摘要
目的:Ⅲ度烧伤创面的处理临床上仍然以切痂植皮术治疗为主,由于切痂时切除了并未损伤的皮下脂肪组织,使其愈后外观变化明显。实验拟观察关节部位Ⅲ度烧伤削痂后于脂肪层移植大张自体中厚皮的疗效,并与切痂植皮进行比较。方法:①于2001-01/2007-06南昌大学第一附属医院烧伤科收治的关节Ⅲ度烧伤患者中抽取39例(45个关节)作为削痂组,同时抽取45例(共60个关节)作为切痂组。所有患者对治疗及实验方案均知情同意,且得到医院伦理道德委员会批准。②削痂组削痂植皮,保留正常皮下脂肪等组织。切痂组切痂植皮,切痂平面包括全层皮肤和皮下脂肪组织一并切除直至深筋膜层。削痂或切痂后植大张自体中厚皮。③创面修复后4￣6周观察两组患者的关节外观和关节活动功能;比较两组患者术后2周的植皮成活率和创面修复时间。结果:两组患者均进入结果分析。①两组患者烧伤关节创面修复后与对称的正常关节比较,削痂组外观变化不明显,周径缩小3.6%(P>0.05),功能好,关节活动度减少5.3%(P>0.05);切痂组外观变化明显,周径缩小23.4%(P<0.05),功能较差,关节活动度减少21.9%(P<0.05)。②两组患者术后2周植皮成活率和创面修复时间差异均无显著性意义(P>0.05)。结论:脂肪层移植大张自体中厚皮于Ⅲ度烧伤削痂后关节部位,能够维护肢体的美观,保护关节功能,疗效优于切痂植皮。
AIM： Third degree burn are mainly treated by escharectomy and skin grafting in clinic, but the skin appearance has also been changed due to the.excision of uninjured subcutaneous fatty tissue. We conducted a study to investigate the result of grafting big autologous split-skin on the adipose layer after shaving II burns eschar at the joint spot, and compare with the effect of excising eschar.
METHODS： ①Among the patients with Ⅲ burns at the joint spot, who were enrolled from the Department of Burns in the First Affiliated Hospital of Nanchang University from January 2001 to June 2007, 39 patients （45 joints） were selected as tangential excision of eschar group, simultaneous 45 patients （60 joints） were served as escharectomy group. All the patients and relatives were informed of the treatment and trial, saying yes. Approvals were obtained from the hospital ethical committee. ②Tangential excision of eschar group grafted big autologous split-skin after shaving eschar, with the presence of adipose layer. Escharectomy group grafted big autologous split-skin after excising eschar, including full-thickness skin, subcutaneous fatty tissue and deep fascia. ③At 4-6 weeks after treatment, the joint shape, joint movement, skin survival rate and the time of wound healing after healing were compared between the two groups.
RESULTS： All the patients were involved in the result analysis. ①There was no significant difference in appearance between tangential excision of eschar group joints after healing and symmetrical normal joints. The circumference reduced 3.6% （P 〉 0.05）, joint function was good, and range of joint movement reduced 5.3% （P 〉 0.05）. There were significant differences in appearance between escharectomy group joints after healing and symmetrical normal joints. The circumference reduced 23.4% （P 〈 0.05）, joint function was bad, and range of joint movement reduced 21.9% （P 〈 0.05）. ②The skin survival rate and the time of wound healing between the two groups wer
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第47期9535-9537,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
