交锁髓内钉联合封闭式负压引流治疗胫骨开放性骨折

Intramedullary interlocking nails combined with VSD treating open fracture of tibia-shaft

目的:探讨交锁髓内钉联合封闭式负压引流(Vacuum-sealing drainage,VSD)治疗胫骨开放性骨折的疗效。方法:33例胫骨干开放性骨折病例,彻底清创后行交锁髓内钉固定,伤口置管持续冲洗,创面用封闭式负压引流材料覆盖,接负压封闭式引流,5～7 d更换VSD材料,创面肉芽新鲜后二期植皮或行皮瓣转移术修复皮肤缺损。结果:33例骨折31例一期愈合,无1例感染发生;28例皮肤缺损行皮瓣转移术修复,5例经换药后皮肤覆盖修复,均无感染发生。结论:在彻底清创的前提下联合应用交锁髓内钉与封闭式负压引流治疗GustiloⅢb以下型开放性胫骨干开放性骨折是一种安全、有效的方法。

Objective To investigate the effects of intramedullary interlocking nails combined with VSD for open fracture of tibia-shaft.Method A group of 33 cases of open tibia-shaft fracture was collected,after thoroughly debrided,all the fractures were fixed with intramedullary interlocking nails,a continuing douching tube was put in the wounds,then vacuum-sealing drainage（VSD） was used to cover the wounds,the VSD was connected to negative pressure,the VSD material was replaced 5～7 days later.Dermatoplasty or skin flap transfer was conducted after the granulation become flash.Results Thirty-one fractures were primarily healed,none infection happened in all 33 cases,28 cutaneous deficiency were plerosised via transfer of skin flap,the other 5 cutaneous deficiency were recovered by change of dressing,no infection happened.Conclusion After thoroughly debrided,intramedullary interlocking nails combined with VSD is a safe and effective method to open fracture of tibia-shaft below GustiloⅢb.