不同皮瓣修复术治疗指端缺损的临床疗效对比  

Comparison of clinical effects on different skin flap repair in the treatment of fingertip defect

作　　者：解学关[1] 戴琰琨[1] 丁明胜[1] 孟胜东 胡浩 XIE Xue-guan;DAI Yan-kun;DING Ming-sheng;MENG Sheng-dong;HU Hao(Department of Hand and Foot Surgery,Huai’an Second People’s Hospital,Huai’an Jiangsu 223001,China)

机构地区：[1]淮安市第二人民医院手足外科,江苏淮安223001

出　　处：《局解手术学杂志》2021年第11期960-964,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：淮安市科技计划项目(HAS201202)。

摘　　要：目的探讨不同皮瓣修复术对指端缺损患者的临床疗效。方法回顾性分析69例指端缺损患者的临床资料,根据手术方案分为对照组(n=34)和观察组(n=35)。对照组行传统桡背侧皮瓣修复术,观察组行拇指桡侧背穿支螺旋桨皮瓣修复术。统计比较2组皮瓣成活情况、手术相关指标、手术前后炎症应激反应指标、手指功能情况、并发症及患者满意度。结果2组皮瓣成活率及手术时间比较,差异无统计学意义(P>0.05),观察组创面完全愈合时间短于对照组,两点辨别觉小于对照组,差异有统计学意义(P<0.05)。2组术后3 d血清肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平均较术前升高(P<0.05),2组术后5 d上述各血清因子水平与术前比较,差异均无统计学意义(P>0.05),且各时间点2组间各血清因子水平比较差异无统计学意义(P>0.05)。术后6个月观察组密歇根手功能量表(MHQ)中外观、疼痛、日常生活能力、工作或学习评分高于对照组,手指关节活动度(TAM)大于对照组(P<0.05)。并发症方面,观察组皮瓣瘀紫发生率低于对照组(P<0.05),而2组皮瓣水泡、痛性瘢痕、冬季发凉发生率比较,差异无统计学意义(P>0.05)。术后6个月,观察组患者总满意度高于对照组,差异有统计学意义(P<0.05)。结论与传统桡背侧皮瓣修复术比较,拇指桡侧背穿支螺旋桨皮瓣修复术具有创面愈合快、皮瓣感觉和手指功能恢复好、皮瓣瘀紫风险低、患者满意度高等优势,可保证皮瓣成活,且未增加手术时间及创伤,对指端缺损的综合治疗效果理想。Objective To explore the clinical effects of different skin flap repair on the patients with fingertip defect.Methods The clinical data of 69 patients with fingertip defect were retrospectively analyzed,and they were divided into the control group(n=34)and the observation group(n=35)according to the surgical plan.The control group underwent traditional radial dorsal flap repair,while the observation group underwent thumb radial dorsal perforating propeller flap repair.The survival status of skin flaps,operation-related indicators,inflammatory stress response indicators before and after the operation,finger function,complications and patients’satisfaction of the two groups were statistically compared.Results There was no statistically significant difference in the skin flap survival rate or the operation time between the two groups(P>0.05).The time of complete wound healing in the observation group was shorter than that in the control group,and the two-point discrimination was less than that in the control group,the differences were statistically significant(P<0.05).The serum tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),cortisol(Cor)and adrenocorticotropic hormone(ACTH)levels 3 days after operation of the two groups were higher than those before operation(P<0.05).There was no statistically significant difference in the levels of the above-mentioned serum factors 5 days after operation of the two groups compared with those before the operation,and there was no statistically significant difference in the levels of serum factors between the two groups at each time point(P>0.05).The scores of appearance,pain,ability of daily living,work or study in the michigan hand outcomes questionnaire(MHQ)scale 6 months after operation in the observation group were higher than those in the control group,and the total angle of motion(TAM)of finger joint was greater than that in the control group(P<0.05).In terms of complications,the incidence of skin flap bruises in the observation group was lower than that in the contr

关 键 词：指端缺损 传统桡背侧皮瓣修复术 拇指桡侧背穿支螺旋桨皮瓣修复术 炎症反应 应激反应 

分 类 号：R622[医药卫生—整形外科]