可调节牵张力的皮肤牵张闭合器在小腿和足踝部创面修复中的应用  

Clinical application of adjustable traction skin stretchers in repair of wounds at the lower leg,foot and ankle

作　　者：宋文超 吴学建[1] 唐举玉[2] 王剑利 刘波[4] 肖鹏[1] 孟冲[1] 官建中[5] 宋涛[6] 倪国骅 张德洪 张卫红[1] Song Wenchao;Wu Xuejian;Tang Juyu;Wang Jianli;Liu Bo;Xiao Peng;Meng Chong;Guan Jianzhong;Song Tao;Ni Guohua;Zhang Dehong;Zhang Weihong(Department of Orthopaedics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China;Hand Microsurgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Orthopaedic Trauma,The Eightieth Group Military Hospital of the PLA,Weifang 261000,China;Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Bone Microrepair Surgery,Honghui Hospital,Affiliated to Xi'an Jiaotong University Medical College,Xi'an 710054,China;Department of Trauma Microorthopedics,The First Affiliated Hospital of Henan Polytechnic University,Jiaozuo 454001,China;Department of Repair and Reconstruction Surgery,Yunnan Zhongde Orthopaedic Hospital,Kunming 650000,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450003 [2]中南大学湘雅医院手显微外科,长沙410008 [3]解放军陆军第八十集团军医院创伤骨科,潍坊261000 [4]北京积水潭医院手外科,北京100035 [5]蚌埠医学院第一附属医院骨科,蚌埠233004 [6]西安交通大学医学院附属红会医院骨显微修复外科,西安710054 [7]河南理工大学第一附属医院创伤显微骨科,焦作454001 [8]云南中德骨科医院修复重建外科,昆明650000

出　　处：《中华创伤骨科杂志》2023年第3期226-232,共7页Chinese Journal of Orthopaedic Trauma

基　　金：河南省科技攻关计划项目(182102410044)。

摘　　要：目的探讨可调节皮肤牵张力的皮肤牵张闭合器在小腿和足踝部创面修复中的应用效果。方法回顾性分析2016年8月至2022年9月期间郑州大学第一附属医院、西安交通大学医学院附属红会医院、河南理工大学第一附属医院及云南中德骨科医院收治的56例小腿、足踝部皮肤缺损创面患者资料。男35例,女21例;年龄(39.9±18.7)岁;创面类型:创伤创面43例,烧伤创面3例,炎性创面6例,骨筋膜室综合征减张切口创面3例,瘢痕创面1例。皮肤缺损面积为2.5 cm×2.0 cm~20.0 cm×10.0 cm;创面病程为(8.6±7.8)d。所有患者均应用可调节牵张力的皮肤牵张闭合器修复创面:排钩式牵张闭合器修复28例,单杆式牵张闭合器修复20例,单杆式牵张闭合器结合外固定支架修复5例,单杆式、排钩式牵张闭合器组合牵张修复3例。记录患者的创面牵张闭合时间、创面皮缘颜色、创面周围皮肤肿胀程度、患肢功能恢复情况及并发症发生情况等。结果56例患者创面牵张闭合时间为(7.8±3.8)d。皮肤牵张后创面皮缘颜色:正常16例,暗红38例,暗黑2例;创面周围皮肤肿胀程度:1度21例,2度33例,3度2例。56例患者术后获(8.9±4.1)个月随访。48例患者一次性闭合创面;8例患者结合自体皮片植皮修复,创面闭合。2例患者牵张皮肤出现张力性水泡部分坏死,其中1例结合自体皮片植皮修复,另1例通过换药愈合;2例患者深部骨感染复发,采用Ilizarov技术行骨搬移修复骨缺损,创面愈合。56例患者创面以远下肢肌力均恢复正常,邻近创面关节活动度也恢复正常。结论可调节牵张力的皮肤牵张闭合器修复小腿、足踝部创面可以精确调控皮肤牵张力,疗效良好、并发症少。Objective To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg,foot and ankle.Methods A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg,foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University,Honghui Hospital,Affiliated to Xi'an Jiaotong University Medical College,The First Affiliated Hospital of Henan Polytechnic University,and Yunnan Zhongde Orthopedic Hospital.There were 35 males and 21 females,aged(39.9±18.7)years.There were 43 traumatic wounds,3 burns,6 inflammatory wounds,3 relief incisions due to osteofascial compartment syndrome,and 1 scar.The areas of skin defect ranged from 2.5 cm×2.0 cm to 20.0 cm×10.0 cm.The duration of wounds was(8.6±7.8)d.All the wounds were repaired with adjustable traction skin stretchers.The row-hook type of skin stretchers was used in 28 cases,the single-rod type in 20 cases,the single-rod type combined with an external fixator in 5 cases,and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure,color of wound skin margin,skin swelling around the wound,functional recovery of affected limb and complications were recorded.Results The time from skin stretching to wound closure was(7.8±3.8)d in the 56 patients.The color of wound skin edge after stretching was normal in 16 cases,dark red in 38 cases,and dark in 2 cases;the skin swelling around the wound was degree 1 in 21 cases,degree 2 in 33 cases,and degree 3 in 2 cases.The 56 patients were followed up for(8.9±4.1)months.Primary wound closure was achieved in 48 patients,and secondary wound closure in 8 patients after repair with an autologous skin graft.Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients,one of whom was repaired with an autologous skin graft and the other of whom by dressing change.Deep bone infection recurred in 2 patients wh

关 键 词：下肢 足 创伤和损伤 修复外科手术 皮肤牵张技术 

分 类 号：R658.3[医药卫生—外科学]