复合组织瓣移植修复对严重足部踝关节皮肤缺损患者Maryland足功能评分及创面渗出液中TGF-β1和VEGF水平的影响  

Effect of composite tissue flap transplantation in repairing severe skin defect at ankle joint on Maryland foot score and the levels of TGF-β1 and VEGF in wound exudates

作　　者：袁长勇 刘洪全 刘跃廷 安长学 冯俊[2] YUAN Changyong;LIU Hongquan;LIU Yueting;AN Changxue;FENG Jun(Department of Hand Microsurgery,Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine,Panzhihua 617000,Sichuan,China;Department of Otolaryngology,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]攀枝花市中西医结合医院手显微外科,四川攀枝花617000 [2]川北医学院附属医院耳鼻喉科,四川南充637000

出　　处：《贵州医科大学学报》2022年第7期821-825,共5页Journal of Guizhou Medical University

基　　金：四川省教育厅科研课题(18ZA0203)。

摘　　要：目的复合组织瓣移植修复对严重足部踝关节皮肤缺损的疗效、Maryland足功能评分及创面渗出液中转化生长因子β1(TGF-β1)、血管内皮生长因子(VEGF)水平的影响。方法将108例严重足部踝关节皮肤缺损患者分为对照组(n=53)和观察组(n=55),对照组采取常规皮瓣移植修复,观察组采取复合组织瓣移植修复;比较两组患者治疗后皮肤缺损修复情况、临床效果、围术期指标,比较两组患者术后1周、3个月及6个月时的Maryland足功能评分,于术前及术后第4周时检测创面渗出液中TGF-β1及VEGF水平,统计近期和远期并发症的发生率。结果观察组患者的1期修复率(52.73%)高于对照组(26.43%),治疗优良率(94.55%)也高于对照组(71.70%),差异有统计学意义(P<0.05);观察组患者的手术时间及住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后6个月Maryland足功能评分>术后3个月>术后1周,同时点比较观察组>对照组,差异有统计学意义(P<0.05);术前,两组患者创面的TGF-β1、VEGF水平比较,差异无统计学意义(P>0.05);术后第4周,两组患者TGF-β1和VEGF水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组近期、远期并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论复合组织瓣移植修复对严重足部踝关节皮肤缺损患者的效果较好,足功能恢复好,其机制可能与这种移植修复方法促进损伤组织分泌TGF-β1及VEGF有关。Objective To investigate the effect of composite tissue flap transplantation in repairing severe skin defect at ankle joint on therapeutic outcome,Maryland foot score and the levels of TGF-β1 and VEGF in wound exudates.Methods One hundred and eight patients with severe skin defects at ankle joint were divided into control group(n=53)and observation group(n=55).Control group were treated with conventional skin flap transplantation,while observation group were given with composite tissue flap transplantation.Skin defect healing,clinical effect and perioperative indicators were compared between two groups after transplantation.Maryland function scores were compared between two groups at 1 week,3 and 6 months after transplantation.The levels of TGF-β1 and VEGF in wound exudates were detected before transplantation and at 4 th week after transplantation.The incidences of short-term and long-term complications were calculated.Results In observation group vs control group,the healing rate at I phrase was 52.73%vs.26.43%(P<0.05),and the excellent rate of therapeutic outcomes was 94.55%vs.71.70%(P<0.05).The operation time,length of hospital stay and intraoperative blood loss were significantly less in observation group than those in control group(P<0.05).After transplantation,significant differences were observed with respect to Maryland foot score(6 months>3 months>1 week).There were not remarkably differences in the levels of TGF-β1 and VEGF in wound exudates before transplantation(P>0.05).At 4 weeks after transplantation,the levels of TGF-β1 and VEGF in two groups were higher than those before transplantation(P<0.05),and they were greater in observation group than in control group(P<0.05).The incidences of short-term and long-term complications were lower in observation group than control group(P<0.05).Conclusion Composite tissue flap transplantation is effective in treating patients with severe skin defects at ankle joint.It restores foot function.Promoting damaged tissues to secret TGF-β1 and VEGF might be its a

关 键 词：严重足部踝关节皮肤缺损 复合组织瓣 移植修复 围术期指标 Maryland足功能评分 创面愈合 

分 类 号：R684[医药卫生—骨科学]