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

doi:10.6040/j.issn.1671-7554.1.2015.001

摘要/Abstract

摘要： 目的研究单侧外固定支架结合负压封闭引流技术(VSD)治疗胫腓骨Gustilo Ⅲ型骨折的临床疗效。方法从2010年7月至2015年4月我科收治的胫腓骨Gustilo Ⅲ型骨折患者中选取57例为观察组,行单侧外固定支架结合VSD治疗;选取2006年7月至2010年6月在我科行切开复位钢板内固定术的同类患者59例为对照组。观察两组平均骨性愈合时间、住院时间、术中出血量及术后并发症的发生情况。所有患者随访半年,观察两组的疗效。结果观察组平均骨性愈合时间(180.65±30.36)d、住院时间(27.84±3.87)d、术中出血量(393.56±12.09)mL,分别低于对照组(340.00±40.51)d、(46.27±4.84)d、(545.36±50.40)mL,差异有统计学意义(P均<0.05)。观察组骨髓炎发生率1.75%、浅表感染率5.26%、畸形愈合发生率0.00%,分别低于对照组11.86%、21.05%、8.47%,差异有统计学意义(P均<0.05)。观察组疗效优者占比80.70%、优良率91.23%,均分别高于对照组的61.02%、77.97%,差异有统计学意义(P均<0.05)。结论单侧外固定支架结合VSD治疗胫腓骨Gustilo Ⅲ型骨折,不仅有利于骨折愈合,而且可缩短患者住院时间并减少并发症的发生。

关键词: Gustilo Ⅲ型骨折, 胫腓骨, 负压封闭引流技术, 单侧外固定支架

Abstract: Objective To explore the clinical outcome of unilateral external fixator combined with vacuum sealing drainage (VSD) technology in the treatment of tibiofibula Gustilo Ⅲ type fracture. Methods A total of 57 patients who were treated with unilateral external fixator combined with VSD from July 2010 to April 2015 were taken as observation group, and 59 patients who were treated with open reduction and plate fixation from July 2006 to June 2010 were selected as control group. The average osseous healing time, length of hospital staying, intraoperative blood loss and postoperative complications of the two groups were observed. All the patients were followed up for half a year. Results The average osseous healing time[(180.65±30.36)d], length of hospital staying[(27.84±3.87)d], intraoperative blood loss[(393.56±12.09)mL] in observation group were significantly lower than those of control group[(340.00±40.51)d, (46.27±4.84)d and (545.36±50.40)mL, all P<0.05]. The osteomyelitis rate(1.75%), superficial infection rate(5.26%) and malunion rate(0.00%) in observation group were respectively lower than those in control group (11.86%, 21.05%, 8.47%, all P<0.05). The rates of good and excellent/good in observation group were 80.70% and 91.23%, which were significantly higher than those in control group (61.02% and 77.97%, all P<0.05). Conclusion Unilateral external fixator combined with VSD is a good way to treat tibiofibula Gustilo Ⅲ type fracture, which is beneficial to fracture healing and can reduce the length of hospital stay and complications.

Key words: Closed negative pressure drainage technology, Tibiofibula, Gustilo Ⅲ type fracture, Unilateral external fixator

中图分类号:

R683.42

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.

DONG Wuping. Clinical outcome of unilateral external fixator combined with closed negative pressure drainage technology in the treatment of tibiofibula Gustilo Ⅲ type fracture[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(9): 86-89.

参考文献

[1] 廖凯男,卞则栋,熊耕,等.自体真皮结合负压封闭引流技术治疗小儿感染性创面研究[J]. 中华医院感染学杂志,2015,1(1):206-208. LIAO Kainan, BIAN Zedong, XIONG Geng, et al. Clinical effect of autologous dermis combined with vacuum sealing drainage on treatment of children with wound infections[J]. Chinese Journal of Nosocomiology, 2015, 1(1):206-208.
[2] 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]. 安微医学,2013,34(5):44-46. SUN Xudong, WANG Jinhua, SHEN Xiang, et al. External fixation combined with the application of VSD in the treatment of open fractures of Gustilo Ⅲ[J]. Anhui Medical Journal, 2013, 34(5):44-46.
[3] 张亮,刘文军,金涛,等. 胫骨骨折内侧锁定板固定术后感染的病原菌分布及相关因素分析[J]. 中华医院感染学杂志,2014,24(2):450-452. ZHANG Liang, LIU Wenjun, JIN Tao, et al. Distribution of pathogens causing infections in tibial fractures patients after medial locking plate fixation and influencing factors[J]. Chinese Journal of Nosocomiology, 2014, 24(2):450-452.
[4] 杨明辉,朱仕文,高志强,等. 跨关节外固定架联合克氏针治疗开放性桡骨远端骨折[J]. 中华医学杂志,2014,1(22):1729-1932. YANG Minghui, ZHU Shiwen, GAO Zhiqiang, et al. Outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire fixation[J]. National Medical Journal of China, 2014, 1(22):1729-1932.
[5] 许桦,马海涛,毕大卫,等. 腓骨前方外侧入路治疗GustiloⅢ型胫腓骨远端骨折[J]. 中国骨伤,2012,25(8):29-31. XU Hua, MA Haitao, BI Dawei, et al. Treatment of Gustilo Ⅲ distal tibiofibula fractures through trans-fibular anterior-lateral approach[J]. China Journal of Orthopaedics and Traumatology, 2012, 25(8):29-31.
[6] 胡锐,任义军,严立,等. 一期内固定联合皮瓣移植治疗下肢GustiloⅢB型开放性骨折并严重软组织缺损[J].中华显微外科杂志,2014,1(6):560-563. HU Rui, REN Yijun, YAN Li, et al. Primary internal fixation combined with flap transfer to treat Gustilo-ⅢB open fractures of lower extremity with severe soft tissue defect[J]. Chinese Journal of Microsurgery, 2014, 1(6):560-563.
[7] Wei SJ, Cai XH, Wang HS, et al. A comparison of primary and delayed wound closure in severe open tibial fractures initially treated with internal fixation and vacuum-assisted wound coverage: a case-controlled study[J]. Int J Surg, 2014, 12(7):688-694.
[8] 黄武君,裘曙文,何勇. 132例胫腓骨开放性骨折创口感染回顾性分析[J]. 中华医院感染学杂志,2011,21(14):2918-2920. HUANG Wujun, QIU Shuwen, HE Yong. Wound infections in 132 patients with open tibia and fibula fractures: a retrospective analysis[J]. Chinese Journal of Nosocomiology, 2011, 21(14):2918-2920.
[9] 姚隽,吕振京,宋会江,等. 对微型外固定支架治疗掌指骨开放性粉碎性骨折应用的临床分析[J]. 中华显微外科杂志,2014,37(5):513-515.
[10] 黄彬,陈伟明,黄勇仪,等. 游离皮瓣联合VSD技术治疗前臂大面积皮肤软组织缺损[J]. 中华显微外科杂志,2015,38(1):90-92.
[11] 李志君,郑玉鹏,王坤,等. 清创后外固定支架固定治疗Gustilo Ⅲ型重度胫腓骨开放性骨折[J]. 中医正骨,2012,24(12):38-39.
[12] Malhotra AK, Goldberg S, Graham J, et al. Open extremity fractures: impact of delay in operative debridement and irrigation[J]. J Trauma Acute Care Surg, 2014, 76(5):1201-1207.
[13] 汪凯,王明刚,赵李平,等. 持续负压封闭引流预防腹股沟淋巴结清扫术后淋巴漏[J]. 中华整形外科杂志,2014,30(4):262-264. WANG Kai, WANG Minggang, ZHAO Liping, et al. The role of continuous vacuum sealing drainage in the prevention of lymph leakage after inguinal lymph nodes dissection[J]. Chinese Journal of Plastic Surgery, 2014, 30(4):262-264.
[14] 温添林,杨惠林,张志明,等.单臂多功能外固定支架治疗胫腓骨开放性粉碎性骨折[J].海南医学,2009,20(1):27-29. WEN Tianlin, YANG Huilin, ZHANG Zhiming, et al. Treatment of open tibia-fibula shatter fracture with single lateral multifunctional external fixator[J]. Hainan Medical Journal, 2009,20(1):27-29.
[15] 诸利梅,何斐英,韦小花,等. 负压封闭引流技术在骨伤感染创面修复中的应用研究[J]. 中华医院感染学杂志,2014,1(11):2790-2792. ZHU Limei, HE Feiying, WEI Xiaohua, et al. The application efficacy observation of the vacuum sealing drainage technology in the treatment of the fractures infected wounds[J]. Chinese Journal of Nosocomiology, 2014, 1(11):2790-2792.

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