急诊使用外固定架联合VSD处理严重软组织损伤的四肢开放性骨折效果评价  

Effect evaluation of emergency use of external fixation combined with VSD for open fractures of extremities with serious soft tissue injury

作　　者：覃海森[1] 梁国挺[1] 林浩[2] 李晓锋[1] 刘兴涛[1] 

机构地区：[1]广东省第二人民医院急诊外科,510317 [2]广东省第二人民医院创伤外科,510317

出　　处：《中国医疗前沿》2013年第9期54-55,88,共3页China Healthcare Innovation

摘　　要：目的探讨急诊使用外固定架联合负压封闭引流术(vacuum sealing drainage,VSD)治疗合并严重软组织损伤的四肢开放性骨折的临床效果。方法对38例有严重软组织损伤的四肢开放性骨折患者急诊采用外固定架辅以有限内固定固定骨折,并早期联合VSD。其中11例面积较大皮肤软组织撕脱创面I期打薄皮肤回植,20例软组织缺损创面无法I期修复,经VSD后创面缺损由新生肉芽组织填充,行皮瓣或自体中厚皮片移植术修复;7例软组织严重污染并高度肿胀,经2次清创术并联合使用VSD,行直接拉拢缝合或自体中厚皮片移植术修复创面。结论 11例I期回植的皮肤绝大部分存活;20例合并软组织缺损创面未发生感染,7例软组织严重污染并高度肿胀患者患肢肿胀消退,未发生骨筋膜室综合症,Ⅱ期修复均成活。随访15-24个月,所有病例骨折愈合,无骨髓炎、骨不连发生,外固定架及内固定均拆除。结论外固定架联合VSD急诊处理合并严重软组织损伤的四肢开放性骨折疗效良好。Objective To investigate the clinical effect of external fixation combined with vacuum sealing drainage（vacuum sealing drainage,VSD） in emergency treatment of open fractures of extremities with severe soft tissue injury. Methods Totally 38 cases open limb fractures with serious soft tissue injury were treated with external fixator supplemented with limited internal fixation and combined with VSD in emergency. 11 cases with large area skin avulsion were treated by skin grafting. Totally 24 cases of soft tissue defect cannot be repaired in one- stage. Skin defects were filled by granulation tissue after the application of VSD and repaired by flaps and free skin graft. Totally 7 cases of Soft tissue serious pollution and high swelling, after two times debridement and application of VSD ,were repaired by suture or autologous split-thickness skin graft. Results 11 cases of skin grafting were almost healed. 20 cases of soft tissue defect were not infected.？ cases of Soft tissue serious pollution and high swelling regress without the occurrence of osteofascial compartment syndrome.Laps and skin graft after the secondary operation all survived. During follow-up ranging from 6-24 months, all cases were healed without the occurrence of osteomyelitis and nonunion. External fixation and internal fixation were removed. Conclusion Using external fixation combined with VSD is an effective and efficient method for treating open fracture of extremities with Serious soft tissue injury.

关 键 词：开放性骨折 软组织损伤 外固定架 负压封闭引流 

分 类 号：R683.4[医药卫生—骨科学]