關(guān)節(jié)部位Ⅲ度燒傷切(削)痂后MEBO培養(yǎng)創(chuàng)面延期植皮臨床分析

摘要： 目的:總結(jié)關(guān)節(jié)部位Ⅲ度燒傷切(削)痂實(shí)行濕潤燒傷膏(MEBO)培養(yǎng)創(chuàng)面,延期植皮的臨床效果,并同過去采用切(削)痂后Ⅰ期植皮病歷資料進(jìn)行歷史對照分析,評價(jià)方法的優(yōu)劣。方法:2005年1月至2009年12月收治的關(guān)節(jié)部位Ⅲ度燒傷患者42例(59個(gè)創(chuàng)面)作為實(shí)驗(yàn)組,早期切(削)痂后即刻外用MEBO包扎換藥處理,3天～5天創(chuàng)面清潔、新鮮,行延期自體皮移植;2000年1月至2004年12月收治的32例(45個(gè)創(chuàng)面)作為對照組,早期切(削)痂后Ⅰ期自體皮移植;比較分析兩組的植皮成活率、皮下血腫與感染發(fā)生率、關(guān)節(jié)外觀及恢復(fù)狀況。結(jié)果:切(削)痂后,創(chuàng)面經(jīng)過MEBO培養(yǎng)進(jìn)行延期植皮組較Ⅰ期植皮組的植皮成活率高,皮下血腫發(fā)生率低,關(guān)節(jié)的外觀和功能恢復(fù)良好,組間比較具有統(tǒng)計(jì)學(xué)意義(P<0.01或P<0.001)。結(jié)論:關(guān)節(jié)部位Ⅲ度燒傷創(chuàng)面,早期切(削)痂,先采用MEBO進(jìn)行創(chuàng)面換藥,無損傷地清除壞死組織,培養(yǎng)新鮮健康的組織,再行延期自體皮移植,具有手術(shù)創(chuàng)傷小、神經(jīng)肌腱損傷少、安全、植皮成活率高、皮下血腫發(fā)生率低、愈后外形和功能良好等優(yōu)點(diǎn),綜合效果優(yōu)于Ⅰ期植皮方法。
Objective:To summarize the clinical effect of delayed skin grafting in treating joint burn wounds after eschar excision plus MEBO as dressing care.Meanwhile,the results obtained were compared with former clinical data of primary skin grafting in treating joint burn wounds after eschar excision,The merits of two methods were evaluated.Method: 42 cases of joint burn patients with 3~(rd) degree wounds(59 sites) in a period of Jan.2005 to Dec.2009 were collected as testing group.Early eschar excision was made,then MEBO ointment was used as dressing care immediately,delayed autologous skin grafting was conducted when wounds were kept clean and fresh after 3～5 days of excision.32 cases of joint burn patients with 3~(rd) degree wounds(45 sites) from Jan,2000 to Dec.2004 were collected as control group,in which, primary autologous skin grafting was done after early excision.Some indexes including skin grafting survival rate,incidence of hematoma and infection,joint appearance and recovery situation in two groups were compared and analyzed.Results: There were statistically significant differences(P <0.01 or P < 0.001 ) in several indexes observed between two groups. Compared with control group,the patients in testing group had higher skin grafting survival rate,lower incidence of hematoma and infection and better joint appearance and function.Conclusion:For joint burn wounds of 3~(rd) degree,effect of delayed skin grafting after eschar excision plus MEBO as dressing care is superior to that of primary skin grafting due to minor operation wounds,less nerve and tendon injury,safe,higher skin grafting survival rate,lower incidence of hematoma and infection and better appearance and function.