褥疮的临床分型及外科治疗

Clinical typing and surgical treatment of pressure sore

目的探讨褥疮的临床分型及根据其分型进行治疗的原则与方法。方法1980年1月至2008年1月,收治褥疮患者145例269处创面。根据患者全身情况及创面特点将褥疮分为轻度22例38处、中度78例115处、重度34例89处、特重11例27处。轻度、特重褥疮采用局部创面换药、中重度褥疮使用皮片移植、局部皮瓣或带血管蒂(肌)皮瓣修复。结果22例轻度患者的38处创面在2～3周内愈合。中、重度患者18处创面皮片移植,100%存活;31处窦道创面拉拢缝合者,28处一期愈合,1处术后2d伤口遭受外力裂开,2处由于伤口少量积血形成窦道,再次给予缝合后愈合良好;皮瓣转移修复创面155处,8处因制动不够导致皮瓣下积血,7处皮瓣远端出现1～2cm坏死,均经过换药愈合。特重患者3例因创面稍小得到治愈,8例创面明显好转。121例患者获随访1年,均无复发。结论褥疮的临床分型有助于制定有针对性的治疗措施,提高治疗成功率。

Objective To investigate the clinical typing and their relevant treatment principle and method of pressure sore.Methods From January 1980 to January 2008, 145 patients with 269 pressure sores were treated.According to the wound characteristics, the pressure sores were classified into four types：mild type（22）, moderate type（78）, heavy type（34） and severe type（11）.Mildtypeand severe type w ere treated by wound dressing change, skin grafting, skin flap and myocutaneous flap were employed to repair moderate type and heavy type.Results Wounds of mild type patients were healed in 2-3 weeks.All wounds of moderate type and heavy type were healed by surgery;and 18 skin grafting survived, all wounds of sinus were sutured by first intention except one wound dehiscenced and two wounds formatted sinus again because of hemorrhage, whichwere given a good healing after being sutured again;and of 155 skin flaps and myocutaneous flaps, 8 cases had subepithelial hemorrhage due to inadequate braking, and 7 cases had a partial necrosis.All were healed by dressing change.Three cases with severe type wounds were cured because of the smaller wound, and eight cases were improved in the wound.The routine follow-up in 121 patients after 1 year showed that no recurrence appeared.Conclusion Clinical typing of pressure sore is helpful to select the suitable operation method and improve the rate of success.