上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (9): 1251-.doi: 10.3969/j.issn.1674-8115.2012.09.023

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严重创伤畸形的修复与功能重建研究进展

李青峰   

  1. 上海交通大学 医学院附属第九人民医院整复外科, 上海 200011
  • 出版日期:2012-09-28 发布日期:2012-09-29
  • 作者简介:李青峰(1964—), 男, 教授, 主任医师, 博士, 博士生导师, 现任上海交通大学医学院附属第九人民医院整复外科行政科主任；电子信箱: liqfliqf@yahoo.com.cn。
  • 基金资助:

    教育部新世纪优秀人才计划（NTEC-04-0436）；国家自然科学基金杰出青年基金（30925034）；国家中长期科技计划公益行业基金（361-200802014）；国家自然科学基金重点项目（30730092, 81230042）；国家“十二五”科技支撑计划（2012BAI11B03）

Appearance repair and functional reconstruction of severe post-traumatic deformity

LI Qing-feng   

  1. Department of Plastic and Reconstructive Surgery, the Ninth People´s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
  • Online:2012-09-28 Published:2012-09-29

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摘要：

严重创伤畸形，是指因烧伤、交通伤、工业伤和爆炸伤等常见重大创伤所致的重要体表器官缺损、畸形和功能障碍。这类疾病具有二大特点，一是高发性和多发性；二是高危害性。作为创伤治疗的主要学科，目前应用的主要修复技术存在很大的局限性和不足：治疗目的仍以“创面修复”为主；治疗手段则仍采用“创伤修复创伤”模式，尚不能达到“形态和功能”重建的治疗目的。本项目是通过将分子生物学、干细胞、数字医学等新知识新技术与传统整形外科技术的结合，发展出更为有效的治疗新方法。完成情况如下：①建立了干细胞移植治疗为主的预构组织血管化生成新技术。②提出并建立了以预构皮瓣技术结合传统皮肤扩张技术为基础的体表组织器官修复再造新理念和新技术。③完成了软组织动态三维力学数字化分析，三维数字模拟软件应用与开发，实现了在2~3种代表性颅面畸形治疗中的应用。④建立和改良了“咬肌神经修复支配面肌功能”“胸锁乳突肌重建面瘫肌肉功能”等新的治疗方法。上述新技术、新方法的开展，显著提高了诸多常见病、疑难病治疗效果。

关键词: 创伤畸形, 干细胞, 预构皮瓣, 组织扩张, 颅面畸形, 面瘫

Abstract:

Severe post-traumatic deformities are defined as severe superficial organs defect, deformity and dysfunction that result from burn, traffic injury, industrial injury or blast injury. This kind of disease has two general characteristics: high incidence and grave harmfulness. In the field of plastic and reconstructive surgery which is the main subject for the restoration of post-traumatic deformities, the weaknesses and limitation of main reconstructive techniques at present is obvious: current treatments aim for recovery of defect, far from the reconstruction of function and appearance. This project has created new more effective treatments by means of the combination of molecular biology, stem cells technology and digital medicine with conventional plastic and reconstructive surgery techniques. The main progress is as follows: (1) Flap prefabrication is a frontier technique for treatment of severe posttraumatic deformities. However, insufficient neovascularization and subsequent necrosis remain difficult problems in applications of the technique. It is found that “therapeutic vasculogenesis” with stem cell transplantation is superior to “therapeutic angiogenesis” with vascular endothelial growth factor (VEGF) administration in improving revascularization during flap prefabrication in our research. The therapeutic vasculogenesis effect of somatic stem cells can be enhanced by VEGF gene transfection, which means a reduced quantity of stem cells would be needed for treatment after VEGF gene transfection. The further founding is that application of hypoxia-mimetic could promote the directional migration and homing of transplanted stem cells. (2) Series methods and revolution of superficial tissue and organ reconstruction with flap prefabrication and tissue expansion. (3) The 3-d digital dynamic mechanics analysis of soft tissue is accomplished. And 3-d digital simulation software has been applied in the treatment of 2-3 types of typical craniofacial deformities successfully. (4) Some treatment methods are established or improved such as facial nerve reconstruction by masseter-facial nerve coaptation, transposition of pedicled sternocleidomastoid muscle for repair of facial paralysis, etc. By the development and application of these new techniques and methods mentioned above, the therapeutic effects were well improved.

Key words: post-traumatic deformities, stem cell transplantation, soft tissue expansion, craniofacial deformities, facial paralysis