一期原位回植联合VSD和红光治疗四肢皮肤脱套伤的临床疗效分析  

Clinical effect analysis of one-stage in situ implantation combined with VSD in the treatment of limb skin degloving injury

作　　者：王欣[1,2,3] 柳昌焕 方雪 张旺 谭微 王维兴 杨夏晴 WANG Xin;LIU Changhuan;FANG Xue;ZHANG Wang;TAN Wei;WANG Weixing;YANG Xiaqing(Dept.of Orthopedics Trauma and Microsurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Badong People's Hospital,Enshi 444300,Hubei,China;Hubei Clinical Medical Research Center of Trauma MicroSurgery,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,湖北武汉430071 [2]巴东县人民医院,湖北恩施444300 [3]湖北省创伤显微外科临床医学研究中心,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2024年第10期1217-1221,1238,共6页Medical Journal of Wuhan University

基　　金：湖北省骨外科学科能力建设项目(编号:YYXKNL2022009);湖北省自然科学基金计划项目(编号:2024AFC004)。

摘　　要：目的:探讨分析一期原位回植联合负压封闭引流技术(VSD)和红光治疗四肢皮肤脱套伤的临床疗效,为提高临床治疗四肢皮肤脱套伤效果提供可靠依据。方法:收集四肢皮肤脱套伤患者65例,研究组35例行一期原位回植联合VSD和红光治疗,对照组30例行一期原位回植后加压包扎,观察对比两组回植皮肤优良率、术后创面感染率及视觉模拟评分法(VAS)疼痛评分等指标,评估治疗效果。结果:术后随访6~12个月,平均随访(8.91±1.95)个月,研究组35例患者回植皮肤成活效果为优30例、良者3例、差者2例,总体优良率94.29%,对照组30例患者回植皮肤成活效果为优20例、良者4例、差者6例,总体优良率80.00%;研究组术后创面感染4例,感染率11.43%,对照组术后创面感染6例,感染率20.00%;研究组术后24 h VAS疼痛评分为(2.11±0.80)分,术后1周为(1.63±0.65)分,对照组术后24 h VAS疼痛评分为(3.03±0.93)分,术后1周为(2.40±0.67)分,差异均有统计学意义(均P<0.05)。结论:四肢皮肤脱套伤行一期原位回植联合VSD和红光治疗,回植皮肤成活率高,四肢功能恢复佳,感染率低,VAS疼痛评分低,具有很高的临床应用价值。Objective:To investigate the clinical efficacy of one-stage in situ sealing drainage combined with vacuum sealing drainage(VSD)and red light therapy for treating limb skin degloving injuries,aiming to establish a reliable foundation for enhancing clinical treatment protocols.Methods:A total of 65 patients with skin degloving injury of limbs were collected.35 patients in the study group received one-stage in situ implantation combined with VSD and red light treatment,and 30 patients in the control group received pressure dressing after one-stage in situ implantation.The excellent and good rate of skin implantation,postoperative wound infection rate,and visual analogue scale(VAS)pain score of the two groups were observed and compared to evaluate the therapeutic effect.Results:The average follow-up was(8.91±1.95)months for 6 to 12 months.In the study group,the survival effect of skin replantation was excellent in 30 cases,good in 3 cases,and poor in 2 cases,with an overall excellent and good rate of 94.29%.In the control group,the survival effect of skin replantation was excellent in 20 cases,good in 4 cases,and poor in 6 cases.Overall good rate was 80.00%.There were 4 postoperative wound infections(11.43%)in the study group and 6 postoperative wound infections(20.00%)in the control group.The VAS pain score of the study group was(2.11±0.80)points 24 hours after surgery and(1.63±0.65)points 1 week after surgery,and that of the control group was(3.03±0.93)points 24 hours after surgery and(2.40±0.67)points 1 week after surgery,with statistical significance(all P<0.05).Conclusion:One-stage in situ reimplantation combined with VSD and red light treatment for limb skin degloving injury can achieve a high survival rate,good limb function recovery,low infection rate,and low VAS pain score,which has high clinical application value.

关 键 词：皮肤脱套伤 负压封闭引流技术 原位回植 

分 类 号：R658.1[医药卫生—外科学]