负压封闭引流结合外固定支架在儿童胫腓骨开放性骨折GustiloⅢ型治疗中的应用

Closed negative pressure drainage combined with external fixator in treatment of Gustilo Ⅲ type of children open tibiofibula fracture

目的 探讨应用负压封闭引流技术（VSD）结合外固定架治疗胫腓骨开放性骨折合并严重软组织损伤的临床疗效。方法 回顾性分析2012年10月～2014年10月8例胫腓骨开放性骨折合并严重软组织损伤患者的临床资料,进行清创及外固定支架骨折固定后,应用持续负压封闭引流,8～10 d后拆除敷料,必要时再次行负压封闭引流,行游离植皮或股前外侧游离皮瓣移植覆盖创面。结果 8例患者创面全部愈合,其中1例皮肤脱套回植大部分成活,5例患者使用负压封闭引流术治疗后行二期游离植皮全部成活,2例软组织缺损严重行股前外侧游离皮瓣覆盖创面成功。结论 胫腓骨开放性骨折合并严重软组织损伤经彻底清创后使用负压封闭引流技术结合外固定架能有效地封闭创面,提高儿童胫腓骨开放性骨折治疗成功率。

Objective To investigate the application of vacuum sealing drainage （VSD） tech- nology combined with external fixator in the treatment of tibiofibula open fractures with the clinical curative effect of severe soft tissue injuries. Methods A retrospective analysis, of 8 cases of tibiofibula open fractures with severe soft tissue injury from October 2012 to October 2014, were performed continuous closed negative pressure drainage after debridement and external fixation, dismantling dressings 8 to 10 d later, closed negative pressure drainage conducted again if necessary, and free skin graft or femoral anterolateral cover wound free flap transplantation were applied. Results The wound completely healed in all 8 cases, among them, most survived in 1 case with degloving skin reattached, all survived in 5 cases treated by second stage all free skin graft after closed negative pressure drainage, and succeeded in 2 cases with femoral anterolateral free flap coverage for severe soft tissues defect. Conclusion Closed negative pressure drainage combined with external fixation frame in the treatment of open tibiofibula fracrare with severe soft tissue injury after thorough debridement can effectively close wound, improve success rate of treatment of children open tibiofibula fracture.