灌注引流在肘关节恐怖三联征的应用  

Irrigation combined vacuum sealing drainage used after open reduction and internal fixation for terrible triad of the elbow

作　　者：何晓[1] 杨佳瑞 冯泉 李杰[1] 衡立松 张堃[3] HE Xiao;YANG Jia-rui;FENG Quan;LI Jie;HENG Li-song;ZHANG Kun(Yan'an University,Yan'an 716000,China;Xi'an Medical University,Xi’an 710068,China;Department of Traumatic Orthopaedics,Honghui Hospital,College of Medicine,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]延安大学,陕西延安716000 [2]西安医学院,陕西西安710068 [3]西安交通大学附属西安市红会医院创伤骨科,陕西西安710054

出　　处：《中国矫形外科杂志》2021年第4期307-311,共5页Orthopedic Journal of China

基　　金：陕西省社发攻关项目(编号:2017SF-197)。

摘　　要：[目的]探究灌注联合真空封闭引流(vacuum sealing drainage,VSD)在肘关节恐怖三联征应用的临床效果。[方法]回顾性分析2016年1月~2018年12月采用开放复位内固定治疗肘关节恐怖三联征患者74例,其中38例术毕时放置灌注联合VSD(灌注引流组),36例术后仅放置引流管(单纯引流组)。比较两组患者围手术期、随访和影像等资料。[结果]两组患者均顺利完成手术,术中无血管、神经等损伤,灌注引流组引流放置时间和灌注引流量显著大于单纯引流组(P<0.05)。与术后6个月相比,末次随访时两组患者疼痛视觉模拟评分(visual analogue scale,VAS)评分均显著减少(P<0.05),而肘关节伸屈旋转活动度(range of motion,ROM)、前臂旋转ROM和Mayo评分均显著增加(P<0.05)。术后6个月和末次随访时,灌注引流组的VAS评分、肘关节伸屈ROM、前臂旋转ROM和Mayo评分均显著优于单纯引流组(P<0.05)。影像方面,异位骨化的时间均在术后1-3个月,灌注引流组发生率为5.26%,单纯引流组25.00%,两组间差异有统计学意义(P<0.05)。但是,两组间骨折愈合时间比较差异无统计学意义(P>0.05)。[结论]肘关节恐怖三联征骨折内固定术后放置灌注冲洗联合VSD可显著减少肘关节异位骨化发生,利于功能恢复。[Objective]To explore the clinical outcomes of irrigation combined with vacuum sealing drainage(VSD)used after open reduction and internal fixation for terrible triad of the elbow.[Methods]A retrospective study was conducted on 74 patients who underwent open reduction and internal fixation(ORIF)for terrible triad of the elbow in our hospital from January 2016 to December 2018.Of them,38 patients had irrigation combined with VSD after operation ORIF,while the remaining 36 patients received conventional suction-drainage only.The perioperative,follow-up and imaging data were compared between the two.[Results]All the patients in both groups had operation finished successfully without vascular and nerve injury during the operation.The irrigation-drainage group had significantly greater drainage volume and drainage time than the drainage-only group(P<0.05).The VAS score in activity significantly decreased(P<0.05),whereas the elbow flexion-extension and forearm rotation range of motions(ROM),as well as Mayo score significantly increased at the latest follow-up compared with those at 6 months postoperatively(P<0.05).The irrigation-drainage group proved significantly superior to the drainage-only group in VAS,ROM and Mayo scores at 6 months and the latest follow-up(P<0.05).With regard to radiographic assessment,heterotopic ossification,happened mainly in 1 to 3 months after operation,was with incidence of 5.26%in the irrigation-drainage group,whereas 25.00%in the drainage-only group,which was statistically significant(P<0.05).However,there was no a statisitical difference in fracture healing time between the two groups(P>0.05).[Conclusion]The irrigation combined with VSD used after ORIF for terrible triad of the elbow does reduce the chance of heterotopic ossification,and improve functional recovery.

关 键 词：肘关节恐怖三联征 开放复位内固定 灌注 引流 

分 类 号：R687[医药卫生—骨科学]