17例窦道型压疮的临床特点及处理体会

CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF 17 PATIENTS WITH PRESSURE SORE OF SINUS TYPE

目的总结窦道型压疮的临床特点及治疗方法和疗效。方法回顾分析2009年1月-2013年4月收治的17例外伤性截瘫后发生窦道型压疮患者临床资料。男11例,女6例;年龄17~49岁,平均27.4岁。压疮形成时间6个月~7年,中位时间1.5年。14例为首发压疮,3例为复发。单纯窦道型压疮8例10处;复杂窦道型压疮9例9处,假性滑液囊合并1~4个二级窦道。窦道型压疮主要发生于坐骨结节处。压疮创面范围1.5 cm×1.0 cm^3.0 cm×2.0 cm;二级窦道长8~32 cm,平均17 cm。单纯窦道型压疮完整切除假性滑液囊后,一期或二期分别采用局部潜行或菱形皮瓣修复;复杂窦道型压疮于假性滑液囊切除修复基础上,联合彻底切除二级窦道治疗。结果 1处单纯窦道型压疮术后4 d发生切口裂开,经再次缝合并制动后愈合;3处复杂窦道型压疮分别于术后9、17、23 d发生切口局部感染,皮瓣下积脓,经二次彻底清除残余坏死组织后愈合;其余切口均Ⅰ期愈合,皮瓣均成活。患者均获随访,随访时间6~12个月,平均9.3个月。压疮均无复发。结论根据窦道型压疮的临床特点,可分为单纯窦道型压疮和复杂窦道型压疮两种类型,治愈的关键在于彻底切除假性滑液囊和二级窦道。

Objective To sum up the clinical characteristics, surgical management, and effectiveness of pressure sore of sinus type. Methods Between January 2009 and April 2013, 17 patients with 19 pressure sores of sinus type after traumatic paraplegia were treated, and the clinical data were analyzed retrospectively. There were 11 males and 6 females with an average age of 27.4 years （range, 17-49 years）. The median disease duration was 1.5 years （range, 6 months to 7 years）. Of 17 cases, there were 14 primary cases and 3 recurrent cases; 10 focuses of 8 cases were classified as simple sinus type, and 9 focuses of 9 cases as complex sinus type, which had a false synovial sheath complicated with one to four “second sinus”. The pressure sore of sinus type majorly located at the ischial tuberosity. The size of pressure sore ranged from 1.5 cm × 1.0 cm to 3.0 cm × 2.0 cm, and the length of “second sinus” ranged from 8 to 32 cm with an average of 17 cm. After the false synovial sheath was totally excised, the wound was repaired by local sliding or rhombus flaps at the first or second stage in patients with simple sinus type pressure sore. On the basis of excising the false synovial sheath, the “second sinus” was totally removed in the patients with complex sinus type pressure sore. Results Wound dehiscence occurred in 1 case of simple sinus type pressure sore at 4 days, which was cured after it was sutured again. Wound infection occurred at 9, 17, and 23 days respectively in 3 cases of complex sinus type pressure sore, which was cured after second debridement and necrosis tissues removal. The other wounds healed by first intention, and the flaps totally survived. All patients were followed up 6-12 months （mean, 9.3 months）. No recurrence was observed. Conclusion According to the clinical characteristics, pressure sore of sinus type could be divided into simple sinus type and complex sinus type. The key of successful treatment is to thoroughly excise false synovial sheath and “second sinus”.