周锦烽 杨蓊勃 顾延庆 郝超

[摘要]目的：评估机械牵张对于移植皮片的影响，为改善植皮片术后挛缩寻找新的治疗方法。方法：SPF级SD大鼠24只，雄性，3月龄，体重300g～330g，随机分为三组，在每只大鼠背部建立两个大小相同的全厚植皮模型，各组大鼠术后随机选取一皮片，以自制弹性牵张装置分别行纵向、横向及双向牵张，另一皮片为自身对照。牵张2周后测量各治疗组与对照组皮片的面积、长度、宽度，并计算长宽比。结果：经过2周的机械牵张，各治疗组的植皮片在受力的方向上均变长了，从而造成了植皮片形态改变和面积的增加。单向牵张组的植皮术在非受力方向的长度较牵张前有所减少，而自身对照组的皮片则无此改变，说明其长度改变由机械牵张引起，而非术后挛缩引起。结论：初步实验表明，机械牵张可以有效地增加植皮片的长度与面积，全方位的机械牵张作用尤其明显，这一方法值得進一步的深入研究，从而为植皮片术后挛缩这一难题提供更好的治疗方法。

[关键词]SD大鼠;植皮片;机械应力;牵张;挛缩;动物实验

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2019）02-0083-05

Abstract： Objective  To evaluate the effect of mechanical stretching on skin graft and to find a new method to improve the contracture after skin graft. Methods  Twenty-four SD rats of SPF grade， male， aged 3 months， weighing 300g to 330g， were divided into three groups. Two full-thickness skin grafting models of the same size were established in each rat's back. One skin graft was randomly selected from each group after operation， and the self-made elastic stretching device was used for longitudinal， transverse and bidirectional stretching， and the other skin graft was used for self-control. After 2 weeks of distraction， the area， length and width of the skin of each treatment group and the control group were measured， and the aspect ratio was calculated. Results  After two weeks of mechanical stretching， the skin grafts in each treatment group were lengthened in the direction of force， resulting in the morphological changes of skin grafts and the increase of the area. The length of skin graft in unilateral distraction group was less than that before distraction， while the length of skin graft in self-control group was unchanged， indicating that the length change was caused by mechanical distraction， not by postoperative contracture. Conclusion  Preliminary experiments show that mechanical stretching can effectively increase the length and area of skin graft， especially the omni-directional mechanical stretching. This method is worthy of further study， so as to provide a better treatment for contracture after skin graft.

Key words： SD rats; skin graft; mechanical stress; stretch; contracture; animal experiment

皮片移植是烧伤整形科医生修复创面最常用的方法，术后移植皮片会发生不同程度的挛缩，影响植皮部位的外观与功能，这一难题长期困扰着临床医生与患者，因此需要寻找新的、可靠的治疗方式，有学者利用固定的框架来抑制皮片术后挛缩[1-5]，取得了一定的效果。该方法以固定的框架来抵抗移植皮片向内的收缩力，从而抑制皮片挛缩，笔者按照这一思路并加以延伸，采用动物实验的方式，评估机械牵张对于移植皮片的影响，以期为移植皮片术后挛缩的防治提供新的思路。……