真空负压封闭技术加外固定器治疗肢体开放性骨折

Treatment of severe open limb fractures with vacuum sealing technique and external fixator

目的探讨真空负压封闭技术(VS)加外固定器治疗四肢严重开放性骨折的效果。方法近4年来收治63例四肢严重开放性骨折患者,采用VS加外固定器治疗,清创后骨折用Orthofix单边外固定器固定,创面或创腔内用Vacuseal材料覆盖,接负压封闭吸引,6～10d后二期缝合、植皮或皮瓣转移。结果63例患者创面均愈合,浅表感染3例(4.8%)和针道感染13例19针(7.5%);骨折愈合53例(84.1%),延迟愈合或不愈合10例(15.9%)。平均愈合时间6.5个月。结论VS技术结合外固定架固定治疗四肢严重开放性骨折,在迅速有效地稳定骨折的同时,能安全有效地封闭创面,缩短二期创面修复时间,促进骨折愈合,减少并发症;其方法简单有效,值得临床推广应用。

Objective To evaluate the effects of the management of severe open limb fractures with external fixator and vacuum sealing technique (VS). Methods 63 patients with severe open limb fractures were treated with external fixator following debridement. Their wound surfaces or cavities were filled with Polyvinyl alcohol foams with embedded drainage tubes connected to a vacuum bottle. The wounds were closed with secondary suturing, or free flap,or loco-regional flap 6 to 10 days later. Results The wounds of the 63 patients all healed. Pintract infection occurred in l3 cases with l9 tracts (7.5%) and superficial infection in 3 cases (4.8%). 53 cases (84.1%) had bone primary union, and 10 (15.9%) delayed union or nonunion. The average union time was 6.5 months. Conclusion VS technique combined with Orthofix external fixator is a simple and effective treatment method for severe open limb fractures, because it can provide effective and rapid fixation, seal wounds, shorten secondary healing time of wounds, facilitate fracture union and prevent complications.