一期内固定联合负压封闭引流治疗严重软组织缺损的下肢开放性骨折  

Application of anterior internal fixation plus vacuum sealing drainage in the treatment of lower limb open fracture with severe soft tissue defect

作　　者：赵敏[1] 周江军[1] 吕仁发[1] 张懿城[1] 朱治宇[1] 张立[1] 陈荣剑[1] 

机构地区：[1]解放军第184医院骨科,江西鹰潭市335000

出　　处：《中国矫形外科杂志》2011年第22期1879-1882,共4页Orthopedic Journal of China

摘　　要：[目的]合并严重软组织缺损的下肢开放性骨折是一种高能量损伤,常伴有重度污染。本文探讨这一类型的骨折运用一期内固定联合负压封闭引流(VSD)技术治疗的效果。[方法]从2008年6月～2010年10月共收治58例合并严重软组织缺损的下肢开放性骨折患者,分为两组处理。对照组:27例,男18例,女9例,给予普通清创二期内固定、植皮或皮瓣;VSD组:31例,男18例,女13例,急诊彻底清创后均采用一期内固定联合VSD固定骨折并封闭创口,7～21 d后根据肉芽生长情况给予二期缝合、植皮或皮瓣转移。[结果]对照组:28例患者骨折愈合时间6～18个月,平均(9.8±2.91)个月,创面愈合时间20～95 d,平均(46.81±16.80)d。VSD组:31例患者骨折愈合时间4～10个月,平均(6.29±1.88)个月,创面愈合时间14～33 d,平均(19.68±5.30)d。对照组与VSD组的骨折及创面愈合时间有统计学差异(P=0.041,P<0.001),VSD组明显好于对照组,GustilⅢA、ⅢB型骨折愈合时间无明显差异(P=0.906,P=0.080),而创面愈合时间有统计学差异(P<0.001,P=0.035)。[结论]经彻底清创后,一期内固定联合VSD治疗合并严重软组织缺损的下肢开放性骨折,缩短骨折愈合时间,促进伤口愈合,减少并发症。[Objective]Lower limb open fractures with severe soft tissue defect are often high-energy injuries.It is always combined with serious contamination.This study was aimed to investigate the effectiveness in the treatment of lower limb open fracture with severe soft tissue defect by anterior internal fixation combined with vacuum sealing drainage（VSD）. [Method]Fifty-eight patients（M=18,F=13） with severe soft tissue defect and lower limb open fracture were managed from June 2008 to October 2010,and were divided into two groups.Control groups（CG）： all patients were treated by debridement,and later internal fixation after the wound healing.VSD group（VSD-G）：all patients were treated by anterior internal fixation following debridement,and the wound surface were filled with VSD connected to vacuum bottle.The wounds were closed with secondary suturing,or skin transplantation,or local flap grafting 7 to 21 days later. [Result]CG： The bones of 28 patients healed in 6~18 months（avg=9.8±2.91 months）,and the wounds healed in 20~95 ds（46.81±16.80 ds）.VSD-G： The bones of 31 patients healed in 4～10 months（avg=6.29±1.88 months）,and the wounds healed in 14~33 ds（19.68±5.30 ds）.The bones and wonds healing time of VSD-G were statistically significantly shorter than that of CG.The wounds healing time of Gustil IIIA were statistically significantly shorter than that of IIIB,but the bones healing time showed no statistical significant difference. [Conclusion]VSD combined with anterior internal fixation after debridement is a simple and effective treatment method for lower limb open fracture with severe soft tissue defect.It can shorten healing time of wounds,facilitate fracture and reduce the incidence of complications.

关 键 词：负压封闭引流 一期内固定 开放性骨折 软组织缺损 下肢 

分 类 号：R687.3[医药卫生—骨科学]