前臂骨间背侧动脉穿支皮瓣游离移植修复术对手外伤软组织缺损患者患指血流动力学及炎症因子水平的影响  

Effect of free graft repair surgery of interosseous dorsal artery perforator flap of forearm in the affected finger on hemodynamic and inflammatory factor levels in patients with soft tissue defects in hand trauma

作　　者：袁孔 田超[1] 周崔崔 YUAN Kong;TIAN Chao;ZHOU Cuicui(Department of Orthopedics,Hospital of Traditional Chinese Medicine Affiliated to Nanyang Medical College,Henan 473000)

机构地区：[1]南阳医学高等专科学校附属中医院骨科,河南473000

出　　处：《交通医学》2024年第4期341-345,共5页Medical Journal of Communications

摘　　要：目的:探究前臂骨间背侧动脉穿支皮瓣游离移植修复术在手外伤软组织缺损中的应用价值。方法:回顾性分析113例手外伤软组织缺损患者临床资料,根据手术方法不同分为观察组59例和对照组54例。对照组行腹部皮瓣修复术,观察组行前臂骨间背侧动脉穿支皮瓣游离移植修复术。比较两组围手术期指标、手术前后血清炎症因子[C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、降钙素原(procalcitonin,PCT)]水平、术后皮瓣血流动力学(氧分压、血流灌注量、血管充盈时间评分)、术后皮瓣成活率、术后患侧手部运动功能及术后并发症。结果:观察组:住院时间(8.94±1.76)d、创面愈合时间(22.74±3.55)d、抗感染时间(6.25±2.05)d均短于对照组(均P<0.05)。术后3 d、7 d观察组血清CRP(34.48±4.12)mg/L、(14.53±3.95)mg/L,IL-6(31.22±3.58)pg/mL、(12.11±2.18)pg/mL,PCT(1.29±0.15)ng/mL、(0.68±0.09)ng/mL,均低于对照组,差异有统计学意义(均P<0.05)。术后1个月、3个月、6个月观察组氧分压(67.41±8.47)mmHg、(76.41±6.12)mmHg、(82.63±6.55)mmHg,血流灌注量(145.88±17.46)BPU、(185.24±25.41)BPU、(205.63±27.31)BPU,血管充盈时间评分(1.13±0.20)分、(2.39±0.22)分、(2.69±0.15)分,均高于对照组,差异有统计学意义(P<0.05)。术后6个月,两组皮瓣成活率均为100.00%,观察组患侧手部运动功能优良率98.31%,高于对照组的85.19%,但差异无统计学意义(P>0.05)。观察组并发症总发生率5.08%,低于对照组的14.81%,但差异无统计学意义(P>0.05)。结论:前臂骨间背侧动脉穿支皮瓣游离移植修复术治疗手部皮肤缺损患者,能减轻炎症反应,改善局部血流动力学,促进手部运动功能,安全性较高。Objective:To explore the application value of free graft repair surgery of interosseous dorsal artery perforator flap of forearm in the treatment of soft tissue defects in hand trauma.Methods:The clinical data of 113 patients with soft tissue defects in hand trauma were retrospectively analyzed,and they were divided into the observation group(59 cases)and the control group(54 cases)according to different surgical methods.The control group underwent abdominal flap repair,and the observation group underwent free graft repair surgery of interosseous dorsal artery perforator flap of forearm.The perioperative indexes,serum inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)],postoperative flap hemodynamics(partial pressure of oxygen,blood perfusion,vascular filling time score),postoperative flap survival rate,postoperative hand motor function and postoperative complications were compared between the two groups.Results:The length of hospital stay in the observation group was(8.94±1.76)d,wound healing time was(22.74±3.55)d,and the anti-infection time was(6.25±2.05)d,which were shorter than those in the control group(P<0.05).On the 3rd and 7th days after surgery, serum CRP levels were (34.48±4.12) mg/L, (14.53±3.95) mg/L, IL-6 (31.22±3.58) pg/mL, (12.11±2.18) pg/mL. The levels of PCT were (1.29±0.15) ng/mL and (0.68±0.09) ng/mL, which were lower than those in the control group (P<0.05). At 1 month, 3 months and 6 months after surgery, the partial pressures of oxygen were (67.41±8.47) mmHg, (76.41±6.12) mmHg, (82.63±6.55) mmHg, and the blood perfusion volumes were (145.88±17.46) BPU, (185.24±25.41) BPU, (205.63±27.31) BPU, and the vascular filling time scores were (1.13±0.20), (2.39±0.22), (2.69±0.15), which were higher than those in the control group (P<0.05). At 6 months after operation, the survival rate of the flap was 100.00% in both groups, and the excellent motor function rate of the affected hand in the observation group was 98.31%, which was higher than 85.19% in

关 键 词：皮肤缺损 手部 穿支皮瓣 炎症因子 血流动力学 运动功能 皮瓣成活率 

分 类 号：R658.2[医药卫生—外科学]