负压封闭冲洗引流治疗手部急慢性化脓性腱鞘炎的疗效分析  

Effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand

作　　者：王欢[1] 夏芳[2] 邢丹谋[1] 任东[1] 冯伟[1] 陈焱[1] 肖志宏[1] 赵志明[1] 

机构地区：[1] 华中科技大学同济医学院附属普爱医院手外一科,武汉430030 [2] 华中科技大学同济医学院附属普爱医院公共卫生科,武汉430030

出　　处：《中华外科杂志》2017年第5期384-388,共5页Chinese Journal of Surgery

基　　金：武汉市临床医学科研项目（WX14C66）

摘　　要：目的 探讨采用负压封闭冲洗引流技术治疗手指急慢性化脓性腱鞘炎的疗效.方法 回顾性分析2013年1月至2015年4月华中科技大学同济医学院附属普爱医院手外一科收治的9例手指化脓性腱鞘炎患者的临床资料,男性6例,女性3例,年龄27～ 65岁,平均55岁;示指3例,中指3例,环指2例,示中环三指1例.感染原因包括鱼刺刺伤3例,动物骨碎片刺伤3例,木屑刺伤1例,绞肉机绞伤术后感染1例,多手指垃圾车挤压伤术后感染1例.感染细菌：金黄色葡萄球菌2例,表皮葡萄球菌2例,大肠杆菌1例,普通产气杆菌、产酸克雷伯菌、金黄葡萄球菌混合感染1例,鲍曼不动杆菌1例,奇异变形杆菌1例,培养未见致病菌生长1例.切开彻底清创后行负压封闭冲洗引流治疗,观察术后灌洗液性状、创腔炎症反应、预后感染和手指功能恢复情况.结果 7例化脓性腱鞘炎患者冲洗治疗7～14 d,更换负压封闭引流（VSD）敷料1次;1例示指指端缺损皮瓣术后感染患者冲洗治疗21d,更换VSD敷料2次;1例示中环指外伤术后感染患者冲洗治疗28 d,更换VSD敷料3次.9例患者获得3～12个月（平均8.2个月）随访,7例患者无肌腱坏死,伤口二期缝合,感染无复发;2例外伤术后感染患者,肌腱坏死,术中予以切除,感染得到有效控制,伤口二期缝合,感染无复发,术后手指功能评定结果：良6例,差3例.结论 彻底清创后应用负压封闭冲洗引流技术治疗手指急慢性化脓性腱鞘炎,疗效确切,极大减轻患者痛苦,可在一定程度上提高医护工作效率.Objective To investigate the effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand.Methods A total of 9 cases acute and chronic suppurative tenosynovitis patients from January 2013 to April 2015 in Puai Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology were retrospectively reviewed.There were 6 males and 3 females,aging from 27 to 65 years,the average age was 55 years.There were 3 cases of index finger,3 cases of middle finger,2 cases of ring finger,1 case include three fingers.The infection causes included stabbing with fishbone in 3 cases,stabbing with animal bone fragments in 3 cases,wound by sawdust in 3 cases,meat grinder injury in 1 case,multiple fingers crush injury postoperative infection of garbage truck in 1 case.Bacterial infection included 2 cases with Staphylococcus aureus,2 cases with Staphylococcus epidermidis,1 case with normal Escherichia coli,1 case with mixed infection of Enterobacter aerogenes,Klebsiella oxytoca and Staphylococcus,1 case with Bauman Acinetobacter bacillus,1 case with Proteus mirabilis and 1 case of no growth of pathogenic bacteria culture.After thorough debridement,vacuum sealing drainage was used to observe the characteristics of irrigation fluid,the formation of cavity inflammation,the prognosis of infection and the recovery of finger function.Results Seven patients with suppurative tenosynovitis were treated for 7 to 14 days,replaced the vacuum sealing drainage dressing once;1 patient was an illustration of the finger tip defect flap infected patients after 21 days of treatment,replaced the vacuum sealing drainage dressing twice,1 patient was an illustration of the central refers to tramna,postoperative infection patients 28 d,replaced three times in the VSD.The follow-up time was 3 to 12 months （mean 8.2 months）,7 patients without tendon necrosis,secondary suture with no infection,2 cases of traumatic surgery of patients with infection,tendon necrosis was removed,the infection has b

关 键 词：化脓性腱鞘炎 感染 手指 负压封闭引流术 预后 

分 类 号：R687[医药卫生—骨科学]