本文選題：皮膚伸展器 + 創(chuàng)面�。� 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:骨筋膜室綜合征(osteofascial compartment syndrome OCS)是由于筋膜室內(nèi)壓力增高導致肢體急性缺血的一種骨科急癥,病情較輕者可保守治療,保守治療無效者需及時行筋膜室切開減壓術(shù);骨筋膜室綜合征切開減壓后,需要借助VSD覆蓋,待水腫減輕后再行閉合,但是由于皮膚的回縮、組織水腫,創(chuàng)面張力較大,難以直接閉合,往往需要取皮植皮,如高張力下強行閉合;植皮易導致取皮區(qū)和植皮區(qū)瘢痕形成,強行閉合創(chuàng)面因為高張力下引起皮緣血運喪失導致皮膚壞死,往往需二次手術(shù)處理,這些傳統(tǒng)方法并發(fā)癥較高、治療周期長、費用高,如何快速、微創(chuàng)、安全的關(guān)閉骨筋膜室切開后創(chuàng)面成為一個臨床難題;近年來應用新型皮膚伸展器關(guān)閉骨筋膜室切開減壓后創(chuàng)面成為一種新技術(shù)。本文通過應用新型皮膚伸展器閉合骨筋膜室綜合征切開減壓后創(chuàng)面的關(guān)閉與傳統(tǒng)關(guān)閉創(chuàng)面的方法進行對比,為臨床關(guān)閉骨筋膜室切開減壓后皮膚創(chuàng)面提供一種新方法。方法:回顧性統(tǒng)計、分析大連醫(yī)科大學附屬第一醫(yī)院自2013年6月至2016年9月期間,骨科收治入選的38例因外傷導致的骨筋膜室綜合征患者,均為保守治療無效行切開減壓術(shù)患者,根據(jù)關(guān)閉切口方式的不同,分為使用皮膚伸展器組,傳統(tǒng)治療組。其中使用皮膚伸展器組:男性11例、女性3例年齡11-60歲,平均年齡37.2±15.1歲,切口關(guān)閉前均為高張力切口,術(shù)前有3例患者患有內(nèi)分泌疾病;傳統(tǒng)治療組:男性19例、女性5例,年齡10-69歲,平均年齡36.5± 14.4歲,切口關(guān)閉前均為高張力切口,術(shù)前有7例患者患有內(nèi)分泌疾病。分別對兩組的一般情況,手術(shù)時間、術(shù)后抗生素使用天數(shù)、術(shù)后換藥次數(shù)、筋膜室切開后住院天數(shù)、切口關(guān)閉后住院天數(shù)、切口愈合評分等進行比較。結(jié)果:通過對全部患者數(shù)據(jù)進行統(tǒng)計比較,對兩組患者的性別、年齡、部位、合并內(nèi)分泌疾病等進行分析、比較,差異無統(tǒng)計學意義(P0.05);兩組在手術(shù)時間、術(shù)后抗生素使用天數(shù)、術(shù)后換藥次數(shù)、筋膜室切開后住院天數(shù)、切口關(guān)閉后住院天數(shù)、切口愈合評分等P值均小于0.05,差異有統(tǒng)計學意義;其中使用皮膚伸展器組與傳統(tǒng)治療組在手術(shù)時間傳統(tǒng)治療組耗時少于使用皮膚伸展器組,P0.05,差異有統(tǒng)計學意義;在術(shù)后抗生素使用天數(shù)、術(shù)后換藥次數(shù)、筋膜室切開后住院天數(shù)、切口關(guān)閉后住院天數(shù)皮膚伸展器組少于傳統(tǒng)足療組,P0.05,差異有統(tǒng)計學意義;在切口愈合評分方面,皮膚伸展器組也優(yōu)于傳統(tǒng)治療組,P0.05,差異有統(tǒng)計學意義。結(jié)論:新型皮膚伸展器通過伸展皮膚使筋膜室切開減壓術(shù)后創(chuàng)面低張力直接關(guān)閉,避免植皮或皮瓣手術(shù),與傳統(tǒng)關(guān)閉方法相比,該技術(shù)具有微創(chuàng)性、操作簡單,為筋膜室切開減壓術(shù)后創(chuàng)面提供了一個非常安全有效的方法。
[Abstract]:Objective: osteofascial compartment syndrome OCS is a department of orthopedics emergency for acute ischemia of the extremities due to the increased pressure in the fascia, and the condition is more conservative. The patients who are not effective should be treated with fasciotomy and decompression. After the incision and decompression of the bone gluten chamber syndrome, it needs to be covered with VSD to be covered. When the edema is relieved, it is closed again, but due to the retracting of the skin, edema of the tissue, the tension of the wound is large, it is difficult to close the skin directly. It often needs skin grafting, such as strong tension under high tension; skin grafting leads to the formation of scar in the skin and skin area, and the skin necrosis is often caused by the loss of blood transport caused by the skin margin under Gao Zhang force. Two operations, these traditional methods have high complications, long period of treatment and high cost. How to quickly, minimally invasive, and safely close the bone fascia after the incision of the bone fascia becomes a clinical problem. In recent years, new skin extender has been used to close the bone fasciotomy and decompress the wound to become a new technique. The closure of the closed osteofascial compartment syndrome after the incision and decompression is compared with the traditional method of closing the wound, providing a new method for the clinical closure of the skin wound after the incision and decompression of the osteofascial compartment. Methods: a retrospective analysis was made to analyze the admission of the First Affiliated Hospital of Dalian Medical University from June 2013 to September 2016, and the Department of orthopedics was admitted to the hospital. 38 patients with osteofascial compartment syndrome caused by trauma were treated with incision and decompression. According to the different methods of closing the incision, the patients were divided into the skin extender group and the traditional treatment group. The skin extender was used in the group of 11 men and 3 women aged 11-60 years, with the average age of 37.2 + 15.1 years, all before the incision closed. High tension incision, 3 patients had endocrine diseases before operation; the traditional treatment group: male 19, female 5, age 10-69 years old, average age 36.5 + 14.4 years old, high tension incision before incision closure, 7 patients with endocrine disease before operation. The general condition of two groups, operation time, postoperative antibiotic use days, postoperative change, respectively. The number of drugs, the number of days after fasciotomy, the number of days after the closure of the incision, the score of incision healing, and so on. Results: by comparing the data of all the patients, the sex, age, position, and the endocrine disease of the two groups were analyzed, and the difference was not statistically significant (P0.05); the two groups were in the operation time and after the operation. The number of antibiotics used, the number of changes after the operation, the number of days after the fasciotomy, the number of hospitalization days after the incision closed, the P value of the incision healing score were less than 0.05, and the difference was statistically significant. The time of using the skin extender group and the traditional treatment group in the traditional treatment group was less than the use of the skin extender group, and the difference was P0.05. The number of postoperative antibiotics used, the number of postoperative antibiotics, the number of postoperative change, the number of days after the fascia chamber incision, the number of skin stretchers after the closure of the incision was less than the traditional pedicure group, P0.05, the difference was statistically significant; in the wound healing score, the skin extender group was also superior to the traditional treatment group, P0.05, the difference was statistically significant. The new skin extender is minimally invasive, easy to operate and provides a very safe and effective method for fasciocutaneous incision and decompression.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.2

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