摘要
目的:观察压力手套、指蹼加压带及泡沫型硅凝胶贴膜联合应用对预防儿童瘢痕性并指矫正术后指蹼瘢痕增生挛缩的效果。方法:回顾性分析2020年12月至2023年1月昆明市儿童医院烧伤整形外科收治的符合纳排标准的32例瘢痕性并指患儿(共51个瘢痕性并指指蹼)临床资料。根据瘢痕性并指矫正术后预防指蹼瘢痕增生挛缩的方法将患儿分为常规组和观察组,观察组16例患儿共24个瘢痕性并指指蹼,常规组16例患儿共27个瘢痕性并指指蹼。所有患儿均全身麻醉下行瘢痕性并指矫正术重建指蹼,术区拆线后常规组重建指蹼外用硅凝胶,并佩戴使用压力手套及指蹼加压带;观察组重建指蹼使用泡沫型硅凝胶贴膜,并佩戴使用压力手套及指蹼加压带。采用美国手外科学会制定的总主动活动度(TAM)评定2组重建指蹼术后12个月的患指功能。采用改良Withey并指矫正评分评估2组重建指蹼术后12个月瘢痕性并指的复发情况。采用温哥华瘢痕量表(VSS)评价2组重建指蹼术后3、6、12个月的瘢痕情况。记录治疗期间不良反应。数据分析采用Bonferroni校正、重复测量方差分析、χ^(2)检验、t检验、Fisher确切概率法。结果:术后12个月,观察组重建指蹼TAM优良率为95.8%,常规组为77.8%,差异无统计学意义(P>0.05)。观察组重建指蹼瘢痕性并指复发率(0%)低于常规组(22.2%),差异有统计学意义(P<0.05)。术后3个月,观察组重建指蹼瘢痕VSS评分为(2.54±1.37)分,常规组为(2.41±1.59)分,差异无统计学意义(t=16.322,P>0.05);术后6个月及12个月,观察组重建指蹼瘢痕VSS评分分别为(4.02±1.95)分、(2.96±0.68)分,均低于常规组[(5.34±1.29)分、(4.30±0.94)分],差异有统计学意义(t=5.783、9.486,P<0.05)。在治疗过程中,观察组重建指蹼浸渍、皮疹发生率分别为12.5%、12.5%,常规组分别为7.4%、7.4%,差异无统计学意义(P>0.05);观察组重建指蹼疼痛及破溃发生率分别为4.2%、0%,常规组分别为29.6%、22.2%,差异有统计学意义(P<0.05)。结论:儿童瘢痕性并指矫正术后早期联合应用压力手套、指蹼加压带及泡沫型硅凝胶贴膜,能有效预防重建指蹼瘢痕增生挛缩及并指复发,减少治疗不良反应。
Objective To observe the effect of the combined use of pressure gloves,finger web compression starps and foam silicone gel sheeting in preventing hypertrophic contracture of finger web after surgery in children with cicatricial syndactyly.Methods A retrospective analysis was conducted on the clinical data of 32 cicatricial syndactyly children who met the inclusion and exclusion criteria,treated in the Department of Burns and Plastic Surgery,Kunming Children′s Hospital from December 2020 to January 2023,involving a total of 51 cicatricial syndactyly finger webs.Based on the methods of preventing hypertrophic contracture of finger web after surgery,the patients were divided into conventional group and observation group.The observation group comprised 16 patients with 24 cicatricial syndactyly finger webs,while the conventional group consisted of 16 patients with 27 cicatricial syndactyly finger webs.All patients underwent cicatricial syndactyly correction surgery under general anesthesia to reconstruct the webs.After the sutures in surgical area were removed,the conventional group applied silicone gel externally on the reconstructed webs and wore pressure gloves and web compression straps.The observation group used foam silicone gel sheeting on the reconstructed webs and also wore pressure gloves and web compression straps.The total active movement(TAM)developed by the American Society for Surgery of the Hand was used to evaluate the function of the affected finger in the two groups at 12 months after surgery.The modified Withey syndactyly correction score was employed to assess the recurrence of cicatricial syndactyly at 12 months after surgery in the two groups.The Vancouver scar scale(VSS)was utilized to evaluate the scar condition of the two groups at 3,6,and 12 months after surgery.Adverse reactions during treatment were recorded.Bonferroni correction,repeated measures analysis of variance,χ^(2) test,t test,and Fisher′s exact test were performed on the data.Results At 12 months after surgery,the excellent and good rate of TAM in the reconstructed webs of the observation group was 95.8%,while that of the conventional group was 77.8%,there was no significant difference between the two groups(P>0.05).The recurrence rate of cicatricial syndactyly in the reconstructed webs of the observation group was 0%,which was lower than 22.2%of the conventional group,and the difference was statistically significant(P<0.05).At 3 months after surgery,the VSS score of the reconstructed web scars in the observation group was(2.54±1.37),while that of the conventional group was(2.41±1.59),showing no significant difference(t=16.322,P>0.05).At 6 and 12 months after surgery,the VSS scores of the reconstructed web scars in the observation group were(4.02±1.95)and(2.96±0.68)respectively,both lower than(5.34±1.29)and(4.30±0.94)of the conventional group,with significant differences(t=5.783,9.486;P<0.05).During treatment,the incidence rates of maceration and rash in the reconstructed webs of the observation group were 12.5%and 12.5%respectively,while those of the conventional group were 7.4%and 7.4%,showing no significant difference(P>0.05).The incidence rates of pain and ulceration in the reconstructed webs of the observation group were 4.2%and 0%,which were lower than 29.6%and 22.2%of the conventional group,with significant differences(P<0.05).Conclusion The early combined application of pressure gloves,finger web compression straps and foam silicone gel sheeting after surgery in children with cicatricial syndactyly can effectively prevent the hypertrophic contracture of reconstructed web and the recurrence of syndactyly,and reduce the adverse reaction of treatment.
作者
张梦思
麻艺群
蒙礼娟
朱辉
付晋凤
Mengsi Zhang;Yiqun Ma;Lijuan Meng;Hui Zhu;Jinfeng Fu(Department of Burns and Plastic Surgery,Kunming Children′s Hospital,Kunming 650031,China)
出处
《中华损伤与修复杂志（电子版）》
CAS
2024年第4期329-334,共6页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金
昆明市卫生健康委员会卫生科研基金资助项目(2022-04-03-001)。
关键词
烧伤
儿童
瘢痕
压力疗法
硅凝胶膜
Burns
Child
Scar
Stress therapy
Silicone gel sheeting
作者简介
张梦思,主治医师,现就职于昆明市儿童医院烧伤整形外科。现任国际女医师协会烧创伤专业委员会青年委员,中国女医师协会烧创伤专业委员会委员,云南省医学会烧伤整形分会委员,云南省康复医学会烧伤康复专业委员会委员;通信作者:付晋凤,Email:fjf5323909@qq.com。
