李晴　于文君　刘鹏程　孙语悦

[摘要]目的：探討自体皮肤回植联合负压封闭引流技术（Vacuum sealing drainage，VSD）修复皮肤撕脱伤的疗效，并分析影响其术后疗效的相关因素。方法：选取2015年6月-2019年12月笔者医院收治的皮肤撕脱伤患者108例，采用随机数字表法将其分为对照组和观察组，每组各54例。所有患者均采用自体皮肤回植术，对照组术后给予打包加压，观察组术后给予VSD治疗。术后随访3～12个月，并对两组患者疗效进行评价。记录两组患者创面愈合时间、住院时间，术后14d采用视觉模拟评分法（Visual analogue scale，VAS）评价两组患者疼痛状况。根据两组术后疗效情况将所有患者分为愈合组和未愈合组两个亚组。记录患者相关临床资料，采用单因素分析和多元Logistic回归模型分析影响患者术后疗效的相关因素。结果：观察组有效率（96.30%）高于对照组（85.19%），差异有统计学意义（P<0.05）。观察组创面愈合时间、住院时间、VAS疼痛评分均低于对照组，差异均有统计学意义（P<0.05）。单因素分析结果显示，年龄、糖尿病史、受伤原因、撕脱面积、包扎方式、创面是否感染、术后开始功能锻炼时间与患者术后疗效有关（P<0.05）。多因素Logistic分析表明，年龄、糖尿病史、撕脱面积、包扎方式、创面是否感染、术后开始功能锻炼时间是其术后疗效的独立影响因素（P<0.05）。结论：自体皮肤回植联合VSD治疗皮肤撕脱伤有效率较高，可减少创面愈合时间和住院时间，有效缓解创面疼痛，值得推广。年龄、糖尿病史、撕脱面积、包扎方式、创面是否感染、术后开始功能锻炼时间与其术后疗效情况有关。

[关键词]皮肤撕脱伤;自体皮肤回植;负压封闭引流;疗效;影响因素

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）09-0041-04

Analysis of Curative Effect and Influencing Factors of Autologous Skin Replantation Combined with Vacuum Sealing Drainage to Repair Skin Avulsion Injury

LI Qing1，YU Wen-jun1，LIU Peng-cheng1，SUN Yu-yue2

（1.Department of Second Hand and Foot Surgery，First Hospital of Jilin University，Changchun 130031，Jilin，China;2.Operating Room，China-Japan Union Hospital of Jilin University，Changchun 130033，Jilin，China）

Abstract： Objective  To explore the efficacy of autologous skin replantation combined with vacuum sealing drainage （VSD） to repair skin avulsion injury， and analyze the related factors that affect its postoperative efficacy. Methods  From June 2015 to December 2019， 108 patients with skin avulsion injury treated in our hospital were selected and divided into the control group （n=54） and the observation group （n=54） by random number table method. All patients were treated with autologous skin replantation. The control group was given postoperative compression， and the observation group was given VSD after operation. Followed up for 3-12 months after operation， and evaluated the efficacy of the two groups of patients. The wound healing time and hospitalization time of the two groups of patients were recorded. The visual analog score （VAS） was used to evaluate the pain status of the two groups of patients 14 days after surgery. All patients were divided into two subgroups： healing group and non-healing group according to the postoperative efficacy of the two groups. Recorded relevant clinical data of patients， and use univariate analysis and multiple logistic regression models to analyze the related factors that affect the postoperative efficacy of patients. Results  The effective rate of the observation group （96.30%） was higher than that of the control group （85.19%）， the difference was statistically significant （P<0.05）. The wound healing time， hospitalization time， and VAS pain score of the observation group were lower than those of the control group （P<0.05）. Univariate analysis showed that age， history of diabetes， cause of injury， avulsion area， dressing method， whether the wound surface was infected， and the time of postoperative functional exercise were related to the postoperative efficacy of patients （P<0.05）. Multivariate logistic analysis showed that age， history of diabetes， avulsion area， dressing method， whether the wound was infected， and the time to start functional exercise after surgery were independent influencing factors of its postoperative efficacy （P<0.05）. Conclusion  Autologous skin replantation combined with VSD is more effective in treating skin avulsion injury， which can reduce wound healing time and hospitalization time， effectively relieve wound pain， and is worthy of promotion. Age， history of diabetes， avulsion area， dressing method， whether the wound surface is infected， and the time of functional exercise after surgery are related to its postoperative efficacy.

Key words： skin avulsion injury; autologous skin replantation; vacuum sealing drainage（VSD）; efficacy; influencing factors

皮肤撕脱伤是临床常见的严重外科创伤之一，其损伤较重，可直接导致皮肤软组织受损甚至坏死[1-2]。传统的自体皮肤回植联合打包加压是临床治疗皮肤撕脱伤的主要方法，但由于其皮下分泌物引流效果不佳，极易导致回植皮片感染甚至坏死，使得术后效果并不理想[3-4]。因此，术后如何充分引流和预防感染极为重要。负压封闭引流技术（Vacuum sealing drainage，VSD）由单向透气透明薄膜及负压吸引装置组成，能够为创面提供持续的负压引流，从而有效去除了创面的组织渗液[5-6]。……