双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面的临床效果  

Clinical effect of double layer artificial dermis combined with autologous blade thick skin transplantation in repairing the bone or tendon exposure after burn trauma

作　　者：王宏宇 周彪[1] 闫增强[1] 侯智慧[1] 德奇 杨瑞 王睿甲 李洋洋 黄瑞娟[1] 巴特[1] Wang Hongyu;Zhou Biao;Yan Zengqiang;Hou Zhihui;De Qi;Yang Rui;Wang Ruijia;Li YangYang;Huang Ruijuan;Ba Te(Inner Mongolia Burn Research Institute,Department of Burn,Inner Mongolia Baogang Hospital,Baotou 014010,China;Graduate School of Inner Mongolia Medical University,Huhhot 010059,China)

机构地区：[1]内蒙古包钢医院烧伤科,内蒙古烧伤研究所,包头014010 [2]内蒙古医科大学研究生院,呼和浩特010059

出　　处：《中华损伤与修复杂志（电子版）》2023年第1期25-31,共7页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：重大疾病防治科技行动计划创伤修复专项项目(2018ZX-01S-001S01);内蒙古自治区自然科学基金项目(2020MS08022);内蒙古自治区自然科学基金项目(2020MS08181);内蒙古自治区科技创新引导项目(CXYD2020BT03);包头市卫生健康科技计划项目(2021MER-017)。

摘　　要：目的探讨双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面的临床效果。方法选择2019年11月至2022年8月期间内蒙古包钢医院烧伤科收治的符合入选标准的60例烧创伤后骨/肌腱外露患者作为研究对象,对其病例资料进行回顾性分析。根据创面修复方法不同将患者分为对照组和观察组,每组各30例。患者入院后完善相关检查,常规应用青霉素类抗生素控制感染,根据创面细菌培养结果及药物敏感试验结果调整抗生素的应用。观察组患者Ⅰ期行手术清创及双层人工真皮移植;待人工真皮完全血管化后,Ⅱ期去除人工真皮的硅胶层,再次修整创面,移植自体刃厚皮片。对照组待创面具备植皮条件后行单纯皮瓣或皮片移植修复创面。比较2组患者皮片/皮瓣成活率和创面愈合率、住院时间及住院费用、瘢痕生长情况。数据比较采用t检验及χ^(2)检验。结果术后10 d,观察组患者创面植皮术区皮片均成活,皮下无淤血及积液,皮片成活率为100%;对照组4例皮片移植患者皮下淤血较明显,皮片溶解坏死,2例皮瓣移植患者部分皮瓣远端血运障碍,缺血坏死,皮片/皮瓣成活率为80%,2组比较差异有统计学意义(χ^(2)=4.63,P=0.03)。术后28 d,观察组创面全部愈合,术区无渗液、无红肿,创面愈合率为100%;对照组有6例患者创面未完全愈合,创面愈合率为80%,2组比较差异有统计学意义(χ^(2)=4.63,P=0.03)。观察组患者平均住院时间及平均住院费用分别为(28.31±3.39)d、(6.58±1.21)万元,对照组患者平均住院时间及平均住院费用分别为(35.42±4.22)d、(3.27±1.10)万元,2组比较差异均有统计学意义(t=7.21、11.13,P<0.05)。术后6个月,观察组温哥华瘢痕量表评分为(4.72±1.93)分,对照组为(5.88±2.12)分,2组比较差异有统计学意义(t=2.22,P<0.05)。结论双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面,皮片/皮Objective To investigate the clinical effect of double layer artificial dermis combined with autologous blade thick skin transplantation in repairing the exposed bone or tendon wounds after burn trauma.Methods Sixty patients with bone or tendon exposure after burn trauma admitted to the Department of Burn,Inner Mongolia Baogang Hospital from November 2019 to August 2022 meeting the inclusion criteria were selected as the research objects,and their case data were retrospectively analyzed.According to different wound repair methods,the patients were divided into control group and observation group,30 cases in each group.After admission,relevant examinations were performed,penicillin antibiotics were routinely used to control infection,and antibiotic use was adjusted according to the results of wound bacterial culture and drug sensitivity test.Observation group received surgical debridement and double layer artificial dermal transplantation at stageⅠ;after the artificial dermis was completely vascularized,the silicone layer of the artificial dermis was removed in the stageⅡ,the wound was trimmed again,and the autologous thick blade skin was transplanted.The control group underwent simple skin flap or skin graft after the wound was equipped with skin grafting conditions.The survival rate of skin or flap,wound healing rate,hospital stay,hospital expenses and scar growth condition were compared between the 2 groups.Data were compared by t test and chi-square test.Results Ten days after surgery,all the skin grafts in the observation group survived without subcutaneous congestion and effusion,and the survival rate of skin grafts was 100%;in the control group,4 skin graft patients had obvious subcutaneous congestion,skin dissolution and necrosis,and 2 skin flap graft patients had partial flap distal blood circulation disorder and ischemic necrosis,the survival rate of skin/flap was 80%,the difference was statistically significant(χ^(2)=4.63,P=0.03).Twenty-eight days after surgery,all wounds in the observation group w

关 键 词：烧伤 创伤和损伤 人工真皮 骨外露 肌腱外露 

分 类 号：R47[医药卫生—护理学]