不同时期游离股前外侧穿支皮瓣分叶移植术对四肢电烧伤后关节滑膜内神经生长因子与Carroll评分的影响

Effect of free anterolateral thigh perforator flap and leaflet transplantation at different stages on the nerve growth factor in the synovium of the limbs after electric burn and Carroll score

目的探讨不同时期游离股前外侧穿支皮瓣分叶移植术对四肢电烧伤后关节滑膜内神经生长因子(NGF)与Carroll上肢功能测试量表评分的影响。方法回顾性选取2020年1月至2022年6月唐山市第二医院收治的27例四肢电烧伤患者,以初次手术时间进行分组,电烧伤后<7 d手术者12例,为早期组,电烧伤后≥7 d手术者15例,为晚期组。统计分析两组患者手术后1、3、6、12个月关节滑膜内NGF水平、上肢Carroll评分、皮瓣存活及并发症发生情况。结果手术后1、3、6、12个月,早期组NGF吸光度值分别为331.7±19.8、401.5±23.2、489.6±25.7、529.8±35.6,均高于晚期组(269.6±15.1、271.3±16.4、351.6±21.4、452.7±27.4),差异均有统计学意义(P<0.05)。手术后1、3、6、12个月,早期组Carroll评分分别为(37.7±7.4)、(46.8±7.5)、(69.3±7.7)、(91.7±9.5)分,均高于晚期组[(31.5±5.2)、(39.1±6.3)、(51.3±7.2)、(79.6±7.9)分],差异均有统计学意义(P<0.05)。早期组皮瓣存活率为96.9%,并发症总发生率为9.4%,晚期组皮瓣存活率为91.4%,并发症总发生率为40.0%;两组皮瓣存活率相比,差异无统计意义(P>0.05),早期组并发症总发生率低于晚期组,差异有统计意义(P<0.05)。结论早期行游离股前外侧穿支皮瓣分叶移植术治疗四肢电烧伤NGF水平,可明显提升改善患者上肢功能更有利,提高皮瓣存活率,降低并发症发生率。

Objective To analyze the effects of free anterolateral femoral perforator flap lobed transplantation at different stages on nerve growth factor(NGF)in the synovium of the limbs after electric burn and Carroll upper limb function test scale score.Methods Twenty seven patients with electrical burns of limbs admitted to Tangshan Second Hospital from January 2020 to June 2022 were retrospectively selected.They were divided into two groups according to the initial operation time,12 patients who underwent surgery less than 7 days after electrical burns were selected as the early group,and 15 patients who underwent surgery more than 7 days after electrical burns were selected as the late group.The NGF in joint synovium,Carroll score of upper limb at 1 month,3 months,6 months and 12 months after operation,and flap survival and complications were statistically analyzed.Results At 1,3,6,and 12 months after operation,obsorbance value of NGF in the early group were 331.7±19.8,401.5±23.2,489.6±25.7,and 529.8±35.6,respectively,which were higher than those in the late group(269.6±15.1,271.3±16.4,351.6±21.4,452.7±27.4),and the differences were statistically significant(P<0.05).At 1,3,6,and 12 months after operation,the Carroll scores of the early group were(37.7±7.4),(46.8±7.5),(69.3±7.7),and(91.7±9.5)points,respectively,which were higher than those of the late group[(31.5±5.2),(39.1±6.3),(51.3±7.2),and(79.6±7.9)points],and the differences were statistically significant(P<0.05).The flap survival rate was 96.9%in the early group,and the total incidence of complications was 9.4%.The flap survival rate was 91.4%in the late group,and the total incidence of complications was 40.0%.There was no significant difference in the flap survival rate between the two groups(P>0.05),but the total incidence of complications in the early group was lower than that in the late group,and the difference was statistically significant(P<0.05).Conclusion Free anterolateral thigh perforator flap and leaflet transplantation has the advantages of less damage to the donor site,wide range of wound repair applications and high repair quality.Early free anterolateral thigh perforator flap leaflet transplantation is more helpful postoperative intra-articular synovial neurotrophic,revascularization and angiogenesis of transplanted flaps in patients with electrical burns of extremities are more beneficial to improve the function of patients'upper limbs.