复合皮瓣移植联合中药熏洗修复四肢皮肤骨缺损临床研究

Clinical study and prognostic analysis of composite flap transplantation combined with traditional Chinese medicine for the skin repair and bone defects of limbs

目的评价复合皮瓣移植联合中药熏洗修复四肢皮肤骨缺损的疗效。方法将符合入选标准的80例四肢皮肤骨缺损患者按就诊顺序随机分为2组,每组40例。对照组给予复合皮瓣移植治疗,观察组在对照组基础上结合中药熏洗。2组均治疗3个月。观察术后皮瓣移植成活情况、皮瓣肿胀程度,评价临床疗效并记录并发症发生情况。结果观察组皮瓣移植成活率为95.0%(38/40)、对照组为75.0%(30/40),2组比较差异有统计学意义(χ2=6.274,P=0.012)。术后,观察组皮瓣肿胀Ⅰ度患者多于对照组,Ⅳ度患者少于对照组(χ2值分别为8.584、4.210,P值分别为0.003、0.040)。观察组总有效率为97.5%(39/40)、对照组为77.5%(31/40),观察组临床疗效优于对照组(U=2.463,P=0.013),总有效率高于对照组(χ2=7.314,P=0.006)。观察组并发症发生率为2.5%(1/40)、对照组为17.5%(7/40),2组比较差异有统计学意义(χ2=5.000,P=0.025)。结论复合皮瓣移植结合中药熏洗可提高四肢皮肤骨缺损患者的皮瓣移植成活率,降低移植后的皮瓣肿胀程度及并发症发生率,提高临床疗效。

Objective To explore the clinical effect and prognosis of composite skin flap transplantation combined with traditional Chinese medicine for the skin repair and bone defects of extremities. Methods A total of 80 patients with extremities’ bone defect were selected in our hospital between March 2016 and March 2015. The patients were randomly divided into two groups according to the orders of the alternaive medical treatment. The observation group (n=40) was treated with compound skin flap transplantation combined with Chinese traditional medicine steaming and washing. The control group (n=40) was treated with a single compound flap transplantation. The skin flaps, transplant survival rate, flap swelling, treatment effect and complications were observed. Results The survival rate of the observation group was 95%(38/40), and the survival rate of the control group was 75%(30/40). The survival rate between two groups was statitically significant difference (χ2=6.274, P<0.05). The proportion of degree Ⅰ of the skin flap in the observation group significantly higher than that in the control group (χ2=8.584, P=0.003), while the proportion of degree Ⅳ of the skin flap in the observation group significantly lower than that in the control group (χ2=4.210, P=0.040). The total effective rate in the observation group was 97.5%(39/40), the control group was 77.5%(31/40), and the difference between two group was significant (χ2=7.314, P<0.05). The incidence of complications in the observation group was 2.5%(1/40). The incidence of complications in the control group was 17.5%(7/40). The incidence of complications in the observation group was significantly lower than that in the control group (χ2=5.000, P<0.05). Conclusions The combination of skin flap transplantation and Chinese medicine could repair bone defect of the extremities, lower swelling degree of the skin flap after transplantation and improve curative effect, and the incidence of complications after treatment is low and the clinical value is high.