双股丝线缝合Nice结固定联合弹性敷贴牵张治疗皮肤软组织缺损  

Treatment of skin and soft tissue defect with Nice combination with elastic dressing and stretch

作　　者：陈涛 马信龙 马剑雄 余润泽 Chen Tao;Ma Xinlong;Ma Jianxiong;Yu Runze(Postgraduate Institute,Tianjin Medical University,Tianjin 300070,China;Department of Orthopaedics,Anhui No.2 Provincal People's Hospital,Hefei 230041,China)

机构地区：[1]天津医科大学研究生院,300070 [2]安徽省第二人民医院骨科,合肥230041

出　　处：《中华骨科杂志》2020年第3期154-159,共6页Chinese Journal of Orthopaedics

基　　金：安徽省高校自然科学研究项目(ZR2019B05)。

摘　　要：目的探讨双股丝线缝合Nice结固定联合弹性敷贴牵张治疗皮肤软组织缺损的临床疗效。方法回顾性分析2017年8月至2019年4月采用双股丝线缝合Nice结固定联合弹性敷贴牵张治疗的皮肤软组织缺损患者23例,男10例,女13例;年龄(36.5±5.3)岁(范围26~76岁)。缺损大小(60±5.3)cm2(28~96 cm2)。于局麻下对创面进行彻底清创,双股丝线缝合,Nice结固定,创面外用弹性敷贴牵拉固定,每隔3 d换药时进行创面收缩。通过观察和记录创面的愈合级别、愈合率、愈合时间、术后瘢痕温哥华瘢痕量表(Vancouver Scar Scale,VSS)评分评估双股丝线缝合Nice结固定联合弹性敷贴牵张治疗皮肤软组织缺损的疗效。结果手术均在清创室内顺利完成,手术时间(42±10.5)min(范围30~50 min),术中出血量(30±2.5)ml(范围20~60 ml),手术费用(180±11.5)元人民币(范围160~240元人民币)。3例失随访,20例患者得到随访,随访时间(4±2.5)个月(范围3~6个月)。23例患者手术后创面愈合率50%±3.5%(范围40%~56%),20例随访患者术后第3天创面愈合率65%±4.3%(范围53%~75%),术后第6天创面愈合率74%±4.5%(范围65%~80%),术后第9天创面愈合率83%±1.8%(范围76%~85%),术后第12天创面愈合率90%±1.6%(范围84%~95%),术后第15天创面愈合率95%±3.5%(范围94%~98%)。术后随访第42天时20患者创面完全愈合,愈合率100%。创面甲、乙级愈合率95%(19/20),瘢痕VSS评分为4(3,6)分,创面瘢痕优良率80%(16/20)。2例于术后第10天由于缝线切割出现线结部分脱落,二次以Nice结缝合固定。1例感染未完全控制,在线结上覆盖负压封闭引流材料,治疗1周后局部感染控制,再次以Nice结收缩创面至创面愈合。结论双股丝线缝合Nice结固定联合弹性敷贴牵张治疗皮肤软组织缺损具有手术操作简便、手术条件要求低、手术时间短、出血少、费用低、创面愈合级别及愈合率高的优势,适合基层医院应用及推广。Objective To explore the clinical effects of Nice knot combined with elastic compress and stretch in treating skin and soft tissue defect.Methods From August 2017 to April 2019,a total of 23 patients,10 males and 13 females,aged 36.5±5.3 years(range 26-76 years),were retrospectively analyzed.The defect size was 60±5.3 cm2(28-96 cm2).Under local anesthesia,the wound was debrided thoroughly,sutured and fixed by Nice knot.The wound was fixed by elastic dressing and traction.The wound was retracted every 3 days during dressing change.The wound healing grade,healing rate,healing time,and postoperative Vancouver Scar Scale(VSS)were observed and recorded.Results All operations were performed successfully in the debridement room.The operation time was 42±10.5 min(range 30-50 min),intraoperative bleeding 30±2.5 ml(range 20-60 ml),and the operation cost 180±11.5 RMB(range 160-240 RMB).Twenty patients were followed up for 4±2.5 months(range 3-6 months).The wound healing rate of 23 patients was 50%±3.5%(range 40%-56%).For the 20 patients,the wound healing rate was 65%±4.3%(range 53%-75%),74%±4.5%(range 65%-80%),83%±1.8%(range 76%-85%),90%±1.6%(range 84%-95%)and 95%±3.5%(range 94%-98%)at 3,6,9,12 and 15 days,respectively.The wound healing rate of 20 patients was 100%at the 42nd days of follow-up.Wound healing rate of Grade A and grade B was 95%(19/20)with scar VSS score 4(3,6).The excellent and good rate of grade B was 80%(16/20).Two cases were sutured and fixed with Nice knot after 10 days because of the partial loss of the sutures.One case was treated with vacuum sealing drainage(VSD)on-line junction because infection was not completely controlled.Local infection was controlled and the wound was contracted by Nice junction at 1 week.Conclusion The treatment of skin and soft tis sue defect with Nice combination with elastic dressing and traction has the advantages of simple operation,low operation condition,short operation time,less bleeding,low cost,high wound healing grade and healing rate,suitable for basic le

关 键 词：缝合技术 外科胶带 软组织损伤 伤口愈合 

分 类 号：R6[医药卫生—外科学]