Clinical Research On Individualized Treatment Of Soft Tissue Defects Around Joints Guided By Modern Rehabilitation Concept

Objective:Skin and soft tissue defects around joints are very common in clinic.Once improperly handled,joint function is easily limited or even lost,which leads to irreversible damage of joint function.To analyze the efficacy of individualized treatment for those patients with skin and soft tissue defects around joints under the guidance of modern rehabilitation concept,and to provide a reference for clinical rational treatment of soft tissue defects around joints.Methods:From September 2015 to May 2017,52 patients with skin and soft tissue defects around joints who met the criteria and visited our hospital were statistics divided into the experimental group of 26 cases with individualized treatment of soft tissue defects around joints under the guidance of modern rehabilitation concept and the control group of 26 cases with routine treatment.The length of operation,the amount of bleeding during operation,the number of bad wound healing cases,the number of necrosis or partial necrosis of skin flaps cases,the number of repaired skin flaps,skin grafting or debridement suture cases,the thickness of skin flaps,the number of requiring thinning cases,the satisfaction rate of patients and ROM of joints in 1,3and 6 months follow-up were compared between the two groups.Results:The operation time of individualized treatment group was 3.0h±1.2h and that of conventional treatment group was 2.3h±0.9h.T test showed that P < 0.05,which had significant difference.Conventional treatment group only used local transposition flaps to cover the wound surfaces of the joints,which did not use the corresponding tissue to repair or reconstruct those patients with nerve,tendon or ligament defects,so the operation time was significantly faster than that of individualized treatment group.The bleeding volume of individualized treatment group was 35.8ml±15.2ml and that of conventional treatment group was 40.6ml±10.3ml.T test showed that P > 0.05,which had no significantdifference.Chi-square test was used to determine the incidence of complications between the two groups(P < 0.05),which showed a significant difference.In the individualized treatment group,the thickness of skin flaps was 1.2cm±0.5cm after operation,and 2 cases needed to be thinned again by operation because of the influence on the normal life of patients,and the satisfaction rate of patients was 95.6%.While in the conventional treatment group,the thickness of skin flaps was 2.0cm±0.6cm after operation,and 13 cases needed to be thinned again by operation because of the influence on the normal life of patients,and the satisfaction rate of patients was 75.3%.Through t-test and chi-square test,the results showed that P < 0.05 and there was significant difference between the two groups.The excellent rate of joint function in individualized treatment group reached 84.6% after one month of operation,57.7% in conventional treatment group,88.5% after three months of operation and 61.5% in conventional treatment group,96.2% after six months of operation and 65.4% in conventional treatment group,respectively.Rank sum test showed that P < 0.05,there were significant differences.Conclusion:Under the guidance of modern rehabilitation concept,individualized treatment of soft tissue defects around joints has a relatively long operation time,but the incidence of adverse complications such as bad wound healing,necrosis of skin flaps,requiring skin flap repair or skin grafting,debridement suture or thinning of skin flaps by operation is low.Moreover,the flaps are beautiful,functional recovery rate is high,and patients' satisfaction degree is high.Modern rehabilitation concept shall run through the whole process of treatment,and rehabilitation and surgery promote each other and complement each other.