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标题:腓动脉穿支皮瓣联合VSD治疗足踝部皮肤软组织损伤疗效观察 作者:张猛 1,贺西京 2,谢松涛 3,侯宏义 3,赵炜 1,王莎 4,易朝晖 5 卷次: 2019年30卷18期
1.安康市中心医院骨二科,陕西 安康 725000;2.西安交通大学第二附属医院骨二科,陕西 西安 710003;3.空军军医大学西京医院烧伤与皮肤外科,陕西 西安 710032;4.安康市中心医院烧伤外科,陕西 安康 725000;5.安康市镇坪县医院外一科,陕西 安康 725600【摘要】 目的 探讨腓动脉穿支皮瓣联合负压封闭引流术(VSD)治疗足踝部皮肤软组织损伤的治疗效果。方法 选择 2016年 1月至 2018年 8月安康市中心医院所收治的 86例足踝部皮肤软组织损伤患者进行研究。依据随机数表法将患者分为观察组和对照组,每组43例。观察组患者采取腓动脉穿支皮瓣联合VSD修复创面,对照组采取腓动脉穿支皮瓣联合常规换药修复创面,比较两组患者治疗后伤口换药次数、住院时间、住院费用、皮瓣感染率、抗生素使用时间及踝关节功能指标情况。结果 治疗后,观察组患者的换药次数为(8.64±1.36)次,住院时间为(16.45±3.62) d,住院费用为(5429±241)元,对照组换药次数为(12.42±4.25)次,住院时间为(25.31±4.27) d,住院费用为(6 528±227)元,两组比较差异有统计学意义(P<0.05);术后观察组患者有 1例发生创面感染,1例皮瓣坏死,感染率为4.7%,对照组8例发生创面感染,5例皮瓣坏死,感染率为30.2%,观察组患者的感染率明显低于对照组,差异有统计学意义(P<0.05);观察组患者的抗生素使用时间为(7.1±2.1) d,明显少于对照组的(12.4±3.6) d,观察组明显少于对照组,差异有统计学意义(P<0.05);治疗后观察组患者踝关节功能优良率为88.37%,明显高于对照组的65.12%,差异有显著统计学意义(P<0.01)。结论 腓动脉穿支皮瓣联合VSD治疗足踝部皮肤软组织损伤有较好的治疗效果,其可以有效控制组织感染,加速肉芽组织的生长,促进创面愈合,缩短住院时间,获得较好的踝关节功能,值得临床推广应用。【关键词】 腓动脉;穿支皮瓣;负压封闭引流;足踝部;软组织损伤【中图分类号】 R64 【文献标识码】 A 【文章编号】 1003—6350(2019)18—2367—03Therapeutic effect of peroneal artery perforator flap combined with VSD in the treatment of skin and soft tissueinjury of the foot and ankle. ZHANG Meng 1, HE Xi-jing 2, XIE Song-tao 3, HOU Hong-yi 3, ZHAO Wei 1, WANG Sha 4, YIChao-hui 5. 1.Department of Orthopedics, Ankang Central Hospital, Ankang 725000, Shaanxi, CHINA; 2. Department ofOrthopedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi, CHINA; 3. Department ofBurn and Dermatology, Xijing Hospital of Air Force Medical University, Xi'an 710032, Shaanxi, CHINA; 4. Department ofBurn Surgery, Ankang Central Hospital, Ankang 725000, Shaanxi, CHINA; 5. Department of Surgery, Zhenping CountyHospital, Ankang 725600, Shaanxi, CHINA【Abstract】 Objective To explore the therapeutic effect of peroneal artery perforators flap combined with vacu-um sealing drainage (VSD) in the treatment of skin and soft tissue injury of the foot and ankle. Methods A total of 86patients with skin and soft tissue injuries of the foot and ankle were selected, who were admitted to the Ankang CentralHospital from January 2016 to August 2018. According to the random number table method, they were divided into ob-servation group and control group, with 43 cases in each group. Patients in the observation group were treated with pero-neal artery perforators flap combined with VSD to repair wounds, and patients in the control group were treated with pe-roneal artery perforators flap with conventional dressing procedure to repair wounds. The number of wound dressingswas compared between the two groups, as well as the hospitalization time, hospitalization cost, skin flap infection inci-dence, antibiotic use time and the ankle function index. Results After treatment, the mean number of dressing changeswas (8.64±1.36) times, hospitalization time was (16.45±3.62) days, hospitalization cost was (5429±241) yuan in the ob-servation group, as compared with (12.42±4.25) times of the number for dressing changes, (25.31±4.27) days of hospital-ization time, and (6528±227) yuan of hospitalization cost in the control group (all P<0.05). In the observation group, onepatient developed wound infection and 1 with skin flap necrosis after treatment, and the infection rate was 4.7%; whilethere were 8 cases of wound infection and 5 cases of skin flap necrosis in the control group, and the infection rate was30.2%; so the infection rate was significantly lower in the observation group than in the control group (P<0.05). The dura-tion of antibiotic use in the observation group was (7.1±2.1) days, which was significantly less than (12.4±3.6) days in thecontrol group (P<0.05). After treatment, the excellent and good rate of ankle joint function was 88.37% in the observa-tion group, which was significantly higher than 65.12% in the control group (P<0.01). Conclusion Peroneal artery per-·论著·doi:10.3969/j.issn.1003-6350.2019.18.015
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