目的:探讨单采富含血小板血浆治疗膝关节骨性关节炎的治疗效果.方法:选取我院2019年10月到2021年10月收治的100例膝关节骨性关节炎患者作为研究对象,将所有患者依照随机分为联合组与对照组,各50例.对照组患者采取常规股神经脉冲射频术治疗,联合组在对照组基础上增加单采富含血小板血浆治疗,对比两组患者的近远期膝关节疼痛程度,治疗前后白细胞介素-6(IL-6)、白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)表达水平,膝关节功能以及不良反应情况.结果:治疗后1个月、治疗后6月、治疗后1年两组患者视觉模拟量表(VAS)评分逐渐降低,且联合组低于对照组(P＜0.05);两组患者治疗前IL-6、IL-1、TNF-α相关炎症因子水平对比无差异(P＞0.05),治疗后水平均降低,且联合组较对照组低(P＜0.05);治疗前两组患者膝关节主观(IKDC)评分、膝关节功能(Lysholm)评分对比无明显差异(P＞0.05),治疗后两组患者IKDC评分、Lysholm评分均明显降低,且联合组较对照组低(P＜0.05);两组患者不良反应对比无差异(P＞0.05).结论:膝关节骨性关节炎患者在常规治疗基础上增加单采富含血小板血浆治疗能够减轻患者近远期疼痛感,降低患者机体炎症反应,提升膝关节功能,且安全性较高,值得临床应用推广.

目的 观察富血小板血浆(PRP)治疗慢性难愈性创面的临床疗效.方法 选取中国人民解放军联勤保障部队第九二〇医院2019年12月至2020年12月因创伤、压疮、糖尿病等所致慢性难愈性创面的52例患者为研究对象,根据患者是否接受PRP治疗将研究对象分为PRP组和常规组两组,其中PRP组32例,常规组20例.所有患者均给予门诊手术彻底清创,PRP组术后给予PRP凝胶覆盖创面,3 d更换1次凝胶,3次为1个疗程;常规组术后常规换药,根据创面愈合情况选择植皮或皮瓣转移加速创面愈合.1个月后观察两组创面的愈合效果.结果 PRP组32例患者创面经过2～4次PRP凝胶治疗后,均获得痂下愈合,创面愈合时间(25.25±4.93)d,平均换药(5.09±3.21)次.常规组16例经常规换药后愈合,3例植皮后愈合,1例行带蒂皮瓣转移术后愈合,创面愈合时间(42.95±7.97)d,平均换药(24.70±5.70)次.PRP组创面内表皮生长因子(EGF)、胰岛素样生长因子(IGF)、血小板衍生生长因子(PDGF)、转化生长因子β(TGF-β)、血管内皮生长因子(VEGF)的浓度明显高于常规组(P<0.05).结论 与传统的治疗方式相比,富血小板血浆能显著增加创面生长因子浓度,加速伤口愈合,缩短治疗时间,减少治疗费用,减轻患者痛苦.

手部损伤是常见损伤.手部不同组织、不同类型以及不同程度的损伤,其修复方法 各异.本文就手部不同组织损伤特点,提出相应的修复重建方法 ,并对近年来的新方法 、新进展进行归纳总结.

Objective:To investigate the effect of free anterolateral thigh perforator flap in repair of forefoot injuries combined with multiple tissue defect.Methods:A retrospective case series study was conducted on 26 patients who suffered from forefoot injuries combined with multiple tissue defect admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2015 to December 2019. There were 21 males and 5 females, aged 15-61 years [(31.6±12.5)years]. The combined injuries were fracture in 10 patients, arsometatarsal joint dislocation in 3, bone defect in 9, tendon injury in 5, and ligament injury in 3. Management of multiple tissue defect of the forefeet: soft-tissue defect of the forefeet was resurfaced with free anterolateral thigh perforator flaps with the dimension of 6.0 cm×3.5 cm to 26.5 cm×10.0 cm; fracture was fixed by Kirschner wires; joint dislocation was treated by open reduction and Kirschner wires fixations; bone defect was reconstructed either by one-stage bone graft or by use of membrane-induced technique and secondary bone graft, according to the wound conditions; tendon injury of extensor digitorum longus was repaired by direct tendon suture or by tendon transfer; tarsometatarsal ligament injury was primarily sutured. The flap survival rate was observed within 2 weeks after operation. The fracture healing, bone-defect repair, foot appearance, and donor-site healing were detected at 1 month, 3 months, 6 months, 1 year post-operatively and at the last follow-up. The postoperative complications were recorded. The foot function was assessed using American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before operation and at the final follow-up.Results:All patients were followed up for 6-36 months [(20.5±4.6)months]. All flaps survived uneventfully. The fracture healing and bone defect repair were acquired. The flap showed good texture, including primary flap thinning in 11 patients and secondarily thinning in 15 patients at 3-6 months postoperatively. The donor sites showed good healing, leaving only a linear scar. The flap venous crisis developed in 1 patient and survived after emergency vascular exploring. Local infection of flap occurred in 3 patients and was cured after further debridement and the use of sensitive antibiotics. The AOFAS ankle-hindfoot score was 54-94 points [(76.6±10.4)points] at the last follow-up, compared to preoperative 11-51 points [(27.2±11.3)points] ( P<0.01). The results were excellent in 5 patients, good in 11, and fair in 10, with the excellent and good rate of 62%. Conclusions:For forefoot injuries combined with multiple tissue defect, anterolateral thigh perforator flap transplantation with additional techniques to treat fractures, bone defect, tendon and ligament injuries can achieve satisfactory results in aesthetic appearance of the flap and donor site and foot function recovery.

目的:了解昆明地区泌尿生殖道支原体属感染和对抗菌药物的耐药情况.方法:采用支原体属药敏定量培养试剂盒鉴定、检测患者泌尿生殖道分泌物,分析解脲支原体﹙Uu﹚和人型支原体﹙Mh﹚对12种抗生素的耐药性.结果:受检的3322例患者中支原体属感染2129例,阳性率64.1％;其中单一解脲支原体﹙Uu﹚占81.3％,解脲支原体﹙Uu﹚和人型支原体﹙Mh﹚均阳性占16.2％,单一人型支原体﹙Mh﹚阳性占2.5％.单一解脲支原体﹙Uu﹚对环丙沙星耐药性最强,对交沙霉素耐药性最弱.结论:昆明地区泌尿生殖道感染以单一解脲支原体属﹙Uu﹚感染为主,对环丙沙星耐药性最强,对交沙霉素耐药性最弱.