口腔颌面部狗咬伤患者一期缝合与延期缝合的疗效比较

doi:10.13481/j.1671-587x.20160631

吉林大学学报(医学版) ›› 2016, Vol. 42 ›› Issue (06): 1207-1210.doi: 10.13481/j.1671-587x.20160631

口腔颌面部狗咬伤患者一期缝合与延期缝合的疗效比较

张振波^1,2, 赵聪¹, 王雷³, 李明贺⁴

1. 吉林大学口腔医院牙体牙髓病科, 吉林长春 130021;
2. 长春医学高等专科学校口腔教研室, 吉林长春 130031;
3. 吉林大学口腔医院牙周病科, 吉林长春 130021;
4. 吉林大学口腔医院口腔颌面外科, 吉林长春 130021

收稿日期:2016-08-11 出版日期:2016-11-28 发布日期:2016-12-02
通讯作者: 李明贺(Tel:0431-85579361,E-mail:87832900@qq.com) E-mail:87832900@qq.com
作者简介:张振波(1972-),女,吉林省长春市人,副教授,主要从事口腔颌面外科的基础和临床方面的研究。
基金资助:
吉林省卫计委青年科研项目资助课题（3D514CP23431）；吉林省科技厅自然科学基金资助课题（3D515V663431）

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

ZHANG Zhenbo^1,2, ZHAO Cong¹, WANG Lei³, LI Minghe⁴

1. Department of Endodontology, Stomatology Hospital, Jilin University, Changchun 130021, China;
2. Department of Oral Teaching and Research, Changchun Medical College, Changchun 130031, China;
3. Department of Periodontics, Stomatology Hospital, Jilin University, Changchun 130021, China;
4. Department of Oral and Maxillofacial Surgery, Stomatology Hospital, Jilin University, Changchun 130021, China

Received:2016-08-11 Online:2016-11-28 Published:2016-12-02

摘要/Abstract

摘要：

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。

关键词: 狗咬伤, 一期缝合, 延期缝合

Abstract:

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 injection 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.

Key words: dog bite, primary closure, delayed closure

中图分类号:

R782.4

张振波, 赵聪, 王雷, 李明贺. 口腔颌面部狗咬伤患者一期缝合与延期缝合的疗效比较[J]. 吉林大学学报(医学版), 2016, 42(06): 1207-1210.

ZHANG Zhenbo, ZHAO Cong, WANG Lei, LI Minghe. Comparison of therapeutic effects between primary closure and delayed closue in patients with dog bite wound[J]. Journal of Jilin University Medicine Edition, 2016, 42(06): 1207-1210.

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口腔颌面部狗咬伤患者一期缝合与延期缝合的疗效比较

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

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