早期应用VSD技术联合抗生素占位器治疗26例成人Gustilo ⅢB型胫骨干开放性骨折的疗效

Analysis of early curative effect of infertion control 26 adults Gustilo Ⅲ B open tibial fractures treated by the VSD with antibiotic loaded cement spacers

目的探讨早期应用负压吸引技术联合抗生素占位器治疗成人Gustilo ⅢB型胫骨干开放性骨折的疗效。方法对2011年1月至2016年1月解放军沈阳军区总医院骨科应用VSD技术联合抗生素占位器治疗的26例成人GustiloⅢB型胫骨干开放性骨折进行回顾性分析。清创中，在对骨折断端予充分固定后，用抗生素占位器填充骨缺损，运用负压吸引技术对创面进行覆盖及持续负压吸引。记录清创术后不同时间段的血沉、C反应蛋白，中性粒细胞百分比等各项炎性指标情况，并记录每天负压引流量，且定期对引流液做细菌培养，以监控是否感染；在随后的清创术中评估抗生素占位器填充及创面情况；统计该组患者清创术次数及评估总体抗生素占位器的展位效应情况。结果26例成人Gustilo ⅢB型胫骨干开放性骨折清创术次数为1～2次。该组患者在清创术后平均24h各项炎性指标明显上升，平均49h～75h时炎性指标趋于平稳，自98h开始，炎性指标明显下降，并趋于正常。术后不同时间段负压引流液的细菌培养结果均提示：无细菌生长。在该组病例清创术中可见抗生素占位器在骨缺损处占位充分，无软组织嵌入，占位效果良好；创面干爽，并有大量新鲜肉芽组织产生，未见各种污物及分泌物产生，占位效果良好。结论治疗成人GustiloⅢB型胫骨干开放性骨折时，负压吸引技术联合抗生素占位器能辅助清创术更加有效的监控及预防感染，同时抗生素骨水泥占位器对大段骨缺损进行填充及支撑，为后期的骨缺损治疗打下坚实的基础，值得临床推广使用。

Objective To analyze the early curative effect of 26 cases with adult Gustilo ⅢB open tibial fractures treated by the vacuum sealing drainage with antibiotic loaded cement spacers.Methods A totle of 26 patients with Gustilo ⅢB open tibial fractures in our hospital from January 2011 January to January 2016 were treated by the vacuum sealing drainage with antibiotic loaded cement spacers in surgery. The bone defect was filled by antibiotic loaded cement spacers after fracture was firmly fixed,and the wound was coverred by the vacuum sealing drainage on the end.In different stages of treatment,we would summarize inflammatory indicators.At last time we would do skin flap transplantation to the wound which was clean or we would continue to do the debridement and change antibiotic loaded cement spacers with the vacuum sealing drainage.After the first debridement,we defected the blood sedimentation, creactive protein, neutrophil percentage, ete after debridement and recorded the drain amount which was done bacterial culture on time from vacuum sealing drainage.In the second debridement,we evaluated whether antibiotic loaded cement spacers filled befect sufficiently,and the wound was clean. After finished skin flap transplantation,we assessed the time of infection control and the number of debridement. Results These patients with Gustilo m B open tibial fractures went thought about one or two times and the infection was controlled effectively in an average of （7.5 ±2.3） days. All inflammatory markers of these patients are significantly increased within 24 hours after surgery and leveled off from 49 to 75 hours after sugery. What＇s more, the inflammatory index declined obviously, and returns to normal after 98 hours of the first debridement.We done cultures to testfluid drainage from vacuum sealing drainage and remaindered no bacterial growed.We saw that antibiotic loaded cement spacers fully filled in bone defect,and the wound was clean and there was a lot of fresh granulation tissue and no rheum.Conclusions To treat adult Gustilo Ⅲ B open tibial fractures,the vacuum sealing drainage with antibiotic loaded cement spacers can more effectively control the infection, short the average day in hospital and fill in bone defect adequately.This technique can lay the foundation of fixation treatment. This technology is worth popularizing in clinical.