中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2015年
43期
7047-7052
,共6页
党正杰%张宝泉%王守峰%杨新刚%高伟
黨正傑%張寶泉%王守峰%楊新剛%高偉
당정걸%장보천%왕수봉%양신강%고위
生物材料%材料相容性%新型皮肤牵拉器%深度创面%皮肤牵引%临床应用%组织构建
生物材料%材料相容性%新型皮膚牽拉器%深度創麵%皮膚牽引%臨床應用%組織構建
생물재료%재료상용성%신형피부견랍기%심도창면%피부견인%림상응용%조직구건
背景：以往的皮肤外扩张装置修复深度创面或皮肤缺损存在瘢痕增生明显、需多次手术、患者痛苦大及费用高等不足。目的：观察自行设计皮肤牵拉器(专利号：ZL 201220022443.7)治疗深度创面的临床效果。方法：纳入30例深度烧伤创面、皮肤缺损或条索状瘢痕患者，其中男22例，女8例，年龄18-49岁，均采用皮肤牵拉器进行皮肤牵引治疗，随机分为2组，其中20例从1 kg拉力开始牵引，每2 d增加1 kg，直至5 kg，每日牵拉6 h，共牵拉10 d，检测牵拉即刻、牵拉1，5，10，15，20，30及60 min时皮肤的血流量，并观察创缘皮肤改变，观察牵拉结束后的皮肤组织学变化；另10例中，2例、6例、2例分别以2，4，7 kg拉力进行皮肤牵引，观察皮肤血流量及皮肤改变等情况，寻找出最合适、安全的拉力。结果与结论：30例均一期愈合，愈合时间8-24 d，随访见外观与功能恢复良好，无皮肤坏死、感染及末梢循环障碍。皮肤牵拉器在4 kg拉力作用下最安全、合适，不会出现皮肤血循环障碍或撕裂。牵引后，皮肤血流增加，细胞数增多，以基底细胞数目增多明显，胶原纤维粗而密，弹力纤维明显增加，成纤维细胞和毛细血管密度增加。说明应用自行设计的皮肤牵拉器进行皮肤牵引，可以较好地闭合创面，减少瘢痕形成。
揹景：以往的皮膚外擴張裝置脩複深度創麵或皮膚缺損存在瘢痕增生明顯、需多次手術、患者痛苦大及費用高等不足。目的：觀察自行設計皮膚牽拉器(專利號：ZL 201220022443.7)治療深度創麵的臨床效果。方法：納入30例深度燒傷創麵、皮膚缺損或條索狀瘢痕患者，其中男22例，女8例，年齡18-49歲，均採用皮膚牽拉器進行皮膚牽引治療，隨機分為2組，其中20例從1 kg拉力開始牽引，每2 d增加1 kg，直至5 kg，每日牽拉6 h，共牽拉10 d，檢測牽拉即刻、牽拉1，5，10，15，20，30及60 min時皮膚的血流量，併觀察創緣皮膚改變，觀察牽拉結束後的皮膚組織學變化；另10例中，2例、6例、2例分彆以2，4，7 kg拉力進行皮膚牽引，觀察皮膚血流量及皮膚改變等情況，尋找齣最閤適、安全的拉力。結果與結論：30例均一期愈閤，愈閤時間8-24 d，隨訪見外觀與功能恢複良好，無皮膚壞死、感染及末梢循環障礙。皮膚牽拉器在4 kg拉力作用下最安全、閤適，不會齣現皮膚血循環障礙或撕裂。牽引後，皮膚血流增加，細胞數增多，以基底細胞數目增多明顯，膠原纖維粗而密，彈力纖維明顯增加，成纖維細胞和毛細血管密度增加。說明應用自行設計的皮膚牽拉器進行皮膚牽引，可以較好地閉閤創麵，減少瘢痕形成。
배경：이왕적피부외확장장치수복심도창면혹피부결손존재반흔증생명현、수다차수술、환자통고대급비용고등불족。목적：관찰자행설계피부견랍기(전리호：ZL 201220022443.7)치료심도창면적림상효과。방법：납입30례심도소상창면、피부결손혹조색상반흔환자，기중남22례，녀8례，년령18-49세，균채용피부견랍기진행피부견인치료，수궤분위2조，기중20례종1 kg랍력개시견인，매2 d증가1 kg，직지5 kg，매일견랍6 h，공견랍10 d，검측견랍즉각、견랍1，5，10，15，20，30급60 min시피부적혈류량，병관찰창연피부개변，관찰견랍결속후적피부조직학변화；령10례중，2례、6례、2례분별이2，4，7 kg랍력진행피부견인，관찰피부혈류량급피부개변등정황，심조출최합괄、안전적랍력。결과여결론：30례균일기유합，유합시간8-24 d，수방견외관여공능회복량호，무피부배사、감염급말소순배장애。피부견랍기재4 kg랍력작용하최안전、합괄，불회출현피부혈순배장애혹시렬。견인후，피부혈류증가，세포수증다，이기저세포수목증다명현，효원섬유조이밀，탄력섬유명현증가，성섬유세포화모세혈관밀도증가。설명응용자행설계적피부견랍기진행피부견인，가이교호지폐합창면，감소반흔형성。
BACKGROUND:Previously deep burn wound or skin defects are generaly repaired with skin grafting or flap of skin grafting. Obvious scar hyperplasia usualy appears after operation, which requires multiple surgeries. Meanwhile, patients have to suffer from great pain and bear high cost. OBJECTIVE: To observe the clinical effects on deep wounds by continuous traction of self-designed skin-stretching device (patent No. ZL 2012 2 0022443.7). METHODS: Thirty patients with deep burn wound, skin defect or funicular scar were enroled, including 22 males and 8 females, aged 18-49 years, and randomly divided into two groups. Skin-stretching device was adopted for skin traction treatment. Twenty cases underwent skin traction from 1 kg puling force to 5 kg, with an increase of 1 kg per 2 days, 6 hours a day for 10 days. Blood flow at the beginning, 1, 5, 10, 15, 20, 30, 60 minutes of the skin traction, and the changes of wound edge skin as wel as histological changes of the skin were observed. Of the remaining 10 cases, 2, 6, and 2 cases underwent skin traction of 2, 4, 7 kg, respectively. Blood flow and skin changes were also observed to find out the most suitable and safe force. RESULTS AND CONLUSION:Al the 30 cases achieved primary healing without necrosis of skin, infection or peripheral circulatory disorders, and the appearance and function recovered wel. The healing time was 8-24 days. The skin-stretching device was most safe under 4 kg puling force, by which, there was neither blood circulation obstacle nor tear of skin. After traction, the skin blood flow and the number of cels increased, especialy the epithelial basal cels. The colagen fibers became thicker and denser, and the elastic fibers regenerated significantly; the fibroblasts and capillary density increased. It has been proved that we can better close the wound and reduce scar formation effectively with the self-designed skin-stretching device for skin traction.
