影响人工真皮治疗手外伤效果的因素分析

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1、授予单位代码10089学号或申请号13044中国图书分类号R622+.1HebeiMedicalUniversity硕士学位论文学术学位影响人工真皮治疗手外伤效果的因素分析研究生：刘少华导师：张桂生教授专业：外科学二级学院：第三医院2018年3月目录中文摘要················································································1英文摘要·······································································

2、·········3研究论文影响人工真皮治疗手外伤效果的因素分析前言················································································7材料与方法·······································································8结果··············································································11附图·········

3、·····································································15附表··············································································22讨论··············································································28结论················································

4、······························33参考文献········································································34综述手外伤疾病的当前治疗方案·············································40致谢····················································································53个人简历······················

5、························································54影响人工真皮治疗手外伤效果的因素分析摘要目的:人工真皮是一种非细胞双层板样、具有生物特性的可替代皮肤组织的膜样结构。该结构内层由胶原及6-硫酸软骨素组成，表面被临时的硅胶树脂表皮替代物覆盖。内层结构允许成纤维样细胞，巨噬细胞和淋巴细胞迁徙，以及毛细血管长入至表层，从而为达到皮肤的再生提供了一定的生物条件。起初，人工真皮应用于威胁生命的三度烧伤创面的治疗。人工真皮有不同的尺寸和不同的形状可供临床医生选择，此外还有表层覆以或没有覆以硅胶树脂表皮替代物的两

6、种类型。对于没有硅树脂表皮替代物的人工真皮可以直接在创面上进行移植。人工真皮可以使新皮闭合创面，并且减少迁徙的肌成纤维细胞的数量。这样可以减少人工真皮下的表浅组织与其下的关节，肌腱，神经的粘连。人工真皮已经成功的应用于烧伤，肿瘤切除，脱套伤，先天性畸形等疾病的治疗，并且取得了令人满意的治疗效果。本研究的目的在于探讨人工真皮治疗手外伤的临床疗效，并分析得出影响其效果的因素。方法:2013年4月至2015年12月期间，对25例皮肤软组织缺损的手外伤患者，清创后一期给予人工真皮覆盖闭合创面，术后2～3周创面上形成粉红色的类真皮样组织，其中合并骨及肌腱外露的创面均被覆盖，

7、去除人工真皮硅胶膜后二期移植自体薄层皮片。部分创面未行自体皮移植手术，创面自然上皮化。该项研究得到了解放军第二五二医院伦理委员会的审批，并通过。所有患者均在手术前得知此项研究的目的及意义，并且签字同意参加该项研究。25例患者，其中男性患者18例，女性患者7例，平均年龄35.2岁（16岁～59岁）。人工真皮根据手外伤导致的皮肤创面缺损的形状及面积进行相应的裁剪。创面皮肤缺损面积为2.0cm×1.5cm～9.0cm×6.5cm。通过统计分析患者的治疗效果，得出影响治疗效果的因素。治疗效果依据VancouverScarScale(VSS)以及HandScore进行评估。

8、结果:25