膜诱导技术联合局部肌皮瓣修复大转子区窦腔型压力性损伤的临床疗效  

Clinical efficacy of membrane induction technique combined with local myocutaneous flap in repairing sinus cavity pressure injury in the greater trochanteric region

作　　者：佟琳 张万福 韩飞 官浩 Tong Lin;Zhang Wanfu;Han Fei;Guan Hao(Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032

出　　处：《中华烧伤与创面修复杂志》2024年第5期443-450,共8页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金面上项目(82272268)。

摘　　要：目的探讨膜诱导技术联合局部肌皮瓣修复大转子区窦腔型压力性损伤的临床疗效。方法该研究为回顾性病例系列研究。2020年1月—2023年1月,空军军医大学第一附属医院烧伤与皮肤外科收治12例符合入选标准的大转子区窦腔型压力性损伤且伴有不同程度感染的患者,其中男8例、女4例,年龄42~76岁,单侧大转子区压力性损伤者9例、双侧大转子区压力性损伤者3例,3例患者并发脓毒症。清创前压力性损伤创面外口面积为1.5 cm×1.0 cm~3.0 cm×3.0 cm,术中清创时测量的内腔面积为10.0 cm×8.5 cm~20.0 cm×10.0 cm。改善全身一般状况后,Ⅰ期行清创后抗生素骨水泥覆盖/填塞,Ⅱ期移植面积为10.0 cm×9.0 cm~22.5 cm×11.5 cm局部肌皮瓣修复创面,将供瓣区创面直接缝合。对比所有患者Ⅰ期术前与Ⅰ期术后7 d的白细胞计数、C反应蛋白、降钙素原、红细胞沉降率等炎症指标水平及创面分泌物标本微生物培养阳性比,记录并发脓毒症患者Ⅰ期术前与Ⅰ期术后3 d精神状况、体温、心率、呼吸频率,观察所有患者Ⅱ期术后局部肌皮瓣成活及创面愈合情况,随访所有患者压力性损伤复发情况及肌皮瓣外观和质地。结果12例患者Ⅰ期术后7 d的白细胞计数、C反应蛋白水平、降钙素原水平、红细胞沉降率均较Ⅰ期术前明显下降(t值分别为6.67、7.71、2.72、3.52,P<0.05);Ⅰ期术后7 d创面分泌物标本微生物培养阳性比为2/12,较Ⅰ期术前的11/12明显降低(P<0.05)。3例并发脓毒症患者Ⅰ期术后3 d精神状况较Ⅰ期术前明显好转,体温恢复正常,心率<90次/min,呼吸频率<20次/min。共15个创面经局部肌皮瓣移植修复,Ⅱ期术后14个局部肌皮瓣存活良好,创面愈合;1个局部肌皮瓣远端少部分坏死,经床旁清创缝合后14 d愈合。Ⅱ期术后随访3~24个月,所有患者压力性损伤均未复发,肌皮瓣不臃肿,肌皮瓣颜色与周围皮肤组织近似且质地柔软Objective To investigate the clinical efficacy of membrane induction technique combined with local myocutaneous flap in repairing sinus cavity pressure injury in the greater trochanteric region.Methods The study was a retrospective case series study.From January 2020 to January 2023,12 patients with sinus cavity pressure injury in the greater trochanteric region combined with varying degrees of infection who met the inclusion criteria were admitted to the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University,including 8 males and 4 females,aged 42-76 years.There were 9 patients with unilateral greater trochanteric pressure injury and 3 patients with bilateral greater trochanteric pressure injury.Three patients were complicated with sepsis.The external wound opening area of pressure injury before debridement was 1.5 cm×1.0 cm-3.0 cm×3.0 cm,and the internal cavity area measured during intraoperative debridement was 10.0 cm×8.5 cm-20.0 cm×10.0 cm.After the general condition of the whole body was improved,the covering/filling with antibiotic bone cement after debridement was performed in stageⅠ,the wound was repaired with local myocutaneous flap with the area of 10.0 cm×9.0 cm-22.5 cm×11.5 cm in stageⅡ,and the wound in the donor area was sutured directly.The levels of inflammatory indexes including white blood cell count,C-reactive protein,procalcitonin,and erythrocyte sedimentation rate,as well as the positive proportions of bacterial culture in wound exudation samples of all patients before and at 7 days after stageⅠsurgery were compared.The mental status,body temperature,heart rate,and respiratory rate of patients complicated with sepsis before and at 3 days after stageⅠsurgery were recorded.The survival of local myocutaneous flap and wound healing were observed in all patients after stageⅡsurgery.The recurrence of pressure injury and the appearance and texture of the myocutaneous flap were followed up in all patients.Results Compared with those

关 键 词：压力性溃疡 外科皮瓣 膜诱导技术 创面修复 大转子 局部肌皮瓣 

分 类 号：R622[医药卫生—整形外科]