内固定结合负压封闭引流闭合创面治疗胫腓骨骨折  

Efficacy of surgical procedure for tibia-fibula fracture using a combination of internal fixation and vacuum sealing drainage

作　　者：孟勇[1] 郭燕庆[1] 于永林[1] MENG Yong GUO Yan-qing YU Yong-lin(Department of Orthopaedics, Weihai Municipal Hospital, Weihai Shandong 264200, Chin)

机构地区：[1]威海市立医院骨科,山东威海264200

出　　处：《局解手术学杂志》2017年第3期208-211,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨内固定结合负压封闭引流闭合创面治疗胫腓骨骨折的临床疗效。方法选取我院2012年1月至2015年12月108例胫腓骨骨折手术患者按手术方法分为观察组和对照组,每组54例。观察组采用接骨板或者髓内钉行骨折内固定加负压封闭引流(VSD),6~10 d后取下VSD行植皮术;对照组采用外固定结合克氏针、螺钉固定骨折,术后常规换药,二期植皮、皮瓣修复创面。记录并评价2组患者住院时间、平均换药次数、二期手术时间、局部感染率、骨折愈合时间等。结果观察组住院时间为(24.8±4.2)d,创面闭合时间为(9.4±1.7)d,局部感染率为5.6%,骨不愈合率为7.4%,骨髓炎率为1.9%,骨折愈合时间为(17±4.7)周;对照组住院时间为(32.2±8.7)d,创面闭合时间为(14.1±3.8)d,局部感染率为22.2%,骨不愈合率为9.3%,骨髓炎率0,骨折愈合时间为(16±6.5)周,观察组住院时间和创面闭合时间均短于对照组,观察组局部感染率低于对照组,差异均具有统计学意义(P<0.05),2组骨不愈合率、骨髓炎率、骨折愈合时间比较,差异无统计学意义(P>0.05)。结论内固定结合负压封闭引流治疗胫腓骨骨折可缩短创面愈合时间,降低住院时间,减少感染发生率。Objective To evaluate the efficacy of surgical procedure for tibia-fibula fracture using a combination of internal fixation and vacuum sealing drainage（VSD）. Methods Totally 108 patients were enrolled in this study and these patients were from January 2012 to December 2015 divided into two groups（54 per group） according to the surgical method. Patients in the observation group were treated with locking plates or intramedullary nails fixation combined with VSD covered the wound for the following 6 to 10 days, and then the transplanta- tion was performed. Patients in control group received external fixation with kirschner wire and screw fixation. When granulation tissue filled the wound ,flap transplantation was performed to repair tissue defect and cover the exposed bone. The average hospital stay, operation time, local infection rate, fracture healing time were recorded and analyzed. Results In the observation group, the average hospital stay was （ 24.8±4.2） d, wound closure time was （ 9.4 ±1.7 ） d, rate of local infection was 5.6% , rate of bone nonunion was 7.4% , rate of osteomyelitis was 1.9%, fracture healing time was （ 17 ±4.7 ） weeks ; the corresponding data in the control group was （ 32.2± 8.7 ） d, （ 14.1 ± 3.8 ） d, 22.2% ,9.3 % ,0 and （ 16±6.5 ）weeks. The average hospital stay, wound closure time and infection rate of the two groups were of significant differenee（P 〈0.05）. There was no significant difference in terms of bone nonunion rate, osteomyelitis rate and union time （P 〉 0.05）. ConcLusion Tibia-fibula fracture patients can be effectively treated with a combination of internal fixation and vacumn sealing drainage （VSD）. This treatment may shorten the length of hospital stay,reduce the wound-close time and lower the infection rate.

关 键 词：负压封闭引流 内固定 胫腓骨骨折 

分 类 号：R683.42[医药卫生—骨科学]