CAJ | 학술논문

目的探讨应用负压引流技术辅助人工真皮和自体皮移植修复关节开放和/或骨折处骨外露创面的临床效果. 方法 2008年11月-2014年11月,2家笔者单位收治存在关节开放和/或骨折处骨外露的11例患者,根据Ⅰ期治疗方法不同分为试验组6例、对照组5例.试验组患者包括关节开放4例、骨折处骨外露1例、关节开放合并骨折处骨外露1例,创面扩创后,移植剪孔的人工真皮,并在其上应用负压引流装置,持续负压治疗1周.对照组患者包括关节开放2例、骨折处骨外露2例、关节开放合并骨折处骨外露1例,创面扩创后,仅移植剪孔的人工真皮.Ⅱ期手术时,在完成血管化的人工真皮上,2组患者创面均移植自体刃厚皮修复. 结果试验组5例患者的关节开放创面,人工真皮血管化良好,自体皮移植成活,创面愈合.对照组3例患者的关节开放创面,人工真皮移植均因感染而失败,后采用局部组织瓣修复.2组3例单纯骨折处骨外露创面患者,无论是否应用负压引流装置,人工真皮均顺利血管化,移植自体皮均成活,创面愈合良好. 结论负压引流技术辅助人工真皮与自体皮移植可用于修复关节开放和/或骨折处骨外露创面.
목적 탐토응용부압인류기술보조인공진피화자체피이식수복관절개방화/혹골절처골외로창면적림상효과. 방법 2008년11월-2014년11월,2가필자단위수치존재관절개방화/혹골절처골외로적11례환자,근거Ⅰ기치료방법불동분위시험조6례、대조조5례.시험조환자포괄관절개방4례、골절처골외로1례、관절개방합병골절처골외로1례,창면확창후,이식전공적인공진피,병재기상응용부압인류장치,지속부압치료1주.대조조환자포괄관절개방2례、골절처골외로2례、관절개방합병골절처골외로1례,창면확창후,부이식전공적인공진피.Ⅱ기수술시,재완성혈관화적인공진피상,2조환자창면균이식자체인후피수복. 결과 시험조5례환자적관절개방창면,인공진피혈관화량호,자체피이식성활,창면유합.대조조3례환자적관절개방창면,인공진피이식균인감염이실패,후채용국부조직판수복.2조3례단순골절처골외로창면환자,무론시부응용부압인류장치,인공진피균순리혈관화,이식자체피균성활,창면유합량호. 결론 부압인류기술보조인공진피여자체피이식가용우수복관절개방화/혹골절처골외로창면.
Objective To explore the clinical effects of negative pressure wound therapy (NPWT)combined with artificial dermis grafting and autologous skin grafting on repair of open joint wounds and/or wounds with exposed bone fracture.Methods Eleven patients with open joint wounds and/or wounds with exposed bone fracture,hospitalized from November 2008 to November 2014,were enrolled in the study.According to the differences of the first stage treatment,all patients were divided into experimental group (n =6,including 4 patients of open joint wounds,1 patient of wound with exposed bone fracture,and Ⅰ patient of open joint wound with exposed bone fracture),and control group (n =5,including 2 patients of open joint wounds,2 patients of wounds with exposed bone fracture,and 1 patient of open joint wound with exposed bone fracture).After debridement,the wounds in both groups were grafted with punctured artificial dermis,while NPWT was only used over the artificial dermis of experiment group for 1 week.In the operation at second stage,autologous split-thickness skin was grafted on the vascularized artificial dermis in both groups.Results In 5 patients of open joint wounds in experimental group,the artificial dermis was vascularized well,autologous skin grafts survived,and wounds were healed.In 3 patients of open joint wounds in control group,the artificial dermis grafting all failed due to local infection,and then these wounds were repaired with local tissue flap grafting.Artificial dermis in 3 patients of wounds with exposed bone fracture in both groups was vascularized well after grafting,and the wounds were healed after autologous skin grafting,whether or not NPWT was used.Conclusions NPWT combined with artificial dermis grafting and autologous skin grafting can be used for repairing open joint wounds and/or wounds with exposed bone fracture.