Ⅲ型腕部高压电烧伤患者治疗转归调查  

Investigation on the treatment outcomes of typeⅢhigh-voltage electrical burns of the wrist

作　　者：赵筱卓 沈余明 Zhao Xiaozhuo;Shen Yuming(Burn Department of Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院烧伤科,北京100035

出　　处：《中国现代手术学杂志》2023年第3期218-225,共8页Chinese Journal of Modern Operative Surgery

基　　金：中国科学院理化技术研究所所长基金;国家重点研发计划(2018YFA0703104)。

摘　　要：目的总结Ⅲ型腕部高压电烧伤患者的治疗方法及转归,分析不同策略创面修复的临床疗效。方法采用回顾性病例对照研究,收集首都医科大学附属北京积水潭医院烧伤科2008年1月~2020年9月收治的Ⅲ型腕部高压电烧伤住院患者的病历资料,共有28例患者35个腕部入组。以2013年12月31日为界,前一阶段(常规治疗组,简称常规组)9例11个腕部,接受常规治疗;后一阶段(显微技术治疗组,简称显微组)19例24个腕部,接受显微外科治疗。回顾性分析性别、年龄、烧伤总面积、单侧/双侧、伤后至首次皮瓣移植时间、患肢血管重建、皮瓣选择、游离皮瓣面积、皮瓣转移术后感染率、手术次数、创面修复时间、治疗结局、总截肢率等临床指标。结果28例患者均为男性,平均年龄(39.43±12.40)岁。所有患者均接受静脉桥接或通血皮瓣手术进行血运重建。伤后至首次皮瓣/肌皮瓣移植时间为4(3,6)d。常规组共行带蒂轴型皮瓣修复8例,游离皮瓣3例;显微组共行带蒂轴型皮瓣修复6例,游离皮瓣/肌皮瓣18例;两组比较有显著性差异(P=0.011)。常规组接受手术3(2,3)次,显微组接受手术1(1,2.75)次,两组比较有显著性差异(P=0.020)。皮瓣修复术后皮瓣下方继发感染7例,常规组4例,显微组3例,两组比较无显著性差异(P=0.625)。总截肢率22.86%(8/35),常规组27.27%(3/11),显微组20.83%(5/24),两组比较无显著性差异(P=0.462)。腕部创面愈合时间(入院至腕部创面愈合拆线)22(18~38)d,常规组38(25,40)d,显微组20.5(17.25,27)d,有显著性差异(P=0.010)。结论Ⅲ型腕部电烧伤的治疗需在尽早重建血运、彻底清创的同时,优先选择以游离皮瓣/肌皮瓣对腕部创面进行修复,可缩短创面愈合时间,减少手术次数。Objective To analyze the treatment outcomes of typeⅢhigh-voltage electrical burns of the wrist in Beijing Jishuitan Hospital,Capital Medical University,and to provide references for the diagnosis and treatment in this kind of injury.Methods The medical records of 28 hospitalized patients(35 wrists)with typeⅢhigh-voltage electrical burns on wrists were collected from January 2008 to September 2020.The patients were divided into two groups,9 cases(11 wrists)from January 2008 to December 2013 for the routine treatment group(group A),and 19cases(24 wrists)from January 2014 to September 2020 for the microscopic technology treatment group(group B).The gender,age,total burn area,unilateral/bilateral injury,time from injury to the first skin flap transplantation,vascular reconstruction of the affected limb,flap selection,postoperative infection rate,the number of operations,wound healing time,treatment outcomes and total amputation rate were analyzed and compared retrospectively.Results The patients were all male with an average age of(39.43±12.40)years.All patients underwent venous bridging or vascular flap surgery for revasculariza-tion.Time from injury to the first flap/myocutaneous flap transplantation was 4(3,6)days.In group A,there were 8 cases underwent pedicle axial flap repair and 3 cases underwent free flap repair;In group B,there were 6 cases underwent pedicle axial flap repair and 18 cases underwent free flap/myocutaneous flap repair(P=0.011).Surgeries were undergone 3(2,3)times for group A,while 1(1,2.75)times for group B(P=0.020).There were 7 cases of flap infection,4 for group A and 3 for group B(P=0.625).The total ampu-tation rate was 22.86%(8/35),27.27%(3/11)for group A and 20.83%(5/24)for group B(P=0.462).Healing time of wrist wounds(from admission to wrist wound healing and suture removal)was 22(18~38)days,38(25,40)days for group A and 20.5(17.25,27)days for group B(P=0.010).Conclusion In the treatment of typeⅢelectrical burns of wrists,blood supply should be reconstructed as soon as possible.At

关 键 词：电烧伤 腕损伤 创面修复 游离皮瓣 游离肌皮瓣 

分 类 号：R647[医药卫生—外科学]