皮瓣联合流体悬浮床治疗骶尾部压疮的研究

Research on the treatment of sacrococcygeal pressure ulcer with skin flap combined with fluid suspension table

目的探讨皮瓣联合悬浮床治疗截瘫后骶尾部Ⅳ期压疮的临床效果。方法回顾性分析2017年10月至2021年10月收治46例截瘫后骶尾部难治性Ⅳ期压疮患者临床资料。按照入院后不同处理方案分为以下2组:悬浮组(n=23)入院后即行流体悬浮床治疗;常规组(n=23)使用普通病床。2组患者均一期行创面清创负压封闭引流治疗,二期行皮瓣修复创面。比较两组患者二期术后14 d皮瓣成活率、皮瓣裂开率、愈合时间和住院时间。结果皮瓣修复术后14 d,悬浮组皮瓣22例成活,仅1例皮瓣远端小面积瘀血表皮坏死,2例缝合处局部裂开,少量渗液,均通过换药后治愈;常规组16例皮瓣成活,7例皮瓣部分坏死,9例皮瓣缝合处裂开,经再次行清创局部皮瓣转缝或清创缝合术后治愈。悬浮组皮瓣成活率、皮瓣裂开率分别为95.65%、8.69%,均优于悬浮组(72.73%、39.13%),差异有统计学意义(P<0.05)。悬浮组创面愈合时间和住院时间分别为(22.35±5.53)、(24.17±5.93)d,均短于常规组[(28.56±4.60)、(30.78±4.90)]d,差异有统计学意义(P<0.05)。随访6个月~2年,患者生活质量明显改善,44例压疮无复发,2例患者术后1年其他部位受压溃烂,再行皮瓣修复。结论对于难治性骶尾部Ⅳ期压疮,皮瓣联合悬浮床的应用可提高皮瓣成活率,缩短住院时间和创面愈合时间,减少压疮复发。

Objective To investigate the clinical effect of skin flap combined with suspension table in the treatment of sacrococcygeal stage IV pressure ulcer after paraplegia.Methods It was retrospectively analyzed the clinical data of 46 patients with sacrococcygeal refractory stage IV pressure ulcer after paraplegia from October 2017 to October 2021.According to different treatment plans after admission,they were divided into two groups:the suspension group(n=23)received fluid suspension table treatment immediately after admission;the routine group(n=23)used ordinary tables.Patients in both groups received wound debridement and drainage with negative pressure in the first stage and wound repair with skin flap in the second stage.The survival rate of skin flap at 14 days after the second stage,the rate of skin flap rupture,the healing time and the length of hospital stay were compared between the two groups.Results 14 days after flap repair,22 flaps in the suspension group survived,only 1 case had a small area of ecchymotic epidermal necrosis at the distal end of the flap,and 2 cases had local rupture at the suture with a small amount of fluid seepage,all of which were cured by dressing change.In the conventional group,16 cases of flap survival,7 cases of flap necrosis,9 cases of flap suture split,and were cured after re-debridement of local flap suture or debridement suture.The survival rate and split rate of skin flap in the suspension group were 95.65%and 8.69%,respectively,which were better than those in the suspension group(72.73%and 39.13%),and the difference was statistically significant(P<0.05).The wound healing time and hospital stay in the suspension group were(22.35±5.53)and(24.17±5.93)d,respectively,shorter than that in the conventional group[(28.56±4.60)and(30.78±4.90)]d,and the difference was statistically significant(P<0.05).After 6 months to 2 years of follow-up,the patients'quality of life was significantly improved,44 cases of pressure ulcers did not recur,2 cases of other parts of the compression ulcers 1 year after surgery,and then underwent flap repair.Conclusion For refractory sacrococcygeal stage IV pressure ulcer,the application of skin flap combined with suspension table can improve the survival rate of skin flap,shorten the hospital stay and wound healing time,and reduce the recurrence of pressure ulcer.