股前外侧穿支皮瓣修复手术治疗手外伤组织缺损对患者手部创面面积、组织愈合时间的影响

目的探讨股前外侧穿支皮瓣修复术治疗手外伤组织缺损的临床效果。方法选取2020年5月-2023年5月长沙市第八医院创伤骨科收治的80例手外伤组织缺损患者,按随机数字表法分为两组,每组各40例。对照组行胸腹部带蒂皮瓣治疗,观察组行股前外侧穿支皮瓣修复术治疗。比较两组修复效果、手部创面面积、组织愈合及抗菌药物使用时间、手功能、上肢功能、疼痛评分、日常生活能力、炎症水平、生活质量及并发症。结果观察组比对照组的修复效果更好(P<0.05);观察组术后手部创面面积小于对照组,创面愈合、抗菌药物使用时间短于对照组(P<0.05);观察组术后MHQ评分、上肢FMA评分、BI评分高于对照组,VAS评分低于对照组(P<0.05);观察组术后CRP、IL-6、IL-8、TNF-α水平低于对照组(P<0.05);观察组术后生活质量各领域评分高于对照组(P<0.05);观察组并发症少于对照组(P<0.05)。结论股前外侧穿支皮瓣修复术效果更佳,可加快手外伤组织缺损患者功能恢复,提高日常生活能力,减轻疾病对生活的影响,且并发症少。

五味消毒饮联合闭式灌洗引流术治疗腰椎内固定术后早期感染(气滞血瘀)随机平行对照研究

[目的]观察五味消毒饮联合闭式灌洗引流术治疗腰椎内固定术后早期感染(气滞血瘀)疗效。[方法]使用随机平行对照方法,将60例住院患者按随机数字表法随机分两组。对照组30例麻醉下行病灶切开清创置管闭式灌洗引流,手术清创过程中应将脓性分泌物或坏死组织彻底清除,保留内固定装置,病灶清理后用双氧水及生理盐水反复冲洗,医用无醇安尔碘液浸泡数分钟后,生理盐水冲洗病灶,术后根据细菌培养结果选用敏感抗生素配于冲洗液中进行持续灌洗引流。维持负压引流3~5d。治疗组30例五味消毒饮(金银花、野菊花、紫花地丁、冬葵子、蒲公英各10g,肿胀明显加泽泻10g,茯苓15g;肿痛明显加虎杖10g;皮温高加生地、丹皮各10g);1剂/d,水煎500mL,早晚口服;西医治疗同对照组。连续治疗7d为1疗程。观测临床表现、抗生素使用时间、感染治愈时间、创口边缘上皮组织覆盖愈合时间、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效12例,有效16例,无效2例,总有效率93. 33%;对照组显效8例,有效12例,无效10例,总有效率66. 67%;治疗组疗效优于对照组(P <0. 05)。抗生素使用时间、感染治愈时间、创口边缘上皮组织覆盖愈合时间治疗组均优于对照组(P <0. 01)。[结论]五味消毒饮联合闭式灌洗引流术治疗腰椎内固定术后早期感染(气滞血瘀),疗效满意,无严重不良反应,值得推广。

The arresting phase determines the total healing time of a locally irradiated skin wound in swine

Objective：Radiation is an important cause of delayed wound healing,and there still exist many questions regarding the patterns and mechanisms of wound healing.This study investigated the characteristics of wound healing after varying doses of local radiation and explored possible causes of the delay in healing caused by radiation.Methods：A full-thickness dorsal longitudinal skin tissue,2 cm in diameter,was excised after local irradiation on one side of the back of swine,and the other side was wounded as a control.The size of the wound area was recorded every two days after injury.Pathological changes,proliferating cell nuclear antigen（PCNA,immunohistochemistry）and apoptosis levels（TUNEL assay）were measured at different time points after wounding.Results：The course of wound healing can be divided into four phases,namely：the arresting phase,the healing priming phase,the fast healing phase,and the healed phase.Although the total wound healing time was closely correlated to the dose of irradiation（R2=0.9758）,it was more dependent on the length of the arresting phase（R2=0.9903）because once the arresting phase ended,the wound healed at a similar speed regardless of radiation doses.Pathological analysis showed that compared with the control side there were more necrotic tissues,slower epithelial crawling,as well as fewer blood vessels and cellular components in the irradiated side at the arresting phase,while other phases revealed no significant difference concerning these measurements.Immunohistochemistry showed that the irradiated wounds had significantly less PCNA-positive and more TUNEL-positive labeling of cells in the arresting phase than in other phases.Moreover,the changes were positively related to the radiation doses,but there was no obvious difference in cell proliferation or apoptosis among the healing priming phase,fast healing phase or healed phase,whether on the control side or on the irradiated side.Conclusions：After local irradiation,the length of the arresting phase determines the wound healing time.Increased apoptosis and decreased cell proliferation might be an important reason for the formation of the arresting phase.