穿支皮瓣整复严重烧伤后四肢大关节部位瘢痕增生挛缩畸形的临床效果  

Clinical effects of perforator flaps on scar hypertrophic contracture deformity of large joints of extremities after severe burns

作　　者：王立生 张蕾[1] 杨霖[1] WANG Li-sheng;ZHANG Lei;YANG Lin(Department of Rehabilitation Medicine,West China Hospital,Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]四川大学华西医院康复医学科,四川成都610041

出　　处：《临床和实验医学杂志》2021年第12期1327-1330,共4页Journal of Clinical and Experimental Medicine

基　　金：四川省科学技术厅科研项目(编号:2019YJ0130)。

摘　　要：目的探究穿支皮瓣整复严重烧伤后四肢大关节部位瘢痕增生挛缩畸形的临床效果。方法前瞻性选取2017年5月至2020年5月四川大学华西医院收治的60例严重烧伤后四肢大关节部位瘢痕增生挛缩畸形患者,按照随机数字表法分为观察组(穿支皮瓣整复)与对照组(人工真皮移植),各30例。比较2组患者的创面瘢痕评分[温哥华瘢痕量表(VSS)]、关节活动度(ROM)、外观满意度以及生活质量,随访并发症发生率。结果观察组患者供皮区创面愈合时间、供皮区VSS评分、植皮区VSS评分分别为(7.28±2.14)d、(0.52±0.14)分、(2.31±1.02)分,均小于对照组[(12.63±3.02)d、(1.58±0.73)分、(4.59±2.13)分],差异均有统计学意义(P<0.05)。观察组患者ROM评分、生活质量评分、外观满意度评分分别为(84.12±7.79)、(86.29±5.57)、(71.09±5.74)分,均明显高于对照组[(69.28±10.21)、(72.33±8.34)、(60.24±6.76)分],差异均有统计学意义(P<0.05)。观察组患者并发症发生率(6.67%)明显低于对照组(26.67%),差异有统计学意义(P<0.05)。结论穿支皮瓣整复严重烧伤后四肢大关节部位瘢痕增生挛缩畸形,有利于创面瘢痕修复,在改善患者关节功能、提高患者外观满意度方面作用突出,并发症少,可在临床广泛推广。Objective To explore the clinical effect of perforator flaps on scar hyperplasia contracture deformity of large joints of extremities after severe burns.Methods A prospective analysis was performed on 60 patients with scar hyperplasia contracture deformity of large joints of extremities after severe burns admitted to West China Hospital of Sichuan University from May 2017 to May 2020.According to the random number table method,they were divided into observation group(perforator flap reconstruction)and control group(artificial dermis transplantation),with 30 cases each.The wound scar score[Vancouver scar scale(VSS)],range of motion(ROM),appearance satisfaction and quality of life of the two groups were compared,and the incidence of complications was followed up.Results In the observation group,the wound healing time,the VSS score of the donor area,and the VSS score of the skin graft area of the observation group were(7.28±2.14)days,(0.52±0.14)points,and(2.31±1.02)points,respectively,which were all shorter than those of the control group[(12.63±3.02)d,(1.58±0.73)points,(4.59±2.13)points],the differences were statistically significant(P<0.05).The ROM score,quality of life score,and appearance satisfaction score of the observation group were(84.12±7.79),(86.29±5.57),(71.09±5.74)points,respectively,which were significantly higher than those of the control group[(69.28±10.21),(72.33±8.34),(60.24±6.76)points],the differences are statistically significant(P<0.05).The incidence of complications in the observation group(6.67%)was significantly lower than that in the control group(26.67%),and the differences were statistically significant(P<0.05).Conclusion Perforator flaps are beneficial to scar hyperplasia contracture deformity of large joints of extremities after severe burns.They play a prominent role in improving joint function and appearance satisfaction of patients with few complications,and can be widely promoted in clinical practice.

关 键 词：严重烧伤 四肢大关节瘢痕增生 挛缩畸形 穿支皮瓣整复 VSS评分 外观满意度 

分 类 号：R644[医药卫生—外科学]