全厚与断层皮片移植修复儿童软组织创面的比较  

Full-thickness versus split-thickness skin grafting for repairing wounds secondary to necrotizing soft tissue infection in children

作　　者：冯彦华 任强 李祥 李京宴 王明新[4] FENG Yan-hua;REN qiang;LI Xiang;LI Jing-yan;WANG Ming-xin(Department of Traumatic Orthopedics,Children′s Hospital of Hebei Province,Shijiazhuang 050000,Hebei,China;Depart-ment of Plastic Surgery,Children′s Hospital of Hebei Province,Shijiazhuang 050000,Hebei,China;The Second Hospital,Hebei Medical University,050000,Hebei,China;Division of Sports Medicine,Department of Orthopedics,The Fourth Medical Center,PLA General Hospi-tal,Beijing 100048,China)

机构地区：[1]河北省儿童医院骨科(创伤外科),河北石家庄050000 [2]河北省儿童医院整形外科,河北石家庄050000 [3]河北医科大学第二医院,河北石家庄050000 [4]解放军总医院第四医学中心骨科医学部运动医学科,北京100048

出　　处：《中国矫形外科杂志》2025年第3期207-212,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:82302412);河北省政府资助临床医学优秀人才培养项目(编号:ZF2024182);河北省医学科学研究课题计划项目(编号:20220782,20240281)。

摘　　要：[目的]探讨全厚与断层皮片移植修复儿童坏死性软组织感染(necrotizing soft tissue infection,NSTI)创面的疗效。[方法]回顾性分析河北省儿童医院2014年1月—2022年6月收治的56例NSTI患儿的临床资料,依据医患沟通结果,31例行全厚皮片移植(全厚组),25例行断层皮片移植(断层组)。比较两组围手术期及随访资料。[结果]两组手术时间、术中失血量、清创后缺损面积、供区部位及处理、移植皮片成活率、下地行走时间和住院时间比较差异均无意义(P>0.05)。所有患儿均获随访,随访时间平均(12.0±2.4)个月。随术后时间推移,两组受区和供区外观视觉模拟评分(visual analogue scale,VAS)和温哥华瘢痕量表(Vancouver scar scale,VSS)评分均显著减少(P<0.05),受区功能显著改善(P<0.05),供区功能无显著变化(P>0.05)。术后3个月、末次随时全厚组受区VAS[(5.7±0.7)vs(6.0±0.4),P=0.017;(2.0±0.7)vs(3.6±0.7),P<0.001]及受区VSS评分[(4.3±0.8)vs(5.4±0.7),P<0.001;(2.5±0.6)vs(4.1±0.5),P<0.001]、受区功能[正常/受限/畸形,(11/16/4)vs(4/11/10),P=0.045;(24/7/0)vs(9/16/0),P=0.002]均显著优于断层组。[结论]全厚皮片在坏死性软组织感染创面修复的治疗中具有良好效果,可用于坏死性软组织感染创面的修复。[Objective]To explore the therapeutic outcomes of full-thickness versus split-thickness skin grafting for repairing the wounds secondary to necrotizing soft tissue infection(NSTI)in children.[Methods]A retrospective study was conducted on 56 children who had wound of NSTI treated in the Children's Hospital of Hebei Province from January 2014 to June 2022.According to patient-doctor communication,31 children underwent full-thickness skin grafting(FT group),while other 25 patients had split-thickness skin grafting performed(ST group).The documents regarding perioperative period and follow-up were compared between the two groups.[Results]There were no significant differences in operation time,intraoperative blood loss,defect area after debridement,donor site and treatment,graft survival rate,walking time and hospital stay between the two groups(P>0.05).As time went during follow-up period lasted for an average of(12.0±2.4)months,the visual analogue scale(VAS)for appearance,and Vancouver scar scale(VSS)of recipient and donor areas significantly decreased(P<0.05),while the function of recipient area significantly improved(P<0.05),despite of the fact that function of donor area remained unchange in both groups(P>0.05).The FT group proved significantly superior to the ST group in terms of VAS for appearance[(5.7±0.7)vs(6.0±0.4),P=0.017;(2.0±0.7)vs(3.6±0.7),P<0.001]VSS score[(4.3±0.8)vs(5.4±0.7),P<0.001;(2.5±0.6)vs(4.1±0.5),P<0.001],the area function[normal/limited/deformity,(11/16/4)vs(4/11/10),P=0.045;(24/7/0)vs(9/16/0),P=0.002]3 months postoperatively and at the latest follow-up.[Conclusion]Full-thickness skin grafting have good consequence in wound repair,and can be used for the repair of wound secondary to necrotic soft tissue infection in children.

关 键 词：儿童坏死性软组织感染 创面修复 全厚皮移植 断层皮片移植 功能恢复 

分 类 号：R687[医药卫生—骨科学]