摘要
目的回顾性分析躯干、下肢大面积深度烧伤患者增生性瘢痕挛缩致膝、髋关节屈曲畸形的治疗方法,并总结其经验。方法笔者将1960年12月-1995年12月收治的15例躯干及下肢深度烧伤后瘢痕挛缩患者屈曲畸形的膝、髋关节(共21个)按畸形程度分为A、B、C 3组。A组瘢痕切除后关节能直接复位,立即用大张自体皮覆盖创面,缝合后包扎固定。B组瘢痕切除后关节不能立即恢复到伸直位,根据供区条件选择大张自体皮或小片头皮覆盖创面,再用踝套进行牵引治疗 (力量逐渐加大),直至关节恢复到伸直位。C组关节瘢痕挛缩伴残余肉芽创面,创面较大者先用异体皮覆盖,待其成活后再切除瘢痕,并按B组方法治疗;肉芽创面较小者在无菌条件下直接与瘢痕一起切除,再按B组方法治疗。结果 14例患者膝、髋关节屈曲畸形均被矫正至伸直位,关节功能恢复良好,仅1例患者关节未完全复位。结论瘢痕松解术及踝套牵引的治疗方法可在较短时间内最大限度地矫正关节畸形,恢复患者下肢功能,减少局部溃疡形成,并且较节省皮源。
Objective To analyze retrospectively the treatment of severe flexion deformity of hip and knee joints due to postburn scar contractureas a result of extensive deep burn of the trunk and lower extremities. Methods Fifteen burn patients with flexion deformity of 21 hip and knee joints due to scar contracture following deep burn of the trunk and lower extremities were enrolled in the study, and they were divided into A, B and C groups. The contracture in the A group could be corrected directly after scar excision followed by immediate grafting autologous skin and proper fixation. The contracture of joints in B group could not be corrected immediately after scar excision, then the scars were excised and the wounds were covered with either large pieces of autoskin or small piece of scalp according to availability of donor sites, and finally traction was applied till flexion deformity was corrected. In the C group contracture of the joints were accompanied with residual granulation wounds. Wound coverage was first accomplished with grafting of alloskin , and the scar was excised after take of the grafts. The subsequent treatment was similar to B group. The patients with small areas of granulation wound were treated with excision of the wounds and the scar at one time, followed by similar treatments as in B group. Results The flexion deformities in hip and knee joints of 14 patients （except 1 patient） were corrected completely, with satisfactory joint function. Conclusion Operative lysis of extensive scar followed by traction with the aid of an ankle gauntlet is an efficient therapeutic strategy in correction of joint deformities accompanied by residual granulation wounds in the lower extremities in a short time with restoration of the function of the joints, lessening the chance of local ulceration, and saving the source of skin donation.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2006年第2期124-126,共3页
Chinese Journal of Burns
关键词
烧伤
膝关节
髋关节
瘢痕
挛缩
牵引术
Burns
Knee joint
Hip joint
Scar
Contracture
Traction
