封闭式负压引流联合反植皮一期闭合开放性创伤截肢创面的临床分析  

EFFECTIVENESS OF VACUUM SEALING DRAINAGE COMBINED WITH ANTI-TAKEN SKIN GRAFT FOR PRIMARY CLOSING OF OPEN AMPUTATION WOUND

作　　者：廖前德[1] 许鉴[1] 翁晓军[1] 钟达[1] 刘志勤[1] 王成功[1] 

机构地区：[1]中南大学湘雅医院骨科,长沙410008

出　　处：《中国修复重建外科杂志》2012年第5期558-562,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的对比观察封闭式负压引流技术(vacuum sealing drainage,VSD)联合反取皮和直接反取皮治疗开放性创伤截肢创面的疗效。方法 2005年3月-2010年6月,应用随机单盲法对收治的60例四肢开放性骨折截肢患者分别采用一期VSD联合反取中厚皮片植皮(试验组,30例)与一期单纯反取中厚皮片植皮覆盖截肢创面(对照组,30例)治疗。两组患者性别、年龄、致伤原因、截肢部位、皮肤缺损面积、术前白蛋白指数及受伤至就诊时间等一般资料比较差异均无统计学意义(P>0.05)。试验组截肢后剪除多余残肢皮肤应用皮鼓取皮制成中厚交错筛网状皮片,植于截肢创面,表面用VSD覆盖,24 h不间断吸引持续7～10 d;对照组截肢后直接行反取中厚皮片覆盖创面,术后常规换药。结果试验组患者于术后平均8 d去除VSD装置。试验组皮片存活率(90.0%)、创面感染率(3.3%)及再截肢率(0)、换药次数[(2.0±0.5)次]、住院时间[(12.0±2.6)d],均显著优于对照组[分别为63.3%、20.0%、13.3%、(8.0±1.5)次、(18.0±3.2)d],比较差异均有统计学意义(P<0.05)。两组患者均获随访,随访时间1～3年,平均2年。末次随访时,试验组瘢痕面积、瘢痕分级及创面两点辨别觉均优于对照组,差异有统计学意义(P<0.05)。两组患者残肢均未见明显肿胀;术后试验组患肢疼痛发生率、残肢长度均优于对照组(P<0.05),而患肢残端形状比较差异无统计学意义(P>0.05)。两组残肢与健侧相比较,均存在肌肉废用性萎缩、肌力下降,各组健侧与患侧肌力比较差异均有统计学意义(P<0.05),但两组患侧间比较差异无统计学意义(P>0.05)。结论与单纯反取中厚皮片比较,VSD联合反取中厚皮片能够一期关闭截肢创面并对创面进行引流,降低感染发生,促进皮片与创面良好贴附,提高了皮片存活率,降低了截肢平面,利于假肢佩戴,是一期处理截肢创面的理想方法之一。Objective To observe the effectiveness of vacuum sealing drainage （VSD） combined with anti-taken skin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 and June 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method. The amputation wounds were treated with VSD combined with anti-taken skin graft （test group, n=30） and direct anti-taken skin graft （control group, n=30）. No significant difference was found in age, gender, injury cause, amputation level, defect size, preoperative albumin index, or injury time between 2 groups （P 〉 0.05）. In test group, the redundant stump skin was used to prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome dealing after amputation, which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressuredrainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, and conventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSD device was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times of dressing change, and the hospitalization days in test group were significantly better than those in control group [ 90.0% vs. 63.3%, 5.3% vs. 20.0%, 0 vs. 13.3% , （2.0 ± 0.5） times vs. （8.0 ± 1.5） times, and （12.0 ± 2.6） days vs. （18.0 ± 3.2） days, respectively] （P 〈 0.05）. The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and two- point discrimination of wound in test group were better than those in control group, showing significant differences （P 〈 0.05）. No obvious swelling occurred at the residual limbs in 2 groups. The 1 imb pain incidence and the residual 1 imb length were better in test group than t

关 键 词：开放性创伤 截肢创面 反取皮植皮 封闭式负压引流技术 

分 类 号：R687.3[医药卫生—骨科学]