附带负压吸引材料的外固定钢板在四肢开放性骨折中的应用
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摘要
目的探讨附带负压吸引材料的外固定钢板在四肢开放性骨折中的应用。方法 2013年12月—2016年12月铜川市人民医院治疗四肢开放性骨折患者100例,男性69例,女性31例;年龄21～61岁,平均38. 8岁;道路交通伤53例,碾压伤37例,高处坠落伤10例。依据治疗方法分为A组和B组,每组50例。A组给予常规外固定架联合负压封闭引流技术(VSD)治疗,B组给予附带负压吸引材料的外固定钢板治疗。比较分析两组换药次数、创面感染发生率、创面愈合时间、住院时间、骨折愈合时间、愈合优良率以及患者疼痛视觉模拟评分(VAS)。结果 B组换药次数[(2. 05±0. 61)次vs.(6. 46±1. 68)次]、创面感染发生率(6. 00%vs. 24. 00%)和创面愈合时间[(17. 42±2. 48) d vs.(26. 15±3. 05) d]、住院时间[(21. 75±2. 79) d vs.(28. 45±3. 48) d]、骨折愈合时间[(5. 98±0. 63)个月vs.(6. 74±0. 75)个月]明显低于A组,B组愈合优良率(96. 00%vs. 80. 00%)明显高于A组,差异有统计学意义(P <0. 05); A组和B组治疗后VAS评分[(1. 85±0. 35)分、(1. 02±0. 24)分]明显低于治疗前[(4. 62±0. 51)分、(4. 65±0. 53)分],但B组治疗后VAS评分明显低于A组,差异有统计学意义(P <0. 05)。结论附带负压吸引材料的外固定钢板治疗四肢开放性骨折可有效减少创面感染的发生,有利于缓解疼痛症状及提高创面、骨折愈合效果,值得临床进一步推广。
Objective To discuss the application of external fixed steel plate with vacuum sealing drainagein open extremity fractures. Methods Totally 100 patients with open extremity fractures were selected from Dec.2013 to Dec. 2016 in the People's Hospital of Tongchuan. There were 69 males and 31 females,with the averageage of 38. 8 years ( range,21-60 years). Injury causes included 53 road traffic injuries,37 crushing injuries and 10 falling injuries. According to the treatment method,they were divided into group A and group B,with 50 cases ineach group. Group A was given conventional external fixation plates combined vacuum sealing drainage (VSD) treatment,and group B was given external fixed steel plates with negative pressure drainage treatment. Comparisonand analysis of the frequency of dressing changes,incidence of wound infection,wound healing time,hospitalizationtime,fracture healing time,excellent and good rate of healing,and VAS between the two groups were carried out.Results The dressing change frequency ((2. 05 ± 0. 61) times vs.(6. 46 ± 1. 68) times),wound infection rate (6.00% vs. 24. 00%) and wound healing time ((17. 42 ± 2. 48) d vs.(26. 15 ± 3. 05) d),hospitalization time ((21. 75± 2. 79) d vs.(28. 45 ± 3. 48) d),fracture healing time ((5. 98 ± 0. 63) months vs.(6. 74 ± 0. 75) months) time ingroup B were significantly less than those in group A. The healing excellence rate (96. 00% vs. 80. 00%) in groupB was significantly higher than that in group A,and the difference was statistically significant ( P < 0. 05). VAS af-ter treatment in group A and group B ((1. 85 ± 0. 35) points,(1. 02 ± 0. 24) points) were significantly lower thanthose before treatment ((4. 62 ± 0. 51) points,(4. 65 ± 0. 53) points),but VAS score after treatment in the group Bwas significantly lower than that in group A,and the difference was statistically significant( P < 0. 05). Conclu-sion External fixed steel plates with vacuum sealing drainage can effectively reduce the wound infection in patientswith open extremity fractures,which is helpful to relieve pain symptoms and improve the effect of wound and fracturehealing of patients. It is worth for further clinical promotion.
Objective To discuss the application of external fixed steel plate with vacuum sealing drainagein open extremity fractures. Methods Totally 100 patients with open extremity fractures were selected from Dec.2013 to Dec. 2016 in the People's Hospital of Tongchuan. There were 69 males and 31 females,with the averageage of 38. 8 years ( range,21-60 years). Injury causes included 53 road traffic injuries,37 crushing injuries and 10 falling injuries. According to the treatment method,they were divided into group A and group B,with 50 cases ineach group. Group A was given conventional external fixation plates combined vacuum sealing drainage (VSD) treatment,and group B was given external fixed steel plates with negative pressure drainage treatment. Comparisonand analysis of the frequency of dressing changes,incidence of wound infection,wound healing time,hospitalizationtime,fracture healing time,excellent and good rate of healing,and VAS between the two groups were carried out.Results The dressing change frequency ((2. 05 ± 0. 61) times vs.(6. 46 ± 1. 68) times),wound infection rate (6.00% vs. 24. 00%) and wound healing time ((17. 42 ± 2. 48) d vs.(26. 15 ± 3. 05) d),hospitalization time ((21. 75± 2. 79) d vs.(28. 45 ± 3. 48) d),fracture healing time ((5. 98 ± 0. 63) months vs.(6. 74 ± 0. 75) months) time ingroup B were significantly less than those in group A. The healing excellence rate (96. 00% vs. 80. 00%) in groupB was significantly higher than that in group A,and the difference was statistically significant ( P < 0. 05). VAS af-ter treatment in group A and group B ((1. 85 ± 0. 35) points,(1. 02 ± 0. 24) points) were significantly lower thanthose before treatment ((4. 62 ± 0. 51) points,(4. 65 ± 0. 53) points),but VAS score after treatment in the group Bwas significantly lower than that in group A,and the difference was statistically significant( P < 0. 05). Conclu-sion External fixed steel plates with vacuum sealing drainage can effectively reduce the wound infection in patientswith open extremity fractures,which is helpful to relieve pain symptoms and improve the effect of wound and fracturehealing of patients. It is worth for further clinical promotion.
引文
[1]李开浪.外固定器结合封闭负压引流在四肢骨关节严重开放性骨折患者中的应用效果[J].医疗装备,2017,30(2):10-11.
[2]Hossain E,Dugar N,Garg AK,et al.Comparative results of treatment of open diaphyseal fractures of tibia by the use of commonly used external fixators[J].Indian Med Assoc,2013,111(12):830-832.
[3]杨卫强,蒋振刚,郭新军,等.锁定钢板外固定术联合局部负压吸引治疗儿童下肢开放性骨折36例[J].山东医药,2015,55(39):32-34.
[4]刘小明,胡耀华.四肢开放性骨折合并血管损伤的诊断与治疗[J].实用临床医学,2015,16(7):49-50.
[5]罗志先,王非.应用单侧外固定支架急诊治疗GustiloⅢ型开放性损伤[J].中国骨科临床与基础研究杂志,2016,8(4):228-231.
[6]胡冬平.活血祛瘀汤对手法复位夹板外固定治疗桡、尺骨干双骨折后疼痛、肢体肿胀的影响[J].中国现代医生,2016,54(33):12-14.
[7]杨敬,王强,朱伟,等.外固定架联合负压封闭引流在开放性骨折中的应用[J].中国煤炭工业医学杂志,2016,18(4):549-551.
[8]Ziran BH,Becher SJ.Radiographic predictors of compartment syndrome in tibial plateau fractures[J].Orthop Trauma,2013,27(11):612-615.
[9]程建文,苏伟,谭桢,等.Ilizarov外固定联合负压封闭引流修复四肢骨折合并骨筋膜室综合征[J].中国组织工程研究,2014,18(44):7162-7166.
[10]王辉,谭家昌,杨有猛,等.负压吸引结合微创分期策略治疗胫腓骨开放性骨折[J].创伤外科杂志,2016,18(7):432-434.
[11]李乔,谭进红,马小明,等.锁定钢板外置与外固定支架固定骨折的生物力学研究[J].组织工程与重建外科,2015,11(5):320-322.
[12]孙旭东,王金华,沈祥,等.外固定支架结合负压封闭引流技术在GustiloⅢ型开放性骨折中的应用[J].安徽医学,2013,34(5):560-562.
[13]罗忠纯,刘凯,宋春林,等.锁定钢板外置和外支架固定治疗开放性胫骨骨折的临床疗效比较[J].华西医学,2015,30(7):1213-1216.
[14]Prasarn ML,Ahn J,Achor TS,et al.Acute compartment syndrome in patients with tibia fractures transferred for definitive fracture care[J].Am J Orthop(Belle Mead N J),2014,43(4):173-177.
[15]王军,鲁敏,李临齐.单侧多功能外固定支架与钢板内固定治疗开放性胫腓骨骨折的疗效比较[J].海南医学,2016,27(24):4087-4089.
[16]Valdez C,Schroeder E,Amdur R,et al.Serum creatine kinase levels are associated with extremity compartment syndrome[J].Trauma Acute Care Surg,2013,74(2):441-445.
[17]柳申鹏,万广,梁秋冬,等.外固定架结合泡沫敷料覆盖负压引流修复软组织严重损伤的四肢开放性骨折[J].中国组织工程研究,2014,18(44):7157-7161.
[18]Mc Queen MM,Duckworth AD,Aitken SA,et al.The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome[J].Bone Joint Surg(Am),2013,95(8):673-677.
[19]王旭.VSD加外固定架在四肢开放性骨折中的应用[J].中国现代药物应用,2013,7(24):77-78.
[20]康映泉,邱宏,何少华,等.负压封闭引流在儿童四肢软组织缺损治疗中的应用[J].创伤外科杂志,2013,15(5):425-427.
[2]Hossain E,Dugar N,Garg AK,et al.Comparative results of treatment of open diaphyseal fractures of tibia by the use of commonly used external fixators[J].Indian Med Assoc,2013,111(12):830-832.
[3]杨卫强,蒋振刚,郭新军,等.锁定钢板外固定术联合局部负压吸引治疗儿童下肢开放性骨折36例[J].山东医药,2015,55(39):32-34.
[4]刘小明,胡耀华.四肢开放性骨折合并血管损伤的诊断与治疗[J].实用临床医学,2015,16(7):49-50.
[5]罗志先,王非.应用单侧外固定支架急诊治疗GustiloⅢ型开放性损伤[J].中国骨科临床与基础研究杂志,2016,8(4):228-231.
[6]胡冬平.活血祛瘀汤对手法复位夹板外固定治疗桡、尺骨干双骨折后疼痛、肢体肿胀的影响[J].中国现代医生,2016,54(33):12-14.
[7]杨敬,王强,朱伟,等.外固定架联合负压封闭引流在开放性骨折中的应用[J].中国煤炭工业医学杂志,2016,18(4):549-551.
[8]Ziran BH,Becher SJ.Radiographic predictors of compartment syndrome in tibial plateau fractures[J].Orthop Trauma,2013,27(11):612-615.
[9]程建文,苏伟,谭桢,等.Ilizarov外固定联合负压封闭引流修复四肢骨折合并骨筋膜室综合征[J].中国组织工程研究,2014,18(44):7162-7166.
[10]王辉,谭家昌,杨有猛,等.负压吸引结合微创分期策略治疗胫腓骨开放性骨折[J].创伤外科杂志,2016,18(7):432-434.
[11]李乔,谭进红,马小明,等.锁定钢板外置与外固定支架固定骨折的生物力学研究[J].组织工程与重建外科,2015,11(5):320-322.
[12]孙旭东,王金华,沈祥,等.外固定支架结合负压封闭引流技术在GustiloⅢ型开放性骨折中的应用[J].安徽医学,2013,34(5):560-562.
[13]罗忠纯,刘凯,宋春林,等.锁定钢板外置和外支架固定治疗开放性胫骨骨折的临床疗效比较[J].华西医学,2015,30(7):1213-1216.
[14]Prasarn ML,Ahn J,Achor TS,et al.Acute compartment syndrome in patients with tibia fractures transferred for definitive fracture care[J].Am J Orthop(Belle Mead N J),2014,43(4):173-177.
[15]王军,鲁敏,李临齐.单侧多功能外固定支架与钢板内固定治疗开放性胫腓骨骨折的疗效比较[J].海南医学,2016,27(24):4087-4089.
[16]Valdez C,Schroeder E,Amdur R,et al.Serum creatine kinase levels are associated with extremity compartment syndrome[J].Trauma Acute Care Surg,2013,74(2):441-445.
[17]柳申鹏,万广,梁秋冬,等.外固定架结合泡沫敷料覆盖负压引流修复软组织严重损伤的四肢开放性骨折[J].中国组织工程研究,2014,18(44):7157-7161.
[18]Mc Queen MM,Duckworth AD,Aitken SA,et al.The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome[J].Bone Joint Surg(Am),2013,95(8):673-677.
[19]王旭.VSD加外固定架在四肢开放性骨折中的应用[J].中国现代药物应用,2013,7(24):77-78.
[20]康映泉,邱宏,何少华,等.负压封闭引流在儿童四肢软组织缺损治疗中的应用[J].创伤外科杂志,2013,15(5):425-427.