新型皮肤扩展器延期闭合小腿骨筋膜间室综合征减张切口的临床疗效  

Efficacy of the new skin-stretching system for delayed closure of decompression incision of osteofacial compartment syndrome

作　　者：郭骏 孙晨 曹洪 孙志波 禹志宏 GUO Jun;SUN Chen;CAO Hong;SUN Zhi-bo;YU Zhi-hong(Department of Trauma Orthopedics,Shiyan People’s Hospital/People’s Hospital Affiliated to Hubei University of Medicine,Shiyan Hubei 442000,China)

机构地区：[1]十堰市人民医院/湖北医药学院附属人民医院创伤骨科,湖北十堰442000

出　　处：《局解手术学杂志》2020年第12期1004-1007,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金青年科学基金项目(81602867);湖北省自然科学基金面上项目(2018CFB524);湖北省教育厅科学技术研究计划指导性项目(B2018110);湖北省教育厅科学技术研究计划指导项目(B2017485)。

摘　　要：目的探讨新型皮肤扩展器延期闭合小腿骨筋膜间室综合征减张切口的临床疗效。方法回顾性分析18例采用新型皮肤扩展器延期闭合小腿骨筋膜间室综合征减张切口患者的临床资料,患者经筋膜间室切开减压术后,皮肤缺失面积为10 cm×4 cm^28 cm×10 cm,平均宽度为(15.0±6.9)cm。应用新型皮肤扩展器对合皮肤,以4 min皮肤扩展、1 min皮肤松弛为单位反复循环牵拉。若Pinch实验阴性则Ⅰ期闭合创面;若Pinch实验阳性则保留皮肤扩展器,术后每天根据张力、皮缘血供、患肢远端感觉情况逐渐收紧皮肤牵张带,缩小及闭合创面直至皮缘贴合,Ⅱ期闭合创面。记录手术时间、术中出血量、创面愈合时间、住院时间及术后并发症,并观察切口愈合情况。结果所有患者手术时间23~80 min,平均(31.5±10.7)min;术中出血量30~75 mL,平均(45.6±7.9)mL;住院时间3~20 d,平均(10.9±5.6)d。4例患者创面Ⅰ期直接闭合;13例患者创面术后持续牵拉3~9 d后Ⅱ期闭合创面;1例患者因创面太大,且牵拉时引起的疼痛感无法耐受,最终Ⅱ期行植皮和皮瓣修复。患者术后随访6~15个月,平均(8.2±3.5)个月;平均创面愈合时间(17.8±3.6)d;随访期间未出现感染、坏死及张力性水泡病例,创缘皮肤均呈线性愈合,瘢痕小。结论应用新型皮肤扩展器延期闭合小腿骨筋膜间室综合征减张切口,可促进切口愈合,缩短患者手术时间和住院时间,是一种安全、有效、简便的治疗方法。Objective To investigate the clinical efficacy of a new skin-stretching system for gradual direct closure of secondary wounds after osteofacial compartment syndrome.Method The clinical data of 18 patients with osteofacial compartment syndrome treated by the new skin-stretching system were analyzed retrospectively.The skin defect area was 10 cm×4 cm to 28 cm×10 cm,and the mean width was(15.0±6.9)cm after fasciotomy.The skin was closed with 4 minutes stretch and 1 minute relaxation by the new skin-stretching system circularly.If the Pinch tests were negative,the wound was closed primarily;if positive,the skin-stretching system was gradually tightened according to the tension,the blood supply of the wound edge skin and the feeling of the distal end of the affected limb,to lessen and close the wound until the wound skin was sutured,then secondary closure was completed.The operation time,intraoperatve blood loss,wound healing time,hospital stay and postoperative complications were recorded.Results The operation time was 23 to 80 minutes,with the average of(31.5±10.7)minutes;the intraoperative blood loss was 30 to 75 mL,with the average of(45.6±7.9)mL;the hospital stay was 3 to 20 days,with the average of(10.9±5.6)days.Skin defect wounds of 4 cases received primary closure;13 cases received secondary closure after gradually stretched for 3 to 9 days,with the average of 6 days;1 patient conducted skin graft and flap repair at the stageⅡsince the skin defect was big and the pain caused by traction was unable to tolerate.All patients were followed up for 6 to 15 months with the average of(8.2±3.5)months.The average time of wound healing was(17.8±3.6)days.There was no infection,necrosis,tension vesicles occurred.The wound edge skin was healed linearly with slight scars.Conclusion The new skin-stretching system is a secure and effective method to complete the gradual direct closure of secondary wounds after osteofacial compartment syndrome,and it can promote the wound healing and shorten the operation time and hos

关 键 词：皮肤扩展器 骨筋膜间室综合征 修复 皮肤缺损 无张力创面闭合术 延期闭合 减张切口 

分 类 号：R686.3[医药卫生—骨科学]