负压引流技术辅助人工真皮与自体皮移植修复关节开放和／或骨折处骨外露创面的临床研究

Clinical study on repair of open joint wounds and/or wounds with exposed bone fracture using nega- tive pressure wound therapy combined with artificial dermis grafting and autologous skin grafting

目的探讨直用负压引流技术辅助人工真皮和自体皮移植修复关节开放和／或骨折处骨外露创面的临床效果。方法2008年11月－2014年11月，2家笔者单位收治存在关节开放和／或骨折处骨外露的11例患者，根据I期治疗方法不同分为试验组6例、对照组5例。试验组患者包括芙节开放4例、骨折处骨外露1例、关节开放合并骨折处骨外露1例，创面扩创后，移植剪孔的人工真皮，并存其上应用负压引流装置，持续负压治疗1周。对照组患者包括关节开放2例、骨折处骨外露2例、关节开放合并骨折处骨外露1例，创而扩创后，仅移植剪孔的人工真皮。Ⅱ期手术时，在完成血管化的人工真皮上，2组患者创面均移植自体刃厚皮修复。结果试验组5例患者的关节开放创面，人工真皮血管化良好，自体皮移植成活，创面愈合。对照组3例患者的关节开放创面，人工真皮移植均因感染而失败，后采用局部组织瓣修复。2组3例单纯骨折处骨外露创而患者，无论是否应用负压引流装置，人工真皮均顺利血管化，移植自体皮均成活，创面愈合良好。结论负压引流技术辅助人工真皮与自体皮移植可用于修复关节开放和／或骨折处骨外露创面。

Objective To explore the clinieal effects of negative pressure wound therapy （NPWT） combined with artificial dermis grafting and autologous skin grafting on repair of open joint wounds and/or wounds with exposed bone fracture. Methods Eleven patients with open joint wounds and/or wounds with exposed bone fracture, hospitalized from November 2008 to November 2014, were enrolled in the study. Ac- cording tu the differences of the first stage treatment, all patients were divided into experimental group （ n = 6, including 4 patients of open joint wounds, 1 patient of wound with exposed bone fracture, and 1 patient of open joint wound with exposed hone fracture） , and control group （ n = 5, including 2 patients of open joint wounds, 2 patients of wounds with exposed bone fracture, and 1 patient of open joint wound with exposed bone fracture）. After debridement, the wounds in both groups were grafted with punctured artificial dermis, while NPWT was only used over the artificial dermis of experiment group for I week. In the operation at sec- ond stage, autologous split-thickness skin was grafted on the vaseularized artificial dermis in both groups. Results In 5 patients of open joint woonds in experimental group, the artificial dermis was vascularized well, aulolugous skin grafts survived, and wuunds were healed. In 3 patients of open juinl wounds in control group, the artificial dermis grafting all failed due to local infection, and then these wounds were repaired with local tissue flap grafting. Artificial dermis in 3 patients of wounds with exposed bone fracture in hoth groups was vaseularized well after grafling, and the wounds were healed after autologuns skin grafting, whether or not NPWT was used. Conclusions NPWT combined with arlificial dermis grafting and aatolo- gous skin grafting can be used for repairing open juint wounds and/or wounds with exposed hone fracture.