摘要
目的比较应用单层型+双层型人工真皮复合移植和双层型人工真皮移植修复下肢大面积骨外露创面的临床疗效。方法采用回顾性病例对照研究分析2009年11月至2020年11月北京积水潭医院收治的34例(37个创面)下肢大面积骨外露创面患者临床资料,其中男27例,女7例;年龄9〜67岁[35.5(29,45)岁]。小腿及足踝部骨外露面积≥10cm^(2)(短径≥2cm).20例(21个创面)Ⅰ期采用双层型人工真皮移植(A组);14例(16个创面)Ⅰ期采用单层型+双层型人工真皮复合移植(B组).两组Ⅱ期均移植自体刃厚皮片观察Ⅱ期术后2周及2个月创面总愈合率,比较两组Ⅱ期术后2周及术后2个月创面愈合优良率、Ⅰ期与Ⅱ期手术间隔时间。应用温哥华瘢痕量表(VSS)评分评估Ⅱ期术后5〜6个月时两组植皮区瘢痕情况。结果患者均获随访1〜24个月[5(2,7.5)个月]。Ⅱ期术后2周及2个月创面总愈合率分别为81%(30/37)及97%(36/37).其中术后2周创面愈合优良率A组为76%(16/21),B组为88%(14/16);术后2个月创面愈合优良率A组为95%(20/21),B组为100%(16/16)(P均>0.05)D A组中4个创面需要再次移植人工真皮完成骨外露创面覆盖,B组均单次移植完成骨外露创面覆盖。A组中剔除4例经二次人工真皮移植的患者,Ⅰ期与Ⅱ期手术间隔时间为20(16,21)d,B组为21(21,23)d(P>0.05)。Ⅱ期术后5〜6个月时A组VSS评分为(9.2±1.1)分,B组为(8.0±1.2)分(P<0.05)。分项评分中色泽A组为(2.5±0.5)分,B组为(2.0±0.6)分;柔软度A组为(2.2±0.7)分,B组为(1.6±0.5)分,B组均较A组明显改善(P<0.05)结论应用人工真皮移植可有效修复下肢大面积骨外露创面,单层型+双层型人工真皮复合移植可避免大面积下肢骨外露创面修复时多次移植人工真皮,且Ⅰ期与Ⅱ期手术间隔时间无明显延长,术后植皮区瘢痕色泽和柔软度得到改善,提高了创面修复效率和质量。
Objective To compare the efficacy of hilayer artificial dermis graft plus single layer dermal template and hilayer artificial dermis graft only in repairing lower extremity wounds with large area of exposed hone.Methods A retrospective c ase-control study was conducted to analyze the clinical data of 34 patients with 37 wounds of the lower extremity involving large area of exposed bone admitted to Beijing Jishuitan Hospital from November 2009 to November 2020.There were 27 males and 7 females,aged 9-67 years[35.5(29,45)years].The exposed bone in the lower leg,ankle and foot was greater than 10 cnr in size(the shortest distance from edge to edge of bony exposure was more than 2 cm).At the first stage,the wounds were grafted with bilayer type artificial dermis only for 21 wounds of 20 patients in Group A,and grafted with hilayer type artificial dermis plus single layer dermal template for 16 wounds of 14 patients in Group B.At the second stage,the auto-skin graft was performed in the two groups.The wound healing rate was observed in all Datients,and was comparerl between the two groups at 2 weeks and 2 months after the second stage operation.At the same time,the interval between first stage and second stage surgerv was measured.The Vancouver Scar Scale(VSS)was used to evaluate the scar in the skin grafting area in the two groups at 5-6 months after the second stage operation.Results All patients were followed up for 1 to 24 months[5(2,7.5)months].The total excellent and good wound healing rate in all patients was 81%(30/37)at 2 weeks and 97%(36/37)at 2 months.There was no significant difference between the Grouj)A and Group B in the excellent and good wound healing rate at 2 weeks[(76%(16/21)vs.88%(14/16)]and at 2 months[95%(20/21)100%(16/16)](P>0.05).In Group A,the hilayer artificial derm is was grafted into 4 wounds again to complete exposed hone coverage.However,all wounds in Group B were(covered initially without re-grafting.The interval between the two-stage operation was 20(16,21)days in Group A after the 4 patients who underwent secondary artificial dermal transplantation were excluded,showing no significant difference from 21(21,23)tlays in Group B(P>0.05).At 5-6 months after the second stage operation,the VSS score in Group B[(8.0±1.2)points]was significant less than that in Group A[(9.2±1.1)days](P<0.05).In the sub-index of VSS,the score of color and softness of scar in Group B[(2.0±0.6)points,(1.6±0.5)points]were significantly improved compared to those in Group A[(2.5±0.5)points,(2.2±0.7)points](P<0.05).Conclusions The artificial dermis grafting is effective in treatment of lower extremity wounds with large area of exposed hone.However,the bilayer artificial dermis graft Plus single layer dermal template can avoid artificial dermal re-graft in repair of large area of exposed hone,and the interval between two-stage operation is not significantly prolonged.Moerover,the color and texture of scar after skin grafting and wound repair efficiency and quality are improved.
作者
陈欣
杜伟力
温春泉
张琮
田彭
Chen Xin;Du Weili;Wen Chunquan;Zhang Cong;Tian Peng(Department of Burns,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第6期519-525,共7页
Chinese Journal of Trauma
关键词
皮肤
人工
真皮
小腿损伤
足损伤
伤口愈合
骨外露
Skin,artificial
Dermis
Leg injuries
Foot injuries
Wound healing
Exposed bone
