摘要
目的回顾性分析下肢坏死性筋膜炎的诊疗及预后, 总结坏死性筋膜炎的发病机制及临床特点。方法大连市中心医院2016年9月至2020年12月收治25例下肢坏死性筋膜炎的患者, 男13例, 女12例, 年龄48~75岁, 平均年龄63岁。入院后严格评估患者身体一般状况, 完善相关术前检查, 并进行坏死性筋膜炎实验室风险指数(LRINEC)评分。在保证无手术禁忌的情况下, 行多次清创术, 术中留取所清除坏死组织行一般细菌培养, 并进行药敏试验。其中8例患者经清创后, 患肢出现较大面积皮肤坏死, 选择截肢术。其余17例患者清创后选择保肢治疗, 保肢治疗采取清创+游离植皮术, 术后鼓励患者加强康复锻炼, 最大程度地恢复肢体功能。结果随访0.6~3.0年, 平均1.8年, 随访方式包括门诊复诊、微信联系或电话询问等。17例患者移植皮肤均成活, 愈合时间为(27.5 ± 6.9) d。18例患者为多种细菌感染, 7例患者为单一细菌感染。所有患者均未出现因瘢痕挛缩所导致的关节功能障碍, 以及植皮区再发感染等情况。结论坏死性筋膜炎需要早期诊断、早期治疗, 而正确选择治疗方式与患者的预后密切相关。
Objective To retrospectively analyze the treatment of 25 cases of lower necrotizing fasciitis.Methods A total of 25 patients with lower limb necrotizing fasciitis(13 males and 12 females),with mean age 63 years old(48-75 years old)in Dalian Municipal Central Hospital from September 2016 to December 2020.After admission,the patient′s general physical condition was strictly evaluated,the relevant preoperative examination was improved,and the necrotizing fasciitis laboratory risk index(LRINEC)score was performed.In the absence of surgical contraindication,multiple debridement was performed,leaving the necrotic tissue removed for general bacterial culture and drug sensitivity test in parallel.After debridement,eight patients showed a large area of skin necrosis,and amputation was selected.The other 17 patients chose limb protection treatment after debridement,and adopted debridement and free skin grafting.After surgery,patients were encouraged to strengthen rehabilitation exercise to restore limb function to the maximum extent.Results With followed up 0.6 to 3.0 years,with an average of 1.8 years.Methods include outpatient return visit,WeChat contact or telephone inquiry.The skin survived in 17 patients with mean healing time(27.5±6.9)d.Eighteen patients were multiple bacterial infections and seven patients were single bacterial infections.All patients had no joint dysfunction caused by scar contracture,and reinfection in the skin grafting area.Conclusions Necrotizing fasciitis requires early diagnosis and early treatment,with correct choice of treatment method is closely related to the patient′s prognosis.
作者
王春生
钟怡鸣
孙焕伟
张洪权
杨卫东
高斌
苏毅
邹啸威
孙阳
徐媛媛
Wang Chunsheng;Zhong Yiming;Sun Huanwei;Zhang Hongquan;Yang Weidong;Gao Bin;Su Yi;Zou Xiaowei;Sun Yang;Xu Yuanyuan(Department of Hand and Foot Microsurgery,Dalian Municipal Central Hospital,Dalian 116033,China)
出处
《中国医师进修杂志》
2022年第2期113-118,共6页
Chinese Journal of Postgraduates of Medicine
关键词
筋膜炎
坏死性
感染
截肢术
植皮
Fasciitis,necrotizing
Infection
Amputation
Skin grafting
