儿童烧伤手部瘢痕挛缩畸形临床分析

发布时间：2018-06-22 20:08

本文选题：儿童烧伤 + 瘢痕挛缩　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨儿童手部瘢痕挛缩畸形原因,分析近年我院儿童烧伤后手瘢痕挛缩行手术治疗及功能锻炼情况,评估手术治疗手部瘢痕的疗效。方法:收集广西医科大学第一附属医院2013年01月至2016年12月共四年的114例患者(122只手)的数据,分析儿童烧伤原因及常见的畸形类型,根据伤后瘢痕挛缩情况进行手术治疗,观察术后植皮存活情况,随访了解瘢痕挛缩手的外观及功能(生活)恢复情况。结果:(1)儿童烧伤情况及主要原因:学龄前儿童为烧伤的主要阶段,学龄前儿童共99例,约占总数的84.2%,其中幼儿期59例,占总数的51.75%,致伤原因为热液烫伤为主;随着年龄的增长,自幼儿期开始各年龄段受伤的总数有下降趋势,火焰烧伤所占的比例有所上升,但仍以热液烫伤为主。(2)性别及地域分布:儿童烧伤及手部瘢痕挛缩畸形以男孩多见,其中男性69例(60.5%),女性45例(39.5%),男:女为3:2;在地域分布上,农村多于城市,农村患儿90例,约占总数的78.9%。(3)烧伤手畸形情况:手部的畸形类型主要表现为屈曲畸形及背伸畸形,屈曲畸形占病例数的95.6%;在左右手中,以左手多见,占总数的55.7%。(4)手术情况:114例行自体皮移植,其中96例成活优良,17例成活一般,1例成活差;手术治疗时间在伤后3个月以内患者有15例(13.16%),其中手功能评定达到“优”的例数有4例;手术治疗时间在伤后3个月-6个月的患者有21例(18.42%),其中手功能评定达到“优”的例数有12例;手术治疗时间在6个月-12个月的患者有43例(37.72%),其中手功能评定达到“优”的例数有23例;手术治疗时间在12个月以上的患者有35例(30.70%),其中手功能评定达到“优”的例数有10例;(5)随访情况:术后随访患儿74例,随访时间为出院后3月-4年,经手术治疗联合功能康复锻炼治疗,手功能评定的结果为:优49例,良22例,可3例,差0例,明显改善手部功能障碍达95.95%[(“优”+“良”)/总例数]。结论:(1)儿童烧伤以幼儿期多见,烧伤的最主要原因为热液烫伤,其次为火焰烧伤,且农村多于城市;(2)儿童烧伤手部瘢痕挛缩畸形以屈曲畸形多见,瘢痕畸形在6个月到1年内手术的疗效较好,如果严重畸形应尽早行手术治疗;(3)手术治疗手部瘢痕挛缩可快速恢复手功能,手术及功能锻炼可使手功能评价为“良”以上可达90%以上。
[Abstract]:Objective: to investigate the causes of hand scar contracture deformity in children, to analyze the surgical treatment and functional exercise of hand scar contracture after burn in our hospital in recent years, and to evaluate the curative effect of operation on hand scar. Methods: the data of 114 patients (122 hands) from January 2013 to December 2016 in the first affiliated Hospital of Guangxi Medical University were collected. The causes of burns and common deformities in children were analyzed. The surgical treatment was performed according to the condition of scar contracture after injury. To observe the survival of skin graft after operation and to observe the appearance and function of scar contracture hand. Results: (1) Burn status and main causes of children: preschool children were the main stage of burn. There were 99 cases of preschool children, accounting for 84.22.Among them, 59 cases were in infancy, accounting for 51.75% of the total. The main cause of injury was hot fluid scalding. Since infancy, the total number of injuries in each age group has declined, and the proportion of flame burns has increased, but it is still mainly hot fluid scalding. (2) gender and geographical distribution: children burn and hand scar contracture deformity are more common in boys. There were 69 males (60.5%) and 45 females (39.5%), male: female: 3: 2. In terms of geographical distribution, 90 children were found in rural areas, accounting for 78.9% of the total. (3) deformities of burned hands: flexion deformities and dorsiflexion deformities were the main types of deformities in the hands. Flexion deformities accounted for 95.6% of the cases, left hand accounted for 55.7% of the total in left and right hands. (4) Graft of skin autograft was performed in 114 cases, including 96 cases with good survival and 17 cases with poor survival. There were 15 cases (13.16%) of the patients within 3 months after injury, among which 4 cases were evaluated as "excellent" by hand function evaluation. There were 21 patients (18.42%) who had been treated for 3 months to 6 months after injury, among which 12 cases had "excellent" hand function evaluation. There were 43 cases (37.72%) with operation time from 6 months to 12 months, of which 23 cases were evaluated as "excellent". 35 cases (30.70%) were treated with operation for more than 12 months, including 10 cases whose hand function was excellent. (5) Follow-up: 74 cases were followed up after operation, the follow-up time was from 3 months to 4 years after discharge. After surgical treatment combined with functional rehabilitation exercise, the results of hand function evaluation were excellent in 49 cases, good in 22 cases, fair in 3 cases, and poor in 0 cases. The obvious improvement of hand dysfunction was 95.95% [(excellent "good" / total number of cases]. Conclusion: (1) Children burn is more common in early childhood, the main cause of burn is hot fluid scalding, followed by flame burn, and more in rural areas, (2) children burn hand scar contracture deformity is more common in flexion deformity. The surgical treatment of scar deformity is better in 6 months to 1 year. If the severe deformity is serious, the surgical treatment should be done as soon as possible. (3) the operation on scar contracture of the hand can quickly recover the hand function. Operation and functional exercise can make the evaluation of hand function more than 90%.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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