本文選題：鼓膜穿孔　切入點：軟骨-軟骨膜　出處：《安徽醫(yī)科大學》2016年碩士論文

【摘要】：目的1.比較鼓膜穿孔后,植入軟骨-軟骨膜復合體重建鼓膜的時間與鼓膜自行愈合時間的差異是否有統(tǒng)計學意義。2.探討應用軟骨-軟骨膜復合體作為植入體重建鼓膜過程中,軟骨-軟骨膜復合體厚度的變化趨勢。3.觀察軟骨-軟骨膜復合體用于鼓膜穿孔修補重建鼓膜術(shù)中,其不同愈合時期,重建鼓膜的組織學結(jié)構(gòu)及其纖維-軟骨膜層血管密度的變化,并了解不同時期血管數(shù)量的差異有無顯著性。方法研究對象均來源于安徽省立醫(yī)院動物實驗中心飼養(yǎng)豚鼠,共選取45只雄性健康雜色豚鼠(200-250g),所有研究對象的飼養(yǎng)、管理及實驗過程均符合國際科學技術(shù)委員會發(fā)布的《實驗動物管理條例》、衛(wèi)生部發(fā)布的《醫(yī)學實驗動物管理實施細則》和安徽醫(yī)科大學實驗動物理論委員會章程,實驗用豚鼠全身無明顯畸形,耳廓反射正常,耳內(nèi)鏡下檢查外耳道及鼓膜均正常。將45只雄性豚鼠隨機分為A、B、C三組,每只豚鼠分別在顯微鏡下行左側(cè)耳鼓膜穿孔術(shù),術(shù)后立即采用耳甲腔軟骨-軟骨膜復合體作植入體修補同側(cè)穿孔鼓膜,其中B組5只豚鼠的右耳行鼓膜穿孔造模,不行鼓膜修補術(shù)。分別觀察A組(2周)、B組(6周)及C組(12周),記錄各組研究對象鼓膜愈合時間,測量不同愈合時期植入的軟骨-軟骨膜復合體重建鼓膜的厚度,觀察顯微鏡下植入復合體的組織學形態(tài),并在顯微鏡下記錄纖維-軟骨膜層血管數(shù)量的多少。所得數(shù)據(jù)應用計算機SPSS16.0分析軟件對數(shù)據(jù)進行統(tǒng)計處理。結(jié)果1.經(jīng)過觀察,左耳鼓膜愈合時間為3.8±0.84天,右耳鼓膜穿孔自行愈合時間為7.2±0.84天,左耳鼓膜愈合時間較右耳明顯縮短,差異有統(tǒng)計學意義(P0.05);2.三組中植入后復合體的厚度變化為A組(0.227±0.024mmm),較植入前增大14.4%,差異有統(tǒng)計學意義(P0.05)；B組(0.191±0.016mm),軟骨厚度較植入前無顯著變化(P0.05),且較A組術(shù)后兩周時厚度降低,組間差異有統(tǒng)計學意義(P0.05);C組(0.169±0.017mm)較植入前減小14.2%,差異有統(tǒng)計學意義(P0.05),且與A組相比減少34.2%,組間差異顯著(P0.05);3.重建鼓膜中纖維-軟骨膜層血管密度：植入后第2周,纖維-軟骨膜層單位面積中血管數(shù)量(13.28±2.49)個,植入后第6周,單位面積中血管數(shù)量(7.71±2.49)個,植入后第12周,單位面積內(nèi)鮮有血管存在,且各組間單位面積血管數(shù)量差異均有統(tǒng)計學意義(P0.05)。第2周和第6周時重建鼓膜的組織學結(jié)構(gòu)為鱗狀上皮層、纖維-軟骨膜層、軟骨層和粘膜層。第12周時為鱗狀上皮層、軟骨層和粘膜層。結(jié)論植入體重建鼓膜的愈合時間短于鼓膜白行愈合的時間；三組中植入后復合體的厚度較植入前呈先增大后減小的變化；重建鼓膜中纖維-軟骨膜層血管數(shù)量表現(xiàn)為先增加后減少；重建鼓膜最終組織學分層與正常鼓膜組織學結(jié)構(gòu)相似。從組織學的角度,軟骨-軟骨膜復合體是一種適宜的鼓膜修補材料。
[Abstract]:Objective 1. To compare the difference between the time of reconstruction of tympanic membrane and the time of self-healing of tympanic membrane after tympanic membrane perforation. 2. To explore the use of chondrochondral complex as body weight in the process of tympanic membrane reconstruction. The change trend of chondrochondrochondral complex thickness. 3. To observe the effect of chondrochondrochondral complex on tympanic membrane repair and reconstruction in different healing stages. The histological structure of the reconstructed tympanic membrane and the changes of vascular density of fibrous chondrocyte layer were studied. Methods the subjects of the study were collected from the animal experimental center of Anhui Provincial Hospital to raise guinea pigs. A total of 45 male healthy heterochromatic guinea pigs were selected for feeding. The management and experimental process are in accordance with the regulations on the Management of Laboratory Animals issued by the International Commission of Science and Technology, the rules for the implementation of the Management of Medical Laboratory Animals issued by the Ministry of Health, and the articles of association of the Committee on Experimental Animal Theory of Anhui Medical University. There were no obvious deformities, normal auricle reflex and normal external auditory meatus and tympanic membrane under endoscope in guinea pigs. Forty-five male guinea pigs were randomly divided into three groups, the left ear tympanic membrane perforation was performed under microscope, and 45 male guinea pigs were randomly divided into three groups. The tympanic membrane of ipsilateral perforated tympanic membrane was repaired with the chondrochondrochondral complex of the auricular cavity immediately after operation, and the tympanic membrane perforation was made in the right ear of 5 guinea pigs in group B. No tympanic membrane repair was performed. The tympanic membrane healing time was recorded in group A (2 weeks) and group C (6 weeks), and the thickness of cartilage chondrochondral complex implanted in different healing period was measured. The histological morphology of the implanted complex was observed under the microscope, and the number of fibrochondrocytes was recorded under the microscope. The data were statistically processed by computer SPSS16.0 software. Results 1. The healing time of tympanic membrane was 3.8 鹵0.84 days in left ear and 7.2 鹵0.84 days in right ear. The healing time of tympanic membrane in left ear was significantly shorter than that in right ear. In group A, the thickness of complex was 0.227 鹵0.024 mm ~ (-1), which was increased by 14.4mm ~ (-1) than that before implantation. The difference was statistically significant (P < 0.05). The thickness of cartilage in group B was not significantly changed compared with that before implantation (P 0.05mm), and the thickness of cartilage was lower than that of group A at two weeks after implantation, and the thickness of cartilage was lower than that of group A at two weeks after implantation, and the thickness of cartilage in group B was significantly lower than that in group A at two weeks after implantation. There was a significant difference between the two groups (P 0.05 鹵0.017 mm). The difference was statistically significant (P 0.05 鹵0.169 鹵0.017 mm), and the difference was significant compared with group A (P 0.05). The vascular density of fibrous chondrochondral layer in the reconstructed tympanic membrane was significantly lower than that in group A at 2 weeks after implantation. There were 13.28 鹵2.49 vessels per unit area of fibrous chondrochondral layer and 7.71 鹵2.49 vessels per unit area at the 6th week after implantation. At the 12th week after implantation, there were few vessels in the unit area. The histological structure of the reconstructed tympanic membrane was squamous epithelium layer, fibrochondral layer, chondroid layer and mucosal layer at the 2nd and 6th week, and squamous epithelium layer at the 12th week. Conclusion the healing time of the tympanic membrane was shorter than that of the white tympanic membrane in the three groups, and the thickness of the complex increased first and then decreased in the three groups. The number of fibrochondral lamina vessels in the reconstructed tympanic membrane increased first and then decreased. The final histological stratification of the reconstructed tympanic membrane was similar to that of the normal tympanic membrane. Cartilage-chondrochondral complex is a suitable material for tympanic membrane repair.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R764.9

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