对比应用新型皮肤伸展器与传统方法关闭筋膜室切开减压术后创面的临床疗效分析

发布时间：2018-04-24 11:19

本文选题：皮肤伸展器 + 创面　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:骨筋膜室综合征(osteofascial compartment syndrome OCS)是由于筋膜室内压力增高导致肢体急性缺血的一种骨科急症,病情较轻者可保守治疗,保守治疗无效者需及时行筋膜室切开减压术;骨筋膜室综合征切开减压后,需要借助VSD覆盖,待水肿减轻后再行闭合,但是由于皮肤的回缩、组织水肿,创面张力较大,难以直接闭合,往往需要取皮植皮,如高张力下强行闭合;植皮易导致取皮区和植皮区瘢痕形成,强行闭合创面因为高张力下引起皮缘血运丧失导致皮肤坏死,往往需二次手术处理,这些传统方法并发症较高、治疗周期长、费用高,如何快速、微创、安全的关闭骨筋膜室切开后创面成为一个临床难题;近年来应用新型皮肤伸展器关闭骨筋膜室切开减压后创面成为一种新技术。本文通过应用新型皮肤伸展器闭合骨筋膜室综合征切开减压后创面的关闭与传统关闭创面的方法进行对比,为临床关闭骨筋膜室切开减压后皮肤创面提供一种新方法。方法:回顾性统计、分析大连医科大学附属第一医院自2013年6月至2016年9月期间,骨科收治入选的38例因外伤导致的骨筋膜室综合征患者,均为保守治疗无效行切开减压术患者,根据关闭切口方式的不同,分为使用皮肤伸展器组,传统治疗组。其中使用皮肤伸展器组:男性11例、女性3例年龄11-60岁,平均年龄37.2±15.1岁,切口关闭前均为高张力切口,术前有3例患者患有内分泌疾病;传统治疗组:男性19例、女性5例,年龄10-69岁,平均年龄36.5± 14.4岁,切口关闭前均为高张力切口,术前有7例患者患有内分泌疾病。分别对两组的一般情况,手术时间、术后抗生素使用天数、术后换药次数、筋膜室切开后住院天数、切口关闭后住院天数、切口愈合评分等进行比较。结果:通过对全部患者数据进行统计比较,对两组患者的性别、年龄、部位、合并内分泌疾病等进行分析、比较,差异无统计学意义(P0.05);两组在手术时间、术后抗生素使用天数、术后换药次数、筋膜室切开后住院天数、切口关闭后住院天数、切口愈合评分等P值均小于0.05,差异有统计学意义;其中使用皮肤伸展器组与传统治疗组在手术时间传统治疗组耗时少于使用皮肤伸展器组,P0.05,差异有统计学意义;在术后抗生素使用天数、术后换药次数、筋膜室切开后住院天数、切口关闭后住院天数皮肤伸展器组少于传统足疗组,P0.05,差异有统计学意义;在切口愈合评分方面,皮肤伸展器组也优于传统治疗组,P0.05,差异有统计学意义。结论:新型皮肤伸展器通过伸展皮肤使筋膜室切开减压术后创面低张力直接关闭,避免植皮或皮瓣手术,与传统关闭方法相比,该技术具有微创性、操作简单,为筋膜室切开减压术后创面提供了一个非常安全有效的方法。
[Abstract]:Objective: osteofascial compartment syndrome OCS is a department of orthopedics emergency for acute ischemia of the extremities due to the increased pressure in the fascia, and the condition is more conservative. The patients who are not effective should be treated with fasciotomy and decompression. After the incision and decompression of the bone gluten chamber syndrome, it needs to be covered with VSD to be covered. When the edema is relieved, it is closed again, but due to the retracting of the skin, edema of the tissue, the tension of the wound is large, it is difficult to close the skin directly. It often needs skin grafting, such as strong tension under high tension; skin grafting leads to the formation of scar in the skin and skin area, and the skin necrosis is often caused by the loss of blood transport caused by the skin margin under Gao Zhang force. Two operations, these traditional methods have high complications, long period of treatment and high cost. How to quickly, minimally invasive, and safely close the bone fascia after the incision of the bone fascia becomes a clinical problem. In recent years, new skin extender has been used to close the bone fasciotomy and decompress the wound to become a new technique. The closure of the closed osteofascial compartment syndrome after the incision and decompression is compared with the traditional method of closing the wound, providing a new method for the clinical closure of the skin wound after the incision and decompression of the osteofascial compartment. Methods: a retrospective analysis was made to analyze the admission of the First Affiliated Hospital of Dalian Medical University from June 2013 to September 2016, and the Department of orthopedics was admitted to the hospital. 38 patients with osteofascial compartment syndrome caused by trauma were treated with incision and decompression. According to the different methods of closing the incision, the patients were divided into the skin extender group and the traditional treatment group. The skin extender was used in the group of 11 men and 3 women aged 11-60 years, with the average age of 37.2 + 15.1 years, all before the incision closed. High tension incision, 3 patients had endocrine diseases before operation; the traditional treatment group: male 19, female 5, age 10-69 years old, average age 36.5 + 14.4 years old, high tension incision before incision closure, 7 patients with endocrine disease before operation. The general condition of two groups, operation time, postoperative antibiotic use days, postoperative change, respectively. The number of drugs, the number of days after fasciotomy, the number of days after the closure of the incision, the score of incision healing, and so on. Results: by comparing the data of all the patients, the sex, age, position, and the endocrine disease of the two groups were analyzed, and the difference was not statistically significant (P0.05); the two groups were in the operation time and after the operation. The number of antibiotics used, the number of changes after the operation, the number of days after the fasciotomy, the number of hospitalization days after the incision closed, the P value of the incision healing score were less than 0.05, and the difference was statistically significant. The time of using the skin extender group and the traditional treatment group in the traditional treatment group was less than the use of the skin extender group, and the difference was P0.05. The number of postoperative antibiotics used, the number of postoperative antibiotics, the number of postoperative change, the number of days after the fascia chamber incision, the number of skin stretchers after the closure of the incision was less than the traditional pedicure group, P0.05, the difference was statistically significant; in the wound healing score, the skin extender group was also superior to the traditional treatment group, P0.05, the difference was statistically significant. The new skin extender is minimally invasive, easy to operate and provides a very safe and effective method for fasciocutaneous incision and decompression.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.2

【参考文献】