褥疮的临床分型及手术治疗原则

CLINICAL TYPING AND SURGICAL PRINCIPLE OF PRESSURE SORE

目的探讨临床褥疮的分型及根据其分型进行手术治疗原则及方法。方法1983年1月~2006年4月,收治褥疮患者122例179处。男93例,女29例;年龄15~68岁。褥疮位于骶尾部54处,股骨大转子37处,坐骨结节30处,足跟17处,尺骨鹰嘴15处,肩胛部9处,外踝7处,腓骨小头4处,胫前3处及腰部3处。褥疮形成时间2个月~11年。褥疮范围1.5cm×1.0cm^20.0cm×18.0cm。根据创面特点将褥疮分为窦道型12处、溃疡型74处和混合型93处。针对不同类型褥疮,分别采用中厚皮片、局部皮瓣或带血管蒂(肌)皮瓣修复。本组(肌)皮瓣切取范围5.0cm×3.5cm^26.0cm×14.5cm,皮片切取范围7cm×5cm^23cm×12cm。结果窦道型褥疮除1例伤口裂开,经再次缝合制动后愈合,余伤口均期愈合;皮瓣完全成活。溃疡型褥疮2例皮瓣远端1~2cm坏死,经换药后愈合,余中厚皮片与带血管蒂(肌)皮瓣均成活;伤口均期愈合。混合型褥疮局部皮瓣与带血管蒂(肌)皮瓣均成活;8处因囊壁或坏死组织切除不彻底,出现1~2处窦道,经对症处理后愈合;伤口均期愈合。供区创面均期愈合。73例患者术后获随访6个月,4例混合型褥疮复发,复发率为5.5%;余患者局部情况均良好。结论褥疮的临床分型有助于制定有针对性的手术治疗措施,提高治疗成功率。

Objective To investigate the clinical typing and their relevant surgical treatment principle and method of pressure sore. Methods From January 1983 to April 2006, 122 patients with 179 pressure sores were treated. There were 93 males and 29 females, aging 15-68 years. The pressure sores were located at sacrococcygeus （54 lesions）, petrochanteric region （37 lesions）, ischial tuberosity （30 lesions）, heel （17 lesions）, olecranon （15 lesions）, scapula （9 lesions）, lateral malleolar （7 lesions）, caput fibulace （4 lesions）, pretibial （3 lesions）, and lumbar region （3 lesims） respectivly. The disease course was from 2 months to 11 years. The areas of pressure sores were from 1.5 cm× 1.0 cm to 20.0 cm× 18.0 cm. According to the wound characteristics, the pressure sores were divided into three types：sinus type（12/179）, ulcer type （74/179） and mixed type（93/179）. Aimed at different types of pressure sore, skin grafting, skin flap and myocutaneous flap were employed to repair wound. The areas of flaps were from 5.0 cm×3.5 cm to 26.0 cm× 14.5 cm. The areas of skin grafting were from 7 cm×5 cm to 23 cm × 12 cm. Results All wounds of sinus type healed by first intention except one; and all flaps survived. All wounds of uler type healed by first intention; and the flaps survived completely except two which had a partial necrosis. All flaps which harvested to repair 93 pressure sores of mixed type were survived. But one or two sinus occurred in 8 cases. Two healed by operation, and the others healed by dressing exchange. The wounds healed by first intention. The donor sites healed by first intention. The routine follow-up in 73 patients after 6 months showed that the recurrence appeared in 4 mixed type. The recurrence rate was 5.5% and the other patients had good outcome. Conclusion Clinical typing of pressure sore is helpful to select the suitable operation method and improve the rate of success.