双层负压封闭引流治疗跟骨骨折术后迟发严重感染的疗效观察  

Clinical effect of double layer vacuum sealing drainage in the treatment of delayed severe infection after calcaneal fracture operation

作　　者：马海东[1] 白洁 杜晓健[1] 刘洪达[1] 高岩[1] 李建军[3] 梁卫东 曹立海[1] 曲家富[1] 

机构地区：[1]唐山市第二医院足踝外科,河北063000 [2]武警河北总队医院唐山分院 [3]唐山市第二医院创伤科,河北063000

出　　处：《中华医学杂志》2017年第3期212-216,共5页National Medical Journal of China

摘　　要：目的对比双层负压封闭引流（VSD）技术与单纯换药治疗跟骨骨折术后迟发严重感染的临床疗效。方法回顾自2008年8月至2015年7月唐山市第二医院足踝外科收治的跟骨骨折术后3个月以上迟发严重感染的病例73例，根据治疗方式分成双层VSD组38例，单纯换药组35例。两组病例经正规伤口清创扩创及消毒后，双层VSD组给予创面双层VSD，换药组每天给予常规换药，术后两组患者均应用敏感抗菌药物进行治疗。两组病例针对换药次数，伤口愈合时间，细菌培养转阴时间及Ⅱ期围手术期愈合时间进行对比。结果负压封闭引流组换药7次，伤口愈合时间为27 d，细菌培养转阴时间8 d，Ⅱ期围手术期愈合时间13.5 d；换药组换药次数为34次，伤口愈合时间44 d，细菌培养转阴时间18 d，Ⅱ期围手术期愈合时间17 d。两组数据应用中位数作比较，经秩和检验，差异均有统计学意义（Z值分别为-6.670、-5.529、-5.011、-3.227，P〈0.05）。双层VSD组较单纯换药组换药次数明显减少，伤口愈合时间、细菌培养转阴时间及Ⅱ期围手术期愈合时间明显缩短。结论应用双层VSD技术对比传统换药治疗跟骨骨折术后迟发严重感染，具有简单易学、安全快捷、治愈时间短，患者痛苦少，后期生活质量高等优点，是一种安全有效的治疗方法。ObjectiveTo observe the clinical effect of vacuum sealing drainage （VSD） technique and simple dressing change in the treatment of delayed severe infection after calcaneal fracture surgery.MethodsFrom August 2008 to July 2015 , 73 patients with delayed severe infection were treated after calcaneal fractures 3 months in Department of Foot and Ankle, the Second Hospital of Tangshan City, according to the treatment methods are divided into vacuum sealing drainage group of 38 cases, 35 cases of simple dressing group.Two groups of patients after regular wound debridement debridement and sterilization after vacuum sealing drainage group received double wound VSD dressing group received postoperative dressing, two groups of patients with sensitive antibiotics for treatment.Two groups of patients according to the frequency of dressing change, wound healing time, bacterial clearance time and healing time were compared in stage Ⅱ during the perioperative period.ResultsVacuum sealing drainage group： dressing： 7 times, the wound healing time was 27 days, bacterial culture negative for 8 days, the healing time of 13.5 days of perioperative period; treatment group： 34 times the number of dressing, wound healing time was 44 days, bacterial culture negative for 18 days, the healing time of 17 days of surgery period. Two groups of data were compared with the median, after the rank sum test, the difference was statistically significant （Z values were -6.670, -5.529, -5.011, -3.227, P〈0.05）. The vacuum sealing drainage group compared with conventional dressing group significantly reduced the number of dressing, wound healing time, healing time was significantly shortened bacterial clearance time and perioperative period Ⅱ.ConclusionDouble VSD is easy , safe and quick, short cure time, less pain, higher quality of late life advantages, compared with the traditional dressing treatment of calcaneal fractures of postoperative delayed severe infection, is a safe and effective method.

关 键 词：感染 引流 跟骨 封闭敷料 

分 类 号：R687.3[医药卫生—骨科学]