外固定支架联合负压封闭引流术治疗下肢开放性粉碎性骨折合并严重软组织损伤

External fixator combined with vacuum sealing drainage in the treatment of open and comminuted fracture of lower leg combined with serious injury of soft tissue

目的探讨外固定架联合负压封闭引流术(vacuum sealing drainage,VSD)处理合并严重软组织损伤的下肢开放性粉碎性骨折的效果。方法 86例严重软组织损伤的小腿骨折患者均采用急诊清创、外固定架联合负压封闭引流术治疗,若合并大面积皮肤软组织撕脱,则取撕脱皮肤并打薄回植,以VSD覆盖;若合并软组织缺损,则清创后以VSD覆盖;若合并骨筋膜室综合征,则在切开减张后同期VSD覆盖。结果 86例患者中,除3例因个人因素中途出院外,其余83例均完成了既定治疗方案,转移皮瓣和植皮均成活,创面愈合良好,无一例截肢。结论合并严重软组织损伤的小腿骨折患者,早期简单清创后采取外固定架联合负压封闭引流术的方法,在迅速稳定骨折的同时,能有效封闭创面,改善二期创面修复环境,有利于骨折愈合,减少并发症。

Objective To explore the clinical effect of external fixator combined with vacuum sealing drainage（VSD） in the treatment of open and comminuted fracture of lower leg combined with serious injury of soft tissue.Methods Totally 86 cases of patients with lower leg fracture combined with serious soft tissue injury were treated with emergency debridement,external fixation and VSD.The patients with large area skin avulsion were treated with skin grafting and followed by VSD cover;the patients combined with soft tissue coloboma were treated with debridement and VSD cover;the patients with osteofascial compartment syndrome were treated with incision,and then followed by VSD cover.Results Besides 3 cases left hospital ahead of schedule by their personal reason,other 83 patients were all completed the established treatment.Flaps and skin graft were all survived and wound healing was good.All cases were healed with no signs of amputation.Conclusion The application of external fixator combined with VSD is an effective and efficient method in the treatment of open and comminuted fracture of lower leg combined with serious injury of soft tissue,which can provide effective and rapid fixation,seal wounds,shorten secondary healing time,facilitate fracture healing and reduce the incidence of complications.