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湿润烧伤膏治疗挤压伤骨外露一例

2010年-12月-16日 来源:中国烧伤创疡杂志社
                                                  李清华,侯 强,刘霞,徐西胜,李承存,尚 峰,路艳花
                                                        泰山医学院附属医院烧伤科,山东 泰安 271000
      
      【摘要】目的:探讨湿润烧伤膏(MEBO)治疗挤压伤骨外露的效果。方法:患者右足背车轮挤压伤,足背拇长伸肌腱和趾跖关节外露,入院后即进行清创处理,剪除坏死组织,保留有生机的组织,创面外涂MEBO,厚2mm~3mm,每日换药2~3次,同时卧床抬高患肢,保证创面回流通畅。结果:用药2天创面红肿消退,4天~5天可见创缘肉芽组织生长,12天后骨质坏死带与正常生长带界限明显,15天后行坏死骨质咬除术和肉芽组织微粒皮种植术,术后7天可见微粒皮长出,15天皮片融合,创面封闭。结论:挤压伤应用MEBO再生疗法治疗,能改善创面微循环,祛腐生肌,促进创面再生修复,方法简便易行,效果好。
      【关键词】再生疗法;湿润烧伤膏;挤压伤
      【标识符】doi:10.3969/j.issn.1001-0726.2010.02.029
       A case Report on Treating Bone Exposure caused by Crush Injury with MEBO.LI QING-hua,HOU Qiang,LIU Xia,et al.Burns Department,the Affiliated Hospital of Tai’an Medical College,Tai’an City,Shandong Province,271000,China.
      【Abstract】 Objective:To observe  the clinical effect of treating bone exposure caused by crush injury with MEBO.Method:The patient was admitted with crush injury of right foot back caused by wheels,that resulted in dorsum pollicis longus tendon and toe metatarsal joint exposed.After wound debridement,removal of necrotic tissue and retaining life tissue in vitality,MEBO was applied to the wounds with thickness of 1~2mm,2~3 times per day.At the same time,bed rest and raising affected limb were required to ensure smooth return of blood circulation.Result:Wound redness and swelling subsided can be observed after 2 days of treatment;the growth of granulation tissue on the wound edge can be founded after 4~5 days;a clear boundary between bone necrosis zone and normal growth zone was observed after 12 days;necrosis bone bite surgery and granulation tissue micro-particle skin grafting were carried out after 17 days.On the 7th day after operation,micro-particle skin was observed.The wound was closed by skin fusion on the 15th day. Conclusion:MEBO can improve microcirculation of wound,remove necrosis tissue and promote tissue regeneration and achieve wound regeneration and repair.It has significant effect to treat crush injury with MEBO due to good effect and simple operation.
       【Key words】 Regenerative therapy;MEBO;Crush injury
        挤压伤是指骨端或身体其他部位受压迫导致受累部位的肌肉肿胀和/或神经失调。由于局部组织神经血管受到损伤,严重病例深部肌腱及骨组织出现血运障碍,发生坏死,亦属于溃疡的范畴。传统的治疗方法是采用外科清创减压,大张皮片移植覆盖创面治疗,但患者痛苦大,花费多,效果不甚满意。我科收治一例足背车轮挤压伤患者,应用湿润烧伤膏治疗,取得满意效果,现报告如下:
       1.病例先容
       
患者,男性,52岁,农民。因右足背车轮挤压伤8天收住入院。患者在农忙时不慎被手扶拖拉机后车轮压伤右足。伤后被紧急送往本地医院,创面简单清创包扎,以后每日用凡士林油纱换药治疗,选用头孢他啶和甲硝唑等药物滴注。治疗8天效果欠佳,遂转入我院。体格检查:T 37.0℃,P 78次/分,R 19次/分,BP 110/70mmHg。专科检查:创面位于右足背,组织缺损面积约13cm×10cm;创周红肿明显,皮肤张力较大,压之凹陷;创面明显凹于正常皮肤,足背拇长伸肌腱和趾跖关节裸露;创面基底晦暗,无新鲜组织生长,未见明显异常分泌物。辅助检查:WBC 7.2×109/L,RBC 4.8×1012/L,HGB 144g/L,GLU 5.84mmol/L;外院右足X光片示:右足第一跖骨基底部见低密度透亮影,第一楔骨足舟骨骨质欠完整。
       入院治疗:嘱患者绝对卧床休息,抬高患肢15°~20°,保证创面回流通畅,减轻创面肿胀,避免患肢用力和创面受压。创面清创,剪除坏死组织,保留有生机的组织。将MEBO均匀涂于创面,药膜厚度约2mm~3mm,每日用MEBO换药2~3次。用药2天后创周肿胀消退;用药4天~5天后,可见创缘肉芽组织生长,新鲜红润,触之易出血;用药12天后骨质坏死带与正常生长带界限渐明显。于入院第15天行坏死骨质咬除术和肉芽组织微粒皮种植术。术后7天可见微粒皮长出,术后15天皮片融合,创面封闭。
       2.体会
       
挤压伤运用MEBO进行湿性再生医疗技术治疗时,其方法与其他创疡创面处理一样。清创时要尽量祛除坏死组织,保留有生机组织。创面用药的原则是:(1)尽早用药,最好在损伤即时清创涂药,此时疗效最佳。在本病例中,患者伤后在当地医院治疗8天,疗效不佳转我院,贻误最佳治疗时机,使创面淤滞带进行性发展为坏死带,形成不可逆性坏死,加深了创面深度。(2)全程用药,保证创面持久的药物供应。在创面液化期,MEBO用量要足,及时清除创面液化物,剪除松动的坏死组织;在肉芽组织生长期和皮片融合期,MEBO用量要少,避免创面浸渍。(3)不用干燥剂、收敛剂等刺激性药物涂抹创面。此患者创面白天采用半暴露疗法,以便及时补充创面药物。夜间创面包扎,一方面可以保护创面,另一方面可以使创面维持在一个恒定的温度,促进创面修复。(4)在坏死的肌腱和骨质与正常组织松动分离时,进行清创。切勿急于求成,避免对机体造成不必要的损伤。在创缘皮片不能爬行封闭创面时,可选用植皮术。(5)完善必要的检查,了解患者是否合并糖尿病等其他疾病,以免影响创面愈合。
      【编辑概况】
       李清华(1976~),女(汉族),山东招远人,泰山医学院毕业,主治医师.
       侯 强(1978~),男(汉族),山东泰安人,泰山医学院毕业,主治医师.
       刘 霞(1975~),女(汉族),山东泰安人,泰山医学院毕业,护师.
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