交锁髓内钉联合负压封闭引流治疗胫骨干开放性骨折

Treatment of intramedullary interlocking nails combined with vacuum sealing drainage for open fracture of tibia shaft

目的探讨交锁髓内钉联合负压封闭引流(VSD)治疗胫骨干开放性骨折的疗效。方法我科自2008年1月～2011年3月运用磁力导航胫骨交锁髓内钉联合内置多侧孔硅胶管冲洗管负压封闭引流材料治疗GustiloⅡ型、Ⅲa型、Ⅲb型胫骨干开放性骨折33例,5～7d更换护创材料,创面肉芽新鲜后Ⅱ期缝合、游离植皮或组织瓣移植术修复皮肤缺损。结果 33例中29例Ⅰ期愈合1,例老年患者因合并糖尿病,血糖控制不佳发生迟发性骨髓炎2,例延迟愈合,1例骨不连。15例GustiloⅢb型皮肤缺损行皮瓣转移术修复,10例GustiloⅢa型行植皮治疗,8例GustiloⅡ型经换药后创面愈合。结论在彻底清创无高危因素的前提下,联合应用交锁髓内钉与负压封闭引流治疗GustiloⅢb以下型胫骨干开放性骨折是一种安全、有效的方法。

Objective To investigate the curative effects of intramedullary interlocking nails combined with vacuum sealing drainage（VSD） for open fracture of tibia shaft.Methods From Jan.2008 to Mar.2011,33 cases of open tibia-shaft fracture of type Gustilo Ⅲb（or less degree） were treated with intramedullary interlocking nails combined with VSD.After thorough debridement,all the fractures were fixed with intramedullary interlocking nails,a continuing douching tube was put in the wounds,then VSD was used to cover the wounds.VSD was replaced 5-7 days later.Dermatoplasty or skin flap transfer was conducted after the granulation tissue became fresh.Results Primary healing was achieved in 29 cases,tardive osteomyelitis in 1 an aged diabetes mellitus patient with poor control of blood sugar,delayed healing in 2 cases,bone non-union in 1 case.Among 31 cases of bone healing,skin flap transposition was performed in 15 cases of skin delect,skin grafting in 10 cases（Gustilo Ⅲa type）,skin covering in 8 cases after dressing change.No infection happened.Conclusion After thorough debridement,intramedullary interlocking nails combined with VSD is a safe and effective method to treat open fracture of tibia shaft of type Gustilo Ⅲb（or less degree）.