负压封闭引流技术在肢体脱套伤一期原位植皮中的临床研究

发布时间：2018-07-07 08:01

本文选题：负压封闭引流技术 + 肢体脱套伤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨负压封闭引流技术(VSD)在肢体脱套伤一期原位植皮治疗中的临床效果,为其推广使用提供主要依据。方法:以威海市立医院2011年6月~2016年11月收治的肢体脱套伤病患为研究对象,共计52例。其中实验组26例患者使用一期联合应用原位植皮与负压封闭引流技术(VSD)进行治疗,其中男20例,女6例;这26位患者年龄保持在19到52岁之间,平均年龄大致为37.2岁。自受伤到最终患者就诊基本时间在50分钟到4小时之间,平均2.4个小时。其中26位患者受伤的原因16例由于手足原因,另外有3例肩背侧,7例是四肢的原因。受伤导致皮肤撕脱的面积保持在5cm×6cm--13cm×16cm,其中4例患者合并肌健损伤、开放性骨折。对照组26例患者采取常规清创原位植皮打包换药治疗方法,其中22例是男性,4例是女性。这26位患者年龄保持在21岁至51岁之间,平均年龄为36.3岁。就诊时间从受伤到患者就诊基本在0.5到4个小时之间,平均2.3小时。他们受伤的原因,其中10例是错误操作机器导致,10例则是车轮碾压导致受伤,其它6例则是意外导致的外伤。受伤的部位基本上分布在手足、肩背侧以及四肢,其中15例在手足,4例在肩背侧,7例在四肢。受伤导致皮肤撕脱的面积基本上保持在:4cm×6cm-12cm×16cm,3例患者合并肌腱损伤、开放性骨折。两组数据在统计学中的差异无意义,其基本情况具有可比性。结果:通过对两组相关数据进行对比,发现实验组的治疗效果比对照组明显要好,实验组患者在创伤一期愈合比例、伤口愈合时间、术后一周愈合面积、换药频次、住院时间均与对照组存在显著差异,且差异具有统计学意义(P0.05)。结论:在肢体脱套伤一期原位植皮治疗中应用负压封闭引流技术(VSD)能提高植皮的存活率,达到了及时清除坏死物质,有效清创,改善循环的目的,缩短了治疗周期,缓解了病人的痛苦,降低了住院费用,由于此技术能够高效的利用患者自身的撕脱皮肤,缩减植皮供应区的面积,进而达到缓解患者身心痛苦,减轻经济负担的作用,特别是它能够减少疤痕色素沉积、淡化供给区的疤痕区域,此类效果对于皮肤大面积撕脱者效果更为明显,具有显著的临床效果,值得其在临床中的推广应用。
[Abstract]:Objective: to investigate the clinical effect of negative pressure blocking drainage (VSD) in the treatment of limb shedding injury in one stage. Methods: from June 2011 to November 2016, 52 patients with limb shedding injury in Weihai Municipal Hospital were studied. Among them, 26 patients in the experimental group were treated with in situ skin grafting combined with negative pressure blocking drainage (VSD), including 20 males and 6 females. The age of 26 patients remained between 19 and 52 years old, with an average age of 37.2 years. The basic time from injury to final patient was between 50 minutes and 4 hours, averaging 2.4 hours. Among them, 16 cases were injured because of hand and foot, and 3 cases with dorsal shoulder and 7 cases with extremities. The area of skin avulsion caused by injury was kept at 5cm 脳 6cm--13cm 脳 16 cm. In the control group, 26 patients were treated with routine debridement and skin graft packing and dressing change, among which 22 cases were male and 4 cases were female. The 26 patients remained between 21 and 51, with an average age of 36.3. The time from injury to patient was between 0.5 and 4 hours, with an average of 2.3 hours. The causes of their injuries were 10 cases of maloperation of the machine and 10 cases of injuries caused by wheel compaction and 6 cases of accidental injuries. The injuries were mainly located in the dorsal side of the hand and foot, the dorsal side of the shoulder and the extremities, of which 15 cases were in the dorsal side of the hand and foot, 4 cases in the dorsal side of the shoulder and 7 cases in the extremities. The area of skin avulsion caused by injury was maintained at 4 cm 脳 6cm-12cm 脳 16 cm in 3 patients with tendon injury and open fracture. The difference between the two groups of data in statistics is meaningless and the basic situation is comparable. Results: by comparing the data of the two groups, it was found that the treatment effect of the experimental group was better than that of the control group. The proportion of primary wound healing, the wound healing time, the healing area of the first week after operation, the frequency of dressing change in the experimental group were better than those in the control group. The length of hospitalization was significantly different from that of the control group (P0.05). Conclusion: the negative pressure blocking drainage (VSD) technique can improve the survival rate of skin grafts, remove necrotic substances in time, effectively debridement, improve circulation and shorten the treatment period. It alleviates the pain of patients and reduces the cost of hospitalization. Because this technology can efficiently use the patients' own avulsion skin, reduce the area of skin graft supply area, and then achieve the purpose of alleviating the patients' physical and mental pain and reducing the economic burden. Especially, it can reduce scar pigment deposition and desalinate scar area in supply area. This kind of effect is more obvious for large area avulsion of skin and has remarkable clinical effect, so it is worth popularizing and applying in clinic.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R658

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