关节部位Ⅲ度烧伤切(削)痂后MEBO培养创面延期植皮临床分析

Clinical Observation of Delayed Skin Grafting in Treating Joint Burn Wounds after Eschar Excision Plus MEBO as Dressing Care

目的:总结关节部位Ⅲ度烧伤切(削)痂实行湿润烧伤膏(MEBO)培养创面,延期植皮的临床效果,并同过去采用切(削)痂后Ⅰ期植皮病历资料进行历史对照分析,评价方法的优劣。方法:2005年1月至2009年12月收治的关节部位Ⅲ度烧伤患者42例(59个创面)作为实验组,早期切(削)痂后即刻外用MEBO包扎换药处理,3天～5天创面清洁、新鲜,行延期自体皮移植;2000年1月至2004年12月收治的32例(45个创面)作为对照组,早期切(削)痂后Ⅰ期自体皮移植;比较分析两组的植皮成活率、皮下血肿与感染发生率、关节外观及恢复状况。结果:切(削)痂后,创面经过MEBO培养进行延期植皮组较Ⅰ期植皮组的植皮成活率高,皮下血肿发生率低,关节的外观和功能恢复良好,组间比较具有统计学意义(P<0.01或P<0.001)。结论:关节部位Ⅲ度烧伤创面,早期切(削)痂,先采用MEBO进行创面换药,无损伤地清除坏死组织,培养新鲜健康的组织,再行延期自体皮移植,具有手术创伤小、神经肌腱损伤少、安全、植皮成活率高、皮下血肿发生率低、愈后外形和功能良好等优点,综合效果优于Ⅰ期植皮方法。

Objective： To summarize the clinical effect of delayed skin grafting in treating joint burn wounds after eschar excision plus MEBO as dressing care. Meanwhile, the results obtained were compared with former clinical data of primary skin grafting in treating joint burn wounds after eschar excision, The merits of two methods were evaluated. Meth- od： 42 cases of joint burn patients with 3ra degree wounds （59 sites） in a period of Jan. 2005 to Dec. 2009 were collected as testing group. Early eschar excision was made, then MEBO ointment was used as dressing care immediately, delayed autologous skin grafting was conducted when wounds were kept clean and fresh after 3 - 5 days of excision. 32 cases of joint burn patients with 3^rd degree wounds （45 sites） from Jan, 2000 to Dec. 2004 were collected as control group, in which, primary autologous skin grafting was done after early excision. Some indexes including skin grafting survival rate, incidence of hematoma and infection, joint appearance and recovery situation in two groups were compared and analyzed. Results： There were statistically significant differences （P 〈0. 01 or P 〈 0. 001 ） in several indexes observed between two groups. Compared with control group, the patients in testing group had higher skin grafting survival rate, lower incidence of hemato- ma and infection and better joint appearance and function. Conclusion： For joint burn wounds of 3rd degree, effect of de- layed skin grafting after eschar excision plus MEBO as dressing care is superior to that of primary skin grafting due to minor operation wounds, less nerve and tendon injury, safe, higher skin grafting survival rate, lower incidence of hematoma and infection and better appearance and function.