人工真皮联合自体薄皮片移植在关节部位烧伤瘢痕挛缩修复中的临床应用

Clinical application of artificial dermis combined with autologous thin skin graft in the repair of burn scar contracture of joint

目的研究人工真皮联介自体薄皮片移植作关节部位烧伤瘢痕挛缩修复中的临床应用价值。方法选取2015年7月至2018年4月河北省保定市第五医院收治的52例关节部位烧伤瘢痕挛缩患者进行前瞻性研究,随机数字表法分组,各26例,瘢痕松解后观察组采用人工真皮联合自体薄皮片移植,对照组采用中厚皮移植术,比较两组自体皮成活率,并取人工真皮聚酯纤维膜下组织,行HK染色,观察病理学变化,比较两组植皮区温哥华瘢痕评估表评分(VSS)、功能活动情况、感染率、创面愈合时间及供皮区愈合后VSS评分结果观察组自体皮成活率(92.31%)与对照组(84.62%)比较,差异无统计学意义(P>0.05);与术前相比,两组术后3、6个月及1年VSS评分均降低(P<0.05);观察组术后3、6个月及1年VSS评分低于对照组(P<0.05);观察组功能活动优良率(100.00%)高于对照组(76.92%)(P<0.05);两组感染率(3.85%vs7.69%)比较差异无统计学意义(P>0.05);两组植皮区愈合时间比较差异无统计学意义(P>0.05);观察组供皮区愈合时间短于对照组,供皮区愈合后VSS评分低于对照组(P<0.05)结论人工真皮联合自体渖皮片移植应用于关节部位烧伤瘢痕挛缩患者中,河改善患者植皮区、供皮区瘢痕情况,缩短供皮区愈合时间,改善烧伤瘢痕挛缩关节功能.

Objective To study the clinical value of artificial dermis combined with autologous thin skin graft in the repair of burn scar contracture in joints.Methods A total of 52 patients with hum scar contractures were enrolled in the No.5 Hospilal of Baoding from July 2015 to April 2018.According to dilferent methods of repair,26 cases were used in each group.The observation group was treated with artificial dermis combined with autologous thin skin graft.The control group was treated with medium-t hick ness skin grafting.The survival ralte of autologous skin was comjiared between the two groups.The tissue of artificial dermal polyester fiber was taken and HE staining was performed to observe ihe pathological changes.The Vancouver skin scar assessment score(VSS),functional activity,infection rate,wound healing time,and VSS score after healing of the donor site were romparecl Detween the two groups.Results Tin survival rate of autologous skin in the observation group(92.31%)was not significantly different from that in tlie control group(84.62%)(P>0.05).Compared with preoperative,the VSS scores at 3,6 months and 1 year alter operation in both groups were decreased(P<0.05).The VSS scores of the observation group were lower than those of the control group at 3,6 months and 1 year(P<0.05).The excellent rate of functional activity in the observation group(100.00%)was higher than that of the control group(76.92%)(P<0.05);riicre was no significant difference in the infection rate(3.85% vs 7.69%)and healing time of skin grafting area between the two groups(P>0.05).The healing time of donor site was shorter than that of ihe control group(P<0.05).The VSS score of the donor site was lower than that of the control group(P<0.05).Conclusions Artificial demiis combined with autologous thin skin graft can be used in patients with hum scar contracture in joints,which can improve the scarring of skin grafting area and donor site,shorten the healing time of donor site and improve the function of burn scar contracture joint.