人工真皮联合自体刃厚皮片移植治疗手足肌腱外露创面的临床效果

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摘要目的探讨人工真皮联合自体刃厚皮片移植治疗手足肌腱外露创面的临床效果，为手足肌腱外露创面的治疗提供更加合理有效的方案。方法选取2018年1月1日～2020年1月1日唐山工人医院骨科收治的所有手足肌腱外露创面的患者50例作为研究对象。以2019年10月1日为界限，分为对照组和观察组，每组各25例。所有患者入院后均行常规换药，进行创面准备。待创面清洁、达到植皮条件后，对照组行游离皮瓣移植术，观察组一期以人工真皮覆盖创面，2周后行自体刃厚皮片移植术，创面愈合后比较两组治疗效果。结果观察组患者创面愈合时间长于对照组，供皮区愈合时间短于对照组，差异有统计学意义（P<0.05）；观察组创面愈合后3、6个月温哥华瘢痕量表（VSS）评分低于对照组，差异有统计学意义（P<0.05）；观察组供皮区创面愈合后6个月VSS评分低于对照组，差异有统计学意义（P<0.05）；两组创面愈合后6个月的VSS评分均低于创面愈合后3个月VSS评分，差异有统计学意义（P<0.05）；观察组患者总满意度高于对照组，差异有统计学意义（P<0.05）；观察组畸形发生率低于对照组，差异有统计学意义（P<0.05）。结论初步认为手足肌腱外露创面的患者采用人工真皮联合自体刃厚皮片移植治疗，在总体治疗效果和患者满意度方面优于游离皮瓣移植，且手术更加简单易行，风险更低，值得临床推广。

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关键词 ：人工真皮, 手足创面, 肌腱外露, 自体刃厚皮片

Abstract：Objective To explore the clinical effect of the combination of artificial dermis and autologous blade-thick skin graft on the treatment of exposed hand-foot-tendon wounds,so as to provide more reasonable and effective treatment solutions.Methods A total of 50 patients with exposed hand-foot-tendon wounds admitted to the Department of Orthopedic of Tangshan Gongren Hospital from January 1,2018 to January 1,2020 were selected as study subjects.With October 1,2019 as the limit,they were divided into the control group and the observation group,with 25 cases in each group.After their admission,all patients obtained the routine dressing change for the preparation of the wound.When the wound surface was cleaned and reached the skin grafts conditions,the patients in control group performed the simple autologous skin flap transplantation,while the patients involved in observation group were given artificial dermis to cover the wound in the first stage,and then 2 weeks later,they accepted the autologous brade-thick skin graft.Subsequently,the postoperative efficacy of the two groups was compared after the wound was healed.Results The wound healing time of patients in the observation group was longer than that of the control group,and the healing time of donor site was shorter than that of the control group,and the differences were statistically significant (P<0.05).The scores of Vancouver scar scale (VSS) in observation group were lower than those in control group at 3 and 6 months after wound healing,and the differences were statistically significant (P<0.05).The VSS score of observation group at 6 month after wound heal in the donor site was lower than that of the control group,and the difference was statistically significant (P<0.05).The VSS scores of the two groups at 6 months after wound healing were lower than those at 3 months after wound healing,and the differences were statistically significant (P<0.05).The total satisfaction in the observation group was higher than that in the control group,and the difference was statistically significant (P<0.05).The incidence of deformity in observation group was lower than that in control group,and the difference was statistically significant (P<0.05).Conclusion It is preliminarily believed that,compared with the autologous skin flap transplantation,the overall treatment effect of artificial dermis with autologous blade-thick skin graft treatment is better for patients developing with exposed hand-foot-tendon wounds,and the surgery is simpler and easier to be operated,thus indicating the lowest risk.Therefore,it deserves to be promoted clinically.

Key words： Artificial dermis Hand-foot-tendon wounds Tendon exposed Autologous blade-thick skin graft

通讯作者: 张义庚，男，主任医师，研究方向：骨外科学

作者简介: 宋好好（1993-），男，华北理工大学研究生学院骨外科学2018级在读硕士研究生，研究方向：骨外科学

引用本文:

宋好好1；张义庚；刘纯；王帅；胡建威；张月明. 人工真皮联合自体刃厚皮片移植治疗手足肌腱外露创面的临床效果[J]. 中国当代医药, 2021, 28(4): 51-54.
SONG Hao-hao；ZHANG Yi-geng； LIU Chun； WANG Shuai； HU Jian-wei；ZHANG Yue-ming. Clinical effect on the treatment of open wound of tendon of hand and foot with artificial dermis combined with autologous blade-thick skin graft. 中国当代医药, 2021, 28(4): 51-54.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I4/51

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