【摘要】：毛發(fā)相對(duì)于人的五官來說有著非常重要的美學(xué)價(jià)值。健康的頭發(fā)能夠提升一個(gè)人的自信與魅力。脫發(fā)作為一種臨床常見毛發(fā)病,雖不屬嚴(yán)重疾病,但卻對(duì)人們的精神、心理產(chǎn)生較大的影響。因此,人們對(duì)禿發(fā)的診治要求日益迫切,現(xiàn)代醫(yī)學(xué)也越來越重視對(duì)脫發(fā)的研究。目前臨床上常見的脫發(fā)類型包括雄激素性脫發(fā)、瘢痕性脫發(fā)、先天性脫發(fā)及斑禿[1]。對(duì)于小面積的脫發(fā)患者來說,單位毛囊顯微移植術(shù)是最常應(yīng)用的治療方法,采用該項(xiàng)技術(shù)可實(shí)現(xiàn)毛囊在禿發(fā)區(qū)域的重新再分布,并能基本達(dá)到一個(gè)較為理想的遠(yuǎn)期術(shù)后外觀。因此在近年來被廣泛應(yīng)用于頭發(fā)、眉毛、胡須甚至是陰毛的修復(fù)。但無論是哪一種修復(fù)技術(shù)的采用,都是以患者自體擁有充足的供區(qū)毛發(fā)為前提,其毛發(fā)來源相對(duì)有限,對(duì)于大面積脫發(fā)患者甚至是全禿患者來說,該技術(shù)存在供區(qū)不足的隱患。同時(shí),供區(qū)遺留永久性瘢痕、移植成活率不穩(wěn)定等問題也明顯影響該項(xiàng)技術(shù)的遠(yuǎn)期效果。許多禿發(fā)患者頭發(fā)的丟失是進(jìn)行性的,毛發(fā)修復(fù)也無法逆轉(zhuǎn)或是其停止,更無法預(yù)測(cè)去發(fā)展情況。所以,如何提供更多毛發(fā)來源成為現(xiàn)今毛發(fā)修復(fù)外科較難解決的問題。毛囊組織工程近年來就此問題進(jìn)行了深入的探討和研究并取得了一定進(jìn)展,已經(jīng)通過將鼠源和人源毛囊細(xì)胞重建出毛囊,但經(jīng)傳代培養(yǎng)后的毛乳頭細(xì)胞和毛囊干細(xì)胞活性下降,難以獲得具有高活性的細(xì)胞。但其研究仍然屬實(shí)驗(yàn)室研究階段,并未能真正投入臨床工作中。在此背景下出現(xiàn)的人工毛發(fā)移植為這些問題的解決帶來了希望。 為解決上述供區(qū)嚴(yán)重不足患者的臨床需求,國(guó)內(nèi)外學(xué)者對(duì)人工毛發(fā)進(jìn)行了積極地探索和研究。1976年首先由日本學(xué)者提出了人工毛發(fā)移植這一概念。但是最初的人工毛發(fā)是由工業(yè)上使用的聚酯纖維、聚丙烯酸、人造纖維或是加工過的人體毛發(fā),為了使人工毛發(fā)更加逼真,還需對(duì)其進(jìn)行染色。而這些化工原料本身和染色劑均對(duì)人體有著較大的毒副作用從而導(dǎo)致人體產(chǎn)生排異反應(yīng)。幾乎所有的移植物均在10周內(nèi)脫落,甚至還伴隨包括持續(xù)存在的面部浮腫,蜂窩織炎、頭皮硬結(jié)、永久性瘢痕和持續(xù)性的頭發(fā)自然脫落在內(nèi)的嚴(yán)重的毒副作用和永久性后遺癥。但由于其具備操作簡(jiǎn)單、不受供區(qū)限制、術(shù)后外觀良好等優(yōu)勢(shì),研究者一直未放棄對(duì)人工毛發(fā)的改進(jìn)[2]。1996年意大利學(xué)者提出了一種boifiber合成纖維(聚酰胺人工毛發(fā)纖維)。隨后陸續(xù)有國(guó)外學(xué)者將這種纖維在臨床應(yīng)用于修復(fù)禿發(fā),結(jié)果顯示其組織相容性良好,可考慮將其用于大面積禿發(fā)的修復(fù)。但通過長(zhǎng)期臨床觀察和回訪發(fā)現(xiàn),該聚酰胺人工毛發(fā)纖維的年脫落率約為20-25%,患者需定期進(jìn)行補(bǔ)種[2,3]。這就給廣大患者的生活帶來了極大不便,因此依然無法確實(shí)地滿足患者的需求。我科實(shí)驗(yàn)室自2005年起開始自主研發(fā)毛囊單位樣結(jié)構(gòu)可移植假發(fā)(聚丙烯人工毛發(fā))[6],經(jīng)過兩代的技術(shù)改良,也已將其應(yīng)用于動(dòng)物實(shí)驗(yàn)和臨床研究[7]。以上兩種人工毛發(fā)的組織相容性及遠(yuǎn)期效果仍然值得探討。針對(duì)進(jìn)一步降低人工毛發(fā)的術(shù)后不良反應(yīng)、外觀不自然,遠(yuǎn)期脫落率等問題,我們可以更加系統(tǒng)全面的對(duì)臨床上各種類型的永久性脫發(fā)的的療法進(jìn)行補(bǔ)充和完善。本實(shí)驗(yàn)研究擬采用眼科鑷和持針器在原有活結(jié)之上再打一個(gè)外科結(jié),當(dāng)纖維拉緊時(shí)形成的線結(jié)較前增大一倍,以期可以更牢固的將聚酰胺人工毛發(fā)纖維固定在頭皮中。從而可以降低其遠(yuǎn)期脫落率。觀察聚酰胺人工毛發(fā)纖維植入后的組織相容性及遠(yuǎn)期效果,探索其作為一種治療毛發(fā)缺失疾病的新療法廣泛應(yīng)用于臨床的可能。 材料與方法 1、實(shí)驗(yàn)材料及儀器 聚酰胺人工毛發(fā)纖維(深圳天林實(shí)業(yè)有限公司,CE0373/TGA, Medicap Ltd.,Carpi (MO), Italy),移植筆(Medicap Ltd授權(quán),深圳天林實(shí)業(yè)有限公司),持針器,眼科鑷,壓力蒸汽消毒器,光學(xué)顯微鏡,生物顯微鏡。 2、聚酰胺人工毛發(fā)纖維的固定結(jié)改良 聚酰胺人工毛發(fā)纖維外觀與人發(fā)極為相似,其一端連有一個(gè)活結(jié),用移植筆頭的彎針?biāo)鶐У墓葱皖^勾住該活結(jié)頭就可準(zhǔn)確地將纖維移植入頭皮中。隨著移植針頭深入進(jìn)頭皮,活結(jié)滑動(dòng)拉緊,固定在頭皮下�，F(xiàn)采用眼科鑷和持針器在原有活結(jié)之上再打一個(gè)外科結(jié),當(dāng)纖維拉緊時(shí)形成的線結(jié)較前增大一倍,可以更牢固的固定在頭皮中。本實(shí)驗(yàn)用纖維呈黑色,長(zhǎng)度為15cm。 3、聚酰胺人工毛發(fā)纖維的動(dòng)物移植 選取新西蘭大白兔作為實(shí)驗(yàn)動(dòng)物,將其隨機(jī)分為A、B兩組,A組為對(duì)照組,行常規(guī)方法移植；B組為實(shí)驗(yàn)組,行改良后方法移植。 在白兔耳緣靜脈注射3.0%戊巴比妥鈉30mg／kg麻醉,至瞬目反射消失。麻醉成功后,白兔呈俯臥位,固定其四肢；剃除白兔頭頂部兔毛,備皮；使用0.3%碘伏、75%酒精消毒頭部皮膚,鋪無菌孔巾。使用移植筆針頭勾住聚酰胺人工毛發(fā)纖維的結(jié)頭,將其植入白兔頭頂部皮膚至皮下,深度為2~3mm。每只兔子頭頂部取兩個(gè)區(qū)域進(jìn)行移植,一個(gè)區(qū)域進(jìn)行大體觀察,另一區(qū)域行組織學(xué)觀察。每個(gè)區(qū)域分別植入50根纖維,單只兔子共植入纖維100根。移植完成后修剪外露部的纖維長(zhǎng)度,單層紗布輕輕覆蓋移植創(chuàng)面,第二天將其取下。 4、聚酰胺人工毛發(fā)纖維的遠(yuǎn)期脫落率觀察 術(shù)后定期觀察白兔的頭部傷口愈合情況,有無紅腫、潰爛及移植纖維的整體外觀。分別于術(shù)后1周,1個(gè)月,3個(gè)月,9個(gè)月,12個(gè)月對(duì)兩組白兔頭部遺留人工纖維進(jìn)行計(jì)數(shù),計(jì)算毛發(fā)的脫落率。 5、聚酰胺人工毛發(fā)纖維的組織學(xué)觀察 在術(shù)后1周,1個(gè)月,3個(gè)月,9個(gè)月,12個(gè)月時(shí),在無菌條件下將10只兔子組織觀察區(qū)域內(nèi)的全層頭皮帶聚酰胺人工毛發(fā)纖維一起取下,漂洗去血漬后用10%甲醛固定,常規(guī)石蠟包埋,切片,HE染色,不同組織深度切片觀察聚酰胺人工毛發(fā)纖維周圍的組織反應(yīng)情況。 6、統(tǒng)計(jì)學(xué)處理 所得數(shù)據(jù)用SPSS16.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,對(duì)常規(guī)纖維移植和改良后的纖維移植的年脫落率比較采用兩獨(dú)立樣本t檢驗(yàn)分析處理, P0.05為有顯著差異。 結(jié)果 1.移植的聚酰胺人工毛發(fā)纖維與真發(fā)外觀相似,可通過特制移植器實(shí)現(xiàn)定向移植,移植后纖維方向良好,分布自然,外觀效果滿意。術(shù)后即時(shí)可見移植孔周圍輕度出血紅腫,一周后移植孔愈合,周圍兔毛正常生長(zhǎng)。至術(shù)后一年移植纖維處瘢痕肉眼不可辨,纖維周圍未見有異常滲出,破潰及糜爛。 2.觀察對(duì)照組和實(shí)驗(yàn)組可以發(fā)現(xiàn),在移植后一月內(nèi)可見數(shù)量不等的移植物脫落,主要集中在移植術(shù)后一周,此后隨著周圍皮膚組織的包繞和聚酰胺人工毛發(fā)纖維固定結(jié)頭的錨定,纖維脫落逐漸減少,在移植后半年后基本不再有脫落現(xiàn)象。1年后觀察,對(duì)照組(A組)的平均脫落率約為24±2.4%,實(shí)驗(yàn)組(B組)的平均脫落率約為10±3.1%,二者之間存在顯著差異(P0.0001)。 3.移植后1周聚酰胺人工毛發(fā)纖維固定結(jié)頭周圍可以見到輕度的炎癥反應(yīng)細(xì)胞,毛細(xì)血管輕度充血,纖維周圍可見到增生的上皮細(xì)胞包繞,炎癥反應(yīng)輕微；移植術(shù)后1個(gè)月,移植纖維周圍組織的炎癥細(xì)胞和淋巴細(xì)胞明顯減少,膠原纖維增多,纖維周圍依舊可見上皮細(xì)胞包繞,3-9個(gè)月后淋巴細(xì)胞及其它炎癥反應(yīng)細(xì)胞基本消失,膠原纖維增生反應(yīng)明顯,無色素沉著；1年后纖維周圍只可見到大量的膠原纖維包繞,無淋巴細(xì)胞等炎癥細(xì)胞浸潤(rùn),局部無色素沉著。 結(jié)論 綜上所述,本實(shí)驗(yàn)通過使用精細(xì)眼科鑷和持針器對(duì)聚酰胺人工毛發(fā)纖維的固定結(jié)頭進(jìn)行改良,增大其固定結(jié)頭體積。通過動(dòng)物實(shí)驗(yàn)可以觀察到,聚酰胺人工毛發(fā)纖維具有良好的組織相容性,增大其固定結(jié)頭并不會(huì)引起更強(qiáng)烈的組織排斥,且移植后纖維外觀與真發(fā)相似,改良后移植纖維脫落率大大降低。這很有可能在將來為臨床大面積禿發(fā)患者提供更多的治療選擇。該聚酰胺人工毛發(fā)纖維可根據(jù)患者自身毛發(fā)的長(zhǎng)度及色澤進(jìn)行定制,用于修復(fù)大面積禿發(fā),縮短患者手術(shù)時(shí)間、降低患者手術(shù)痛苦,并且可以省去臨床毛發(fā)移植外科醫(yī)師的毛囊提取程序,可為臨床工作帶來極大的方便。
[Abstract]:Hair has a very important aesthetic value relative to the five senses of human beings. Healthy hair can enhance one's self-confidence and charm. As a common clinical hair disease, alopecia is not a serious disease, but it has a great impact on people's spirit and psychology. Therefore, the diagnosis and treatment of alopecia is increasingly urgent, modern medicine. More and more attention has been paid to the study of alopecia.The most common types of alopecia include androgenic alopecia, cicatricial alopecia, congenital alopecia and alopecia areata[1].For small area alopecia patients, unit hair follicle microtransplantation is the most commonly used treatment method, which can achieve hair follicle in the alopecia area again. It is widely used in hair, eyebrows, whiskers and even pubic hair repair in recent years. However, the use of any repair technique is based on the fact that the patient has sufficient donor hair, and the source of hair is relatively limited for large area alopecia. Many bald patients have progressive hair loss, hair repair can not be reversed or stopped, and the development of estrus can not be predicted. In recent years, hair follicle tissue engineering has made some progress in this field. Mouse and human hair follicle cells have been reconstructed into hair follicles, but subcultured dermal papilla cells and hair follicle trunks have been subcultured. It is difficult to obtain cells with high activity because of the decrease of cell activity. However, the research is still in the stage of laboratory research and can not really be put into clinical work.
In 1976, Japanese scholars first proposed the concept of artificial hair transplantation, but the original artificial hair was made of industrial polyester fiber, polyacrylic acid, artificial fiber or processed people. Body hair, in order to make artificial hair more realistic, needs to be dyed. These chemicals themselves and dyes have a greater toxic side effects on the human body resulting in rejection. Almost all grafts are shed within 10 weeks, and even accompanied by persistent facial edema, cellulitis, scalp. Severe toxic side effects and permanent sequelae, including induration, permanent scarring and persistent hair loss, have not been abandoned by researchers because of its advantages such as simple operation, no donor site restriction and good appearance after operation [2].In 1996, Italian scholars proposed a boifiber synthetic fiber. Afterwards, some foreign scholars have applied this kind of fibers to repair bald hair. The results show that the fibers have good histocompatibility and can be used to repair large area alopecia. Since 2005, our laboratory has independently developed a hair follicle unit-like structure transplantable wig (polypropylene artificial hair)[6]. After two generations of technical improvement, it has also been used in animal experiments and clinical practice. Study [7]. The histocompatibility and long-term effect of the above two kinds of artificial hair are still worth discussing. In order to further reduce the adverse reactions, unnatural appearance and long-term shedding rate of artificial hair, we can more systematically and comprehensively complement and perfect the clinical treatment of various types of permanent hair loss. In order to fix polyamide artificial hair fibers firmly in the scalp, a surgical knot will be made on top of the original knot by ophthalmic tweezers and needle holder. The long-term shedding rate will be reduced. The histological phase of the implanted polyamide artificial hair fibers will be observed. To explore the long-term effect and tolerance of the treatment of hair loss as a new treatment of hair loss disease is widely used in clinical possibilities.
Materials and methods
1, experimental materials and instruments
Polyamide artificial hair fiber (Shenzhen Tianlin Industrial Co., Ltd., CE0373/TGA, Medicap Ltd., Carpi (MO), Italy), transplant pen (Medicap Ltd authorization, Shenzhen Tianlin Industrial Co., Ltd.), needle holder, ophthalmic tweezers, pressure steam disinfector, optical microscope, biological microscope.
2, improved fixation of polyamide artificial hair fibers.
The appearance of polyamide artificial hair fiber is very similar to that of human hair. One end of the fiber is connected with a knot. The knot can be accurately transplanted into the scalp by hooking the knot head with the curved needle of the transplanted pen. With the needle penetrating into the scalp, the knot slides and tightens and is fixed under the scalp. A surgical knot is made on top of the flexible knot. The knot formed when the fiber is tensioned doubles and can be more firmly fixed in the scalp.
3, animal transplantation of polyamide artificial hair fibers
New Zealand white rabbits were randomly divided into group A and group B. Group A was the control group, and group B was the experimental group.
After anesthesia, the rabbits were in prone position and fixed their limbs; the rabbit's hair was shaved off, and the skin was prepared; 0.3% iodophor and 75% alcohol were used to disinfect the skin of the head and spread aseptic orifice towels. The knots of polyamide artificial hair fibers were hooked with a pencil needle. Each rabbit was transplanted in two areas on the top of the head. One area was grossly observed and the other area was histologically observed. Fifty fibers were implanted in each area and 100 fibers were implanted in each rabbit. Cover the wound lightly and remove it second days later.
4, the long-term abscission rate of polyamide artificial hair fibers
The wound healing of the rabbit's head was observed regularly after operation, whether there was redness, swelling, ulceration and the overall appearance of the grafted fibers.
5. Histological observation of polyamide artificial hair fibers
At 1 week, 1 month, 3 months, 9 months and 12 months after operation, 10 rabbits were taken off the full-thickness scalp-belt polyamide artificial hair fibers in the observation area under aseptic condition. After bleeding, they were fixed with 10% formaldehyde, embedded in routine paraffin, stained with HE, and observed around the polyamide artificial hair fibers in different tissue depths. Tissue reaction.
6, statistical processing
The data were statistically processed by SPSS16.0 software. The annual shedding rate of conventional fiber transplantation and improved fiber transplantation were compared and analyzed by two independent samples t test. The difference was significant in P 0.05.
Result
1. The transplanted polyamide artificial hair fiber is similar to the real hair in appearance, and can be transplanted by special transplanter. The fibers have good orientation, natural distribution and satisfactory appearance. There is no discernible mark on the naked eye. There is no abnormal exudation, ulceration and erosion around the fibers.
2. Observation of the control group and the experimental group can be found in a month after transplantation, the number of graft shedding, mainly concentrated in one week after transplantation, and then with the surrounding skin tissue wrapping and polyamide artificial hair fiber anchorage, fiber shedding gradually reduced, after six months of transplantation basically no shedding phenomenon. One year later, the average shedding rate of the control group (group A) was about 24.4%, and that of the experimental group (group B) was about 10.3.1%. There was a significant difference between the two groups (P 0.0001).
3. There were mild inflammatory cells around the fixed nodule of polyamide artificial hair fiber one week after transplantation, mild congestion of capillaries, and proliferation of epithelial cells around the fibers with mild inflammation. One month after transplantation, inflammatory cells and lymphocytes in the tissues around the transplanted fibers were significantly reduced and collagen fibers were increased. Many, still visible around the fiber epithelial cells wrapped, 3-9 months later lymphocytes and other inflammatory cells disappeared, collagen fiber proliferation reaction is obvious, no pigmentation; 1 year later around the fiber only visible a large number of collagen fibers wrapped, no lymphocytes and other inflammatory cells infiltration, local no pigmentation.
conclusion
To sum up, the fixed ends of polyamide artificial hair fibers were improved by using fine ophthalmic tweezers and needle holders to increase the volume of fixed ends. It may provide more treatment options for patients with large area alopecia in the future. The polyamide artificial hair fiber can be customized according to the length and color of the patients'hair, used to repair large area alopecia and shorten the patients' hands. The operation time can reduce the patient's operation pain and save the hair follicle extraction procedure of clinical hair transplantation surgeon, which can bring great convenience for clinical work.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.71

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