摘要
目的 探讨重度颈部瘢痕畸形的序贯修复治疗策略。方法从2006年1月至2011年12月上海交通大学医学院附属第九人民医院共治疗24例颈部严重瘢痕畸形患者，其中男18例，女6例，平均年龄35．4岁，致病原因包括火焰烧伤，化学品灼伤及热液烫伤，均属于Ⅲ度或Ⅳ度颈部瘢痕挛缩畸形。患者术前和术后测量3种颏颈角的数值，包括软组织颏颈角，骨性颏颈角和动态颏颈角，作为评估术前严重程度和术后恢复情况的重要指标。第1期的治疗包括颈部瘢痕切除和挛缩松解，双向颈阔肌肌瓣应用，颏颈角重建以及皮片移植。3—6个月后开始第2期的治疗，包括下颌瘢痕切除，矫正下唇外翻，切取肩胛（旁）皮瓣游离重建下颌区域。患者出院后定期回门诊随访，进行颈部大体外观、活动功能评估和颏颈角的测量。结果随访到完成两期治疗的患者22例，全部患者颏颈角改变明显，颈部活动功能和美学形态上得到了显著改善。治疗前后颏颈角的改变分别为：软组织颏颈角从130°±34°减小至110°±24°，骨性颏颈角从71°±23°增大至95°±19°，动态颏颈角从25°±18°增大至80°±26°，差异均有统计学意义（均P〈0．05）。结论针对重度颈部瘢痕畸形分区进行的序贯修复治疗效果良好，具有松解挛缩彻底、不易复发、修复代价较小、功能与外观恢复兼顾的优点。
Objective To explore serial reconstruction strategy for severe cervical cicatrix deformity. Methods A total of 24 cases, Ⅲ or Ⅳ degree cervical contracture deformity, were treated in Shanghai Ninth People＇s Hospital from January 2006 to December 2011. There were 18 males and 6 females with an average age of 35.4 years. The etiologies included burns, chemical injuries and scalding. Three evaluation indices of mental cervical angle （MCA） including soft tissue MCA, osseous MCA and dynamic MCA were measured before treatment and during follow-ups. The first-stage treatment was comprised of cervical cicatrix resection, eontracture release, lift of dual direction platysma flap, reconstruction of MCA and skin grafting. At Months 3 -6, second-stage treatment was performed, including lower mandible scar resection, correction of lower lip eversion, lower mandible region reconstruction with free （para-） scapular skin flap. After two-stage treatment, the patients underwent periodical re-evaluations for gross appearance, function and measurement of MCA. Results Twenty-two patients completing two-stage reconstruction were followed up. Notable improvement of cervical mobilization and contour were achieved. Soft tissue MCA decreased from 130°±34° to 110° ± 24°, osseous MCA increased from 71 ° ± 23° to 95°± 19° and dynamic MCA increased from 25°± 18° to 80° ± 26°. Conclusions The serial treatment strategy is effective. In comparisons with reconstruction with skin graft only or skin flap only, the strategy possesses many advantages.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第14期1050-1054,共5页
National Medical Journal of China
关键词
瘢痕
修复外科手术
临床方案
外科皮瓣
Cicatrix
Reconstructive surgical procedures
Clinical protocols
Surgical flaps
