改良后的聚酰胺人工毛发纤维的组织相容性及远期脱落率的实验研究

发布时间：2018-09-14 07:41

【摘要】：毛发相对于人的五官来说有着非常重要的美学价值。健康的头发能够提升一个人的自信与魅力。脱发作为一种临床常见毛发病,虽不属严重疾病,但却对人们的精神、心理产生较大的影响。因此,人们对秃发的诊治要求日益迫切,现代医学也越来越重视对脱发的研究。目前临床上常见的脱发类型包括雄激素性脱发、瘢痕性脱发、先天性脱发及斑秃[1]。对于小面积的脱发患者来说,单位毛囊显微移植术是最常应用的治疗方法,采用该项技术可实现毛囊在秃发区域的重新再分布,并能基本达到一个较为理想的远期术后外观。因此在近年来被广泛应用于头发、眉毛、胡须甚至是阴毛的修复。但无论是哪一种修复技术的采用,都是以患者自体拥有充足的供区毛发为前提,其毛发来源相对有限,对于大面积脱发患者甚至是全秃患者来说,该技术存在供区不足的隐患。同时,供区遗留永久性瘢痕、移植成活率不稳定等问题也明显影响该项技术的远期效果。许多秃发患者头发的丢失是进行性的,毛发修复也无法逆转或是其停止,更无法预测去发展情况。所以,如何提供更多毛发来源成为现今毛发修复外科较难解决的问题。毛囊组织工程近年来就此问题进行了深入的探讨和研究并取得了一定进展,已经通过将鼠源和人源毛囊细胞重建出毛囊,但经传代培养后的毛乳头细胞和毛囊干细胞活性下降,难以获得具有高活性的细胞。但其研究仍然属实验室研究阶段,并未能真正投入临床工作中。在此背景下出现的人工毛发移植为这些问题的解决带来了希望。为解决上述供区严重不足患者的临床需求,国内外学者对人工毛发进行了积极地探索和研究。1976年首先由日本学者提出了人工毛发移植这一概念。但是最初的人工毛发是由工业上使用的聚酯纤维、聚丙烯酸、人造纤维或是加工过的人体毛发,为了使人工毛发更加逼真,还需对其进行染色。而这些化工原料本身和染色剂均对人体有着较大的毒副作用从而导致人体产生排异反应。几乎所有的移植物均在10周内脱落,甚至还伴随包括持续存在的面部浮肿,蜂窝织炎、头皮硬结、永久性瘢痕和持续性的头发自然脱落在内的严重的毒副作用和永久性后遗症。但由于其具备操作简单、不受供区限制、术后外观良好等优势,研究者一直未放弃对人工毛发的改进[2]。1996年意大利学者提出了一种boifiber合成纤维(聚酰胺人工毛发纤维)。随后陆续有国外学者将这种纤维在临床应用于修复秃发,结果显示其组织相容性良好,可考虑将其用于大面积秃发的修复。但通过长期临床观察和回访发现,该聚酰胺人工毛发纤维的年脱落率约为20-25%,患者需定期进行补种[2,3]。这就给广大患者的生活带来了极大不便,因此依然无法确实地满足患者的需求。我科实验室自2005年起开始自主研发毛囊单位样结构可移植假发(聚丙烯人工毛发)[6],经过两代的技术改良,也已将其应用于动物实验和临床研究[7]。以上两种人工毛发的组织相容性及远期效果仍然值得探讨。针对进一步降低人工毛发的术后不良反应、外观不自然,远期脱落率等问题,我们可以更加系统全面的对临床上各种类型的永久性脱发的的疗法进行补充和完善。本实验研究拟采用眼科镊和持针器在原有活结之上再打一个外科结,当纤维拉紧时形成的线结较前增大一倍,以期可以更牢固的将聚酰胺人工毛发纤维固定在头皮中。从而可以降低其远期脱落率。观察聚酰胺人工毛发纤维植入后的组织相容性及远期效果,探索其作为一种治疗毛发缺失疾病的新疗法广泛应用于临床的可能。材料与方法 1、实验材料及仪器聚酰胺人工毛发纤维(深圳天林实业有限公司,CE0373/TGA, Medicap Ltd.,Carpi (MO), Italy),移植笔(Medicap Ltd授权,深圳天林实业有限公司),持针器,眼科镊,压力蒸汽消毒器,光学显微镜,生物显微镜。 2、聚酰胺人工毛发纤维的固定结改良聚酰胺人工毛发纤维外观与人发极为相似,其一端连有一个活结,用移植笔头的弯针所带的勾型头勾住该活结头就可准确地将纤维移植入头皮中。随着移植针头深入进头皮,活结滑动拉紧,固定在头皮下。现采用眼科镊和持针器在原有活结之上再打一个外科结,当纤维拉紧时形成的线结较前增大一倍,可以更牢固的固定在头皮中。本实验用纤维呈黑色,长度为15cm。 3、聚酰胺人工毛发纤维的动物移植选取新西兰大白兔作为实验动物,将其随机分为A、B两组,A组为对照组,行常规方法移植；B组为实验组,行改良后方法移植。在白兔耳缘静脉注射3.0%戊巴比妥钠30mg／kg麻醉,至瞬目反射消失。麻醉成功后,白兔呈俯卧位,固定其四肢；剃除白兔头顶部兔毛,备皮；使用0.3%碘伏、75%酒精消毒头部皮肤,铺无菌孔巾。使用移植笔针头勾住聚酰胺人工毛发纤维的结头,将其植入白兔头顶部皮肤至皮下,深度为2~3mm。每只兔子头顶部取两个区域进行移植,一个区域进行大体观察,另一区域行组织学观察。每个区域分别植入50根纤维,单只兔子共植入纤维100根。移植完成后修剪外露部的纤维长度,单层纱布轻轻覆盖移植创面,第二天将其取下。 4、聚酰胺人工毛发纤维的远期脱落率观察术后定期观察白兔的头部伤口愈合情况,有无红肿、溃烂及移植纤维的整体外观。分别于术后1周,1个月,3个月,9个月,12个月对两组白兔头部遗留人工纤维进行计数,计算毛发的脱落率。 5、聚酰胺人工毛发纤维的组织学观察在术后1周,1个月,3个月,9个月,12个月时,在无菌条件下将10只兔子组织观察区域内的全层头皮带聚酰胺人工毛发纤维一起取下,漂洗去血渍后用10%甲醛固定,常规石蜡包埋,切片,HE染色,不同组织深度切片观察聚酰胺人工毛发纤维周围的组织反应情况。 6、统计学处理所得数据用SPSS16.0软件进行统计学处理,对常规纤维移植和改良后的纤维移植的年脱落率比较采用两独立样本t检验分析处理, P0.05为有显著差异。结果 1.移植的聚酰胺人工毛发纤维与真发外观相似,可通过特制移植器实现定向移植,移植后纤维方向良好,分布自然,外观效果满意。术后即时可见移植孔周围轻度出血红肿,一周后移植孔愈合,周围兔毛正常生长。至术后一年移植纤维处瘢痕肉眼不可辨,纤维周围未见有异常渗出,破溃及糜烂。 2.观察对照组和实验组可以发现,在移植后一月内可见数量不等的移植物脱落,主要集中在移植术后一周,此后随着周围皮肤组织的包绕和聚酰胺人工毛发纤维固定结头的锚定,纤维脱落逐渐减少,在移植后半年后基本不再有脱落现象。1年后观察,对照组(A组)的平均脱落率约为24±2.4%,实验组(B组)的平均脱落率约为10±3.1%,二者之间存在显著差异(P0.0001)。 3.移植后1周聚酰胺人工毛发纤维固定结头周围可以见到轻度的炎症反应细胞,毛细血管轻度充血,纤维周围可见到增生的上皮细胞包绕,炎症反应轻微；移植术后1个月,移植纤维周围组织的炎症细胞和淋巴细胞明显减少,胶原纤维增多,纤维周围依旧可见上皮细胞包绕,3-9个月后淋巴细胞及其它炎症反应细胞基本消失,胶原纤维增生反应明显,无色素沉着；1年后纤维周围只可见到大量的胶原纤维包绕,无淋巴细胞等炎症细胞浸润,局部无色素沉着。结论综上所述,本实验通过使用精细眼科镊和持针器对聚酰胺人工毛发纤维的固定结头进行改良,增大其固定结头体积。通过动物实验可以观察到,聚酰胺人工毛发纤维具有良好的组织相容性,增大其固定结头并不会引起更强烈的组织排斥,且移植后纤维外观与真发相似,改良后移植纤维脱落率大大降低。这很有可能在将来为临床大面积秃发患者提供更多的治疗选择。该聚酰胺人工毛发纤维可根据患者自身毛发的长度及色泽进行定制,用于修复大面积秃发,缩短患者手术时间、降低患者手术痛苦,并且可以省去临床毛发移植外科医师的毛囊提取程序,可为临床工作带来极大的方便。
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.71

【相似文献】