封闭式负压引流结合改良抗生素骨水泥体表半开放技术治疗慢性溃疡创面  

Effectiveness of vacuum sealing drainage combined with modified external fixation antibiotic-impregnated cement semi-open technique in treating chronic ulcer wounds

作　　者：林金銮[1,2,3] 谢昀 郑力峰[1,2,3] 方凯彬 林建华[1,2,3] LIN Jinluan;XIE Yun;ZHENG Lifeng;FANG Kaibin;LIN Jianhua(Department of Orthopaedics,the First Affiliated Hospital,Fujian Medical University,Fuzhou Fujian,350005,P.R.China;Department of Orthopaedics,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou Fujian,350212,P.R.China;Fujian Institute of Orthopaedics,Fuzhou Fujian,350005,P.R.China;Department of Orthopaedics,the Second Affiliated Hospital,Fujian Medical University,Quanzhou Fujian,362000,P.R.China)

机构地区：[1]福建医科大学附属第一医院骨科,福州350005 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心骨科,福州350212 [3]福建省骨科研究所,福州350005 [4]福建医科大学附属第二医院骨科,福建泉州362000

出　　处：《中国修复重建外科杂志》2024年第9期1117-1122,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：福建省科技创新联合资金资助(2023Y9064);福建省卫生健康面向农村和城市社区推广适宜技术资助计划(2023TG013);福建省引导性科技计划项目(2023Y0016)。

摘　　要：目的探讨清创-封闭式负压引流(vacuum sealing drainage,VSD)-体表薄片抗生素骨水泥半开放外置序贯方案治疗慢性溃疡创面疗效。方法回顾性分析2019年1月—2023年6月收治且符合选择标准的43例慢性溃疡创面患者临床资料。其中,采用清创-VSD-体表薄片抗生素骨水泥半开放外置序贯方案治疗23例(改良组),清创-VSD-传统骨水泥技术覆盖治疗20例(对照组)。两组患者性别、年龄、合并2型糖尿病患者构成比、存在吸烟史患者构成比、身体质量指数、创面部位等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组创面愈合质量及愈合时间、骨水泥覆盖后细菌培养阳性率、骨水泥松动率以及手术次数、住院次数、住院时间、住院费用。结果与对照组相比,改良组骨水泥覆盖后创面细菌培养阳性率及骨水泥松动率低,手术次数、住院次数、住院时间以及住院费用均减少,差异有统计学意义(P<0.05)。两组患者均完成创面修复,无截肢患者;改良组创面愈合质量优于对照组,创面愈合时间更短,差异均有统计学意义(P<0.05)。患者均获随访,随访时间1~5年,平均3.4年。随访期间创面溃疡均无复发。结论清创-VSD-体表薄片抗生素骨水泥半开放外置序贯方案治疗慢性溃疡创面,可有效减少骨水泥松动发生,利于诱导膜形成及创面愈合,明显减少手术次数及住院时间。Objective To investigate the effectiveness of debridement-vacuum sealing drainage(VSD)-modified external fixation antibiotic-impregnated cement semi-open technique in treatment of chronic ulcer wounds.Methods Clinical data of 43 patients with chronic ulcer wounds who met the selection criteria and admitted between January 2019 and June 2023 were retrospectively analyzed.Among them,23 cases were treated with debridement-VSDmodified external fixation antibiotic-impregnated cement semi-open technique(improved group),and 20 cases were treated with debridement-VSD-traditional antibiotic-impregnated cement technique(control group).There was no significant difference in gender,age,constituent ratio of patients with type 2 diabetes mellitus,constituent ratio of patients with smoking history,body mass index,wound site,and other baseline data between the two groups(P>0.05).The healing quality and healing time,the positive rate of bacterial culture after bone cement coating,the loosening rate of bone cement,the number of operations,the number of hospitalizations,the length of hospitalization,and the cost of hospitalization were recorded and compared between the two groups.Results Compared with the control group,the positive rate of bacterial culture after bone cement coating and the loosening rate of bone cement in the improved group was significantly lower,as well as the number of operations,the number of hospitalizations,the length of hospitalization,and hospitalization cost significantly reduced(P<0.05).Wound repair was completed in both groups without amputation.The wound healing quality of the improved group was better than that of the control group and the wound healing time was shorter,the differences were significant(P<0.05).All patients were followed up 1-5 years(mean 3.4 years),and no ulcers recurred during follow-up.Conclusion Debridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique in the treatment of chronic ulcer wounds can effectively reduce the loosening rate of bone cemen

关 键 词：慢性溃疡创面 序贯治疗 封闭式负压引流 改良抗生素骨水泥技术 诱导膜 

分 类 号：R641[医药卫生—外科学]