GustiloⅢ型胫腓骨开放性骨折急诊清创后伤口闭合的时机与方法选择  

The timing of wound closure and the choice of methods in Gustilo Ⅲ type tibiofibula open fractures after emergency debridement

作　　者：郎良军[1] 唐令[1] 周云斌[1] 

机构地区：[1]余姚市人民医院急诊创伤科,浙江省余姚315400

出　　处：《中国基层医药》2016年第7期1030-1033,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨GustiloⅢ型胫腓骨开放性骨折急诊清创后伤口闭合的时机与方法。方法选取2014年1月至2015年1月42例GustiloⅢ型胫腓骨开放性骨折患者作为观察组，均进行急诊清创后骨折固定，清创后立即进行创口分泌物培养，若培养结果为阳性，则再次清创，直至培养结果为阴性时方可于48 h后闭合伤口。选取以往收治的GustiloⅢ型胫腓骨开放性骨折患者共38例，均为进行急诊清创骨折固定后常规处理闭合伤口，将其设为对照组。比较两组伤口感染率和骨折愈合情况。结果观察组骨折固定后伤口感染率为4．76％，显著低于对照组的15．79％，差异有统计学意义（χ2＝10．739，P＝0．000）；观察组伤口愈合时间和骨折愈合时间均显著优于对照组，差异有统计学意义（ t＝9．684、7．324，均P＜0．05）。结论 GustiloⅢ型胫腓骨开放性骨折急诊清创后伤口闭合时机应根据伤口分泌物培养结果而定，培养结果为阴性时即可进行伤口闭合，根据软组织损伤的程度大小，选择合适的伤口闭合方式。Objective To explore the timing of wound closure and the choice of methods in Gustilo Ⅲtype tibiofibula open fractures after emergency debridement.Methods 42 patients with Gustilo Ⅲ type tibiofibula open fractures from January 2014 to January 2015 were selected as the observation group.All patients were performed emergency fracture fixation after debridement and wound secretion culture immediately after debridement, if the training result was positive,the debridement,again until the training results for negative when square in 48 hours after closing a wound.Selected 38 patients with GustiloⅢtype tibiofibula open fractures,the prompt debridement 38 cases were fracture fixed routine treatment after closing the wound,they were set as the control group.Compared two groups of patients with wound infection and fracture healing.Results The fractures wound infection rate of the observation group was 4.76%,which was significantly lower than 15.79% of the control group,the difference was statistically significant（χ2 =10.739,P=0.000）.The wound healing time and fracture healing time of the observation group were significantly better than those of the control group,there were statistically significant differences（ t=9.684,7.324,all P〈0.05）.Conclusion GustiloⅢtype emergency open tibiofibula fracture after debridement of the wound closure time should according to the results of wound secretion culture,cultivate the results can be achieved when the negative for wound closure,according to the degree of injury of soft tissue,to choose the right means of wound closure.

关 键 词：骨折 开放性 清创术 胫骨 腓骨 

分 类 号：R687.3[医药卫生—骨科学]