Ilizarov外固定联合负压封闭引流修复四肢骨折合并骨筋膜室综合征

Ilizarov external fixation combined with vacuum sealing drainage for the repair of limb fractures with osteofascial compartment syndrome

背景:目前治疗骨折合并骨筋膜室综合征常采用单边外固定架固定骨折,凡士林纱布覆盖减压创面,需长期、频繁敞开换药,增加了感染概率,不利于创面引流及肉芽组织培养,造成住院周期长、效果欠佳。目的:探讨Ilizarov外固定联合负压封闭引流修复四肢骨折合并骨筋膜室综合征的临床效果。方法:将32例四肢骨折合并骨筋膜室综合征患者按随机数字表法均分为2组,在进行相同切开减压和药物治疗的基础上,治疗组采用Ilizarov外固定架固定骨折,负压封闭引流覆盖创面;对照组采用单边外固定架固定骨折,凡士林纱布覆盖创面,比较两组骨折愈合、临床结局、住院时间及治疗费用。结果与结论:治疗组治愈10例,肌挛缩4例,截肢2例;对照组治愈7例,肌挛缩6例,截肢3例,两组临床结局指标比较差异无显著性意义。治疗组骨折愈合率及治疗费用高于对照组(P<0.05),住院时间、植皮及感染发生率低于对照组(P<0.05)。表明在及时切开减压的基础上,采用Ilizarov外固定联合负压封闭引流修复四肢骨折合并骨筋膜室综合征保肢率高,可有效治疗骨折,提高骨折愈合率,降低感染率、植皮率,缩短住院时间,但费用较高。

BACKGROUND：Osteofascial compartment syndrome is usual y due to application of external fixation for fracture treatment. Vaseline gauze is used to cover and compress the wound. Frequent dressing change induces infection and is harmful to wound drainage and tissue granulation, final y causing prolonged time of hospitalization and bad results. OBJECTIVE：To investigate the clinical efficacy of Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome. METHODS：A total of 32 patients with limb fractures with osteofascial compartment syndrome were randomly divided into two groups. Al patients adopted the same fasciotomy and drug treatment. In treatment group, the fracture was fixed with Ilizarov external fixation and the wound was covered with the vacuum sealing drainage dressing. In control group, the fractures were treated by unilateral external fixation and the wound was covered with the vaseline gauze. The fracture healing, clinical effects, hospitalization duration and costs between two groups were compared. RESULTS AND CONCLUSION：In the treatment group, there were 10 cases of healing wel , 4 cases of muscle contracture and 2 cases of amputation. In the control group, there were 7 cases of healing wel , 6 cases of muscle contracture and 3 cases of amputation. No significant difference in clinical outcome measures was detected between the two groups. Fracture healing rate and costs were higher in the treatment group than in the control＆amp;nbsp;group （P〈0.05）, but hospitalization duration, skin grafts and the incidence of infection were lower in the treatment group than in the control group （P〈0.05）. Results suggested that on the basis of timely fasciotomy and decompression, Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome has a high limb salvage rate, which can effectively treat fractures, elevate the healing rate of fractures, reduce infection rate and skin grafting rate, shorten hospital stays. However, the hospitalization expense is higher.