功能部位整形术在深Ⅱ度烧伤后瘢痕畸形修复患者中的应用效果

周晓倩 蔡芳 钟莉

[摘要]目的：探究早期功能部位整形術在深Ⅱ度烧伤创面愈合后瘢痕畸形修复中的应用。方法：选取2014年8月-2017年4月笔者医院收治的64例深Ⅱ度烧伤后瘢痕畸形修复患者作为研究对象，按随机数字表法分为对照组和治疗组，各32例。对照组采用常规治疗及功能锻炼，治疗组在此基础上采用早期功能部位整形术治疗，两组随访12个月。观察两组治疗前后瘢痕严重程度，统计治疗组植皮存活率，评价两组治疗后的关节功能恢复情况，并统计两组临床疗效。结果：与治疗前相比，治疗后1、3、6、12个月两组患者VSS评分均呈逐渐降低趋势，且治疗组显著低于对照组，差异有统计学意义（P<0.01）。治疗组关节植皮总存活率为98.56%，其中以手、肩部的平均存活率最高，分别为99.44%、98.76%，肘、膝部分别为97.62%、97.18%。治疗后3个月两组关节功能情况比较差异无统计学意义（P>0.05）;治疗后6、12个月，治疗组关节功能显著优于对照组，差异有统计学意义（P<0.01）。治疗后12个月治疗组临床总有效率高达100.00%显著高于对照组的81.82%，差异有统计学意义（χ2=8.394，P=0.004）。结论：对深Ⅱ度烧伤后瘢痕畸形患者应用功能部位整形术，能够改善瘢痕挛缩畸形及关节功能，且植皮存活率高，临床效果显著优于常规治疗，值得临床推广应用。

[关键词]瘢痕畸形;深Ⅱ度烧伤;创面愈合;关节功能;植皮存活率

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）06-0043-03

Application Effect of Functional Site Plastic Surgery in the Repair of Scar Deformity after Deep Second Degree Burn

ZHOU Xiao-qian，CAI Fang，ZHONG Li

（Department of Cosmetic Plastic Burn Surgery，West China Hospital， Sichuan University，Chengdu 610041，Sichuan，China）

Abstract： Objective  To investigate the application of early functional site plastic surgery in the repair of scar deformity after deep second degree burn wound healing. Methods  64 patients with scar deformity after deep second degree burn in our hospital from August 2014 to April 2017 were selected as the research objects and randomly divided into the control group and the treatment group， 32 cases in each group. The control group was treated with routine treatment and functional exercise， and the treatment group was treated with early functional site plastic surgery on this basis. The two groups were followed up for 12 months. The scar severity before and after treatment was observed， the survival rate of skin graft in the treatment group was counted， the recovery of joint function after treatment in the two groups was evaluated， and the clinical efficacy of the two groups was counted. Results  Compared with before treatment， the VSS scores of the two groups were gradually decreased at 1， 3， 6 and 12 months after treatment， and the treatment group was significantly lower than the control group， the differences were statistically significant（P<0.01）. In the treatment group， the total survival rate of joint skin graft was 98.56%， and the average survival rates of hand and shoulder were the highest， which were 99.44% and 98.76% respectively， and those of elbow and knee were 97.62% and 97.18% respectively. There was no significant difference in joint function between the two groups 3 months after treatment（P>0.05）. At 6 and 12 months after treatment， the joint function of the treatment group was significantly better than that of the control group（P<0.01）. 12 months after treatment， the total effective rate of the treatment group was 100.00%， significantly higher than that of the control group（81.82%，χ2=8.394，P=0.004）. Conclusion  The application of functional part plastic surgery in patients with deep burn scar deformity can improve the scar contracture and joint function， and the survival rate of skin grafting is high， and the clinical effect is significantly better than that of conventional treatment， which is worth popularizing and applying in clinical practice.

Key words： scar deformity; deep second degree burn; wound healing; joint function; skin graft survival rate

深Ⅱ度烧伤创伤愈合是创面残留的真皮组织以及皮肤附件再生修复的过程，其愈合速度较慢，极易形成瘢痕增生、挛缩，导致关节屈曲或过伸畸形，严重影响患者生活质量[1]。目前治疗方法主要为保守治疗和手术治疗，保守治疗操作较为繁琐，患者的耐受程度不高，有时反而可能促进瘢痕的增生以及创面感染的风险[2]。手术治疗保留真皮深层未受损害的上皮，可达到改善关节功能、减少并发症的目的[3]。研究报道[4]，功能部位整形术对于改善深Ⅱ度烧伤创面愈合后瘢痕挛缩的临床效果显著。本研究旨在探讨对深Ⅱ度烧伤后瘢痕畸形修复患者应用功能部位整形术治疗，观察其对瘢痕挛缩畸形和关节功能障碍的影响，现报道如下。……