摘要
目的:探究前臂骨间背侧动脉穿支皮瓣游离移植修复术在手外伤软组织缺损中的应用价值.方法:回顾性分析113例手外伤软组织缺损患者临床资料,根据手术方法不同分为观察组59例和对照组54例.对照组行腹部皮瓣修复术,观察组行前臂骨间背侧动脉穿支皮瓣游离移植修复术.比较两组围手术期指标、手术前后血清炎症因子[C 反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、降钙素原(procalcitonin,PCT)]水平、术后皮瓣血流动力学(氧分压、血流灌注量、血管充盈时间评分)、术后皮瓣成活率、术后患侧手部运动功能及术后并发症.结果:观察组:住院时间(8.94±1.76)d、创面愈合时间(22.74±3.55)d、抗感染时间(6.25±2.05)d均短于对照组(均P＜0.05).术后 3 d、7 d 观察组血清 CRP(34.48±4.12)mg/L、(14.53±3.95)mg/L,IL-6(31.22±3.58)μg/mL、(12.11±2.18)μg/mL,PCT(1.29±0.15)ng/mL、(0.68±0.09)ng/mL,均低于对照组,差异有统计学意义(均P＜0.05).术后1个月、3个月、6个月观察组氧分压(67.41±8.47)mmHg、(76.41±6.12)mmHg、(82.63±6.55)mmHg,血流灌注量(145.88±17.46)BPU、(185.24±25.41)BPU、(205.63±27.31)BPU,血管充盈时间评分(1.13±0.20)分、(2.39±0.22)分、(2.69±0.15)分,均高于对照组,差异有统计学意义(P＜0.05).术后6个月,两组皮瓣成活率均为100.00％,观察组患侧手部运动功能优良率98.31％,高于对照组的85.19％,但差异无统计学意义(P＞0.05).观察组并发症总发生率5.08％,低于对照组的14.81％,但差异无统计学意义(P＞0.05).结论:前臂骨间背侧动脉穿支皮瓣游离移植修复术治疗手部皮肤缺损患者,能减轻炎症反应,改善局部血流动力学,促进手部运动功能,安全性较高.
Abstract
Objective:To explore the application value of free graft repair surgery of interosseous dorsal artery perfo-rator flap of forearm in the treatment of soft tissue defects in hand trauma.Methods:The clinical data of 113 patients with soft tissue defects in hand trauma were retrospectively analyzed,and they were divided into the observation group(59 cases)and the control group(54 cases)according to different surgical methods.The control group underwent abdominal flap repair,and the observation group underwent free graft repair surgery of interosseous dorsal artery perforator flap of forearm.The perioperative indexes,serum inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)],postoperative flap hemodynamics(partial pressure of oxygen,blood perfusion,vascular filling time score),postoperative flap survival rate,postoperative hand motor function and postoperative complications were compared between the two groups.Results:The length of hospital stay in the observation group was(8.94±1.76)d,wound healing time was(22.74±3.55)d,and the anti-infection time was(6.25±2.05)d,which were shorter than those in the control group(P＜0.05).On the 3rd and 7th days after surgery,serum CRP levels were(34.48±4.12)mg/L,(14.53±3.95)mg/L,IL-6(31.22±3.58)μg/mL,(12.11±2.18)μg/mL.The levels of PCT were(1.29±0.15)ng/mL and(0.68±0.09)ng/mL,which were lower than those in the control group(P＜0.05).At 1 month,3 months and 6 months after surgery,the partial pressures of oxygen were(67.41±8.47)mmHg,(76.41±6.12)mmHg,(82.63±6.55)mmHg,and the blood perfusion volumes were(145.88±17.46)BPU,(185.24±25.41)BPU,(205.63±27.31)BPU,and the vascular filling time scores were(1.13±0.20),(2.39±0.22),(2.69±0.15),which were higher than those in the control group(P＜0.05).At 6 months after operation,the survival rate of the flap was 100.00％in both groups,and the excellent mo-tor function rate of the affected hand in the observation group was 98.31％,which was higher than 85.19％in the control group,but the difference was not statistically significant(P＞0.05).The total incidence of complications in the observation group was 5.08％,which was lower than 14.81％in the control group,but the difference was not statistically significant(P＞0.05).Conclusion:Free graft repair surgery of interosseous dorsal artery perforator flap of forearm can reduce inflammation,improve local hemodynamics,and promote hand motor function in patients with hand skin defects,with high safety.
维普
万方数据