负压封闭引流技术在GustiloⅢB、C型骨折创面的应用及疗效  

Application and curative effect of vaccum sealing drainage in Gustilo IIIB and IIIC fracture of the wound

作　　者：张伟 阮腊林 吴凯[2] 陈伟高[2] 张湘生[3] 付晓玲[2] 

机构地区：[1]新余市钢铁集团中心医院骨科,江西新余338000 [2]南昌大学第二附属医院骨科,江西南昌330000 [3]中南大学湘雅二医院骨科,湖南长沙410000

出　　处：《中国现代医学杂志》2014年第28期101-103,共3页China Journal of Modern Medicine

摘　　要：目的探讨负压封闭引流（VSD）技术在GustiloⅢB、C型骨折创面的应用、疗效及注意事项。方法回顾性分析2009年9月-2010年12月应用VSD技术治疗的30例GustiloⅢB、C型骨折患者资料,全部患者均在8 h内实施清创、骨折复位和外固定支架固定,行VSD技术封闭创面并定期更换,二期进行游离植皮术或皮瓣转移术覆盖创面。记录植皮成活率、并观察皮肤恢复程度。结果 30例患者术后29例经植中厚皮片覆盖创面,创面愈合时间为25-40 d,平均27 d,植皮成活率为优,皮肤恢复程度为良;1例发生感染及骨质外露,加强换药后骨皮质坏死,先行游离植皮缩小创面,咬除坏死骨皮质,2个月后行皮瓣转移覆盖创口后愈合,创面愈合时间为96 d,皮瓣成活率为优,皮肤恢复程度为优。结论 VSD技术为GustiloⅢB、C型骨折提供了一种有效的创面覆盖方法,可以控制感染、刺激新鲜肉芽组织生长,为二次植皮术提供了良好的条件。使用中应注意充分清创、合理固定及预防感染等对症支持治疗。【Objective】To discuss thecurative effect of vacuum sealing drainage（VSD） technology in Gustilo III B, C type fracture of wounds, and its key points.【Methods】30 cases of Gustilo III B, C type fracture patients from2009 September to 2010 December by VSD technology in treatmentwere retrospectively analyzed, all patients were treated by the implementation of debridement, fracture reduction and external fixation within 8 h. And V S D technique was used to close the wound and was replaced regularly. In two phase,grafting free skin or transferring flap was used to cover the wounds. The survival rate of skin graft was recorded, and skin recovery degree was observed.【Results】Medium thickness skin was grafted to 29 cases of patients after operation in 30 cases for covering the wounds. The wound healing time was 25~40 d and 27 d on average. The survival rate of skin graft for the gifted,skin recovery was good; one case was infected and bonewas exposed. After dressing change, cortical bone was necrosis, firstly free skin was grafted to reduce wound, the necrotic bone cortex was bited. Wounds healed in the 2 months after flap transfer for coverage. Wound healing time was 96 d, flap survival rate and degree of recovery weregood.【Conclusion】VSD technology of Gustilo III B, C type fractures provide an effective coverage of the wound, which can control the infection, and stimulate growth of fresh granulation tissue. And it can provide good conditions for thesecond skin grafting. Adequately debrided, reasonable fixation and infection prevention and treatment should be paid attention to.

关 键 词：负压封闭引流 四肢创伤 软组织缺损 

分 类 号：R683.42[医药卫生—骨科学]