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  [摘要]目的：探讨应用皮肤软组织扩张术治疗四肢关节部位瘢痕的方法及临床效果。方法：根据四肢关节部位瘢痕的挛缩情况、位置、及面积大小，I期选用挛缩瘢痕松解改形、长方形或肾形扩张器纵向交错置入、40℃热盐水注射扩张与功能锻炼交替进行的方法提高正常皮肤的有效扩张。扩张达标后扩张皮瓣II期采用松解纤维囊、推进滑行、易位成形或菱形瓣转移的方法促进扩张皮瓣的合理利用。矫正畸形后根据扩张皮瓣大小适度切除瘢痕，扩张皮瓣修复方法以推进滑行、易位成形为主，以减少并发症的发生。结果：自2006年3月～2010年8月采用上述多方法联合临床应用25例。发生扩张器外露1例，II期术后1例小部分瘢痕残留，1例扩张皮瓣长度不够设计菱形瓣转移张力过大，皮瓣远端血运障碍导致愈合不良，其余病例瘢痕切除完全，畸形矫正彻底，功能正常，外形美观。结论：在关节周围有充足可扩张正常皮肤的情况下，通过多方法联合应用可提高正常皮肤的有效扩张和扩张皮瓣的合理利用，有助于关节功能的恢复和外形的美观，减少并发症的发生。

 [关键词]关节；瘢痕；扩张器；皮肤扩张术

 [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2011)06-0906-03

 Application of expandor in the treatment of scar in limbs arthrosis

 WANG Hong-yuan,WANG Ming-gang,ZHAO Li-ping,SHUI Qing-fu,WANG Kai,GAO Xin-yu

 (Department of Plastic Surgery,Anhui Province Hospital,Hefei 230001,Anhui,China)

 Abstract： ObjectiveTo discuss the method and effect of treating scar in limbs arthrosis using expandor.MethodsIn the first stage, webbed scar solution,rectangle or kidney shape expandor insertion,40℃ warm saline injection and functional exercise were practiced alternately to expand skin sufficiently according to the location,type and area of scar in limbs arthrosis,during the second stage,the expanded flap was transferred through rotation,advancement or designed as Z or rhombus shape to repair the defects after scar resection,it was a good way to reduce the complication.ResultsFrom March 2006 to August 2010,25 cases were performed by two stages operation mentioned above,one expandor exposed,dyshemia was occurred in the distal end of one flap due to hypertension and one case remained a little scar, the rest flaps were survived well and recovered to a natural appearance.ConclusionsThe expanded skin flap is an idea choice for the function and appearance recovery of arthrosis on the premise of effectively expand and utilize.

 Key words:arthrosis;scar;expander;skin expansion

 四肢关节部位各种创伤后遗留的瘢痕不仅影响美观，也会造成不同程度的功能障碍和畸形。随着人们生活质量的提高，对四肢关节部位瘢痕的治疗要求也越来越高。传统的植皮术常有色素沉着和远期皮片收缩，既影响美观又妨碍功能；皮瓣移植常有手术风险大、皮瓣臃肿和色差等缺陷。“皮肤扩张器的应用是整形外科历史上最有创造性的成就”，无疑是一种较理想的治疗方法[1]，但四肢关节部位皮肤扩张并发症较多[2]，注水时疼痛使关节保护性屈曲导致有效扩张皮肤减少，修复后跨关节直线瘢痕收缩影响关节功能，扩张皮瓣转移血供较差等问题。如何把四肢关节部位瘢痕周围的正常皮肤有效扩张，扩张皮瓣得到合理利用，减少并发症的发生，使治疗后关节功能、形态满意将是笔者整形美容外科必须探讨的问题。我科自2006年3月～2010年8月采用上述多方法联合临床应用25例，获得了较满意的临床效果。

 1临床资料

 本组25例，男11例，女14例。年龄8～36岁，平均年龄16.9 岁。共置入扩展器67只，最大容量400ml，最小容量50ml，注水壶均内置。瘢痕成因：火焰烧伤3例，沸水烫伤17例，化学烧伤1 例，手术及创伤4例。关节部位：肩关节4例，肘关节13例，髋关节2例，膝关节8例 ......