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系統識別號 U0026-0812200914303588
論文名稱(中文) 以力學觀點評估不同缝線技術對皮膚創傷癒合的影響
論文名稱(英文) Mechanical evaluation of the influence of different suture patterns on skin healing
校院名稱 成功大學
系所名稱(中) 醫學工程研究所碩博士班
系所名稱(英) Institute of Biomedical Engineering
學年度 96
學期 2
出版年 97
研究生(中文) 葉政鑫
研究生(英文) Cheng-Hsing Yeh
電子信箱 piconaro@gmail.com
學號 p8695407
學位類別 碩士
語文別 中文
論文頁數 65頁
口試委員 口試委員-陳嘉炘
口試委員-蘇芳慶
口試委員-黃玲惠
指導教授-葉明龍
中文關鍵字 力學性質  縫合技術  傷口癒合 
英文關鍵字 Suture patterns  Wound healing  Mechanical property 
學科別分類
中文摘要 過去針對縫線對傷口癒合的影響主要在兩方面,一是傷口癒合隨時間的組織變化,用組織染色的方式來判斷癒合的程度,主要是判斷新生組織形成的成分及數量,及細胞的增生的數量。另一方式的測試多在體外用不同的縫線打不同的結,測量其強度,或者採取單一縫法,觀察癒合時間對皮膚抗拉強度的關係。至今,未有研究是針對不同的縫合技術在不同時間的癒合情形的拉伸強度。此計畫的目的是直接對不同縫線技術下的受傷組織在不同的術後時間做力學評估,以力學性質來評估受傷組織是否受縫線縫法影響其傷口之癒合強度。
以大鼠皮膚為實驗對象,在大鼠背上兩側製造2cm的傷口,使用4/0缝線,分別為皮上(4n)、皮下(4v)、皮上皮下(4n4v)以3種縫法縫合,經1、2、4及6週癒合時間後,計算其抗拉強度、應變場及彈性係數以及組織染色。
實驗結果發現,對於癒合2週之傷口,4n傷口之癒合程度小於4v及4n4v(p=0.028),但到6週時,4n以及4v傷口已大於4n4v(p=0.017、0.012),4n4v抗拉強度變差的原因可能是Vicryl縫線的『降解時間』、『應力遮蔽效應』以及『缝針對皮膚破壞的程度』所造成,此資訊對缝線技術的改善將是很大的幫助。另外研究發現近頭部之鼠皮厚度,較近尾部厚,這在過去文獻裡還未有人提及,未來可供設計實驗參數之參考。
英文摘要 In the past wound healing studies were focused on the histological analyses. Histological stains for sliced tissues were used to analyze the progress of healing. The other studies related on suture technologies were focused on mechanical strengths of different suture method in vitro without real living tissues. We hypothesize the suture strength and tying method should play an important role in the progress of healing. So far, no similar studies had been investigated. The purpose of this study is to investigate the effect of mechanical property respect to different suture patterns in wounded skin.
This study tries to analyze the temporal wound healing strength after skin injury. Three suture technologies were used to investigate their effects of the strength of healing tissues. Rat skins will be used in this project. First, rat was made 3 2-cm long cuts on the back and sutured with 3 different patterns (4n, 4v, 4n4v). In 1, 2, 4, and 6 weeks, a 3 x 5 cm skin along the injured sites was harvested for mechanical testing and histological staining. A soft tissue MTS with special skin grip was used to test the strength of the healing skins. Hematoxylin and Eosin staining and Masson Trichrome staining were used to observe the healing tissue and cell numbers along the healing injury sites.
The results show that 4n-sutured skin had worse recovery than 4v and 4n4v(p=0.028) in 2 weeks wound skin. But 4n and 4v-sutured had better recovery than 4n4v in 6 weeks. We think that different healing courses for 4n, 4v, 4n4v suture patterns may result from the degradation of Vicryl suture, stress shielding effect, and the degree of skin destruction. This information was helpful for suture technique improvement. We also find the dorsum skin near head was thicker than that near tail. This finding was first time, and it can be used as important reference for designing experimental parameter in the future.
論文目次 中文摘要 I
ABSTRACT III
誌謝 V
目錄 VII
表目錄 XI
圖目錄 XIII
第1章 緒論 1
1.1 皮膚結構 1
1.1.1 Rat與人類皮膚的差異 2
1.2 傷口癒合過程 3
1.3 傷口修復之動物模型 6
1.3.1 急性傷口模型 6
1.3.2 癒合能力受損模型 8
1.3.3 慢性傷口模型 8
1.4 影響傷口癒合的因素 9
1.5 缝線在傷口癒合所扮演的角色 9
1.6 相關文獻探討 10
1.6.1 應力環境對「未受傷/受傷皮膚」的影響 10
1.6.2 針對不同缝法或材料之缝線力學特性 11
1.6.3 以數學模型方式模擬 11
1.6.4 縫線與傷口癒合之相關研究 12
1.6.5 實驗流程標準化之參考研究 13
1.6.6 過去研究之優缺點 14
1.7 實驗動機與目的 15
第2章 實驗方法 17
2.1 實驗設備 17
2.1.1 拉力測試機台 17
2.1.2 照相擷取系統 18
2.1.3 切試片器與夾具 19
2.1.4 缝線 21
2.2 實驗參數選擇的原由 22
2.3 實驗設計 23
2.4 實驗流程 24
2.5 動物實驗 25
2.6 力學測試-抗拉強度試驗 26
2.7 應變場分析 28
2.8 組織切片染色 28
2.8.1 HEMATOXYLIN AND EOSIN STAINING 29
2.8.2 Masson Trichrome Stains 29
2.9 統計分析 30
第3章 結果 31
3.1 驗證兩種切試片器的互用性 31
3.2 老鼠皮膚厚度分布 31
3.3 不同癒合時間之皮膚外觀 32
3.4 控制組之抗拉強度 33
3.5 鼠皮對於不同缝法和癒合時間的影響 34
3.6 應變場分析結果 39
3.7 組織切片染色及力學破壞外觀 43
第4章 討論 47
4.1 老鼠皮膚外觀特性的觀察 47
4.2 控制組之抗拉強度探討 47
4.3 不同缝法對鼠皮的影響 48
4.4 癒合皮膚內部構造推測 49
4.5 實驗限制 52
4.5.1 夾具改良 52
4.5.2 CCD問題 52
4.5.3 自動化資料處理 52
4.6 未來研究 53
第5章 結論 55
第6章 參考文獻 57
附錄一 動物實驗管理小組審查同意書 61
附錄二 動物實驗申請表修正申請單 63
自述 65
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