2018年初,世界卫生组织(World Health Organization, WHO)开始使用首个全球烧伤注册平台(global burn registry,GBR)[1],目的 是使公共卫生和医疗管理机构全面了解烧伤影响因素,合理制订和高效实施烧伤预防措施.全球烧伤每年约造成18万人死亡,其中大部分发生于低收入和中等收入国家.高收入国家得益于使用安全厨房灶具、安装烟雾探测器和消防花洒、设置儿童警示,甚至制定热水温度相关法规等一系列措施,在降低烧伤死亡方面取得了显著进展.而低收入和中等收入国家由于缺乏烧伤相关数据,无法准确制定和实施预防措施.为此,从2013年开始,WHO、全球清洁炉灶联盟(Global Alliance for Clean Cookstoves,GACC)、疾病预防控制中心(Centers for Disease Control and Prevention,CDC)和国际烧伤学会(International Society for Burn Injuries,ISBI)联合开发了一种简易的烧伤数据采集表格,并基于WHO DataCol(Data Collector)建立了用于验证该表格有效性的研究平台[2].2016年,Peck等 [3]报道:经过8个月来自30个国家52家医院的验证,完成该烧伤数据采集表约需5 min,85％的医院反映GBR数据采集表格对于制定、评估和监测烧伤预防措施非常有价值.经系统检索国内文献,尚未发现GBR数据采集表格中文翻译版及应用研究相关报道.为便于国内推广应用,笔者翻译该数据采集表格,并展望其应用.

目的 建立山羊自体肋软骨切取后软骨碎屑回植供区软骨膜的动物模型,以组织学、生物力学指标为观察对象,研究自体肋软骨碎块回植后的转归.方法 取8 ～12个月龄成年山羊12只随机分为3组,每组4只.肋软骨切取后,各组处理方法:Ⅰ组,直接将软骨膜缝合,形成封闭的空腔;Ⅱ组,将切取的肋软骨切碎成均匀的小碎块,将其回植填塞入肋软骨缺损处,总量约为缺损的1/5～1/4,缝合软骨膜封闭缺损;Ⅲ组,在Ⅱ组的基础上,在缺损段内喷入生物蛋白胶,使之充满回植入软骨碎屑的缺损腔隙,缝合软骨膜封闭;Ⅳ组,切取正常肋软骨作为对照,未做任何处理.术后16周处死并观察各组胸廓及修复段形态,利用生物力学检测各组肋软骨修复段强度.结果 Ⅰ～Ⅲ组胸廓形态良好,无塌陷,修复段组织与肋骨软骨连结处愈合较好,修复段呈纤维增生;组织学观察显示,Ⅰ～Ⅲ组修复组织主要为纤维组织,回植软骨均能存活,无明显增殖;压力、拉伸、折弯及撞击实验数据显示,Ⅱ组修复强度优于Ⅰ和Ⅲ组,但弱于Ⅳ组.结论 将软骨碎屑回植,虽不能促进软骨的再生修复,却能明显加强修复组织生物力学强度,加强胸廓的稳定性.

Objective To explore how to prevent the expander shifting after operation of deltopectoral flap predilatation. Methods 60 suitable cases were included in the study. Deltopectoral flaps predilatation was performed to treat these patients with suitable volume expanders, which also was needed to pay more attentions to sufficient hemostasis and disjuncting layer during the operation as well as early water flooding and appropriate immobilization after operation. Results all of 60 cases were well ectasised with complications of hematoma for 2 cases and syringe valve outerop for 3cases. After being corrected in time,all the cases were satisfactoried with the flaps well survival and faciocervical scars effectively repair after skin flaps transpositioned. Conclusion The combination of preoperative,intraoperative and postoperative intervention can effectively prevent the expander shifting after deltopectoral flap predilatation,which can be the better preparation for the second stage operation.

OBJECTIVE:To investigate the influence on costal cartilage reparative regeneration by replanting the small blocks of autogeneic cartilage into the perichondrial pocket at the donor-site. METHODS:16 rabbits (8-10 weeks old, 1.8-2.2 kg) were randomly divided into four groups as three experimental groups and one control group. The 1.5 cm in length of costal cartilage defect was made in experimental groups with the perichondrium and costochondral junction left completely intact. The cartilage defect was closed by 3 methods as saturation directly, or replanting the small blocks of autogeneic cartilage, or plugging bio-protein jelly after cartilage replanting. Each experimental group was handled with two methods in two sides of costal cartilage. No operation was performed in control group. All the rabbits were sacrificed 16 weeks after operation. The appearance of thoracic cage and new-formed tissue at the defect site were examined grossly. Haematoxylin-eosin staining was performed to evaluate the characteristics of new-formed tissues and biomechanical detection was used to measure intension of new-formed tissues. RESULTS:The appearance of thoracic cage was normal in every experimental group. Histological study showed that the defect was filled with abundant fibrous tissue in each group. The chipping of cartilage survived effectively with little proliferation. Biomechanical detection showed that the intension of new-formed tissue in the non-replanted group [(193.92 +/- 41.41) N] was obviously less than that in the replanted group [(318.88 +/- 28.28) N], or bio-protein jelly group [(301.00 +/- 39.52) N], or control group [(300.54 +/- 38.35) N] (P < 0.01). Furthermore, there was no statistical difference between the latter three groups (P > 0.05). CONCLUSIONS:Although replanting the chipping of cartilage can't promote reparative regeneration of hyaline cartilage, it can definitively strengthen the intensity of new-formed tissue, reinforce thoracic stability. It may also indirectly decrease the incidence rate of postoperative chest wall deformity.

<正>淋巴水肿是由于淋巴循环障碍及富含蛋白质的组织间液持续积聚引起,分为原发性和继发性两种,临床上以继发性多见,常由于手术、放疗、肿瘤等原因造成淋巴管狭窄、闭塞以及纤维化,使四肢远端淋巴回流受阻所致,最常见的是乳腺癌根治术后的上肢淋巴水肿[1]。