关节镜在头皮扩张器置入中应用.docVIP

关节镜在头皮扩张器置入中应用 　 作者：胡亚兰 胡亚欣 郭树忠 王薇薇 张毅 尹卫群 李倩 【摘要】 目的 总结临床应用关节镜埋置头皮扩张器的经验。方法 应用关节镜置入头皮扩张器16例，36个，采用远位、垂直、小切口，在关节镜直视下分离头皮组织腔隙，扩张器置入后，注射壶外置。术中即刻注水，注水量为扩张器容量的1/4～1/2，术后第2天开始持续恒压注水，观察头皮扩张所需时间及并发症发生情况。结果 头皮扩张所需时间1～1.5个月，无血肿、切口裂开、扩张器外露等并发症发生，伤口均I期愈合，效果满意。结论 应用关节镜埋置头皮扩张器组织创伤小，出血少，术后不容易发生并发症，同时缩短了扩张所需时间。 【关键词】 关节镜; 头皮; 扩张器 　　【Abstract】 Objective To review clinical experiences in application of arthroscopies in placement of scalp tissue expanders. Methods Arthroscopies were used to place tissue expanders in 16 patients under the scalp and 36 tissue expanders were placed.The incision was small,vertical and far away from the area that was to be expanded.Arthroscopies were used when the dissection of the expander pocket,insertion of expander,negative pressure drainage was performed with expander pot outside.Then,the expander was inflated intraoperatively with a volume of 1/4 to 1/2 of the expander capacity,and routine injection was carried out since the second day after the operation.It needed time to observe the skin distention and complication. Results The scalp distention needed 1 to 1.5 months.The complications including haematoma,disruption of wound and exposure of tissue expander were not found.The results were satisfactory in all the patients. Conclusion The advantages of applying the arthroscopies in the placement of scalp tissue expander are that they will produce small wound,bleed with small amount,reduce the incidence of complications and shorten the time that scalp distention needs. 　　【Key words】 Arthroscopies;Scalp;Tissue expanders 　　皮肤扩张术在整形外科已较广泛应用，具有传统的组织修复方法不可比拟的优点，然而有住院时间长，并发症发生率比较高的缺点[1]。扩张术的操作方法不断改进对减少并发症、缩短扩张时间具有重要意义。近年来，应用关节镜微创技术发展比较快，我们从2000年以来将关节镜用于头皮扩张器置入术，取得了较好的效果。 　　1 临床资料 　　1.1 一般资料 本组共16例，其中男13例，女3例，年龄16～35岁，均为烧伤和创伤后瘢痕。16例患者中置入1个扩张器的2例，置入2个扩张器的8例，置入3个扩张器的6例。扩张器置入的部位为头部。 　　1.2 手术方法 切口设计：基本同普通的扩张器置入方法，但是切口小，方向与扩张器边缘垂直，距离扩张器边缘可以远些，这样术后扩张器不容易从切口外露，而且也可以早开始向扩张器内注液。扩张器选择长方形，容量100～450 ml。采用局部浸润麻醉。 　　手术步骤：切开头皮后(切口长度1.5 cm)放置关节镜，剥离的平面同普通剥离法，关节镜下用剥离剪刀，以钝性剥离为