外固定架结合持续负压封闭引流治疗芦山地震胫骨远端开放性骨折

External fixators combined with continuous vacuum sealing drainage for treatment of open distal tibial fractures after Lushan earthquake

目的探讨外固定架联合负压封闭引流（vacuum sealing drainage，VSD）在地震伤员胫骨远端开放性骨折早期治疗的临床价值。方法早期采用外固定架联合VSD负压吸引术治疗芦山地震中的严重胫骨远端开放性骨折伴软组织缺损伤员22例，其中男9例，女13例；年龄25。85岁，平均42．6岁。致伤原因：重物砸伤19例，高处坠落伤3例。按照Gustilo分型，Ⅱ型4例，ⅢA型6例，ⅢB型10例，HIC型2例。结果9例行局部植皮术，11例行皮瓣转移术，2例行截肢手术；17例外固定架固定3周内转化为内固定治疗。结论采用外固定架联合VSD治疗伴软组织缺损的胫骨远端开放性骨折，在迅速稳定骨折、保护局部软组织的同时，通过持续VSD负压吸引装置可以封闭创腔，降低局部感染，刺激创面产生大量新鲜肉芽组织覆盖骨面，为创面植皮或局部皮瓣转移争取时机，为最终外固定转换为内固定治疗、促进伤员肢体功能恢复提供了有利条件。

Objective To investigate the clinical significance of external fixators combined with vacuum sealing drainage （VSD） in early treatment of open distal tibial fractures after Lushan earthquake. Methods The study involved 22 cases of severe open distal tibial fractures associated with soft tissue defects treated with external fixators combined with VSD in the early stage after Lusban earthquake. There were 9 males and 13 females, at age of 25-85 years （ mean 42.6 years）. Causes for the injury were hit- ting by heavy objects in 19 cases and fall from height in three cases. Gustilo classification of the open fracture were type Ⅱ in four cases, type Ⅲ A in six, type Ⅲ B in 10 and type m c in two. Results Al- together, nine cases had regional skin grafting, 11 flap transferring, two amputation. Seventeen cases were transformed to internal fixations within three weeks after the use of external fixators. Conclusions External fixators combined with VSD stabilize displaced fracture fragments rapidly and protect regional soft tissues. Simultaneously, continuous VSD closes wound cavity, reduces regional infection and stimulates wounds producing large amount of fresh granulation tissues over bone surface, which consequently wins time for skin grafting or regional flap transferring as well as creates a favorable condition for the ultimate conversion of external fixation to internal fixation and for the recovery of lower limb function.