osteogenesis functions.In this study,a bi-layer,biomimetic,artificial periosteum composed of a methacrylated gelatin–nano-hydroxyapatite(GelMA-nHA)cambium layer and a poly(N-acryloyl 2-lycine)(PACG)-GelMA-Mg^(2+)fibrous layer was fabricated via 3D printing.The GelMA-nHA layer is shown to undertake the function of improving osteogenic differentiation of rat bone marrow mesenchymal stem cells with the sustainable release of Ca^(2+) from nHA nanoparticles.The hydrogen-bonding-strengthened P(ACG-GelMA-L)-Mg^(2+)hydrogel layer serves to protect the inner defect site and prolong degradation time(60 days)to match new bone regeneration.Furthermore,the released magnesium ion exhibits a prominent effect in regulating the polarization phenotype of macrophage cells into theM2 phenotype and thus promotes the angiogenesis of the human umbilical vein endothelial cells in vitro.This bi-layer artificial periosteum was implanted into a critical-sized cranial bone defect in rats,and the 12-week post-operative outcomes demonstrate optimal new bone regeneration.

Experiment study on combined free periosteum grafting and new reconstituted bone xenograft in repairing segmental defects

Objective: To study the efficacy of combined use of a new grafting material, new reconstituted bone xenograft (NRBX) and free periosteal graft in repair of segmental bony defects. Methods: NRBX was made by combining recombi- nant human BMP2(rhBMP2) and an antigen-free bovine cancellous bone (BCB) as a carrier. NRBX was used alone, in combination with free periosteal graft to repair a 1. 5 cm defect in the radius of rabbit. The defect-repairing capability for each of the treatment modalities was assessed with radiographical, biomechanical, densitometrical and histological methods. Results: NRBX used alone was capable of healing the defect in large by 16 weeks, with a similar repair process and mecha- nism seen with econstituted bone xenograft (RBX). Combined use of NRBX and free periosteal graft was superior in terms of increased and quality of the new bone formed at the early stage of the repair pass (within 12 weeks) to NRBX used alone, with the defect basically healed by 12 weeks. Conclusion: Both methods are effective in repairing segmental bone defects, but NRBX used in combination with free periosteal graft is preferred, because of the satisfactory osteogenesis, osteoconduction and osteoinduction.

Reconstruction of Hemipelvectomy Defect Using a Fillet Flap with Femoral Periosteum

Backgrounds: Reconstruction after hemipelvectomy is very important for rehabilitation into society. The pelvis plays an important role for support of the intra-abdominal organs. Methods: We operated 3 cases using fillet flaps with the femoral periosteum for reconstruction of hemipelvectomy defect. Results: It is useful to elevate the flap all around with the femoral periosteum, because the periosteum can be sutured to supporting pelvic structures with the aim to support intra-abdominal organs. Conclusion: Without alternative supports for the bony pelvis, pelvic reconstructions are at risk for hernia and it may be difficult for outpatients to fit their habiliments after radical cure. The rigid support for the intra-abdominal organs occurs in association with the suture pelvic and femoral periosteum.

A Case Report of Immediate Implant Placement Combined with Flap Surgery,Guided Bone Regeneration and Non-submerged Healing with a Labial Bone Wall Defect in the Esthetic Zone

[Basckground]This case report presented a methodology for immediate implantation in the esthetic zone with a facial bone defect along with flap surgery,guided bone regeneration,and non-submerged healing.[Case presentation]A 27-year-old female patient was complaining of the aesthetic complication that was caused via metallic staining of the neck of ceramic crowns in the maxillary right anterior region for one year.She has experienced immediate implantation along with flap surgery,guided bone regeneration(GBR),and non-submerged healing.The torque of the implant reached to the 35 N·cm to confirm primary stability.Six months after surgery,the healing abutment and the implant were fixed,the gingiva was healthy in the surgical area,and the nearby teeth and the opposite teeth were normal.[Results]The results of cone-beam computer tomography(CBCT)revealed that bone defects were filled with the newly formed bone.At the same time,the final impressions accomplished,and an all-ceramic crown was fit-placed.As a whole,the patient satisfaction rate was high.[Conclusions]Immediate implant placement with flap surgery,GBR,and non-submerged healing with a facial bone wall defect in the esthetic zone is an achievable process.

Double J Fixation after Craniotomy: Technical Description of a Modification Method for Bone Flap Fixation (Hiederov Method)

Background: Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is needed. Purpose: The aim is to assess our new innovative technique in bone flap fixation against traditional techniques. Patients and Methods: The study was a prospective randomized controlled study enrolled at Al-Amal Hospital and Al-Ahly Bank Hospital from 2014-2019. Forty-eight patients were randomized in the study. Group A (24 patients) underwent titanium miniplate fixation while group B (24 patients) underwent our new technique. The new technique is double J tunnels performed by craniotome on either side of the bone (flap and skull sides), then a Prolene suture is passed through the shared stem of J’ holes and secured in the wrapped side of J’s holes and tying it tightly. Both techniques were examined against fixation time, rigidity, offset and final judgment postoperatively. Result: There was no statistically significant difference in using both techniques as regard fixation time. Our new technique was not inferior to the traditional one in achieving rigidity (p > 0.05). The final postoperative assessment was as equal as that seen in miniplate fixation. Conclusion: This technique is a simple, easy, cheap and effective method of fixing craniotomy bone flap.

Grafting of iliac bone flap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis and long-dated hip joint function observation

Objective To retrospect the long-dated curative effect of grafting of iliac bone fl ap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis.Methods79cases of femoral head ischemic nec rosis treated by promoted Smith-Petersen incision,neck of femur notch,focus cleaning decompression,grafting of iliac bone flap with deep iliac circumflex vessel and screw fixation.13cases treated by transplanting granular bone after d ecompression.Results Grafting of iliac bone flap with deep iliac circumflex vessel treatment g roup were followed up from 3to 9years,the planting bone healed 3to 6months averagely.Two cases suffered femoral head i schemic necrosis continuous-ly.Other cases received good results.Transplanting granular bone afte r decompression group were followed up 3to 9years,3cases suffered femoral head ischemic necrosis cont inuously,hip joint function was lim ited,patients received hip replacement finally.Conclusion Place of iliac bone flap with deep iliac circumflex vessel is fixed,curative effects ar e credible,which can become the firs t-choice therapy to femoral head is-chemic necrosis of middle age and you ng people(Ficat I ～III stage).

Effects of Fascial Manipulative Treatment on Bone Tissue

The experimental research, presented in this study, focuses on athletic tests with the purpose to highlight the elastic deformations of the bones of the lower limbs, intending to verify whether the manually treated anatomical structure increases in elasticity, becoming able to accumulate more energy in the loading phase, to then release it in the final phase of the thrust. Introduction: Too often neglected, the bone tissue is capable of deforming. The deformation has a key role in the cushioning and dissipation of stress, a function that is hindered in the event of fascial tension, which will consequently fall on other structures used for the same purpose (Discs, menisci, cartilage, …). Structures that, in the event of increased mechanical stress, could undergo degeneration, inflammation, and injury. Materials and Method: Randomized double-blind selection of 38 people, 18 in the treatment group and 20 in the control group, men and women, aged between 16 and 35, who have been part, for at least one year, of a sports club, with a large space dedicated to jumping in its training program, have been divided into two groups: the treatment group, which was treated to increase the performance of the jump and the control group subjected to mild manual pressures, without any intention. Results: The treatment group had an increase in Standing Long Jump (SLJ) for 3.67% (p Conclusions: This study has shown that an osteopathic manipulative treatment, aimed at increasing jumping performance, can increase the performance of the SLJ.

Reconstruction of tracheal defect using the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum

To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy.The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully.Results All flaps survived with epithelization and osteogenesis.The endotracheal tubes were pulled out safely without trachea stenosis in all the patients.Conclusion The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged.This method extends the application of the musculo-periosteum flap.3 refs,4 figs.

去骨瓣减压术治疗颅脑损伤后血肿增大的风险因素分析

目的研究去骨瓣减压术治疗颅脑损伤后血肿增大的风险因素。方法回顾性分析2022年1月至2023年8月本院收治的颅脑损伤117例,所有患者均行去骨瓣减压术,根据术后CT检查血肿是否增大分为发生组(n=62)与未发生组(n=55)。比较两组一般资料及鹿特丹CT评分(Rotterdam CT)、格拉斯哥昏迷评分(GCS)间的差异,经多因素Logistic回归分析去骨瓣减压术治疗颅脑损伤后血肿增大的危险因素。结果两组患者性别、合并高血压、高脂血症、冠心病比较差异无统计学意义(P>0.05),发生组年龄≥65岁、瞳孔散大、发病至开颅时间<4h占比及RotterdamCT评分、血糖、骨瓣最大径明显高于非血肿增大组,GCS评分低于未发生组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄、Rotterdam CT评分、GCS评分、瞳孔状态、发病至开颅时间、血糖、骨瓣最大径是颅脑损伤患者术后血肿增大的危险因素(P<0.05)。结论颅脑损伤患者术后血肿增大受诸多因素影响,其中年龄、瞳孔状态、GCS评分、Rotterdam CT评分、发病至开颅时间、血糖、骨瓣最大径可预测患者术后血肿情况,应予以密切关注。

口腔种植骨增量中的减张技术

临床上,种植位点骨量不足是种植治疗中常遇到的难题。为确保种植区符合种植条件,骨增量手术尤为重要。而骨增量手术成功的关键要素之一是创口无张力的一期愈合。减张技术是获得创口无张力愈合的关键。本文将从减张切口、减张瓣及减张缝合3个方面介绍口腔种植骨增量中的减张技术,以期为临床提供参考。

静电纺丝聚偏氟乙烯压电仿生骨膜的细胞相容性

背景:聚偏氟乙烯具有压电性能、良好的生物相容性和无毒性,使其成为骨膜修复合适的候选材料。目的:评价掺锌镁离子静电纺丝聚偏氟乙烯压电仿生骨膜的体外细胞毒性。方法:采用静电纺丝技术分别制备纯聚偏氟乙烯、掺锌离子聚偏氟乙烯、掺镁离子聚偏氟乙烯、掺锌镁离子聚偏氟乙烯压电仿生骨膜,依次命名为PVDF、PVDF-Zn、PVDF-Mg和PVDF-Zn-Mg,其中锌、镁离子的质量分数均为1%。将成骨细胞、血管内皮细胞分别与4组仿生骨膜共培养,通过碱性磷酸酶染色、CD31免疫荧光染色、扫描电镜观察与CCK-8法检测仿生骨膜的细胞相容性。结果与结论:①成骨细胞:培养7 d的碱性磷酸酶染色显示,PVDF-Zn组碱性磷酸酶分泌多于其他3组。扫描电镜下可见,培养1 d时,细胞在PVDF-Mg和PVDF-Zn-Mg仿生骨膜表面得到了一定的铺展,伪足向四周伸展;到3 d时,各组细胞边缘向材料伸出伪足;到第5,7天时,细胞铺展充分、生长形态良好且牢牢地覆盖在纤维表面,细胞伪足向四周及纤维空隙中伸展。CCK-8检测显示,随着时间的推移,各组仿生骨膜上的细胞增殖呈上升趋势,培养1,3,5,7 d的细胞相对增殖率均≥75%,细胞毒性≤1级。②血管内皮细胞:培养3 d的CD31免疫荧光染色显示,细胞在各组仿生骨膜上良好地黏附和铺展,彼此连接,其中PVDF-Zn-Mg组细胞数量多于其他3组。扫描电镜下可见,培养1,3 d时,细胞开始黏附在各组纤维表面;到5 d时,细胞在纤维表面均铺展良好并伸出明显的伪足;到7 d时,PVDF-Mg、PVDF-Zn-Mg仿生骨膜上的细胞呈复层生长,并伸展伪足至纤维空隙内。CCK-8检测显示,随着时间推移,各组仿生骨膜上的细胞增殖呈下降趋势,培养1,3,5,7 d的细胞相对增殖率均≥125%,细胞毒性为0级。③结果表明:掺锌镁离子静电纺丝聚偏氟乙烯压电仿生骨膜具有良好的细胞相容性。

血管化骨瓣重建颌骨种植体周软组织病理学特点

目的:分析血管化骨瓣重建颌骨区域种植体周软组织结构特点,以及游离龈移植术后种植体周软组织结构改变,为临床治疗提供指导。方法:共纳入2020年10月至2022年12月就诊于北京大学口腔医院牙周科的患者20例,其中5例作为健康对照,全身及牙周健康,行牙冠延长术,收集牙冠延长术中切除的部分健康天然角化龈;15例在颌骨重建区域行游离龈移植术,有10例为腓骨瓣重建,5例为髂骨瓣重建,均在术前采集嵴顶软组织,其中5例患者(3例为腓骨瓣重建,2例为髂骨瓣重建)在术后8周时再次采集种植体周软组织。所有软组织采用苏木精-伊红染色观察组织结构特点,测量上皮钉突处基底层底端至颗粒层顶端的厚度及角化层厚度,采用免疫组织化学染色方法检测白细胞介素-1(interlukin-1,IL-1)、白细胞介素-6(interlukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的分布和表达水平。结果:与健康天然角化龈相比,颌骨重建患者种植体周黏膜缺乏正常复层鳞状上皮的组织结构,上皮钉突处基底层底端至颗粒层顶端的厚度及角化层厚度更小[0.36(0.35,0.47)mm vs.0.27(0.20,0.30)mm,P<0.05;26.37(24.12,31.53)μm vs.16.49(14.90,23.37)μm,P<0.05]。游离龈移植术后,上皮钉突处基底层底端至颗粒层顶端的厚度较治疗前呈现增加的趋势[0.38(0.25,0.39)mm vs.0.19(0.16,0.25)mm,P=0.059],角化层厚度较治疗前增加,差异有统计学意义[28.57(27.16,29.14)μm vs.16.42(14.16,22.35)μm,P<0.05],形成了与健康天然角化龈类似的上皮结构;IL-1、IL-6、TNF-α的阳性细胞个数较术前更多,差异有统计学意义[11.00(9.16,18.00)vs.0.67(0.17,8.93),P<0.05;21.89(15.00,28.12)vs.13.00(8.50,14.14),P<0.05;2.83(1.68,5.00)vs.0.22(0.04,0.63),P<0.05];术后平均光密度值升高,差异有统计学意义[0.18(0.17,0.21)vs.0.15(0.14,0.17),P<0.05;0.36(0.33,0.37)vs.0.28(0.26,0.33),P<0.05;0.30(0.28,0.42)vs.0.23(0.22,0.29),P<0.05],且与健康天然角化龈之间的差异无统计学意义。结论:颌骨重建区域种植体周角化黏膜缺失或不足的患者,通过游离龈移植行角化黏膜增量有利于改善种植体周黏膜的组织结构,维护种植体周黏膜的稳定性。

带真皮的翻转筋膜瓣在小腿外伤后骨裸露创面修复中的应用

目的:探讨带真皮的翻转筋膜瓣在小腿外伤后骨裸露创面修复中的手术方法及术后效果。方法:选取2020年1月-2021年12月笔者医院收治的因外伤致胫腓骨开放性骨折伴骨裸露的12例患者,根据缺损部位、面积,设计带真皮的筋膜瓣,以翻转180°的方式修复小腿外伤后的复杂创面,观察患者治疗效果及术后随访情况。结果:本组11例患者皮瓣完全成活,1例患者皮瓣远端退缩伴少量骨裸露,经行对侧翻转筋膜瓣修复愈合。术后随访6~12个月,所有患者下肢外观及功能恢复良好。结论:带真皮的翻转筋膜瓣修复小腿外伤后骨裸露创面可达到理想的外观和功能恢复,其具有设计灵活、操作简洁、对皮瓣利用度高等特点,可作为临床上小腿外伤后可靠的早期修复方式。

内源性骨膜引导骨再生过程中信号通路富集及FZD家族动态表达研究

目的研究内源性骨膜引导骨再生过程中信号通路富集及卷曲蛋白(FZD)家族动态表达。方法建立猪闭合肋骨膜引导下的骨再生模型,选择7个时间点采集骨膜和再生骨组织进行基因测序,分析差异基因筛选以及相关信号通路富集的情况。选取与骨再生过程中密切相关的FZD分子家族,检测并分析FZD各成员的动态表达变化及其表达相关性。结果实验组相较于对照组,共有7个基因在建模后1个月内的不同时间点持续存在差异表达。差异基因富集显示,早期主要存在免疫反应,后实现组织发展和重塑。FZD家族各成员在不同时间点的表达存在波动,大多数成员的表达高峰在术后3 d,而实验组的倍数改变高峰在术后1个月最为明显,FZD1和FZD2最高,且二者具有较高的相关性。结论本研究筛选出的骨膜引导性骨再生过程中的差异基因以及相关信号通路,为进一步的分子机制研究提供了理论依据,而FZD分子家族动态表达变化在该过程中发挥着重要作用,其具体参与的生物机制尚需进一步研究验证。

口内血管吻合髂骨瓣修复颌骨缺损的临床应用

目的:介绍数字外科引导下利用口内血管吻合技术联合血管化游离髂骨瓣移植在颌骨重建中的临床操作与优势,探讨口内血管吻合技术的临床应用。方法:选取2022年武汉大学口腔医学口腔颌面外科3例因颌骨良性肿瘤需行颌骨切除并同期修复的患者,术前对患者进行颌骨及髂骨CT扫描,制定虚拟手术计划,设计、制作取骨截骨导板,手术切除肿瘤,其中2例为口内入路切除,1例为口外入路切除。截取髂嵴部带血管蒂骨瓣,以面动静脉为受区吻合血管与髂骨瓣血管蒂进行吻合,从而完成髂骨瓣对颌面部缺损的重建修复。随访患者术后恢复情况并进行评估。结果:3例手术均成功完成,其中2例患者无口外切口,1例患者仅有一处原发灶切除为口外切口。术后患者恢复良好,颌面部结构基本对称且美观。结论:口内血管吻合技术与髂骨瓣及虚拟手术计划相结合可以取得良好的术后结果。口内吻合技术不仅可以完成口内颌骨病灶切除后重建,对于需经口外入路切除病灶的病例也有一定优势。

双骨瓣技术在枕下乙状窦后入路中的应用研究

目的探索双骨瓣技术在枕下乙状窦后入路中的临床应用效果。方法前瞻性纳入2021年8月—2022年10月郑州大学第一附属医院神经外科行枕下乙状窦后入路手术治疗的60例患者,随机分为双骨瓣组和单骨瓣组,每组30例。结合术中术后资料,记录两组术中静脉窦损伤情况、术区骨质缺损大小、术后常见并发症情况。结果双骨瓣组术区骨质缺损2.0~4.2 mm,平均(2.78±0.70)mm;单骨瓣组术区骨质缺损4~11 mm,平均(7.78±1.64)mm,两组间比较,差异有统计学意义(P=0.000)。双骨瓣组术中乙状窦损伤1例,单骨瓣组术中乙状窦损伤3例。双骨瓣组1例伤口愈合不良,1例颅内感染;单骨瓣组1例皮下积液,2例颅内感染。结论采取枕下乙状窦后双骨瓣开颅可减少骨质缺损,确保手术安全、高效进行,能取得满意的临床效果。

骨髓间充质干细胞外泌体通过PI3K/Akt通路修复大鼠皮瓣缺血再灌注损伤的实验研究

目的探讨骨髓间充质干细胞外泌体(exosomes derived from bone marrow mesenchymal stem cell,BMSCs-Exos)通过PI3K/Akt通路修复皮瓣缺血再灌注损伤的机制。方法培养大鼠骨髓间充质干细胞(BMSCs),提取细胞上清液中的外泌体并通过电镜、粒径分析及免疫印迹实验进行鉴定。建立以腹壁浅动静脉为血管蒂的大鼠腹部皮瓣缺血再灌注损伤模型;将大鼠随机分为4组:Sham组、IR+PBS组、IR+Exo组及IR+Exo+LY组。术后观察并拍照记录大鼠皮瓣大体情况,第7天计算皮瓣坏死区比例;获取大鼠皮瓣组织样本,HE染色和组织评分评估皮瓣组织损伤程度,免疫组化评估皮瓣p-Akt、VEGFA表达水平和CD34标记的微血管密度。结果相比Sham组,IR+PBS组皮瓣坏死区比例增加,组织结构破坏加重,p-Akt及VEGFA表达水平下降,微血管密度降低;IR+Exo组皮瓣坏死和组织破坏水平降低,p-Akt及VEGFA表达上升,微血管密度增加;而PI3K抑制剂降低了BMSCs外泌体的修复作用,表现为皮瓣坏死增加,p-Akt及VEGFA表达下调,微血管密度减少。结论BMSCs外泌体对大鼠腹部皮瓣缺血再灌注损伤具有显著的保护和修复作用,PI3K/Akt信号通路可能是BMSCs外泌体治疗皮瓣缺血再灌注损伤的关键通路。

微创术治疗自发性脑出血灶周水肿的效果

目的探讨微创术治疗自发性脑出血灶周水肿的疗效及对脑水肿指数、脑脊液水平的影响,以期为临床优化治疗方案提供理论依据。方法采用前瞻性随机对照研究,选取2020年6月至2022年6月收治的78例自发性脑出血合并出血灶周水肿患者作为研究对象,采用随机数字表、密封信法分为观察组(39例)与对照组(39例),对照组接受开颅大骨瓣减压术治疗,观察组接受立体定向手术抽吸治疗。观察两组患者术后3个月的手术疗效,记录两组围手术期指标(手术、住院时间),比较两组术前、术后14 d的脑水肿指数、脑脊液水平[白细胞介素-1β(IL-1β)、S-100钙结合蛋白β(S-100β)]以及术后并发症发生情况。结果术后3个月,观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。观察组手术、住院时间短于对照组,差异有统计学意义(P<0.05)。术后5 d,两组患者脑水肿指数均下降,且观察组小于对照组,差异有统计学意义(P<0.05)。术后14 d,两组患者脑脊液IL-1β、S-100β水平均下降,且观察组低于对照组,差异有统计学意义(P<0.05)。两组患者术后均出现并发症,但差异无统计学意义(P>0.05)。结论微创术能够有效治疗自发性脑出血灶周水肿,改善脑水肿程度,减轻脑损伤程度,值得临床推广应用。