VSD联合外固定支架用于治疗下肢开放性骨折合并软组织缺损的临床疗效

Clinical Effect of VSD Combined with External Fixator for Treatment of Lower Limb Open Fracture Complicated with Soft Tissue Defect

目的探讨分析VSD联合外固定支架用于治疗下肢开放性骨折合并软组织缺损的临床效果。方法选取我院在2012年3月至2014年6月期间收治的下肢开放性骨折合并软组织缺损患者62例作为研究对象。将所有患者进行随机分组,每组各31例,均在8小时内彻底清创修复软组织,试验组患者采用VSD联合外固定支架治疗,对照组患者采用外固定支架及常规二期换药治疗。对所有患者进行术后随访,记录并比较两组患者术后Neer评分情况及其出现骨感染、软组织感染、骨组织和软组织二者同时发生感染等并发症的情况,综合比较两组的临床效果。结果试验组患者术后半年下肢骨Neer评分情况明显优于对照组(P<0.05),其手术治疗显效率(58.06%)及总有效率(90.32%)明显高于对照组患者(22.58%、61.29%),且试验组患者术后半年出现骨感染、软组织感染、骨组织和软组织二者同时发生感染等并发症的发生率(3.23%、0.00%、3.23%)均明显低于对照组患者(29.03%、25.81%、32.26%),差异均具有统计学意义(P<0.05)。结论 VSD联合外固定支架用于治疗下肢开放性骨折合并软组织缺损并发症少见,较常规外固定支架分期治疗操作简便,临床效果显著,且其术后Neer评分情况良好,能在一定程度上缩短患者病程,对于改善患者的负重情况和生活质量具有积极意义。

Objective To explore and analyze the clinical effect of VSD combined with external fixator for the treatment of lower limb open fracture complicated with soft tissue defect. Methods 62 cases of patients with lower limb open fracture complicated with soft tissue defect admitted to our hospital from March 2012 to June 2014 were selected as research objects, and randomly divided into two groups, with 31 cases in each group. All patients received debridement and repaire of soft tissue within 8 hours. The experimental group was treated with VSD combined with external fixator, while the control group was treated with external fixator and conventional 2-stage dressing change. All patients received postoperative follow-up. The postoperative Neer scores and incidence of bone infection, soft tissue infection, and bone infection complicated with soft tissue infection were recorded and compared. The clinical effects of the two groups were evaluated. Results Neer scores of lower limb 6 months after surgery of the experimental group were significantly better than those of the control group （P 〈0.05）. The significantly effective rate and total effective rate of the experimental group were 58.06% and 90.32% respectively, significantly higher than 22.58%and 61.29%of the control group （both P〈0.05）. The incidence of bone infection, soft tissue infection, and bone infection complicated with soft tissue infection of the experimental group was 3.23%, 0.00%and 3.23%, respectively, significantly lower than 29.03%, 25.81%and 32.26%of the control group （all P〈0.05）. Conclusions VSD combined with external fixator has significant clinical effect for the treatment of lower limb open fracture complicated with soft tissue defect, with the advantages of easy operation, fewer complications and good postoperative Neer score, which can shorten the course of disease, and has positive significance in improving patients＆#39; weight loading and quality of life.