【摘要】 目的 探讨人工真皮支架在合并肌腱和(或)骨外露慢性难愈合创面中的应用效果。方法 选取2016年1月至2019年12月广州医科大学附属第六医院收治的150例合并肌腱和(或)骨外露的慢性难愈合创面患者作为研究对象,按照不同治疗方式将其分为观察组(75例)与对照组(75例),观察组患者于负压封闭引流术后行人工真皮支架联合自体刃厚皮片移植治疗,对照组患者于负压封闭引流术后单纯行自体刃厚皮片移植治疗,对比观察两组患者自体刃厚皮片成活情况、愈后皮肤色泽及质地恢复情况。结果 自体刃厚皮片移植术后7 d,观察组患者皮片成活为优者48例、良者27例,明显优于对照组患者的皮片成活为优者32例、良者25例、中者12例、差者6例(Z=-3.529,P<0.001)。自体刃厚皮片移植术后1个月,观察组患者愈后皮肤色泽恢复效果为显效24例、有效49例、无效2例,明显优于对照组患者的显效14例、有效35例、无效26例(Z=-4.101,P <0.001);观察组患者愈后皮肤质地恢复效果为显效24例、有效49例、无效2例,明显优于对照组患者的显效14例、有效35例、无效26例(Z=-4.101,P<0.001)。结论 与负压封闭引流术后单纯行自体刃厚皮片移植相比,合并肌腱和(或)骨外露的慢性难愈合创面患者于负压封闭引流术后行人工真皮支架联合自体刃厚皮片移植治疗更有利于皮片成活和提高愈后皮肤色泽及质地恢复效果,临床应用价值更高。更多还原

【Abstract】 Objective To study the effect of artificial dermal stent on patients with chronic refractory wounds complicated with tendon and/or bone exposure.Methods 150 patients with chronic refractory wounds and tendon and/or bone exposure,admitted to the Sixth Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2019,were enrolled as study subjects,and then divided,based on different treatments they received,into observation group(n=75) and control group(n=75).Patients in observation group were treated with artificial dermal stent in combination with autologous split-thickness skin grafting following vacuum sealing drainage,whereas patients in control group were treated with autologous split-thickness skin grafting alone after vacuum sealing drainage.The survival of the autologous split-thickness skin flaps,and color and texture of healed skin were compared between the two groups.Results Seven days after autologous split-thickness skin grafting,the survival condition of skin flaps of patients were evaluated as excellent in 48 cases and good in 27 cases in observation group,being much better than control group(Z=-3.529,P <0.001)-excellent in 32 cases,good in 25 cases,fair in 12 cases and poor in 6 cases.One month after autologous split-thickness skin grafting,the healed skin color showed markedly effective recovery in 24 cases,effective in 49 cases and ineffective in 2 cases in observation group,being much better than control group where 14 cases were markedly effective,35 cases were effective and 26cases were ineffective(Z=-4.101,P <0.001);in terms of skin texture of healed skin,24 cases showed markedly effective recovery,49 cases effective and 2 cases ineffective in observation group,also being much better than control group(Z=-4.101,P<0.001)-14 cases markedly effective recovery,35 cases effective and 26 cases ineffective.Conclusion In the treatment of patients with chronic refractory wounds complicated with tendon and/or bone exposure,compared with the alone application of autologous split-thickness skin grafting after vacuum sealing drainage,the combined application of artificial dermal stent and autologous split-thickness skin grafting after vacuum sealing drainage is more favorable for the survival of skin flaps,better in facilitating the recovery of skin color and texture,and has much high value of clinical application.更多还原