VSD结合灌洗引流治疗胸腰椎术后切口感染

Clinical Efficacy of Vacuum Sealing Drainage(VSD) Combined with Closed Continuous Douche(CCD) in the Treatment of Thoracolumbar Vertebral Body Disease Postoperative Wound Infection

目的 观察负压封闭引流（vacuum sealing drainage,VSD）结合闭式灌洗引流术（closed continuous douche,CCD）治疗胸腰椎病变术后切口感染的临床疗效.方法 回顾性分析川北医学院附属医院骨科2007年1月至2012年12月,分别采用VSD和VSD＋CCD治疗76 例胸腰椎病变术后切口感染的病例,其中男26 例,女50 例;年龄23～59 岁,平均年龄42.4 岁.通过比较抗生素应用时间、VSD治疗时间及更换次数、创口愈合情况、引流管阻塞情况及副反应等指标来评估疗效.结果 VSD＋CCD组抗生素应用时间明显较VSD组短,差异有统计学意义（P＜0.05）;VSD＋CCD组更换VSD次数明显较VSD组少,差异有统计学意义（P＜0.05）;VSD＋CCD组安置VSD负压吸引治疗创口时间明显较VSD组短,差异有统计学意义（P＜0.05）.VSD组引流管阻塞41次（41/125）,VSD＋CCD组引流管阻塞10次（10/108）,差异有统计学意义（P＜0.05）;VSD组创口愈合26 例（26/31）,有5 例形成窦道出院,经2～3个月院外换药愈合;VSD＋CCD组创口45 例完全愈合（45/45）,差异有统计学意义（P＜0.05）.VSD组出现皮肤发红、发痒6 例,皮疹3 例,皮肤溃烂1 例,混合感染2 例;VSD＋CCD组出现皮肤发红、发痒5 例,皮疹2 例,两组比较差异有统计学意义（P＜0.05）.结论 负压封闭引流结合闭式灌洗引术治疗胸腰椎病变术后切口感染能有效减少并发症,缩短感染伤口治疗时间,促进创口愈合.

Abstract：Objective To observe the clinical efficacy of vacuum sealing drainage （VSD） combined with closed continu- ous douche （CCD） to treat postoperative wound infection of thoracolumbar vertebral body disease. Methods From January 2007 to December 2012,76 cases with postoperative incisional infection of thoracic lumbar spine surgery were respectively trea- ted by VSD and VSD ＋ CCD. The antibiotics applying time, VSD treatment time and replacement frequency, the wound healing situation, drainage tube blockage situation, side reaction and other indexes were compared and retrospectively analyzed to evalu- ate the efficacy. Results Compared with VSD group, VSD ＋ CCD group had shorter time of antibiotics treatment,less replace- ment frequency of VSD and shorter time of VSD treatment, and the differences had statistical significance （ P 〈 0.05 ）. VSD group had 41 times of drainage tube blockage （41/125）, and VSD ＋ CCD group had 10 times （10/108）. There was significant difference （ P 〈 0.05 ）. 26 cases of VSD group had tresis vulnus healed （26/31） and five cases left hospital with sinus forma- tion and healed after 2 ~ 3 months＇ out-hospital dressing,while 45 cases of VSD ＋ CCD group were all completely healed （45/ 45 ）. The difference showed statistical significance （P 〈 0.05 ）. VSD group had 6 cases of skin redness and tickle ,3 cases of rash, 1 case of skin ulcers and 2 cases of mixed infections, while VSD ＋ CCD group only had 5 cases of skin redness and tickle and 2 cases of rash. The difference was statistically significant （ P 〈 0.05 ）. Conclusion VSD combined with CCD to treat postoperative wound infection of thoracolumbar vertebral body disease can effectively reduce complications, shorten wound in- fection treatment time and promote wound healing.