目的 探讨经指关节处深层松解与广泛真皮浅层松解治疗大疱性表皮松解症患者手部瘢痕挛缩的临床疗效.方法 2021年1月至2023年10月在郑州大学第二附属医院收治64例大疱表皮松解症手部瘢痕挛缩的患者,将64例病例按随机数字表法分为指关节深层松解组(A组,32例)和广泛真皮浅层松解组(B组,32例)给予手术治疗.采用独立样本t检验进行比较、分析围手术期的手术时长、住院天数、术后手指关节总活动度(TAM)值和外观满意度评分等指标,创面组织进行标本苏木精-伊红(HE)染色观察和比较各组创面愈合水平.结果 64例病例经过12个月随访,无再次黏连、挛缩等现象.A组手术时长与B组比较,差异无统计学意义[(85.70±10.69)min 比(82.78±15.48)min,t=1.765,P＞0.05],A 组住院时间高于 B 组[(30.65±5.43)d比(21.78±6.45)d,t=5.283,P＜0.05],A 组术前 TAM 值低于术后 12 个月(40.58±5.85 比192.00±7.48,t=37.008,P＜0.05),B 组术前 TAM 值低于术后 12 个月(42.63±6.31 比 188.00±6.52,t=39.541,P＜0.05).A组、B组术前创面组织进行标本HE染色均见表皮内、表皮与真皮交界均可见裂隙,真皮内胶原均质粉染玻璃样变,炎性细胞浸润明显,可见有瘢痕组织增生.两组术后创面已经完全愈合,表皮修复情况良好.A组术前外观满意度低于术后12个月[(23.10±5.30)分比(83.35±9.43)分,t=10.283,P＜0.05],B组术前外观满意度低于术后12个月[(22.34±8.36)分比(88.00±7.56)分,t=17.642,P＜0.05].结论 两种手术方式均可以治疗大疱表皮松解症患者手部瘢痕挛缩,广泛真皮浅层手术松解术后愈合时间更短.
Comparison of the efficacy of two surgical methods for treating hand scar contracture in epidermolysis bullosa
Objective To explore the clinical efficacy of deep release at the metacarpophalangeal joint and extensive dermal superficial release in the treatment of scar contracture of the hand in patients with bullous epidermolysis.Methods From January 2021 to October 2023,64 patients with hand scar contractures due to bullous epidermolysis were admitted to the Second Affiliated Hospital of Zhengzhou University.The 64 cases were randomly divided into two groups according to the random number table method:the deep metacarpophalangeal joint release group(Group A,32 cases)and the extensive superfi-cial dermal release group(Group B,32 cases).Surgical treatment was administered to both groups.T-tests were used to compare and analyze perioperative indicators such as operation time,hospital stay,postoperative total active motion(TAM)of finger joints,and appearance satisfaction scores.Specimens of wound tissue were stained with hematoxylin and eosin(HE)and observed to compare the wound healing levels of each group.Results After a 12-month follow-up of the 64 cases,there were no instances of re-adhesion or contracture.The operation time in Group A was not significantly different from Group B[(85.70±10.69)min vs.(82.78±15.48)min,t=1.765,P＞0.05].The hospital stay in Group A was longer than in Group B[(30.65±5.43)days vs.(21.78±6.45)days,t=5.283,P＜0.05].The preoperative TAM value in Group A was lower than the postoperative value at 12 months(40.58±5.85 vs.192.00±7.48,t=37.008,P＜0.05),and the same was true for Group B(42.63±6.31 vs.188.00±6.52,t=39.541,P＜0.05).Both groups showed clefts within the epidermis and at the dermal-epidermal junction,homogeneous eosinophilic glassy degeneration of collagen in the dermis,significant inflammatory cell infiltration,and scar tissue hyperplasia in the HE-stained specimens of preoperative wound tissue.Both groups'postoperative wounds had completely healed with good epidermal repair.The preoperative ap-pearance satisfaction score in Group A was lower than the postoperative score at 12 months[(23.10±5.30)points vs.(83.35±9.43)points,t=10.283,P＜0.05],and the same was true for Group B[(22.34±8.36)points vs.(88.00±7.56)points,t=17.642,P＜0.05].Conclusion Both surgical methods can treat hand scar contractures in patients with bullous epidermolysis,with the extensive superfi-cial dermal release surgery having a shorter postoperative healing time.
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