屈肌离断联合肌皮瓣转移修复强直性体位患者褥疮的疗效  

Flexor muscle disconnection combined with myocutaneous flap for pressure ulcer in patients of ankylosing posture

作　　者：黄苏 廖选[1] 李升红[1] 张志丹[1] 卢金强[1] 肖丽玲[1] 刘宏伟[1] Huang Su;Liao Xuan;Li Shenghong;Zhang Zhidan;Lu Jiniang;Xiao Liling;Liu Hongwei(Department of Rehabilitation,Eastern Hospital of First Affiliated Hospital of Jinan University,Department of Plastic Surgery,First Affiliated Hospital of Jinan University,Innovative Technology Research Institute of Tissue Repair and Regeneration,Key Laboratory of Regenerative Medicine,Ministry of Education,Guangzhou 510630,China)

机构地区：[1]暨南大学附属第一医院东院区康复科、暨南大学附属第一医院整形外科、暨南大学整形外科新技术研究所、再生医学教育部重点实验室,广州510630

出　　处：《中华创伤杂志》2018年第11期1040-1045,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金（81272100,81372065）;广州市科技计划（201508020253）;广州省产学研项目（32714005）;暨南大学第一临床医学院科研培育专项基金（2017306）

摘　　要：目的探讨屈肌离断联合肌皮瓣修复强直性体位患者褥疮的治疗效果。方法采用回顾性病例系列研究分析2012年1月-2017年7月暨南大学附属第一医院收治的15例截瘫后强直性体位不同部位压疮患者，其中男10例，女5例；年龄40—78岁，平均68岁。压疮创面范围为3cm×3cm～15cm×11cm。骶尾部压疮8例，大转子压疮4例，坐骨结节压疮3例。根据褥疮大小及位置选择邻近肌皮瓣修复，同时联合行高选择性解除屈髋屈膝肌肉手术，保障创面无张力缝合，术后予负压封闭引流（VSD）持续吸引，术后保持体位合理制动至创面愈合拆线。术后观察局部皮瓣下血肿、皮瓣张力、血运（包括皮瓣质地、颜色，弹性等）、创面愈合情况、褥疮是否复发、供区情况及患者满意度。结果患者均获随访12—36个月，平均24个月。12例一次手术修复后褥疮创面愈合；2例因屈髋屈膝肌肉未解除，肌张力极高，关节僵硬，肢体运动时强烈阻力，屈肌反射过强，伤口不愈合，经二次手术愈合；1例因术后肢体被动移动，致使体位不当切口张力过大裂开，经二次手术修复愈合。所有肌皮瓣转移覆盖创面存活良好，创面完全封闭愈合，且伤口外形、皮瓣质地、色泽及弹性恢复良好，术后18d拆除缝线后，患者满意出院。屈肌离断联合肌皮瓣修复强直性体位褥疮创面愈合率达100％。出院后常规褥疮护理，随访未出现新的褥疮。皮瓣供区经自体皮片修复后愈合良好。结论屈肌离断联合肌皮瓣转移修复强直性体位褥疮减张效果显著，加速创面愈合，提高愈合率。Objective To investigate the efficacy of flexor muscle disconnection combined with myoeutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture. Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017. There were 10 males and five females, aged 40-78 years, with an average age of 68 years. The pressure ulcer ranged from 3 cm × 3 cm to 15 cm×11cm. The pressure ulcers were distributed at sacrococcygeal region in eight patients, macro-rotator in four, and ischial nodules in three. According to the size and position of pressure ulcer, different musculocutaneous flaps were selected, and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound. After the operation, the negative pressure closed drainage （VSD） was given to maintain a proper posture for wound healing. The stitches were removed after the wound healed. The wound healing, pressure ulcer recurrence, flap texture, flap color, and donor site were observed, and patient satisfaction were also surveyed. Results All patients were followed up for 12-36 months, average 24 months. The pressure ulcer was healed in 12 patients after the first repair operation. In two nonunion cases, the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint, causing strong resistance during limb movement and strong flexor reflex. Two patients were healed after twice operation. In one patient, the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation, and the wound was healed after twice operation. All muscle flaps covered the wound and survived well, and the wounds were completely closed and healed with good shape, texture as well as elastic recovery. After the suture was remov

关 键 词：压力性溃疡 外科皮瓣 修复外科手术 封闭负压引流 

分 类 号：R622[医药卫生—整形外科]