原位反植皮持续负压封闭引流联合外固定支架分期治疗大面积皮肤撕脱伤合并股骨开放性骨折14例  

Clinical effect of reattachment of skin and VSD combined with external fixator in stage treatment of 14 cases of large avulsion injury of skin complicated with femoral open fracture

作　　者：霍永峰[1] 于吉文[1] 刘建[1] 何维栋[1] 张建[1] 顾光学[1] 盛路新[1] 

机构地区：[1]连云港市第一人民医院创伤骨科,江苏连云港222002

出　　处：《海南医学》2014年第5期723-726,共4页Hainan Medical Journal

摘　　要：目的探讨反植皮负压封闭引流联合外固定支架分期治疗大面积皮肤撕脱伤合并股骨开放骨折的临床疗效。方法对2008年1月至2012年3月收治的14例单侧大面积皮肤撕脱伤合并股骨开放骨折患者采用分期治疗，急诊I期将失活皮肤反取全厚皮片后筛孔状回植修复创面，外固定支架固定股骨骨折，创面VSD敷料覆盖封闭。创面愈合后Ⅱ期更换固定行决定性治疗。结果14例患者治疗过程中均未出现医源性血管神经损伤、深静脉血栓、脂肪栓塞等严重并发症。1例患者于I～Ⅱ期手术间隔时出现感染，Ⅱ期清创行Ilizarov支架固定至骨折愈合，12例获得较长随访（8～36个月，平均22个月），所有12例二次手术后均未出现继发感染及骨髓炎。12例患者骨折愈合时间平均25周（16--40周）。根据膝关节HSS评分，优8例，良3例，可1例，优良率为91．7％。结论反植皮负压封闭引流联合外固定支架分期治疗大面积皮肤撕脱伤合并股骨开放骨折，有效控制了创伤的严重并发症，降低感染率，为患者的早期康复提供了有利条件，疗效满意。Objective To investigate clinical treatment effects of reattachment of skin and vacuum sealing drainage （VSD） combined with external fixator in stage treatment of large avulsion injury of skin complicated with femoral open fracture, and to analyze the treatment and experience. Methods Stage treatment was applied to 14 patients admitted to the hospital from January 2008 to March 2012 for large avulsion injury of unilateral skin complicated with femoral open fracture. In the stage I of emergency treatment, the repair of wound surface was conducted with back implantation of cribriform-shaped full-thickness skin from inactive skin; femoral fracture was fixed with external fixation; the wound surface was filled with VSD dressings. In the stage II, the fixation was changed and definitive treatment was conducted after wound healing. Results The 14 patients had no iatrogenic vascular and nerve injury, deep venous thrombosis, fat embolism and other serious complications during the course of the treatment. One patient suffered infection every once in a while during the operation from stage I to stage II and underwent stage II debridemerit with Ilizarov external fixation until fracture healing. Longer follow-up was performed for 12 patients （8-36 months, with a mean of 22 months）. All the 12 patients had no secondary infection and osteomyelitis after second operation. The mean healing time of the 12 patients was 25 weeks （16--40 weeks）. According to the hospital for special surgery knee score, there were 8 cases classified as excellent, 3 good and 1 fair, with the excellent and good rate of 91.7%. Conclusion Stage treatment of large avulsion injury of skin complicated with femoral open fracture with reattachment of skin and vacuum sealing drainage （VSD） combined with external fixator can effectively control serious complications after trauma and reduce infection rate, as well as provide an advantage for patients＇ early rehabilitation, with satisfying curative effect.

关 键 词：负压封闭引流 分期治疗 皮肤撕脱伤 股骨开放骨折 反植皮 

分 类 号：R683.42[医药卫生—骨科学]