负压封闭吸引治疗创伤性慢性骨髓炎的近期疗效

Clinical Efficacy of Vacuum Sealing Drainage in Treating Traumatic Chronic Osteomyelitis

目的探讨负压封闭吸引(vacuum sealing drainage,VSD)敷料在创伤性慢性骨髓炎治疗中的作用。方法 2006年6月-2009年8月收治13例创伤后慢性骨髓炎有较多脓性渗出物患者,其中男9例,女4例;年龄8～56岁,平均34岁。车祸致胫骨开放性骨折9例;腓骨骨折1例;高处坠落致跟骨开放性骨折2例;股骨骨折1例,术后均合并慢性骨髓炎,病程11～35个月。于病灶清除后,先采用VSD治疗,待创面清洁、骨面有肉芽组织形成后,8例直接二期缝合伤口,4例通过带蒂肌皮瓣或皮瓣修复创面,1例采用背阔肌皮瓣游离移植修复创面。结果使用VSD平均吸引18d,更换VSD平均2.1次。创面渗出物逐渐减少,创面面积减小,经二期缝合、皮瓣移植等方法封闭创面。13例患者经6～31个月随访,慢性创伤后骨髓炎均治愈,无复发。结论采用VSD治疗创伤性慢性骨髓炎具有引流充分、炎症控制快、创面肉芽组织生长快、骨髓炎复发率低的优点。

Objective To evaluate the clinical efficacy of vacuum sealing drainage（VSD） in managing traumatic chronic osteomyelitis.Methods Between June 2006 and August 2009,13 patients with a lot of purulent exudates after traumatic chronic osteomyelitis were treated in our hospital.There were nine males and four females with their ages ranged from 8 to 56 years old,averaging at 34.Among these cases of traumatic chronic osteomyelitis,nine occurred after operation for open tibial fractures and one occurred after operation for open fibula fracture caused by traffic accident;two occurred after operation for open calcaneal fracture and one occurred after operation for femur fracture caused by falling.The course of the disease ranged from 11 to 35 months.After the focus of infection was debrided completely,they were treated with VSD.As soon as the wound surface was clear and the bone surface was covered with granulation tissue,eight patients were treated with secondary suture,four were treated with local skin flap transplantation or musculocutaneous flap transplantation,and one was treated with free latissimus dorsi musculo-cutaneous flap.Results The exudates in and the area of the wound were both decreased after VSD procedure on the wound for an average of 18 days and replacing the VSD for an average of 2.1 times.The wound was covered by second suture or flap transplantation.After a follow-up of 6-31 months,all 13 cases of traumatic chronic osteomyelitis were healed with no recurrence.Conclusion Application of VSD in treating traumatic chronic osteomyelitis can drain thoroughly,control inflammation faster,promote granulation tissue,and decrease the rate of recurrence.