烧烫伤合并颌面部骨折患者最佳骨折复位时机的分析

发布时间：2018-03-19 07:04

本文选题：烧伤　切入点：颌骨折　出处：《中华损伤与修复杂志(电子版)》2016年06期 　论文类型：期刊论文

【摘要】：目的通过总结临床病例,探讨烧烫伤患者在合并颌面部骨折的情况下如何合理选择骨折复位时机。方法选取解放军总医院第一附属医院烧伤整形科2003年6月至2016年8月收治的烧烫伤患者合并颌面部骨折病例,符合纳入标准的共48例,其中男32例,女16例,年龄17~45岁,平均(35±12)岁。下颌骨骨折36例60处,上颌骨骨折12例20处。烧伤面积34%~76%总体表面积(TBSA)。两组患者均进行烧伤治疗和颌面部骨折治疗。根据患者骨折复位手术时间分组:治疗组:休克期后感染期前(伤后1~3 d)手术;对照组:休克期后(伤后4~6 d)手术。对比两组患者术后切口感染率、内固定感染率和平均住院时间。对观察指标采用SPSS 16.0统计软件进行分析。组间比较采用t检验,χ2检验或Fisher确切概率法检验。结果治疗组患者术后切口感染率7.69%、内固定感染率0、平均住院时间(30±3)d,分别低于对照组的术后切口感染率36.36%、内固定感染率18.18%、平均住院时间(47±4)d,差异均具有统计学意义(χ2=3.430、1.976,t=7.949,P值均小于0.05)。结论烧烫伤患者合并颌面部骨折,在休克期之后感染期之前(伤后1~3 d)行切开复位内固定术,既可以降低颌面部手术感染的发生率,又能早期实现经口进食,为患者提供良好营养支持,更好促进烧伤创面愈合。
[Abstract]:Objective to summarize the clinical cases, To explore how to select the time of reduction for burn and scalded patients with maxillofacial fracture. Methods Burn and scalded patients were selected from June 2003 to August 2016 in the Department of Burn and plastic surgery of the first affiliated Hospital of PLA General Hospital. Patients with maxillofacial fractures, A total of 48 patients met the inclusion criteria, including 32 males and 16 females, aged 1745 years, with an average of 35 卤12 years old, and 36 cases with 60 mandibular fractures. There were 20 maxillary fractures in 12 cases with burn area of 34% and total surface area of TBSA.Two patients in both groups were treated with burn and maxillofacial fracture. According to the time of reduction of maxillofacial fracture, the treatment group was divided into two groups: treatment group: operation before infection period after shock stage (1 ~ 3 days after injury); Control group: operation after shock (4 days after injury). The infection rate of incision was compared between the two groups. The internal fixation infection rate and average hospitalization time were analyzed by SPSS 16.0 statistical software. T test, 蠂 2 test or Fisher exact probability test were used in the comparison between groups. Results the postoperative incision infection rate was 7.69% in the treatment group. The infection rate of internal fixation was 0, the average hospitalization time was 30 卤3 days, which was lower than that of the control group, which was 36.36, 18.18 and 47 卤4 days, respectively. The difference was statistically significant (蠂 ~ 23.430 ~ 1.976 ~ 1.976) P < 0.05.Conclusion Burn and scalded patients with maxillofacial fracture are lower than that of control group (P < 0.05). Open reduction and internal fixation before infection stage after shock (1 ~ 3 days after injury) can not only reduce the incidence of infection in maxillofacial surgery, but also realize oral feeding early, which can provide good nutritional support for patients and promote the healing of burn wounds.
【作者单位】：解放军总医院第一附属医院烧伤整形科;

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