坐骨结节压力性损伤的分型及修复策略

目的分析归纳坐骨结节压力性损伤临床分型，总结各型的修复方法，探讨其修复重建效果，为坐骨结节压力性损伤的修复提供新治疗方案。 方法2013年1月至2018年1月，解放军总医院第四医学中心烧伤整形暨创面修复中心共收治坐骨结节压力性损伤患者92例，共109个创面，其中手术修复86例，共101个创面，其中男49例，女37例，年龄31～79岁，根据2016版国际压疮指南分期术语修订版将其分为Ⅲ类创面68个，Ⅳ类创面33个，创口面积1 cm×9 cm～11 cm×16 cm，深度1～6 cm，创基面积2 cm×8 cm～8 cm×14 cm，深部腔隙容积(盐水测定法)3～60 mL；根据彻底清创后组织缺损程度，分为4型，每种分型按相对应的方案修复：Ⅰ型采用直接清创缝合，Ⅱ型采用臀下动脉穿支皮瓣局部转移修复，Ⅲ型采用股薄肌肌瓣或臀大肌肌瓣填充修复，Ⅳ型采用股薄肌肌瓣或臀大肌肌瓣合并臀下动脉穿支皮瓣修复。术后观察愈合效果及随访情况。 结果本组86例患者101个创面中，Ⅰ型创面36个，一期愈合32个创面，翻修4个创面二期愈合；Ⅱ型创面29个，一期愈合23个创面，翻修6个，二期愈合4个；Ⅲ型创面30个，一期愈合28个创面，翻修2个创面二期愈合；Ⅳ型创面6个，一期愈合4个创面，翻修1个创面二期愈合。71例获得6～12个月随访，平均随访7.2个月，复发11例，新发6例。 结论坐骨结节部位特殊，发生压力性损伤后修复比较棘手，根据临床病例的总结归纳，将其分为4型，对不同分型创面选择合适的方案进行修复，可得到满意的修复效果，避免复发。

Classification and treatment strategy of pressure injury of ischial tuberosities

ObjectiveTo analyze and summarize the clinical classification of pressure injury of ischial tuberosities and various repair methods, and explore the effect of repair and reconstruction for providing a new therapeutic schedule for the repair of pressure injury of ischial tuberosities. MethodsFrom January 2013 to January 2018, a total of 109 wounds in 92 patients with pressure injury of ischial tuberosities were treated in Department of Burns and Plastic Surgery, Wound Repair Center, Fourth Medical Center of PLA General Hospital. Among them, A total of 101 wounds were repaired surgically in 86 patients, including 49 males and 37 females, aged 31-79 years. According to the revised edition of the 2016 International Pressure Ulcer Guidelines, in the repaired wounds mentioned above, there were 68 cases of Class Ⅲ wounds and 33 cases of Class Ⅳ wounds. The wound area was 1 cm×9 cm to 11 cm×16 cm, the depth was 1 cm to 6 cm, and the wound base area was 2 cm×8 cm - 8 cm×14 cm, deep lacunar volume (saline water method) 3-60 mL. According to the degree of tissue defect after thorough debridement, it can be divided into 4 types, each of which can be repaired according to the corresponding scheme: type Ⅰ was repaired by direct debridement and suture, type Ⅱ was repaired by local transfer of inferior gluteal artery perforator flaps, type Ⅲ was repaired by filling gracilis muscle flaps or gluteus maximus muscle flaps, type IV was repaired with gracilis or gluteus maximus muscle flaps combined with inferior gluteal artery perforator flaps. The healing effect and follow-up were observed after operation. ResultsOf 101 wounds in 86 patients, 36 wounds were type Ⅰ, 32 wounds were primary healing, 4 wounds were secondary healing after revision; 29 wounds were type Ⅱ, 23 wounds were primary healing, 6 wounds were revision, 4 wounds were secondary healing; 30 wounds were type Ⅲ, 28 wounds were primary healing, 2 wounds were secondary healing after revision; 6 wounds were type Ⅳ, 4 wounds were primary healing and 1 wound was secondary healing after revision. Seventy-one patients were followed up for 6 to 12 months, with an average of 7.2 months, 11 cases relapsed and 6 new cases were found. ConclusionsBecause of the special location of ischial tuberosities, the repair of pressure injury is relatively difficult. According to the summary of clinical cases, it can be divided into 4 types. Satisfactory repair effect can be obtained and recurrence can be avoided by choosing appropriate repair schemes for different types.