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題 名 | Surgical Treatment of Pressure Sores in Patients with Traumatic Spinal Cord Injury: With Relative Emphasis on Multiple and Recurrent Sores=脊髓外傷後肢體癱瘓病人併發壓迫性褥瘡的手術治療 |
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作 者 | 白中和; 蘇宜輝; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 32:1 民88.01-02 |
頁 次 | 頁11-17 |
分類號 | 416.292 |
關鍵詞 | 脊髓外傷; 癱瘓; 壓迫性褥瘡; 手術治療; Pressure sore; Surgical treatment; Spinal cord injury; Multiple and recurrent sores; |
語 文 | 英文(English) |
中文摘要 | 對肢體癱瘓病人,因長期臥床或使用輪椅而致褥瘡的發生,可謂嚴重及令人頓挫 的合併症。更有甚者,褥瘡的發生常為反覆性。治療的目標應以侵襲性低及耐久的方法使褥 瘡得以覆蓋。在此同時亦需考慮將來的再次需要而儘量保留附近有用的血管莖及組織。本文 回顧枋寮醫院過去兩年內接受手術治療的十二例因脊髓外傷致肢體癱瘓病人。共二十三處褥 瘡中,最常見部位是坐骨( 48 %)及薦骨( 26 %),其中 35 %為再發性,五例為多發 性。手術方法包括:直接縫合(十一處)、雙側大臀肌滑動皮瓣(五處)、後大腿皮瓣(三 處)、股外肌肌皮皮瓣、臀腿皮瓣、臀摺疊術及局部皮瓣各一處。手術後平均住院 35 天。 術後合併症包括:二處皮瓣傷口部份裂開、一處皮瓣感染及一例死亡。儘管肌皮皮瓣優於筋 皮皮瓣,但在本篇研究中有數例因有顯著的肌肉纖維化或肌肉壞死,故不宜做肌皮皮瓣手術 。其次,在某特定群的病患中,有反覆及多發性褥瘡的發生情形。手術治療對這群病患似乎 並無顯著的裨益。因此,作者認為術前完整個案之評估,尤其是病患心理層面之分析似乎應 有必要,此點在過去並未被積極考慮。 |
英文摘要 | Twenty-three pressure sores in 12 cases (9 patients) were treated and reviewed after a mean follow-up of 14.3 months. All patients sustained traumatic spinal cord injury associated with either paraplegia (11 cases) or quadriplegia (1 case). The majority of pressure sores were located in the ischium (48%) and sacrum (26%), and some were multiple (5 cases had 16 sores) and recurrent (35%) sores. The surgical procedures involved the use of 11 direct closures, 5 bilateral gluteal sliding myocutaneous flaps, 3 posterior thigh flaps. Vastus lateralis myocutaneous flap, gluteal thigh flap, gluteal plication, and local flap were also performed. Postoperative complications included, 2 sutureline dehiscence, 1 flap infection and 1 mortality. In this series, patients with significant myofibrosis or myonecrosis were not suitable for myocutaneous flap application. There was a tendency where repeated recurrence occurred in certain patients who had multiple and recurrent pressure sores at initial presentation. Surgical treatment of pressure sores did not show significant advantage in these patients, and they seemed to be less than ideal candidates for surgical repair of the pressure sores. In these groups of patients, psychosocial problems appeared to be the primary culprit, and if at all possible, should be treated first before any surgical intervention is attempted. |
本系統中英文摘要資訊取自各篇刊載內容。