皮瓣整形修复小儿手烧伤后瘢痕挛缩畸形的功能恢复情况及疗效研究

Functional Recovery and Effect of Plastic Repair of Scar Contracture Deformity Skin Flaps in Children with Hand Burns

目的:探讨小儿手烧伤后瘢痕挛缩畸形采用皮瓣整形修复的功能恢复及效果。方法:选择2014年1月-2017年1月笔者医院收治的60例手部烧伤后瘢痕挛缩患儿作为研究对象,采用随机数表法随机分为观察组(30例)和对照组(30例)。对照组给予常规瘢痕切除结合组织松解术进行修复,观察组在对照组基础上采取皮瓣整形修复措施,两组患儿术后均进行早期功能锻炼并随访6～12个月。采用温哥华瘢痕评定量表评价两组患儿治疗前后瘢痕修复效果,手指总活动度评价术后指关节功能恢复情况,比较两组患儿治疗效果、外观满意度及并发症发生情况。结果:术后6个月,观察组瘢痕修复评分(6.9±2.2)分明显优于于对照组(8.9±1.6)分,差异有统计学意义(P<0.05)。术后12个月,观察组关节功能恢复优良率、手术治疗有效率、患儿及家属外观满意度均明显高于对照组[93.3%(28/30)、96.7%(29/30)、93.33%(28/30)vs60.0%(18/30)、80.0%(24/30)、66.67%(20/30)],差异均有统计学意义(P<0.05)。观察组并发症发生率为6.7%(2/30)明显优于对照组的36.7%(11/30),差异有统计学意义(χ~2=7.9542,P<0.05)。结论:皮瓣整形修复措施对小儿手烧伤后瘢痕挛缩畸形能有效修复瘢痕组织,改善挛缩畸形,关节功能恢复效果显著且不良反应少,值得在临床广泛推广。

Objective To investigate the functional recovery and effect of skin flap plastic repair for cicatricial contracture deformity after hand burn in children. Methods 60 children with cicatricial contracture after hand burn admitted to our hospital were selected as the research objects from January 2014 to January 2017. Patients were randomly divided into observation group (30 cases) and control group (30 cases) by random number table method. The control group was repaired by traditional scar resection combined with tissue release. On the basis of the control group, the observation group adopted the plastic and repair measures of skin flap. Both groups of children underwent early functional exercise after surgery and were followed up for 6-12 months. The vancouver scar scale was used to evaluate the effect of scar repair before and after treatment in two groups of children, and the total range of motion was used to evaluate the postoperative recovery of finger joint function. The therapeutic effect, appearance satisfaction and complications of the two groups were compared. Results 6 months after operation, the scar repair score of the observation group (6.9±2.2) was significantly better than that of the control group (8.9±1.6), the difference was statistically significant(P <0.05). At 12 months after operation, the excellent and good rate of joint function recovery, the effective rate of surgical treatment and the appearance satisfaction of children and their families in the observation group were significantly higher than those in the control group[93.3%(28/30)、96.7%(29/30)、93.33%(28/30)vs 60.0%(18/30)、80.0%(24/30)、66.67%(20/30)], and the differences were statistically significant(P <0.05). The incidence of complications in the observation group was 6.7%(2/30) significantly higher than that in the control group [36.7%(11/30),χ^2=7.9542,P <0.05]. Conclusion The application of skin flap plastic repair for scar contracture deformity after hand burn in children can effectively repair scar tissue , improve contracture deformity and restore joint function. It has the advantages of less adverse reactions and is worthy of clinical promotion.