脱细胞异体真皮与PELNAC联合烧伤瘢痕表皮移植治疗烧伤瘢痕的对比研究

崔泽龙 首家保 汪海涵 雷剑飞 陈英斌 龙照忠 徐海永 殷国前

摘要：目的  探討脱细胞异体真皮联合自体深二度烧伤瘢痕表皮移植与皮耐克联合深二度烧伤瘢痕表皮移植在烧伤瘢痕治疗中的疗效比较。方法  选取2015年1月～2017年12月到我院治疗的烧伤瘢痕患者60例，进行随机分组，采用脱细胞异体真皮联合自体深二度烧伤瘢痕表皮移植治疗烧伤瘢痕患者（A组）30例，采用皮耐克联合深二度烧伤瘢痕表皮移植治疗烧伤瘢痕患者（B组）30例。分别比较两组的创面愈合时间，于创面愈合后6个月后进行随访并采用温哥华瘢痕量表（VSS）评价瘢痕情况以及参照ADL分级标准评定关节功能。结果  A组创面愈合时间为（12.07±4.30）d，短于B组的（22.00±3.85）d，差异有统计学意义（P<0.05）;A组VSS评分为（4.10±3.27）分，B组为（4.40±3.80）分，两组差异无统计学意义（P>0.05）。A组ADL评分：优5例，良12例，中10例，差3例;B组ADL评分：优4例，良11例，中10例，差5例;组间比较，差异无统计学意义（P>0.05）。结论  脱细胞异体真皮联合自体深二度烧伤瘢痕表皮移植治疗烧伤瘢痕疗效，与皮耐克联合深二度烧伤瘢痕表皮移植治疗烧伤瘢痕疗效无明显差异，但脱细胞异体真皮联合自体深二度烧伤瘢痕表皮移植较皮耐克联合深二度烧伤瘢痕表皮移植创面愈合时间短，在临床有一定优势。

关键词：脱细胞异体真皮;皮耐克瘢痕断层皮片;烧伤;瘢痕

中图分类号：R644                                    文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2019.05.020

文章编号：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.