CAJ | 학술논문

背景：近年来组织工程学取得巨大进展，皮肤组织工程尤为引人注目。人工真皮(PELNAC)相对应用较广泛，但报道以成人为主，缺乏修复儿童创面的报道。目的：探讨人工真皮作为儿童严重创伤创面真皮覆盖物的临床效果。方法：回顾性总结分析22例创面负压引流、人工真皮复合自体刃厚皮片或薄中厚皮片移植覆盖儿童严重创伤创面(实验组)的治疗效果，并与19例创面负压引流、创面肉芽培养、自体刃厚皮片或薄中厚皮片移植于同等创面(对照组)的治疗效果进行对比。分析评价指标包括人工真皮的存活率、创面完全覆盖所需的手术次数、植皮后创面完全愈合时间、随访创面移植区域的色泽、质地、皮下丰满度、瘢痕增生情况以及关节功能影响等。结果与结论：人工真皮移植后10-14 d存活率达90%以上。实验组2例第二次刃厚皮片移植，对照组8例第二次刃厚皮片移植，实验组创面植皮存活率优于对照组(P<0.05)。实验组植皮后创面完全愈合的平均时间为(13.86±3.09) d，对照组为(19.10±4.62) d，实验组平均植皮后创面完全愈合时间短于对照组(P<0.05)。经超过10个月随访，实验组的植皮区色泽、弹性优于对照组；实验组创面移植区域较对照组真皮部分皮下丰满度良好、瘢痕增生明显较轻；实验组关节功能受到不同程度影响5例，对照组关节功能受到影响10例，两组差异有显著性意义(P <0.05)。提示人工真皮抗感染力强、存活率高。将人工真皮应用于儿童严重创伤创面，与创面负压引流、培养肉芽及自体刃厚皮片或薄中厚皮片移植相比，能缩短创面植皮后愈合时间，提高愈合创面的质量，减少对关节功能的影响。
배경：근년래조직공정학취득거대진전，피부조직공정우위인인주목。인공진피(PELNAC)상대응용교엄범，단보도이성인위주，결핍수복인동창면적보도。목적：탐토인공진피작위인동엄중창상창면진피복개물적림상효과。방법：회고성총결분석22례창면부압인류、인공진피복합자체인후피편혹박중후피편이식복개인동엄중창상창면(실험조)적치료효과，병여19례창면부압인류、창면육아배양、자체인후피편혹박중후피편이식우동등창면(대조조)적치료효과진행대비。분석평개지표포괄인공진피적존활솔、창면완전복개소수적수술차수、식피후창면완전유합시간、수방창면이식구역적색택、질지、피하봉만도、반흔증생정황이급관절공능영향등。결과여결론：인공진피이식후10-14 d존활솔체90%이상。실험조2례제이차인후피편이식，대조조8례제이차인후피편이식，실험조창면식피존활솔우우대조조(P<0.05)。실험조식피후창면완전유합적평균시간위(13.86±3.09) d，대조조위(19.10±4.62) d，실험조평균식피후창면완전유합시간단우대조조(P<0.05)。경초과10개월수방，실험조적식피구색택、탄성우우대조조；실험조창면이식구역교대조조진피부분피하봉만도량호、반흔증생명현교경；실험조관절공능수도불동정도영향5례，대조조관절공능수도영향10례，량조차이유현저성의의(P <0.05)。제시인공진피항감염력강、존활솔고。장인공진피응용우인동엄중창상창면，여창면부압인류、배양육아급자체인후피편혹박중후피편이식상비，능축단창면식피후유합시간，제고유합창면적질량，감소대관절공능적영향。
BACKGROUND:In recent years, tissue engineering has made great progress, and skin tissue engineering is especialy noteworthy. Artificial dermis (PELNAC) is relatively used widely, but there is a lack of relevant reports on wound repair in children. OBJECTIVE:To investigate the clinical efficacy of Pelnac? METHODS:In a retrospective study, 22 patients with the wound of severe trauma were treated with Pelnac as skin graft dressings on treatment of the wounds of severe trauma in children. ? graft, negative-pressure wound therapy and split-thickness skin graft as experimental group (Pelnac? group), and another 19 patients treated with granulation formation dressing and split-thickness skin graft as control group. We colected data including the graft livability, the required re-operative times and the epithelization time after the skin graft. During the folow-up, the skin color and texture of survival skin, subcutaneous fulness, scar hyperplasia and the joint function were also evaluated. RESULTS AND CONCLUSION: In the Pelnac ? group, the graft livability was up to 90% within 10-14 days after grafting. The secondary split-thickness skin graft was required in two cases in the Pelnac? group and in eight cases in the control group. There was a significant difference in the graft livability (P < 0.05). The average epithelization time after the skin graft was (13.86±3.09) days in the Pelnac? group, which was significant shorter than the control group, (19.10±4.62) days, after the first time operation (P< 0.05). During the 10 months folow-up, the survival skin color and skin elasticity in the Pelnac? group was significantly better than that in the control group (P< 0.05). Better subcutaneous fulness and milder scar hyperplasy in the injured sites were obtained in the Pelnac? group compared with the control gorup. Five cases had certain joint function limitation in the Pelnac? group, compared to 10 cases in the control group, with a significant difference (P < 0.05). Artificial dermis Pelnac? has a stronger anti-infectious ability and higher graft livability. Pelnac? graft combined with negative-pressure wound therapy, granulation culture and split-thickness skin graft can shorten the epithelization time, improve wound healing and aleviate harm to the joint function after the skin graft.