摘要目的 探讨清创缝合术后局部加压和固定对胫前烧瓶样伤口愈合的促进作用.方法 采用回顾性病例对照研究分析2017年5月-2018年6月山东大学第二医院收治的57例单纯胫前烧瓶样伤口患者临床资料,其中男32例,女25例;年龄20 ～60岁[(41.4±8.1)岁].受伤原因均为急性外伤,伤口长度为1 ～10 cm.患者均仅为急性皮肤软组织损伤,无骨折、大面积皮肤缺损及大面积撕脱伤等情况,并且均无糖尿病、下肢血管性病变等慢性基础疾病.观察组37例,对照组20例.其中,观察组行清创缝合术后采用局部加压包扎及肢体固定;对照组伤口清创缝合后采用常规简单包扎.对比观察两组患者术后3,5,7,14,21 d伤口潜行大小、渗液类型、渗液量、伤口周围皮肤颜色和伤口组织类型,并记录愈合时间.结果 患者均获随访30 ～90 d[(52.2±3.5)d].术后3d,组间各指标比较差异无统计学意义(P＞0.05);术后5d,对照组和观察组渗液量、伤口周围皮肤颜色和伤口组织类型评分分别为(4.2±0.7)分∶(3.3±0.6)分、(3.5±0.7)分∶(2.5±0.6)分、(3.4±0.6)分∶(2.5±0.5)分,组间比较差异有统计学意义(P＜0.05),而伤口潜行大小、渗液类型评分两组间比较差异无统计学意义(P＞0.05),术后7d,对照组和观察组伤口潜行大小、渗液类型、渗液量、伤口周围皮肤颜色和伤口组织类型评分分别为(3.5±0.5)分∶(2.5±0.7)分、(3.4±0.7)分∶(2.4±0.5)分、(4.0±0.8)分∶(2.8±0.5)分、(3.4±0.5)分∶(1.3±0.5)分、(3.3±0.5)分∶(2.1±0.4)分,组间比较差异均有统计学意义(P＜0.05);术后14 d,对照组和观察组伤口潜行大小、渗液类型、渗液量、伤口周围皮肤颜色和伤口组织类型评分分别为(2.9±0.6)分∶(1.2±0.7)分、(2.8±0.7)分∶0分、(3.3±0.7)分∶(1.0±0.0)分、(3.1±0.6)分∶(1.1±0.4)分、(3.0±0.6)分∶(1.2±0.5)分,组间比较差异均有统计学意义(P＜0.05);术后21 d,对照组和观察组伤口潜行大小、渗液类型、渗液量、伤口周围皮肤颜色和伤口组织类型评分分别为(2.5±0.7)分∶0分、(2.5±0.5)分∶0分、(3.0±0.7)分∶(1.0±0.0)分、(2.6±0.7)分∶(1.1±0.3)分、(2.6±1.1)分∶0分,组间比较差异均有统计学意义(P＜0.05).两组伤口愈合率均为100％.对照组和观察组伤口愈合时间分别为(28.3±6.7)d、(15.2±0.9)d(P ＜0.05).结论 对于胫前烧瓶样伤口,清创缝合术后采用局部加压包扎及固定的方法较常规简单包扎明显促进伤口愈合,且具有愈合质量更佳、愈合时间更短等优点.

abstractsObjective To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture.Methods A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018.There were 32 males and 25 females,aged 20-60 years [(41.4 ± 8.1) years].The length of wound ranged from 1 to 10 cm.All patients had only acute skin and soft tissue injury,without any fracture,large area skin defect,large area avulsion injury,or chronic diseases such as diabetes mellitus and lower limb vascular disease.The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture.At 3,5,7,14,and 21 days after operation,the size of the wound,the type and quantity of exudate,the color of skin around the wound and the type of wound tissue were compared,and the healing time was recorded.Results All patients were followed up for 30-90 days [(52.2 ± 3.5) days].Three days after operation,there was no significant difference between the two groups (P ＞0.05).On the 5th day after operation,the scores of exudate amount,skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2 ± 0.7) points ∶ (3.3 ± 0.6) points,(3.5 ± 0.7) points ∶ (2.5 ± 0.6) points,(3.4 ± 0.6) points ∶(2.5 ± 0.5) points (P ＜ 0.05),but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P ＞ 0.05).On the 7th day after operation,the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (3.5 ± 0.5) points ∶ (2.5 ± 0.7) points,(3.4 ±0.7)points ∶ (2.4 ±0.5)points,(4.0±0.8)points ∶ (2.8 ±0.5)points,(3.4 ±0.5)points ∶ (1.3 ±0.5) points,(3.3 ± 0.5) points ∶ (2.1 ± 0.4) points (P ＜ 0.05).On the 14th day after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.9 ± 0.6)points ∶ (1.2 ±0.7)points,(2.8 ±0.7)points ∶ 0 point,(3.3 ±0.7)points ∶ (1.0 ±0.0)points,(3.1 ±0.6)points ∶(1.1 ± 0.4) points,(3.0 ± 0.6) points ∶ (1.2 ± 0.5) points (P ＜ 0.05).Twenty-one days after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.5 ±0.7)points ∶0 point,(2.5 ±0.5)points ∶ 0 point,(3.0 ±0.7)points ∶ (1.0 ±0.0)points,(2.6±0.7)points ∶ (1.1 ±0.3) points,(2.6 ± 1.1) points ∶ 0 point (P ＜ 0.05).The wound healing rate was 100％ in both groups.The wound healing time of the control group and the study group was (28.3 ± 6.7) days and (15.2 ± 0.9) days respectively (P ＜ 0.05).Conclusion For anterior tibial flask-like wound,local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging,with the advantages of better healing quality and shorter healing time.