本文選題：兒童燒傷 + 瘢痕攣縮�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討兒童手部瘢痕攣縮畸形原因,分析近年我院兒童燒傷后手瘢痕攣縮行手術(shù)治療及功能鍛煉情況,評估手術(shù)治療手部瘢痕的療效。方法:收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院2013年01月至2016年12月共四年的114例患者(122只手)的數(shù)據(jù),分析兒童燒傷原因及常見的畸形類型,根據(jù)傷后瘢痕攣縮情況進行手術(shù)治療,觀察術(shù)后植皮存活情況,隨訪了解瘢痕攣縮手的外觀及功能(生活)恢復(fù)情況。結(jié)果:(1)兒童燒傷情況及主要原因:學(xué)齡前兒童為燒傷的主要階段,學(xué)齡前兒童共99例,約占總數(shù)的84.2%,其中幼兒期59例,占總數(shù)的51.75%,致傷原因為熱液燙傷為主;隨著年齡的增長,自幼兒期開始各年齡段受傷的總數(shù)有下降趨勢,火焰燒傷所占的比例有所上升,但仍以熱液燙傷為主。(2)性別及地域分布:兒童燒傷及手部瘢痕攣縮畸形以男孩多見,其中男性69例(60.5%),女性45例(39.5%),男:女為3:2;在地域分布上,農(nóng)村多于城市,農(nóng)村患兒90例,約占總數(shù)的78.9%。(3)燒傷手畸形情況:手部的畸形類型主要表現(xiàn)為屈曲畸形及背伸畸形,屈曲畸形占病例數(shù)的95.6%;在左右手中,以左手多見,占總數(shù)的55.7%。(4)手術(shù)情況:114例行自體皮移植,其中96例成活優(yōu)良,17例成活一般,1例成活差;手術(shù)治療時間在傷后3個月以內(nèi)患者有15例(13.16%),其中手功能評定達到“優(yōu)”的例數(shù)有4例;手術(shù)治療時間在傷后3個月-6個月的患者有21例(18.42%),其中手功能評定達到“優(yōu)”的例數(shù)有12例;手術(shù)治療時間在6個月-12個月的患者有43例(37.72%),其中手功能評定達到“優(yōu)”的例數(shù)有23例;手術(shù)治療時間在12個月以上的患者有35例(30.70%),其中手功能評定達到“優(yōu)”的例數(shù)有10例;(5)隨訪情況:術(shù)后隨訪患兒74例,隨訪時間為出院后3月-4年,經(jīng)手術(shù)治療聯(lián)合功能康復(fù)鍛煉治療,手功能評定的結(jié)果為:優(yōu)49例,良22例,可3例,差0例,明顯改善手部功能障礙達95.95%[(“優(yōu)”+“良”)/總例數(shù)]。結(jié)論:(1)兒童燒傷以幼兒期多見,燒傷的最主要原因為熱液燙傷,其次為火焰燒傷,且農(nóng)村多于城市;(2)兒童燒傷手部瘢痕攣縮畸形以屈曲畸形多見,瘢痕畸形在6個月到1年內(nèi)手術(shù)的療效較好,如果嚴(yán)重畸形應(yīng)盡早行手術(shù)治療;(3)手術(shù)治療手部瘢痕攣縮可快速恢復(fù)手功能,手術(shù)及功能鍛煉可使手功能評價為“良”以上可達90%以上。
[Abstract]:Objective: to investigate the causes of hand scar contracture deformity in children, to analyze the surgical treatment and functional exercise of hand scar contracture after burn in our hospital in recent years, and to evaluate the curative effect of operation on hand scar. Methods: the data of 114 patients (122 hands) from January 2013 to December 2016 in the first affiliated Hospital of Guangxi Medical University were collected. The causes of burns and common deformities in children were analyzed. The surgical treatment was performed according to the condition of scar contracture after injury. To observe the survival of skin graft after operation and to observe the appearance and function of scar contracture hand. Results: (1) Burn status and main causes of children: preschool children were the main stage of burn. There were 99 cases of preschool children, accounting for 84.22.Among them, 59 cases were in infancy, accounting for 51.75% of the total. The main cause of injury was hot fluid scalding. Since infancy, the total number of injuries in each age group has declined, and the proportion of flame burns has increased, but it is still mainly hot fluid scalding. (2) gender and geographical distribution: children burn and hand scar contracture deformity are more common in boys. There were 69 males (60.5%) and 45 females (39.5%), male: female: 3: 2. In terms of geographical distribution, 90 children were found in rural areas, accounting for 78.9% of the total. (3) deformities of burned hands: flexion deformities and dorsiflexion deformities were the main types of deformities in the hands. Flexion deformities accounted for 95.6% of the cases, left hand accounted for 55.7% of the total in left and right hands. (4) Graft of skin autograft was performed in 114 cases, including 96 cases with good survival and 17 cases with poor survival. There were 15 cases (13.16%) of the patients within 3 months after injury, among which 4 cases were evaluated as "excellent" by hand function evaluation. There were 21 patients (18.42%) who had been treated for 3 months to 6 months after injury, among which 12 cases had "excellent" hand function evaluation. There were 43 cases (37.72%) with operation time from 6 months to 12 months, of which 23 cases were evaluated as "excellent". 35 cases (30.70%) were treated with operation for more than 12 months, including 10 cases whose hand function was excellent. (5) Follow-up: 74 cases were followed up after operation, the follow-up time was from 3 months to 4 years after discharge. After surgical treatment combined with functional rehabilitation exercise, the results of hand function evaluation were excellent in 49 cases, good in 22 cases, fair in 3 cases, and poor in 0 cases. The obvious improvement of hand dysfunction was 95.95% [(excellent "good" / total number of cases]. Conclusion: (1) Children burn is more common in early childhood, the main cause of burn is hot fluid scalding, followed by flame burn, and more in rural areas, (2) children burn hand scar contracture deformity is more common in flexion deformity. The surgical treatment of scar deformity is better in 6 months to 1 year. If the severe deformity is serious, the surgical treatment should be done as soon as possible. (3) the operation on scar contracture of the hand can quickly recover the hand function. Operation and functional exercise can make the evaluation of hand function more than 90%.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.5

【參考文獻】

相關(guān)期刊論文 前10條

1 陳卡娜;楊明忠;鐘麗軍;徐琴;狄建華;;冷療對小兒小面積深Ⅱ度燒傷創(chuàng)面的影響[J];中華燒傷雜志;2015年04期

2 丁菲菲;林源;蒙誠躍;韋俊;歐斌賢;賈文波;;手指瘢痕攣縮屈曲嚴(yán)重畸形的矯形治療[J];中華損傷與修復(fù)雜志(電子版);2015年01期

3 趙連魁;趙洪良;鄭文立;李冬軍;李明;孫瑞朋;胡雅萍;;手指塑形彈力套降低兒童手指瘢痕攣縮畸形術(shù)后復(fù)發(fā)率[J];河北醫(yī)藥;2014年19期

4 胡巖;曾麗萍;;手部燒傷后瘢痕攣縮的預(yù)防及康復(fù)治療[J];實用醫(yī)技雜志;2014年06期

5 岳麗青;王曉燕;彭歡;黃曉元;;手燒傷康復(fù)研究進展[J];醫(yī)學(xué)臨床研究;2014年04期

6 馮佳雄;孫澤光;許翔聰;姚楚征;楊永熙;許研然;;1257例小兒燒傷的特點及原因分析[J];當(dāng)代醫(yī)學(xué);2014年12期

7 黃仕光;;兒童手部深度燒傷的治療[J];華夏醫(yī)學(xué);2014年01期

8 王作書;周忠志;黃新靈;;兒童手部燒傷后瘢痕攣縮治療體會[J];中國美容醫(yī)學(xué);2013年24期

9 丁華榮;韋俊;梁自乾;劉曉輝;;燒傷住院患兒985例臨床分析[J];廣西醫(yī)科大學(xué)學(xué)報;2013年04期

10 苗盈盈;王達利;魏在榮;;冷療在早期燒傷創(chuàng)面中的臨床應(yīng)用[J];西南軍醫(yī);2012年04期

，

本文編號：2054088