VSD技术治疗Gustilo Ⅲ型开放性骨折术后慢性难愈性创面感染的临床价值
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摘要
目的探讨GustiloⅢ型开放性骨折术后慢性难愈性创面感染治疗中应用负压封闭引流(VSD)技术的临床价值。方法选取2016年6月-2017年8月医院收治的78例GustiloⅢ型开放性骨折手术治疗后出现慢性难愈性创面感染患者作为研究对象,随机分为试验组和对照组,每组39例。对照组患者采用常规药物治疗,试验组患者采用VSD技术治疗,比较两组患者治疗总有效率、并发症发生率、术后康复出院时间及术后白细胞计数、血沉及C-反应蛋白等指标改善情况。结果试验组治疗总有效率高于对照组(χ2=5.708,P=0.017);后期随访调查发现,试验组发生畸形愈合、患肢功能障碍及骨髓炎等并发症概率低于对照组(χ2=7.415,P=0.006);试验组患者康复出院时间短于对照组(P<0.05);治疗后试验组患者白细胞计数、血沉及C-反应蛋白指标改善情况优于对照组(P<0.05);GustiloⅢ型开放性骨折术后慢性难愈性创面感染患者共检出84株病原菌,其中革兰阳性菌51株占60.71%。结论 GustiloⅢ型开放性骨折术后慢性难愈性创面感染患者采用负压封闭引流治疗效果较好,提升了创面愈合速率,缩短了患者住院时间,不良反应少,治疗安全性高。
OBJECTIVE To explore the clinical value of vacuum sealing drainage(VSD)in treatment of Gustilo typeⅢ open fracture patients with postoperative chronic refractory wound infection.METHODS From Jun 2016 to Aug,2017,a total of 78 patients with Gustilo typeⅢ open fracture who had chronic refractory wound infection after surgical procedures were recruited as the study objects and randomly divided into the experimental group and the control group,with 39 cases in each group.The control group was treated with conventional drugs,while the experimental group was treated with VSD.The total effective rate of treatment,incidence of complications and time of postoperative rehabilitation and discharge as well as postoperative white blood cell counts,erythrocyte sedimentation rate(ESR)and C-reactive protein were observed and compared between the two groups of patients.RESULTS The total effective rate of treatment of the experimental group was 94.87%(37/39),significantly higher than 84.62%(33/39)of the control group(χ2=5.708,P=0.017).The follow-up result indicated that the incidence rates of complications such as malunions,dysfunction of affected extremity and osteomyelitis were significantly lower in the experimental group than in the control group(χ2=7.415,P=0.006).The time of rehabilitation and discharge of the experimental group was significantly shorter than that of the control group(P<0.05).The white blood cell counts,ESR and C-reactive protein were significantly improved better in the experimental group than in the control group after the treatment(P<0.05).Totally 84 strains of pathogens were isolated from the Gustilo typeⅢ open fracture patients with postoperative chronic refractory wound infection.CONCLUSION VSD may achieve remarkable curative effect on the Gustilo typeⅢopen fracture patients with postoperative chronic refractory wound infection,raise the wound healing rate,shorten the length of hospital stay and lead to less adverse reactions,with the safety high.
OBJECTIVE To explore the clinical value of vacuum sealing drainage(VSD)in treatment of Gustilo typeⅢ open fracture patients with postoperative chronic refractory wound infection.METHODS From Jun 2016 to Aug,2017,a total of 78 patients with Gustilo typeⅢ open fracture who had chronic refractory wound infection after surgical procedures were recruited as the study objects and randomly divided into the experimental group and the control group,with 39 cases in each group.The control group was treated with conventional drugs,while the experimental group was treated with VSD.The total effective rate of treatment,incidence of complications and time of postoperative rehabilitation and discharge as well as postoperative white blood cell counts,erythrocyte sedimentation rate(ESR)and C-reactive protein were observed and compared between the two groups of patients.RESULTS The total effective rate of treatment of the experimental group was 94.87%(37/39),significantly higher than 84.62%(33/39)of the control group(χ2=5.708,P=0.017).The follow-up result indicated that the incidence rates of complications such as malunions,dysfunction of affected extremity and osteomyelitis were significantly lower in the experimental group than in the control group(χ2=7.415,P=0.006).The time of rehabilitation and discharge of the experimental group was significantly shorter than that of the control group(P<0.05).The white blood cell counts,ESR and C-reactive protein were significantly improved better in the experimental group than in the control group after the treatment(P<0.05).Totally 84 strains of pathogens were isolated from the Gustilo typeⅢ open fracture patients with postoperative chronic refractory wound infection.CONCLUSION VSD may achieve remarkable curative effect on the Gustilo typeⅢopen fracture patients with postoperative chronic refractory wound infection,raise the wound healing rate,shorten the length of hospital stay and lead to less adverse reactions,with the safety high.
引文
[1]林鹤,郭宗科,韩兵,等.桥式游离背阔肌肌皮瓣联合VSD技术修复小腿GustiloⅢC型骨折创面[J].中国美容医学杂志,2016,25(2):1-4.
[2] Ovaska MT,Madanat R,Makinen TJ.Predictors of postoperative wound necrosis following primary wound closure of open ankle fractures[J].Foot Ankle Int,2016,37(4):401-406.
[3]吕召民,孙凯,江华.胫腓骨GustiloⅢ型骨折患者负压封闭引流技术联合外固定支架治疗的临床研究[J].临床与病理杂志,2016,36(7):983-989.
[4]钟健,于海龙,荆延峰,等.早期应用VSD技术联合抗生素占位器治疗26例成人GustiloⅢB型胫骨干开放性骨折的疗效[J].中国临床实用医学,2016,7(5):30-33.
[5]崔正军,王常印,邹仕波.各种慢性难愈性创面的分类和治疗策略[C]//全国烧伤救治专题研讨会暨福建省第八次烧伤外科学术研讨会,2013.
[6] Gumbel D,Matthes G,Napp M,et al.Current management of open fractures:results from an online survey[J].Arch Orthop Trauma Surg,2016,136(12):1663-1672.
[7]周斌,陈勇杰,唐令.GustiloⅢ型胫腓骨开放性骨折急诊清创后伤口闭合的时机与方法选择[J].浙江创伤外科,2015,20(5):878-880.
[8]董吴平.单侧外固定支架结合负压封闭引流技术治疗胫腓骨GustiloⅢ型骨折的疗效[J].山东大学学报(医学版),2015,53(9):86-89.
[9]杨雷刚,杨云刚,杨秀明,等.I期VSD灌洗下保留游离骨块加髂骨植骨治疗Gustilo I、Ⅱ、ⅢA型开放骨缺损[J].生物骨科材料与临床研究,2015,12(3):31-34.
[10]史满玉,李连涌,李昭铸,等.负压封闭引流结合外固定支架在儿童胫腓骨开放性骨折GustiloⅢ型治疗中的应用[J].哈尔滨医科大学学报,2016,50(4):350-353.
[11]张先燎,黄六英,刘建建,等.改良间歇负压封闭引流(VSD)联合外科皮瓣对胫腓骨中下段GustiloⅢ型骨折临床疗效分析[J].中国当代医药,2017,24(13):66-68.
[12] Ondari JN,Masika MM,Ombachi RB,et al.Unblinded randomized control trial on prophylactic antibiotic use in gustilo II open tibia fractures at Kenyatta National Hospital,Kenya[J].Injury,2016,47(10):2288-2293.
[13]韦文军,蒋礼源,郑小春,等.外固定架联合负压封闭引流技术治疗GustiloⅢ型胫骨开放性骨折65例[J].广西中医药大学学报,2015,18(2):43-45.
[14]饶义康,文云,高勇,等.开放性植骨结合负压封闭引流在GustiloⅢ型四肢骨折的临床应用研究[J].中国医学创新,2016,13(16):108-111.
[2] Ovaska MT,Madanat R,Makinen TJ.Predictors of postoperative wound necrosis following primary wound closure of open ankle fractures[J].Foot Ankle Int,2016,37(4):401-406.
[3]吕召民,孙凯,江华.胫腓骨GustiloⅢ型骨折患者负压封闭引流技术联合外固定支架治疗的临床研究[J].临床与病理杂志,2016,36(7):983-989.
[4]钟健,于海龙,荆延峰,等.早期应用VSD技术联合抗生素占位器治疗26例成人GustiloⅢB型胫骨干开放性骨折的疗效[J].中国临床实用医学,2016,7(5):30-33.
[5]崔正军,王常印,邹仕波.各种慢性难愈性创面的分类和治疗策略[C]//全国烧伤救治专题研讨会暨福建省第八次烧伤外科学术研讨会,2013.
[6] Gumbel D,Matthes G,Napp M,et al.Current management of open fractures:results from an online survey[J].Arch Orthop Trauma Surg,2016,136(12):1663-1672.
[7]周斌,陈勇杰,唐令.GustiloⅢ型胫腓骨开放性骨折急诊清创后伤口闭合的时机与方法选择[J].浙江创伤外科,2015,20(5):878-880.
[8]董吴平.单侧外固定支架结合负压封闭引流技术治疗胫腓骨GustiloⅢ型骨折的疗效[J].山东大学学报(医学版),2015,53(9):86-89.
[9]杨雷刚,杨云刚,杨秀明,等.I期VSD灌洗下保留游离骨块加髂骨植骨治疗Gustilo I、Ⅱ、ⅢA型开放骨缺损[J].生物骨科材料与临床研究,2015,12(3):31-34.
[10]史满玉,李连涌,李昭铸,等.负压封闭引流结合外固定支架在儿童胫腓骨开放性骨折GustiloⅢ型治疗中的应用[J].哈尔滨医科大学学报,2016,50(4):350-353.
[11]张先燎,黄六英,刘建建,等.改良间歇负压封闭引流(VSD)联合外科皮瓣对胫腓骨中下段GustiloⅢ型骨折临床疗效分析[J].中国当代医药,2017,24(13):66-68.
[12] Ondari JN,Masika MM,Ombachi RB,et al.Unblinded randomized control trial on prophylactic antibiotic use in gustilo II open tibia fractures at Kenyatta National Hospital,Kenya[J].Injury,2016,47(10):2288-2293.
[13]韦文军,蒋礼源,郑小春,等.外固定架联合负压封闭引流技术治疗GustiloⅢ型胫骨开放性骨折65例[J].广西中医药大学学报,2015,18(2):43-45.
[14]饶义康,文云,高勇,等.开放性植骨结合负压封闭引流在GustiloⅢ型四肢骨折的临床应用研究[J].中国医学创新,2016,13(16):108-111.