大面积腰臀后部撕脱伤的治疗

The treatment of large-area avulsed wounds on the lumbar back and buttock

目的通过对典型病例的研究,提高大面积腰臀后部撕脱伤的诊治水平,降低死亡率和致残率。方法自2003年1月至2007年9月,对7例大面积腰臀后部撕脱伤患者补充液体和电解质,在维持机体状态稳定后,采用手术植皮、撕脱皮肤反取皮和原位缝合及负压吸引等方法进行治疗。并分析研究患者的临床特点和手术疗效,总结治疗方法。结果原位缝合的7例患者及其中2例患者的部分创面行反取植皮后,其皮片成活率约90%。术后随访7例患者1年,死亡1例,存活6例。结论大面积腰臀后部撕脱伤病情复杂,应根据病情选择治疗方案。早期创面和撕脱皮肤血液循环的判断及治疗方案的选择是临床预后的关键。

Objective To improve the diagnoses and treatment level of large - area avulsed wounds on the lumbar back and buttock, and cut down the death rate and mutilation rate by means of investigation and research in typical cases. Methods From January 2003 to September 2007, 7 cases with large - area avulsed wounds on the lumbar hack and buttock underwent skin grafting surgery, skin was taken to match the avulsed skin, sutured in situ placed underpressure drainage after replenishing liquid and electrolytes to ensure metabolic stabilization. The clinical characteristics of these patients together with the method of therapy and outcomes were analyzed. Results Seven eases of grafting with in situ skin were performed, and 2 of 7 also made use of skin - grafts from other areas of the body. The survival rate for these skin- grafting procedures was approximately 90 %. After one year of follow - up, one patient had died, and six cases survivde. Conclusion The treatments oflarge-area avulsed wounds on the lumber hack and buttock were selected because of the patients＇ complicated conditions. Overall clinical evaluation and selection of treatment in early wounds and avulsed skin blood system is the key for improvement of outcome.