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烧伤瘢痕挛缩治疗的系统评价:寻找证据

A systematic review on burn scar contracture treatment: searching for evidence.

作者信息

Stekelenburg Carlijn M, Marck Roos E, Tuinebreijer Wim E, de Vet Henrica C W, Ogawa Rei, van Zuijlen Paul P M

机构信息

From the *Association of Dutch Burn Centers, Beverwijk, The Netherlands; †Department of Plastic and Reconstructive Surgery, VU Medical Center, Amsterdam, The Netherlands; ‡MOVE Research Institute, VU University of Amsterdam, The Netherlands; §Burn Centre and the Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; ‖EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; ¶Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; and #Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan.

出版信息

J Burn Care Res. 2015 May-Jun;36(3):e153-61. doi: 10.1097/BCR.0000000000000106.

Abstract

Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

摘要

对于重建外科医生而言,治疗烧伤瘢痕挛缩仍然是一个具有挑战性的问题。目前,对于何时采用何种技术尚无共识。因此,我们对烧伤瘢痕挛缩松解术后不同手术技术的有效性进行了系统评价。使用预先定义的检索策略检索电子数据库。纳入评估治疗烧伤瘢痕挛缩手术技术效果的研究。对方法学质量进行检验并汇总数据。共识别出1649篇论文,其中17篇符合纳入标准。3篇报告了对照试验,14篇为队列研究,包括10篇术前术后设计的研究和4篇比较设计的研究。这些论文描述了移植、随机或明确血管化的皮瓣以及真皮替代物的效果。所有研究均存在方法学缺陷,且大多使用了不恰当的统计方法。总结了目前关于烧伤瘢痕挛缩重建技术有效性的证据。由于纳入研究的稀缺性和低质量,无法就不同技术的有效性得出明确结论。因此,无法对日常实践产生直接影响。然而,可以针对提高烧伤瘢痕挛缩松解手术治疗策略有效性的进一步基础研究质量提出建议。

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