皮肤牵张联合高压氧治疗小腿皮肤缺损的疗效观察

Efficacy of skin traction combined with hyperbaric oxygen in the treatment of skin defects in crus

目的探讨皮肤牵张联合高压氧治疗小腿皮肤缺损的疗效。方法收集2010年8月至2018年4月烟台山医院创伤科收治的小服用皮肝缺损患者36例,采用外固定架及皮肤牵张器(北京市骨研所生产)治疗小腿皮肤缺损,待皮肤坏死界限清楚后行皮肤牵张,安放皮肤牵引外固定架。自术后第1天开始,每天将牵引环或牵张器连接杆向皮肤缺损方向推移1 mm,分6次完成。将36例患者按照治疗方法分为2组,常规组19例,高压氧组(高压氧联合皮肤牵张)17例;高压氧组于术后次日开始施行高压氧治疗。结果治疗2个疗程后,高压氧组患者未发生感染,常规组患者有4例发生感染,其中有1例感染较重,暂停牵张,给予敏感抗生素、换药1周后,感染控制,继续皮肤牵张。高压氧组牵引克氏针切出1例,常规组发生克氏针切出皮肤7例,有3例经清创缝合后皮肤愈合,余4例行2次皮肤牵张。结论皮肤牵张联合高压氧治疗小腿皮肤缺损,能显著降低钉道松动和圆针切出率,减少软组织感染率。

Objective To evaluate the efficacy of skin traction combined with hyperbaric oxygen (HBO) in the treatment of skin defects in crus. Methods Thirty-six patients with skin defects in crus admitted into the trauma department of Yantaishan hospital from August 2010 to April 2018, were treated with external fixation device and skin tractor produced by the Beijing Orthopedic Research Institute. Skin traction was performed after the margin of skin necrosis was clearly identified, and the external fixation device for skin traction was properly placed. From the first day after surgery, the traction ring or the tractor connecting rod was moved forward 1mm a day in the direction of skin defect, the procedures of which were divided into 6 times. The patients were randomly divided into 2 groups: the routine group (n=19) and the hyperbaric oxygen group (n=17). The following day after surgery, HBO therapy was implemented. Results Of the 17 patients who received skin traction combined with HBO in the HBO group, there was no case of infection and complications. However, of the 19 patients with routine treatment, there were 4 cases of infection, of which 1 case was seriously infected. Skin traction was momentarily suspended and sensitive antibiotics was applied, and 1 week after treatment, infection was controlled and skin traction continued. In the HBO group, there was 1 case of needle out-cut by Kirschner needle, while there were 7 cases in the routine group, of which 3 cases healed after debridement and suture and other 4 cases were treated with secondary skin traction. Conclusion Skin traction combined with HBO in the treatment of skin defects in crus could significantly reduce the loosening of nails and the rate of needle out-cut, and the rate of soft tissue infection as well.