本文選題：負(fù)壓封閉引流技術(shù) + 肢體脫套傷�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討負(fù)壓封閉引流技術(shù)(VSD)在肢體脫套傷一期原位植皮治療中的臨床效果,為其推廣使用提供主要依據(jù)。方法:以威海市立醫(yī)院2011年6月~2016年11月收治的肢體脫套傷病患為研究對象,共計52例。其中實驗組26例患者使用一期聯(lián)合應(yīng)用原位植皮與負(fù)壓封閉引流技術(shù)(VSD)進(jìn)行治療,其中男20例,女6例;這26位患者年齡保持在19到52歲之間,平均年齡大致為37.2歲。自受傷到最終患者就診基本時間在50分鐘到4小時之間,平均2.4個小時。其中26位患者受傷的原因16例由于手足原因,另外有3例肩背側(cè),7例是四肢的原因。受傷導(dǎo)致皮膚撕脫的面積保持在5cm×6cm--13cm×16cm,其中4例患者合并肌健損傷、開放性骨折。對照組26例患者采取常規(guī)清創(chuàng)原位植皮打包換藥治療方法,其中22例是男性,4例是女性。這26位患者年齡保持在21歲至51歲之間,平均年齡為36.3歲。就診時間從受傷到患者就診基本在0.5到4個小時之間,平均2.3小時。他們受傷的原因,其中10例是錯誤操作機(jī)器導(dǎo)致,10例則是車輪碾壓導(dǎo)致受傷,其它6例則是意外導(dǎo)致的外傷。受傷的部位基本上分布在手足、肩背側(cè)以及四肢,其中15例在手足,4例在肩背側(cè),7例在四肢。受傷導(dǎo)致皮膚撕脫的面積基本上保持在:4cm×6cm-12cm×16cm,3例患者合并肌腱損傷、開放性骨折。兩組數(shù)據(jù)在統(tǒng)計學(xué)中的差異無意義,其基本情況具有可比性。結(jié)果:通過對兩組相關(guān)數(shù)據(jù)進(jìn)行對比,發(fā)現(xiàn)實驗組的治療效果比對照組明顯要好,實驗組患者在創(chuàng)傷一期愈合比例、傷口愈合時間、術(shù)后一周愈合面積、換藥頻次、住院時間均與對照組存在顯著差異,且差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:在肢體脫套傷一期原位植皮治療中應(yīng)用負(fù)壓封閉引流技術(shù)(VSD)能提高植皮的存活率,達(dá)到了及時清除壞死物質(zhì),有效清創(chuàng),改善循環(huán)的目的,縮短了治療周期,緩解了病人的痛苦,降低了住院費(fèi)用,由于此技術(shù)能夠高效的利用患者自身的撕脫皮膚,縮減植皮供應(yīng)區(qū)的面積,進(jìn)而達(dá)到緩解患者身心痛苦,減輕經(jīng)濟(jì)負(fù)擔(dān)的作用,特別是它能夠減少疤痕色素沉積、淡化供給區(qū)的疤痕區(qū)域,此類效果對于皮膚大面積撕脫者效果更為明顯,具有顯著的臨床效果,值得其在臨床中的推廣應(yīng)用。
[Abstract]:Objective: to investigate the clinical effect of negative pressure blocking drainage (VSD) in the treatment of limb shedding injury in one stage. Methods: from June 2011 to November 2016, 52 patients with limb shedding injury in Weihai Municipal Hospital were studied. Among them, 26 patients in the experimental group were treated with in situ skin grafting combined with negative pressure blocking drainage (VSD), including 20 males and 6 females. The age of 26 patients remained between 19 and 52 years old, with an average age of 37.2 years. The basic time from injury to final patient was between 50 minutes and 4 hours, averaging 2.4 hours. Among them, 16 cases were injured because of hand and foot, and 3 cases with dorsal shoulder and 7 cases with extremities. The area of skin avulsion caused by injury was kept at 5cm 脳 6cm--13cm 脳 16 cm. In the control group, 26 patients were treated with routine debridement and skin graft packing and dressing change, among which 22 cases were male and 4 cases were female. The 26 patients remained between 21 and 51, with an average age of 36.3. The time from injury to patient was between 0.5 and 4 hours, with an average of 2.3 hours. The causes of their injuries were 10 cases of maloperation of the machine and 10 cases of injuries caused by wheel compaction and 6 cases of accidental injuries. The injuries were mainly located in the dorsal side of the hand and foot, the dorsal side of the shoulder and the extremities, of which 15 cases were in the dorsal side of the hand and foot, 4 cases in the dorsal side of the shoulder and 7 cases in the extremities. The area of skin avulsion caused by injury was maintained at 4 cm 脳 6cm-12cm 脳 16 cm in 3 patients with tendon injury and open fracture. The difference between the two groups of data in statistics is meaningless and the basic situation is comparable. Results: by comparing the data of the two groups, it was found that the treatment effect of the experimental group was better than that of the control group. The proportion of primary wound healing, the wound healing time, the healing area of the first week after operation, the frequency of dressing change in the experimental group were better than those in the control group. The length of hospitalization was significantly different from that of the control group (P0.05). Conclusion: the negative pressure blocking drainage (VSD) technique can improve the survival rate of skin grafts, remove necrotic substances in time, effectively debridement, improve circulation and shorten the treatment period. It alleviates the pain of patients and reduces the cost of hospitalization. Because this technology can efficiently use the patients' own avulsion skin, reduce the area of skin graft supply area, and then achieve the purpose of alleviating the patients' physical and mental pain and reducing the economic burden. Especially, it can reduce scar pigment deposition and desalinate scar area in supply area. This kind of effect is more obvious for large area avulsion of skin and has remarkable clinical effect, so it is worth popularizing and applying in clinic.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R658

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