一期解剖复位内固定结合负压封闭引流技术治疗开放性跖跗关节骨折脱位  

An Anatomical Reduction and Internal Fixation Combined with Vacuum Sealing Drainage(VSD)to Treatment with the Acute Lisfranc-dislocations

作　　者：刘洪达[1] 曲家富[1] 李绍光[1] 彭义[1] 马海东[1] 

机构地区：[1]华北煤炭医学院附属骨科医院(唐山市第二医院)足踝外科,河北省唐山市063000

出　　处：《中国骨与关节损伤杂志》2010年第12期1083-1085,共3页Chinese Journal of Bone and Joint Injury

基　　金：河北省2009年医学科学研究重点课题计划(编号:20090633)

摘　　要：目的探讨负压封闭引流技术（VSD）在治疗开放性跖跗关节骨折脱位的作用。方法自2008年1月-2009年1月共收治开放性跖跗关节骨折脱位96例,均急诊行清创缝合一期解剖复位内固定内术。26例术后常规换药治疗（换药组）;70例行VSD治疗（VSD组）。结果术后随访1年3个月～2年2个月,平均1年7个月,伤口愈合情况：VSD组51例伤口浅表,拆除VSD敷料后换药1～2周伤口愈合。换药组：15例经3～5周换药后创面愈合,11例因创面面积大,换药4～7周后,行游离植皮术闭合伤口。换药组3例发生骨髓炎及关节化脓感染,骨折愈合时间较VSD组延长2～3周。治疗结果按美国足踝外科协会（AOFAS）中足部分的评分标准测定,VSD组：优32例,良26例,可8例,差4例,优良率为82.9%;换药组：优3例,良8例,可10例,差5例,优良率为42.3%。结论负压封闭引流技术明显促进开放性跖跗关节骨折脱位伤口的愈合,提高AOFAS评分,是治疗开放性跖跗关节骨折脱位新的辅助方法。Objective To explore the treatment effect of acute Lisfranc fracture-dislocations by vacuum sealing drainage（VSD）.Methods From January 2008 to January 2009,of the 96 cases of open Lisfranc fracture-dislocation were treated.All emergency debridement and suture line of fixation.Twenty-six cases of conventional dressing after treatment,70 cases were treated by VSD.Results Postoperative follow-up 1 year and 3 months to 2 years and 2 months,an average of 1 year and 7 months,wound healing situation： Vacuum sealing drainage treatment groups： 51 cases of patients with superficial wounds,removal of VSD dressing 1～2 weeks after wound healing,19 patients due to large wounds,necrotic tissue,after 1～3 times VSD treatment,line free skin graft closed the wound.Traditional dressing group： 15 patients 3 to 5 weeks,after dressing and wound healing,11 patients because of the wound area,dressing 4 to 7 weeks,the line of free skin grafting for wound closure.Conventional dressing group 3 cases had purulent osteomyelitis and joint infection,fracture healing time of the treatment group compared with VSD extension of 2～3 weeks.Treatment outcome according to the United States Association of Foot and Ankle Surgery（AOFAS） in the foot part of the assessment criteria was determined：70 patients with vacuum sealing drainage：excellent in 32 cases,good in 26 cases,fair in 8 cases and poor in 4 cases,excellent rate was 82.9%.Conventional dressing group of 26 cases：excellent in 3 cases,good in 8 cases,fair in 10 cases and poor in 5 cases,excellent rate was 42.3%.Conclusion Vacuum sealing drainage technology significantly promotes the openness of Lisfranc fracture-dislocation of wound healing,improves the AOFAS score.It is a new assistant method to treatment the open Lisfranc fracture-dislocations.

关 键 词：跖跗关节 骨折脱位 空心螺钉 骨折内固定术 负压封闭引流技术 

分 类 号：R683.42[医药卫生—骨科学]