口腔颌面部狗咬伤患者一期缝合与延期缝合的疗效比较

目的：比较口腔颌面部狗咬伤患者行一期缝合与延期缝合治疗的效果，探讨一期缝合的可行性。方法：收集31例颌面部狗咬伤患者的临床资料，按照缝合方式分为一期缝合组（20例）和延期缝合组（11例）。一期缝合组患者伤口周围常规肥皂水冲洗，消毒皮肤，局部浸润麻醉，彻底清创，庆大霉素与甲硝唑交替冲洗，转移皮瓣，缝合伤口，术后应用抗生素并及时接种狂犬疫苗和破伤风疫苗。延期缝合组患者伤口周围常规肥皂水冲洗，消毒皮肤，局部浸润麻醉，彻底清创，庆大霉素与甲硝唑交替冲洗，无菌纱布覆盖创面，定期更换敷料，伤口延期缝合，术后常规注射狂犬疫苗和破伤风疫苗，全身应用抗生素。比较2组患者伤口感染率和温哥华瘢痕评定量表（VSS）评分。结果：一期缝合组20例患者中，有2例（10.00%）出现不同程度的伤口感染，无全身性感染出现，均未发生狂犬病及破伤风；延期缝合组11例患者中，有2例（9.09%）出现不同程度的伤口感染，无全身性感染出现，均未发生狂犬病及破伤风。2组患者伤口感染率比较差异无统计学意义（P>0.05）。一期缝合组患者VSS评分（Z=257）高于延期缝合组（Z=239），组间比较差异有统计学意义（P<0.05）。结论：一期缝合患者伤口感染率与延期缝合相近，但一期缝合的伤口比延期缝合更美观，适用于口腔颌面部狗咬伤患者。

Comparison of therapeutic effects between primary closure and delayed closue in patients with dog bite wound

Objective:To compare the therapeutic effects between primary closue and delayed closure in the patients with dog bite wound,and to discuss the feasibility of primary closure.Methods:A total of 31 patients with dog bite wound were included. The patients were divided into primary closure group (n=20)and delayed closure group (n=11)according to the closue methods.The patients in primary closure group were given the routine soapy water to wash the wound,skin disinfection,local anesthesia,debridement,gentamicin and metronidazole douche, flap transfer and wound closue,antibiotics after the operation,and vaccination of rabies vaccine and tetanus vaccine. The patients in delayed closue group were given the conventional soapy water to wash the wound,skin disinfection, local anesthesia,debridement,gentamicin and metronidazole douche,sterile gauze to cover the wound,regular dressing replacement,delayed closure of wound, routine inj ection of rabies vaccine and tetanus vaccine after the operation,and systemic antibiotics. The infection rate of wound and Vancouver Scar Rating Scale (VSS)scores of the patients in two groups were compared.Results:Among 20 patients in primary closure group, there were 2 patients (10.00%)showed different degrees of wound infection,and there was no systemic infection,rabies and tetanus;among 11 patients in delayed closure group,there were 2 cases (9.09%)showed different degrees of wound infection,and there was no systemic infection,rabies and tetanus. There were no significant differences in the infection rates of wound of the patients between two groups (P>0.05).The VSS score of the patients in primary closure group (Z=257)was higher than that in delayed closure group (Z=239),and the difference was statistically significant (P<0.05).Conclusion:The infection rates of wound of the patients in primary closure group and delayed closure group are basically the same.However,the wound treated with the primary closure shows cosmetic appearance compared with delayed closure. Therefore, primary closure may be an acceptable therapeutic method for the patients with dog bite wound.