中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
18期
2921-2926
,共6页
刘伟%肖军%郑佐勇%肖艳%李晓菲%区广鹏%黄瑞良%艾合买提江玉素甫
劉偉%肖軍%鄭佐勇%肖豔%李曉菲%區廣鵬%黃瑞良%艾閤買提江玉素甫
류위%초군%정좌용%초염%리효비%구엄붕%황서량%애합매제강옥소보
实验动物%组织构建%负压封闭引流%腹股沟皮瓣%游离移植%大面积软组织缺损
實驗動物%組織構建%負壓封閉引流%腹股溝皮瓣%遊離移植%大麵積軟組織缺損
실험동물%조직구건%부압봉폐인류%복고구피판%유리이식%대면적연조직결손
drainage%groin%surgical groin%tissue transplantation%soft tissue defects
背景：合并严重软组织并骨缺损的下肢开放性骨折，伤后胫前皮肤软组织坏死缺损，骨质、钢板外露等在临床上经常发生，关键在于坚强的骨折固定以及合理应用血供可靠的皮瓣封闭创面。<br> 目的：探讨负压封闭引流联合腹股沟游离皮瓣修复胫前大面积软组织缺损的效果。<br> 方法：纳入胫前大面积软组织缺损患者24例，根据修复方案分为2组，各12例。负压封闭引流组软组织缺损范围10 cm×15 cm-15 cm×20 cm。经清创后，外固定支架固定骨折，使用负压封闭引流敷料覆盖创面，三通管接生理盐水随时冲洗血块，7-10 d去除负压封闭引流负压，根据肉芽组织生长情况给予二期缝合，行旋髂浅动脉的髂腹股沟游离皮瓣与膝下内侧动静脉吻合移植修复。非负压封闭引流组创面大小10 cm×15 cm-30 cm×20 cm，受伤至入院时间1-24 h。普通清创换药，二期固定或者皮瓣转移。<br> 结果与结论：修复前住院时间及皮瓣面积比较，负压封闭引流组显著优于非负压封闭引流组(P<0.05)；2组修复术后住院时间、总住院时间差异均无显著性意义(P>0.05)。负压封闭引流组修复治疗后创面感染率为0，非负压封闭引流组治疗8-14 d后创面感染率为75%。2组创面及供区切口均Ⅰ期愈合，植皮顺利成活。2组患者均获随访，随访时间6-36个月，随访过程中非负压封闭引流组骨折愈合时间显著长于负压封闭引流组。2组皮瓣与周围皮肤色泽、质地相似，皮瓣受力处无血管危象的发生，无破溃，无臃肿。提示负压封闭引流联合腹股沟游离皮瓣修复对及时控制创伤后大面积软组织缺损感染，改善创面血运，缩短术前准备时间，及早闭合创面，促进创面及骨折愈合有显著作用，皮瓣质地柔韧，外观良好，活动功能良好，可明显缩短疗程，最大限度恢复患肢功能。
揹景：閤併嚴重軟組織併骨缺損的下肢開放性骨摺，傷後脛前皮膚軟組織壞死缺損，骨質、鋼闆外露等在臨床上經常髮生，關鍵在于堅彊的骨摺固定以及閤理應用血供可靠的皮瓣封閉創麵。<br> 目的：探討負壓封閉引流聯閤腹股溝遊離皮瓣脩複脛前大麵積軟組織缺損的效果。<br> 方法：納入脛前大麵積軟組織缺損患者24例，根據脩複方案分為2組，各12例。負壓封閉引流組軟組織缺損範圍10 cm×15 cm-15 cm×20 cm。經清創後，外固定支架固定骨摺，使用負壓封閉引流敷料覆蓋創麵，三通管接生理鹽水隨時遲洗血塊，7-10 d去除負壓封閉引流負壓，根據肉芽組織生長情況給予二期縫閤，行鏇髂淺動脈的髂腹股溝遊離皮瓣與膝下內側動靜脈吻閤移植脩複。非負壓封閉引流組創麵大小10 cm×15 cm-30 cm×20 cm，受傷至入院時間1-24 h。普通清創換藥，二期固定或者皮瓣轉移。<br> 結果與結論：脩複前住院時間及皮瓣麵積比較，負壓封閉引流組顯著優于非負壓封閉引流組(P<0.05)；2組脩複術後住院時間、總住院時間差異均無顯著性意義(P>0.05)。負壓封閉引流組脩複治療後創麵感染率為0，非負壓封閉引流組治療8-14 d後創麵感染率為75%。2組創麵及供區切口均Ⅰ期愈閤，植皮順利成活。2組患者均穫隨訪，隨訪時間6-36箇月，隨訪過程中非負壓封閉引流組骨摺愈閤時間顯著長于負壓封閉引流組。2組皮瓣與週圍皮膚色澤、質地相似，皮瓣受力處無血管危象的髮生，無破潰，無臃腫。提示負壓封閉引流聯閤腹股溝遊離皮瓣脩複對及時控製創傷後大麵積軟組織缺損感染，改善創麵血運，縮短術前準備時間，及早閉閤創麵，促進創麵及骨摺愈閤有顯著作用，皮瓣質地柔韌，外觀良好，活動功能良好，可明顯縮短療程，最大限度恢複患肢功能。
배경：합병엄중연조직병골결손적하지개방성골절，상후경전피부연조직배사결손，골질、강판외로등재림상상경상발생，관건재우견강적골절고정이급합리응용혈공가고적피판봉폐창면。<br> 목적：탐토부압봉폐인류연합복고구유리피판수복경전대면적연조직결손적효과。<br> 방법：납입경전대면적연조직결손환자24례，근거수복방안분위2조，각12례。부압봉폐인류조연조직결손범위10 cm×15 cm-15 cm×20 cm。경청창후，외고정지가고정골절，사용부압봉폐인류부료복개창면，삼통관접생리염수수시충세혈괴，7-10 d거제부압봉폐인류부압，근거육아조직생장정황급여이기봉합，행선가천동맥적가복고구유리피판여슬하내측동정맥문합이식수복。비부압봉폐인류조창면대소10 cm×15 cm-30 cm×20 cm，수상지입원시간1-24 h。보통청창환약，이기고정혹자피판전이。<br> 결과여결론：수복전주원시간급피판면적비교，부압봉폐인류조현저우우비부압봉폐인류조(P<0.05)；2조수복술후주원시간、총주원시간차이균무현저성의의(P>0.05)。부압봉폐인류조수복치료후창면감염솔위0，비부압봉폐인류조치료8-14 d후창면감염솔위75%。2조창면급공구절구균Ⅰ기유합，식피순리성활。2조환자균획수방，수방시간6-36개월，수방과정중비부압봉폐인류조골절유합시간현저장우부압봉폐인류조。2조피판여주위피부색택、질지상사，피판수력처무혈관위상적발생，무파궤，무옹종。제시부압봉폐인류연합복고구유리피판수복대급시공제창상후대면적연조직결손감염，개선창면혈운，축단술전준비시간，급조폐합창면，촉진창면급골절유합유현저작용，피판질지유인，외관량호，활동공능량호，가명현축단료정，최대한도회복환지공능。
BACKGROUND:Open fracture of lower limb with severe soft tissue and bone defects also accompanies anterior tibial soft tissue defects and exposure of sclerotin and steel plate, which can be crucial y treated with strong fixation and use of skin flap to block the wound. <br> OBJECTIVE:To explore the clinical efficacy of a large area of soft tissue defects in the anterior tibia using vacuum sealing drainage combined with groin free flap. <br> METHODS:A total of 24 patients with a large area of soft tissue defects in the anterior tibia were included in this study and then divided into two groups, with 12 cases in each group. In vacuum sealing drainage group, the scope of soft tissue defects was ranged from 10 cm×15 cm to 15 cm×20 cm. After the debridement, the fracture was fixed with external fixation scaffold and the wound was covered with the vacuum sealing drainage dressing. The blood clot was rinsed with normal saline via T-tube, and 7-10 days later the vacuum sealing drainage was given. According to the growth of granulation tissue, the wound was secondarily sutured, fol owed by groin free skin flap of superficial iliac circumflex artery with medial knee arteriovenous anastomosis transplantation. In the non-vacuum sealing drainage group, the wound size was ranged from 10 cm×5 cm to 30 cm×20 cm, the period from injury to admission was 1-24 hours. They were given conventional debridement and secondary fixation or skin flap transplantation. <br> RESULTS AND CONCLUSION:The length of preoperative hospital stay and the skin flap are in vacuum sealing drainage group were significantly better than those in non-vacuum sealing drainage group (P<0.05). There was no significant difference in the length of postoperative stay and total length of hospital stay between the two groups (P>0.05). The wound infection rate was 0 in vacuum sealing drainage group and 75%in non-vacuum sealing drainage group at 8-14 days after treatment. The wound and donor area incision were healed at I stage, the skin grafts survived. Al the involved patients in two groups were fol owed up, for 6-36 months. During the fol ow-up process, the fracture healing time in non-vacuum sealing drainage group was significantly longer than that in vacuum sealing drainage group. The skin flap in two groups was similar to surrounding skin in color and texture, the flap exhibited no vessels, no ulceration, and no clumsy. The vacuum sealing drainage combined with groin free flap can timely control a large area of soft tissue defects post-trauma, improve wound blood supply, shorten preoperative preparation time, early close the wound, significantly promote the healing of wound and fracture. The skin flap is soft, flexible, wel-looking, and active functional, it significantly shortens the course of treatment and maximizes the recovery of limb function.
