婴幼儿先天性并指畸形外科治疗后并发症原因分析及预防

Cause analysis and prevention of complications after surgical treatment of congenital syndactyly deformity in infants

目的分析婴幼儿先天性并指畸形外科治疗后并发症原因,探讨预防并发症的方法。方法回顾性分析我院2015年1月-2018年3月95例行外科治疗的先天性并指畸形婴幼儿资料,其中术后近期并发症9例,分别是表皮坏死2例,移植皮片坏死1例,伤口愈合不良6例;随访至2018年3月,远期并发症17例,分别是瘢痕屈曲挛缩5例,指蹼爬升粘连11例,继发瘢痕增生形成不全并指1例。分析并发症发生的原因,提出预防措施。结果 <2岁患儿近期并发症发生率为15.69%,明显高于2～3岁、≥3岁组的4.17%、0.00%,差异有统计学意义(P<0.05)。<2岁远期并发症发生率为27.66%,高于2～3岁、≥3岁组的15.38%、0.00%,双侧交叉三角皮瓣成形组远期并发症发生率为32.61%,明显高于双翼皮瓣指蹼成形组的4.08%,解除固定第2d、3-5d开始功能锻炼组远期并发症发生率为6.67%、16.07%,低于5d以上组的29.17%,差异有统计学意义(P<0.05)。手术年龄<2岁、解除固定后开始功能锻炼时间晚是并发症发生的危险因素(OR值=5.82,4.29,95%CI=5.14-7.28,3.67-4.91),双翼皮瓣指蹼成形术是保护因素(OR值=1.43,95%CI=1.17-2.18)。结论婴幼儿先天性并指畸形外科治疗后并发症原因主要是手术时机过早,手术方式选择及术后开始功能锻炼时间较晚。正确的手术设计、适宜的手术时机及术后早期积极的功能锻炼可降低并发症发生率。

Objective:To analyze the causes of complications after surgical treatment of congenital syndactyly deformity in infants and children,and to explore the methods of preventing complications.Methods:Retrospective analysis in January 2015,2018-March 95 underwent surgical treatment of congenital syndactyly and deformed infant data,including 9 cases of recent complications,skin necrosis in 2 cases,transplant flap necrosis in 1 case,6 patients with poor wound healing;17 cases of long-term complications were followed up to March 2018,including 5 cases of cicatricial flexion contracture,11 cases of webbed climbing adhesion,and 1 case of incomplete secondary scar hyperplasia.The causes of complications were analyzed and preventive measures were proposed.Results:The incidence of recent complications in children<2 years old was 15.69%,which was significantly higher than 4.17% and 0.00% in the age group between 2 and 3 years old,and the difference was statistically significant(P<0.05).<2 years old long-term complication rate was 27.66%,higher than 2 ~ 3 years,3 years old or more were 15.38%,0.00%,bilateral cross triangular flap forming group long-term complication rate was 32.61%,significantly higher than the wings flap refers to web forming group 4.08%,2 d,3-5 d remove fixed functional exercise group long-term complication rate was 6.67%,16.07%,less than 29.17% of the above 5 d group,the difference was statistically significant(P<0.05).Age<2 years,and later began after functional exercise remove fixed time is a risk factor for complications(OR=5.82,4.29,95% CI=5.14-7.28,3.67-4.91),refers to the webbed wings flap plasty is to protect the factors(OR=1.43,95% CI=1.17-2.18).Conclusion:The complications after surgical treatment of congenital malformations in infants and young children are mainly caused by early timing of surgery,late selection of surgical methods and late start of functional exercise after surgery.Correct surgical design,appropriate surgical timing and early postoperative active functional exercise can reduce the incidence of complications.