封闭负压引流术结合外科手术治疗创伤性骨髓炎的疗效观察

Therapeutic effect of vacuumassisted closure combining surgical treatments on chronic osteomyelitis after severe open fractures

目的 评价封闭负压引流术结合外科手术治疗创伤性骨髓炎的疗效.方法 将58例符合纳入标准的创伤性骨髓炎患者按照随机数字表法分为两组：试验组35例采用封闭负压引流术结合持续灌洗和引流;对照组23例以局部抗生素灌注、负压引流为主要治疗方法.对两组患者的感染发生率、疗效及健康状况进行评估.结果 所有患者术后随访14～36（28.0 ±7.3）个月.试验组有2例（5.7%,2/35）发生全身感染,对照组有7例（30.4%,7/23）发生全身感染,两组比较差异有统计学意义（P=0.024）.试验组A级愈合24例（68.6%,24/35）,对照组A级愈合13例（56.5%,13/23）,两组患者的A级愈合率比较差异有统计学意义（P＜0.05）.3、9个月时,健康状况评分试验组明显高于对照组（P=0.013、0.005）.结论 采用封闭负压引流术结合外科手术治疗创伤性骨髓炎与传统方法 相比,可有效提高治愈率,缩短住院时间,减少换药次数及减轻患者的痛苦,提高患者的生活质量,临床疗效满意,是治疗创伤性骨髓炎的较理想方法之一.

Objective To evaluate the effect of vacuumassisted closure （VAC） combining surgical treatments on chronic osteomyelitis after severe open fractures. Methods Fifty-eight patients with severe high energy open fractures were enrolled,35 patients were randomized to the experimental group and had identical treatment except that VAC was applied to the wounds between irrigation and debridement procedures, 23 patients were randomized to the control group and underwent initial irrigation and debridement followed by standard fine mesh gauze dressing. The infection rate, therapeutic effect and health condition were evaluated between the two groups. Results All patients were followed up for 14 - 36 （28.0 ± 7.3 ） months.Control group developed 7 cases （ 30.4%, 7/23 ） with deep infections, whereas experimental group developed 2 cases （5.7%,2/35） with deep infections. There was significant difference between the two groups （P =0.024）. There were 24 cases （68.6%,24/35） grade A healing in experimental group,whereas there were 13cases （56.5%, 13/23） grade A in control group,the difference was very singificant （P＜0.05）. The health total score of experimental group was higher than that of control group at 3,9 months after operation （P =0.013,0.005）. Conclusions Patients treated with VAC have a higher recovery rate,shorter length of stay and satisfactory curative effect compared with patients randomized to the traditional methods. VAC represents a promising new therapy for osteomyelitis after severe open fractures.