腹部带蒂皮瓣修复手外伤后感染创面并骨外露的临床效果  

Clinical effect of abdominal pedicled skin flap repair on hand trauma and infection patients with bone exposure

作　　者：杨伟渊[1] 袁云发 秦建华[2] 辛增桃 米子靖 YANG Wei-yuan;YUAN Yun-fa;QIN Jian-hua;XIN Zeng-tao;MI Zi-jing(Hangzhou Plastic Hospital,Hangzhou,Zhejiang 310014,China)

机构地区：[1]杭州整形医院整形外科,浙江杭州310014 [2]杭州整形医院手外科,浙江杭州310014

出　　处：《中华医院感染学杂志》2023年第13期2005-2009,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科学研究基金资助项目(2021424558)。

摘　　要：目的探讨腹部带蒂皮瓣修复手外伤后感染创面并骨外露的临床疗效。方法选取2018年1月-2022年1月杭州整形医院收治的84例手外伤后感染创面并骨外露患者为研究对象,采用随机数字表法分为对照组42例和研究组42例。对照组给予游离皮瓣修复,研究组给予腹部带蒂皮瓣修复。术后随访6个月。比较两组术后6个月的治疗有效率、治疗满意度,手术、创面愈合及术后抗感染药物使用的时间、皮瓣色泽正常比例,术后手部功能恢复情况,术前、术后6个月的炎性因子,随访期间的并发症。结果术后6个月,研究组及对照组总有效率比较,无统计学差异;研究组总体功能、工作能力、日常生活能力、外观及对手的满意度评分更高;疼痛评分更低(P<0.05)。研究组手术、创面愈合及术后抗感染药物使用的时间更短(P<0.05)。术后6个月,两组血清白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、脂肪酶(LPS)及C-反应蛋白(CRP)水平均降低,且研究组更低(P<0.05)。术后6个月,研究组和对照组总满意率比较,无统计学差异。随访期间,研究组并发症发生率为4.76%,低于对照组的21.43%(P<0.05)。结论腹部带蒂皮瓣修复可缩短手术时间、创面愈合的时间,能够有效预防手外伤后感染创面并骨外露患者术后感染,减轻患者炎症反应,促进患者手部功能恢复,具有良好的疗效及安全性。OBJECTIVE To explore the clinical effect of abdominal pedicled skin flap repair on the hand trauma and infection patients with bone exposure.METHODS A total of 84 hand trauma and infection patients with bone exposure who were treated in Hangzhou Plastic Hospital from Jan 20i8 to Jan 2022 were recruited as the research subjects and were randomly divided into the control group with 42 cases and the stud group with 42 cases.The control group was treated with free skin flap repair,and the study group was given abdominal pedicled skin flap repair.A 6-month follow-up was conducted after the surgeries.The effective rate of treatment,satisfaction with treatment,operation duration,wound healing time,time of use of antibiotics for treatment of infection and normal ratio of skin flap color were observed and compared between the two groups after the surgeries for 6 months;the recovery of hand function was observed after the surgeries,the inflammatory factors were observed before and after the surgeries for 6 months,and the complications during the follow-up were analyzed.RESULTS There was no significant difference in the total effective rate between the study group and the control group after the surgeries for 6 months.The scores of overall function,working ability,daily living ability,appearance and satisfaction with hand of the study group were higher than those of the control group;the pain score of the study group was lower than that of the control group(P<o.05).The operation duration,wound healing time and time of use of antibiotics for treatment of postoperative infection were shorter in the study group than in the control group(P<0.05).The levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),lipase(LPS)and C-reactive protein(CRP)of the two groups were reduced after the surgeries for 6 months,and the levels of above indexes of the study group were lower than those of the control group(P<0.05).There was no significant difference in the total satisfaction between the study group and the control group afte

关 键 词：手外伤 感染创面 骨外露 游离皮瓣修复 腹部带蒂皮瓣修复 

分 类 号：R658.2[医药卫生—外科学]