早期和晚期行游离股前外侧穿支皮瓣分叶移植技术对四肢电烧伤后关节功能与Carroll评分影响

Effects of early and late-stage free anterolateral thigh perforator flap and leaflet transplantation technique on joint function and Carroll score after electric burn of extremities.

目的分析早、晚期游离股前外侧穿支皮瓣分叶移植技术对四肢电烧伤患者关节功能、Carroll上肢功能测试量表评分及下肢功能Fugl-Meyer评定量表(FMA-L)评分的影响。方法回顾性选取2016年1月至2020年12月山西省运城市中心医院收治的61例四肢电烧伤患者作为观察对象,按接受初次手术时间分为2组。早期组28例,电烧伤后7 d内行游离股前外侧穿支皮瓣分叶移植手术;晚期组33例,电烧伤7 d后行游离股前外侧穿支皮瓣分叶移植手术。观察并记录2组患者术后12个月的烧伤部位关节功能(膝关节、踝关节、腕关节、指关节及虎口),术前,术后1、3、6、12个月上肢Carroll评分及下肢FMA-L评分、皮瓣存活及并发症等情况。结果早期组患者轻度关节功能障碍发生率为7.50%,显著低于晚期组(27.66%),差异有统计学意义(P<0.05)。早期组术后1、3、6、12个月Carroll评分分别为(37.77±7.45)、(46.82±7.53)、(69.36±7.74)、(84.75±9.57)分,均高于晚期组[(31.58±5.24)、(39.19±6.32)、(51.35±7.22)、(75.66±7.92)分],差异均有统计学意义(P<0.05)。早期组术后1、3、6、12个月FMA-L评分为(17.73±3.44)、(18.92±3.41)、(20.36±3.13)、(21.59±2.74)分,均高于晚期组[(15.31±3.65)、(15.77±3.55)、(16.95±3.39)、(18.68±3.44)分],差异均有统计学意义(P<0.05)。早期组皮瓣存活率为94.67%,晚期组为91.36%,相比差异无统计学意义(P>0.05);早期组并发症总发生率为9.33%,显著低于晚期组(38.27%),差异有统计学意义(P<0.05)。结论早期行游离股前外侧穿支皮瓣分叶移植术对改善四肢电烧伤患者关节功能,促进四肢功能恢复,且兼有皮瓣供区损伤小、适用面广和修复质量高的优点,值得临床予以推广应用。

Objective To analyze the effects of early and late-stage free anterolateral thigh perforator flap transplantation technology on joint function,Carroll upper limb function test scale scores and Fugl-Meyer assessment of lower limb(FMA-L)in patients with electrical burns of extremities impact of scoring.Methods A total of 61 patients with electrical burns on limbs admitted to Yuncheng Central Hospital from January 2016 to December 2020 were selected as observation objects.They were divided into two groups according to the time they received the first operation.Twenty-eight cases were in the early-stage group,and the anterolateral thigh perforator was freed within 7 days after the electrical burn.In the late-stage group,33 patients underwent free anterolateral thigh perforator flap transplantation after 7 days of electric burn.The joint function(knee joint,ankle joint,wrist joint,finger joint and tiger mouth)of burn site,Carroll score of upper limb and FMA-L score of lower limb,flap survival and complications before operation and 1,3,6 and 12 months after operation were observed and recorded in the two groups.Results The incidence of mild joint dysfunction in the early-stage group was 7.50%,which was significantly lower than that in the late-stage group(27.66%),and the difference was statistically significant(P<0.05).Carroll scores in the early group at 1,3,6,and 12 months after surgery were(37.77±7.45),(46.82±7.53),(69.36±7.74),(84.75±9.57)points,respectively,which were higher than those in the late-stage group[(31.58±5.24),(39.19±6.32),(51.35±7.22),(75.66±7.92)points],the differences were statistically significant(P<0.05).The FMA-L scores in the early-stage group at 1,3,6,and 12 months after surgery were(17.73±3.44),(18.92±3.41),(20.36±3.13),(21.59±2.74)points,respectively,which were higher than those in the late-stage group[(15.31±3.65),(15.77±3.55),(16.95±3.39),(18.68±3.44)points],the differences were statistically significant(P<0.05).The flap survival rate in the early-stage group was 94.67%,and the late-stage group was 91.36%,the difference was not statistically significant(P>0.05).The total incidence of complications in the early-stage group was 9.33%,which was significantly lower than that in the late-stage group(38.27%),and the difference was statistically significant(P<0.05).Conclusion Early-stage free anterolateral thigh perforator flap and leaflet transplantation can improve the joint function of patients with electric burns of the limbs,promote the recovery of limb function,and have the advantages of less damage to the donor site,wide application area and high repair quality.It is worthy of clinical practice be promoted and applied.