沈文川 吴贞天 汤俊 丁若虹

[摘要]目的：研究切痂植皮修復关节部位烧伤创面的效果及对局部微循环的影响。方法：选取2013年1月-2017年12月笔者医院收治的182例严重性关节烧伤需要进行切痂植皮修复手术的患者作为研究对象。所有患者均接受切痂植皮手术，对比患者手术前与手术后1、2、3周创面美观性;对比患者手术前与手术后3、7、12d微循环功能。结果：患者创面美观性在手术后逐渐开始恢复，并恢复至正常;患者手术后1、2、3周关节周径显著高于手术前;患者手术后3周关节周径显著高于手术后1、2周，手术后2周关节周径显著高于手术后1周（P<0.05）;手术后3、7、12d血管无聚集人数显著高于手术前;手术后第7、12天血管无聚集人数显著高于手术后第3天，手术后第12天血管无聚集人数显著高于手术后第7天（P<0.05）;手术后3、7、12d血管清晰人数和血流灌注量显著高于手术前;手术后第7、12天血管清晰人数和血流灌注量显著高于手术后第3天，手术后第12天清晰人数和血流灌注量显著高于手术后第7天（P<0.05）。结论：切痂植皮能够明显恢复严重性关节烧伤患者的创面美观性，恢复关节周径，改善患者关节局部微循环，效果较好。

[关键词]切痂植皮;严重性关节烧伤;创面美观性;微循环功能;血管聚集度

[中图分类号]R622+.1    [文献标志码]A    [文章编号]1008-6455（2021）11-0030-04

Effect of Escharectomy and Skin Grafting on Repairing Burn Wounds of Joints and its Influence on Local Microcirculation

SHEN Wen-chuan，WU Zhen-tian，TANG Jun，DING Ruo-hong

（Department of Plastic and Burn Surgery，Huangshi Fifth Hospital，Huangshi 435000，Hubei，China）

Abstract：  Objective  To study the effect of escharectomy and skin grafting to repair burn wounds at joints and its influence on local microcirculation. Methods  One hundred and eighty-two patients with severe joint burns admitted to our hospital from January 2013 to December 2017， who required escharectomy and skin grafting， were selected. These patients received escharectomy and skin grafting. The aesthetics of the wound before the operation and 1， 2 and 3 weeks after the operation as well as the microcirculation function of the patient before the operation and 3， 7 and 12 days after the operation were compared. Results  The wound aesthetics of the patients gradually recovered after the operation and returned to normal. The joint circumference of the patient at 1， 2， and 3 weeks after the operation was significantly higher than that before the operation; the joint circumference was significantly higher at 3 weeks after the operation than that at 1， 2 weeks after operation; and the joint circumference was significantly higher at 2 weeks after the operation than that at 1 week after operation（P<0.05）. The number of blood vessels without agglomeration was significantly higher at 3， 7 and 12 days than that before surgery; the number of blood vessels without agglomeration at 7 and 12 day after the operation was significantly higher than that at 3 day after the operation; the number of blood vessels without agglomeration at 12 day after the operation was significantly higher than that at 7 day after the operation （ P<0.05）. The number of clear blood vessels and the blood perfusion volume at 3， 7 and 12 days after the operation were significantly higher than those before the operation; the number of clear vessels and the blood perfusion volume were significantly higher at 7 and 12 days after the operation than those at 3 day after the operation; the number of clear vessels and the blood perfusion volume were significantly higher at 12 day after the operation than those at 7 day after the operation （P<0.05）. Conclusion  The effect of escharectomy and skin graftingy in repairing patients with severe joint burns is good， which can significantly restore the aesthetics of the wound and the circumference of the joint， and improve microcirculation function of the joint.

Key words： escharectomy and skin grafting; severe joint burns; wound aesthetics; microcirculation function; vascular aggregation

烧伤一般是热液、蒸汽、高温气体、火焰、炙热金属等引起的组织损害，除皮肤和黏膜外，严重者可伤及肌肉、骨、关节甚至内脏[1]。烧伤包括I度烧伤、浅II度烧伤、深II度烧伤、III度烧伤[2]。其中III度烧伤以及深II度烧伤的创面必须进行手术植皮或者皮瓣修复，更严重者需要截肢[3]。严重性关节烧伤也是其中一种，必须得到紧急治疗，如果治疗不得当，会导致关节坏死，造成瘢痕挛缩以及功能障碍等不可逆性损伤[4]。切痂植皮术是目前临床上治疗大面积深度烧伤的主要手段之一，主要是将烧伤部位的全层皮肤和皮下脂肪全部切除，直至深筋膜层[5]。切痂植皮术虽然清除了坏死组织，但也会对机体造成一定的损伤[6]。因此本研究选取笔者医院收治的182例严重性关节烧伤患者临床资料进行分析，以研究切痂植皮修复关节部位烧伤创面的效果及对局部微循环的影响。……