两种带蒂皮瓣移植修复膝部Ⅳ度电烧伤创面的临床疗效  

Clinical curative effects of two types of pedicled flaps in repairing the full-thickness electric burn wounds deep to tendon and bone in the knee

作　　者：薛继东[1] 梁琰 狄海萍[1] 邢培朋 董国赟 梁占领 夏成德[1] Xue Jidong;Liang Yan;Di Haiping;Xing Peipeng;Dong Guoyun;Liang Zhanling;Xia Chengde(Department of Burns,Zhengzhou First People's Hospital,Zhengzhou 450004,China)

机构地区：[1]郑州市第一人民医院烧伤科,郑州450004

出　　处：《中华烧伤与创面修复杂志》2024年第12期1158-1165,共8页Chinese Journal of Burns And Wounds

基　　金：国家临床重点专科建设项目(预卫医函[2023]70号);河南省医学科技攻关计划省部共建重点项目(SBGJ202002126、SBGJ202102208)。

摘　　要：目的比较隐动脉皮瓣与逆行股前外侧穿支皮瓣移植修复膝部Ⅳ度电烧伤创面的临床疗效。方法该研究为回顾性观察性研究。2018年7月—2022年2月,郑州市第一人民医院收治34例符合入选标准的膝部Ⅳ度电烧伤患者,其中男26例、女8例,年龄18~54岁。根据膝部电烧伤创面采用的修复方式,将患者分为采用隐动脉皮瓣修复的隐动脉皮瓣组(18例)、采用逆行股前外侧穿支皮瓣修复的股前外侧皮瓣组(16例)。隐动脉皮瓣组患者清创后骨和/或肌腱外露面积为5 cm×4 cm~12 cm×7 cm,伴关节开放者5例,皮瓣切取面积为9 cm×6 cm~25 cm×12 cm;股前外侧皮瓣组患者清创后骨和/或肌腱外露面积为7 cm×5 cm~15 cm×7 cm,伴关节开放者6例,皮瓣切取面积为15 cm×10 cm~39 cm×25 cm。根据切取皮瓣宽度选择直接缝合或采用躯干中厚皮移植修复供瓣区创面。术后观察皮瓣成活情况。末次随访时,观察皮瓣色泽、质地;检测皮瓣两点辨别觉距离;采用中华医学会手外科学会上肢部分功能评定试用标准评定皮瓣感觉恢复情况,并计算感觉恢复优秀比;采用国际膝关节委员会膝关节主观评分量表评定膝关节功能;采用皮瓣综合评价量表评定皮瓣修复效果,并计算优秀比。结果2组患者术后皮瓣大部分存活良好,仅股前外侧皮瓣组有2例患者皮瓣远端坏死3~5 cm 2,行植皮或局部拉拢缝合后愈合。术后12~18个月进行末次随访时,2组患者皮瓣色泽、质地与膝部皮肤组织相近。隐动脉皮瓣组患者皮瓣感觉恢复优秀比为18/18,明显高于股前外侧皮瓣组的5/16(P<0.05)。隐动脉皮瓣组患者皮瓣两点辨别觉距离为(11.7±1.5)mm,明显短于股前外侧皮瓣组的(21.5±1.7)mm(t=-1.84,P<0.05)。2组患者膝关节功能评分及皮瓣修复效果优秀比均无明显差异(P>0.05)。结论膝部Ⅳ度电烧伤创面可以通过隐动脉皮瓣与逆行股前外侧穿支皮瓣修复。采用这2种皮瓣修复Objective To compare the clinical curative effects of saphenous artery flap and retrograde anterolateral femoral perforator flap in repairing full-thickness electric burn wounds deep to tendon and bone in the knee.Methods This study was a retrospective observational study.From July 2018 to February 2022,34 patients with full-thickness electric burn wounds deep to tendon and bone in the knee and conformed to the inclusion criteria were admitted to Zhengzhou First People's Hospital,including 26 males and 8 females,aged 18 to 54 years.According to the repair method of the electric burn wounds in the knee,the patients were divided into saphenous artery flap group(18 cases)repaired with saphenous artery flap and anterolateral femoral flap group(16 cases)repaired with retrograde anterolateral femoral perforator flap.The exposed area of bone and/or tendon after debridement was 5 cm×4 cm to 12 cm×7 cm,5 patients were combined with open joint,and the resected area of the flap was 9 cm×6 cm to 25 cm×12 cm in saphenous artery flap group;the exposed area of bone and/or tendon after debridement was 7 cm×5 cm to 15 cm×7 cm,6 patients were combined with open joint,and the resected area of the flap was 15 cm×10 cm to 39 cm×25 cm in anterolateral femoral flap group.According to the resected width of the flap,the wounds in the flap donor areas were repaired by direct suture or medium thickness skin graft in the trunk.The survival of the flap was observed after surgery.At the last follow-up,the color and texture of the flap were observed,and the two-point discrimination distance of the flap was detected.The sensory recovery of the flap was evaluated using the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association,and the excellent ratio of sensory recovery was calculated.The function of knee joint was assessed using the Knee Subjective Score Scale of International Knee Documentation Committee.The repairing effect of the flap was evaluated using compre

关 键 词：烧伤 电 膝关节 外科皮瓣 感觉 创面修复 

分 类 号：R647[医药卫生—外科学]