發(fā)布時間：2019-03-03 12:42

【摘要】：目的:通過與傳統(tǒng)經(jīng)典的鄰指、腹部、島狀皮瓣及原位回植手術(shù)方法對照,研究分析人工真皮(PELNAC)修復(fù)手指指端缺損的臨床治療效果方法:回顧性分析總結(jié)2013年6月一2014年12月我科指端缺損治療的病例,在盡可能排除年齡、營養(yǎng)狀況、經(jīng)濟、職業(yè)因素等差異下,隨機的選出以Pelnac修復(fù)指端缺損而治愈的20例患者臨床資料,在類似部位、類似損傷的經(jīng)傳統(tǒng)鄰指、腹部、島狀皮瓣轉(zhuǎn)移術(shù)及原位回植而治愈的患者中,隨機選出鄰指皮瓣20例、腹部皮瓣患者20例、島狀皮瓣20例及原位回植成活20例患者(2例隨訪丟失,故有效數(shù)據(jù)為18例患者)的資料作為對照組。Pelnca治療組創(chuàng)面均急診行清創(chuàng)+Pelnac覆蓋術(shù),術(shù)后4周拆除硅膠膜,傷口每三天換藥一次,待創(chuàng)面自然上皮化。對五組患者術(shù)后進行12-18個月的隨訪并加以對比分析。使用spss19.0軟件包加以統(tǒng)計分析。結(jié)果:pelnac治療組術(shù)后無主要并發(fā)癥,顏色及質(zhì)地有效比為100%,上皮化時間為20.95±3.78天,Pelnac治療指端缺損的有效率為100%,感覺恢復(fù)在S3-S3+。Pelnac治療組與其他治療組相比,Pelnac組疤痕得分低于其他組(P0.05);傷口愈合時間Pelnac組長于其他組(PO.05);住院時間Pelnac組短于其他組(PO.05);Pelnac組患指功能鍛煉時間早于其他組(PO.05);Pelnac組DIP及總TAM要優(yōu)于其他組(PO.05);;Pelnac組愈后外觀好于其他組(P0.05)。患者住院費用,Pelnac組高于原位回植組(P0.05),與島狀皮瓣組無明顯統(tǒng)計學(xué)意義(P0.05),低于鄰指皮瓣及腹部皮瓣組(P0.05)患者手術(shù)時間,Pelnac組與原位回植組無明顯統(tǒng)計學(xué)差異(P0.05),短與其他治療組(P0.05)結(jié)論:1、Pelnac修復(fù)手外傷中指端缺損,手術(shù)操作簡單,手術(shù)時間短,住院時間短,創(chuàng)傷小,術(shù)后患指外觀、感覺良好。2、Pelnac治療方法一次手術(shù)完成,無需二次手術(shù),易于在基層推廣。3、Pelnac治療方法患者術(shù)后患指指間關(guān)節(jié)可早期活動及功能鍛煉,患指活動及功能恢復(fù)良好4、Pelnac治療方法傷口愈合周期長,無菌要求高,費用較高。
[Abstract]:Objective: to compare the traditional methods of orthopedic orthotopic replantation with that of adjacent finger, abdomen, island skin flap and in situ replantation. Study and analysis of the clinical effect of artificial dermis (PELNAC) in the repair of finger tip defect: retrospective analysis of the treatment of finger end defect in our department from June 2013 to December 2014, excluding age, nutritional status and economy as far as possible, Under different occupational factors, the clinical data of 20 patients who were cured by Pelnac repair of finger end defect were randomly selected. In the patients with similar site, similar injury through traditional adjacent finger, abdomen, island flap transfer and in situ replantation, the clinical data were selected randomly, and the clinical data of 20 patients cured by repair of finger end defect with similar injury were randomly selected. There were 20 cases of adjacent finger flap, 20 cases of abdominal flap, 20 cases of island flap and 20 cases of survival after in situ replantation. All the wounds in the Pelnca treatment group were treated with debridement Pelnac coverage, and the silicone film was removed 4 weeks after operation. The wound was changed every three days until the wound was naturally epithelized. Five groups of patients were followed up for 12 months and 18 months after operation and compared with each other. Spss19.0 software package was used for statistical analysis. Results: there were no major complications in the pelnac group, the effective ratio of color to texture was 100%, the epithelization time was 20.95 鹵3.78 days, and the effective rate of Pelnac in the treatment of fingertip defect was 100%. Compared with other groups, the scar score in S3-S3 group was lower than that in other groups (P0.05), and the score of scar in Pelnac group was lower than that in other groups (P0.05). The time of wound healing was longer in Pelnac group than in other groups (PO.05), and the duration of hospitalization in Pelnac group was shorter than that in other groups (PO.05); Pelnac group was earlier than that in other groups (PO.05); Pelnac group DIP and total TAM) was better than other groups (PO.05); group). The appearance of Pelnac group after recovery was better than that of other groups (P0.05). The cost of hospitalization in the Pelnac group was higher than that in the in situ graft group (P0.05), and there was no significant difference between the island flap group and the island flap group (P0.05), but it was lower than that in the adjacent finger flap and abdominal flap group (P0.05). There was no significant difference between Pelnac group and in situ replantation group (P0.05). Conclusion: 1Pelnac has the advantages of simple operation, shorter operation time, shorter hospital stay and less trauma. The appearance of the affected finger after operation is good. 2, the Pelnac treatment method is completed in one operation, does not need the second operation, and is easy to be popularized at the basic level. 3, the patients with Pelnac treatment can have early movement and functional exercise of the interphalangeal joint after operation. The activity and function of the affected finger recovered well. Pelnac treatment had a long healing period, high aseptic requirement and high cost.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R658.2

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