三种创面处理方法治疗胫腓骨骨折合并骨筋膜室综合征临床疗效分析  

Treatment of tibiofibula fracture complicated with osteofascial compartment syndrome by three approaches to wound surface

作　　者：时国华[1] 汤勇[1] 徐云钦[1] 陈德纯[1] 

机构地区：[1]解放军第98医院全军创伤骨科修复重建中心,浙江省湖州市313000

出　　处：《中国骨与关节损伤杂志》2013年第6期534-536,共3页Chinese Journal of Bone and Joint Injury

基　　金：南京军区面上A类资助项目(11MA009)

摘　　要：目的探讨切开复位内固定结合传统敞开引流无菌敷料敷盖、DR脱细胞异种(猪)皮和持续负压封闭引流技术(VSD)3种创面处理技术治疗胫腓骨骨折合并骨筋膜室综合征的疗效。方法 67例胫腓骨骨折合并骨筋膜室综合征,早期均行切开减张术和内固定术,分别以传统敞开引流无菌敷料覆盖(A组,n=35)、DR脱细胞异种(猪)皮覆盖(B组,n=13)、VSD持续吸引(C组,n=19)处理至创面肉芽组织生长良好后,二期行游离植皮术。结果 C组创面修复及骨折愈合良好,且骨筋膜室综合征得到控制;在换药次数、术后3 d伤口渗出量、减轻小腿肿胀程度、疼痛、伤口感染率、住院时间、二期创面修复时间方面,B、C组均优于A组,差异有统计学意义(P<0.05)。结论切开复位内固定结合VSD技术治疗胫腓骨骨折合并骨筋膜室综合征可缩短治疗时间,降低感染率和渗出量,减轻肿胀和疼痛。尽管DR脱细胞异种(猪)皮不及VSD技术优势明显,但是其价格低廉,适用于基层医院的推广。Objective To explore the effect of internal fixation and three approaches to wound surface, aseptic dressing traditionally, DR aceUular xeno-dermis and vacuum sealing drainage （VSD）, on treatment of tibiofibula fracture complicated with osteofascial compartment syndrome. Methods Sixty-seven patients with tihiofibula fracture complicated with esteofascial compartment syndrome were randomly divided into three groups,which were treated by internal fixation adjuvant treatment of traditional method（group A, n=35）, DR acellular xeno--dermis （group B, n=13） and VSD （group C, n=19） respectively. After the granulation tissue grew well, phase II line free skin 8raiting was performed. Results All patients with VSD group wound repair healing was well, and bone compartment syndrome was well controlled. Compared with group A, group B and C were better in the average switching frequency, 3 d postoperative wounds effusion quantity, relieve leg swelling degree, pain, the wound infection rate, length of hospital stay, the second phase of wound repair time ,the difference was statistically significant （P 〈0.05）. Conclusion The internal fixation adjuvant treatment of VSD is a simple but utility method of treating tibiofibula fracture complicated with osteofascial compartment syndrome, which can shorten hospital stay, reduce the infection and exudation, relieve swelling and pain. DR acellular xeno-dermis is not significantly superior to VSD, but it＇s cheaper and easier to use, especially suitable for the basic level hospital.

关 键 词：胫腓骨骨折 骨筋膜室综合征 封闭负压引流技术 DR脱细胞异种(猪)皮 

分 类 号：R683.42[医药卫生—骨科学]