负压封闭引流术联合肌皮瓣移植术治疗胫骨开放性骨折并发慢性骨髓炎的效果分析  

The effect of VSD combined with myocutaneous flap transplantation in treatment of open tibial fracture complicated with chronic osteomyelitis

作　　者：郝进军 李鹏 王玮[2] HAO Jin-jun;Li Peng;WANG Wei(Department of Orthopaedics,The Second Hospital of Dingzhou,Dingzhou Hebei 073000,China;Department of Gynecology,Dingzhou People＇s Hospital,Dingzhou Hebei 073000,China.)

机构地区：[1]河北省定州市第二医院骨科,河北定州073000 [2]河北省定州市人民医院妇一科,河北定州073000

出　　处：《临床和实验医学杂志》2018年第19期2112-2115,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省卫生计生委计划项目任务书(编号:20171494)

摘　　要：目的探讨负压封闭引流术(VSD)联合肌皮瓣移植术治疗胫骨开放性骨折并发慢性骨髓炎的效果。方法选取2016年1月至2017年1月在河北省定州市第二医院骨科治疗的91例胫骨开放性骨折并发慢性骨髓炎患者的临床资料进行回顾性分析,根据患者选取的治疗方案不同,分为观察组(n=44)和对照组(n=47),观察组患者给予VSD联合肌皮瓣移植治疗,对照组患者给予传统皮瓣移植术治疗。观察两组患者的治愈率、皮瓣坏死率、愈合时间、住院时间及费用、术后疼痛情况、术后功能恢复情况及治疗前后白介素6(IL-6)、肿瘤坏死因子α(TNF-α)和C反应蛋白(CRP)水平变化情况。结果观察组治愈率为90.91%,明显高于对照组(P<0.05);观察组皮瓣坏死率为2.27%,愈合时间(14.16±3.24)d,明显少于对照组(P<0.05);观察组术后3 d的视觉模拟评分法(VAS)评分为(5.14±0.82)分,明显低于对照组(P<0.05);观察组疼痛持续时间和住院时间分别为(4.41±1.03)d、(7.10±2.01)d,明显少于对照组(P<0.05);观察组和对照组住院费用比较差异无统计学意义(P>0.05);观察组术后功能恢复明显好于对照组(P<0.05),其中优良率达到100%;观察组治疗后IL-6、TNF-α、CRP均低于对照组,组间比较差异具有统计学意义(P<0.05)。结论 VSD联合肌皮瓣移植术治疗胫骨开放性骨折并发慢性骨髓炎,具有疗效高、愈合快、疼痛轻等优点,值得临床推广应用。Objective To explore the effect of vacuum sealing drainage （VSD） combined with myocutaneous flap transplantation in treatment of patienst with open tibial fracture and chronic osteomyelitis. Methods The clinical data of 91 patients with chronic osteomyelitis complicated with open tibial fracture treated in the Department of Orthopaedics, Second Hospital of Dingzhou City, Hebei Province, during January 2016 to January 2017 were retrospectively analyzed. Patients in observation group were treated with VSD combined with myocutaneous flap transplantation, and patients in control group were treated with traditional flap transplantation.The cure rate, skin flap necrosis rate, healing time, hospitalization time and cost, postoperative pain, postoperative functional recovery and changes in blood levels of interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP） were observed in these two groups. Results The cure rate of observation group was 90.91%, which was significantly higher than that of control group （ P 〈0.05）. The necrotic rate of skin flap in observation group was 2.27% and the healing time was （14.16±3.24） days, which was significantly less than that of control group （ P 〈0.05）. Visual analogue scores （VAS） were （5.14±0.82） in observation group 3 days after operation, which was significantly lower than that of control group （ P 〈0.05）. The duration of pain and hospital stay in observation group were （4.41±1.03） d and （7.10±2.01） d, respectively, which were significantly less than those of control group （ P 〈0.05）. There was no significant difference in hospitalization expenses between observation group and control group （ P 〉0.05）. The postoperative functional recovery in observation group was significantly better than that of control group （ P 〈0.05）, and the excellent and good rate was 100%, and the levels of IL-6, TNF-α and CRP in observation group were significantly lower than those of control group �

关 键 词：胫骨开放性骨折 慢性骨髓炎 负压封闭引流术 肌皮瓣移植术 临床效果 

分 类 号：R687.3[医药卫生—骨科学]