脫細(xì)胞異體真皮與PELNAC聯(lián)合燒傷瘢痕表皮移植治療燒傷瘢痕的對比研究

崔澤龍 首家保 汪海涵 雷劍飛 陳英斌 龍照忠 徐海永 殷國前

摘要：目的? 探討脫細(xì)胞異體真皮聯(lián)合自體深二度燒傷瘢痕表皮移植與皮耐克聯(lián)合深二度燒傷瘢痕表皮移植在燒傷瘢痕治療中的療效比較。方法? 選取2015年1月～2017年12月到我院治療的燒傷瘢痕患者60例，進(jìn)行隨機分組，采用脫細(xì)胞異體真皮聯(lián)合自體深二度燒傷瘢痕表皮移植治療燒傷瘢痕患者（A組）30例，采用皮耐克聯(lián)合深二度燒傷瘢痕表皮移植治療燒傷瘢痕患者（B組）30例。分別比較兩組的創(chuàng)面愈合時間，于創(chuàng)面愈合后6個月后進(jìn)行隨訪并采用溫哥華瘢痕量表（VSS）評價瘢痕情況以及參照ADL分級標(biāo)準(zhǔn)評定關(guān)節(jié)功能。結(jié)果? A組創(chuàng)面愈合時間為（12.07±4.30）d，短于B組的（22.00±3.85）d，差異有統(tǒng)計學(xué)意義（P<0.05）;A組VSS評分為（4.10±3.27）分，B組為（4.40±3.80）分，兩組差異無統(tǒng)計學(xué)意義（P>0.05）。A組ADL評分：優(yōu)5例，良12例，中10例，差3例;B組ADL評分：優(yōu)4例，良11例，中10例，差5例;組間比較，差異無統(tǒng)計學(xué)意義（P>0.05）。結(jié)論? 脫細(xì)胞異體真皮聯(lián)合自體深二度燒傷瘢痕表皮移植治療燒傷瘢痕療效，與皮耐克聯(lián)合深二度燒傷瘢痕表皮移植治療燒傷瘢痕療效無明顯差異，但脫細(xì)胞異體真皮聯(lián)合自體深二度燒傷瘢痕表皮移植較皮耐克聯(lián)合深二度燒傷瘢痕表皮移植創(chuàng)面愈合時間短，在臨床有一定優(yōu)勢。

關(guān)鍵詞：脫細(xì)胞異體真皮;皮耐克瘢痕斷層皮片;燒傷;瘢痕

中圖分類號：R644? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻(xiàn)標(biāo)識碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2019.05.020

文章編號：1006-1959（2019）05-0064-04

Abstract：Objective? To compare the efficacy of acellular allogeneic dermis combined with autologous deep second degree burn scar epidermal grafting and skin Nike combined with deep second degree burn scar epidermal grafting in the treatment of burn scar. Methods? 60 patients with burn scars who were treated in our hospital from January 2015 to December 2017 were randomly divided into three groups： 30 patients with burn scars （group A） treated with acellular allogeneic dermis combined with autologous deep second degree burn scar epidermis transplantation. 30 patients with burn scars （group B） were treated with Skink combined with deep second degree burn scar epidermal grafting. The wound healing time was compared between the two groups. The wounds were followed up 6 months after wound healing and the scar was evaluated by the Vancouver Scar Scale （VSS） and the joint function was evaluated by reference to the ADL grading standard.Results? The wound healing time of group A was （12.07±4.30）d， which was shorter than that of group B （22.00±3.85）d， the difference was statistically significant （P<0.05）. The score of VSS of group A was （4.10±3.27），group B was （4.40±3.80） points， and the difference between the two groups was not statistically significant （P>0.05）. The ADL scores of group A were excellent in 5 cases， good in 12 cases， middle in 10 cases， and poor in 3 cases. Group B ADL scores were excellent in 4 cases， good in 11 cases， middle in 10 cases， and poor in 5 cases. There was no difference between groups（P>0.05）. Conclusion? The effect of acellular allogeneic dermis combined with autologous deep second degree burn scar epithelium transplantation in the treatment of burn scars is not significantly different from that of skin Nike combined with deep second degree burn scar epithelium transplantation. However， acellular allogeneic dermis combined with autologous deep second degree burn scar Epidermal grafting has a shorter healing time than skin Nike combined with deep second degree burn scar epidermal grafting， and has certain advantages in clinical practice.