改良间歇负压封闭引流(VSD)联合外科皮瓣对胫腓骨中下段Gustilo Ⅲ型骨折临床疗效分析

Clinical effect analysis of modified intermittent vacuum sealing drainage(VSD) combined with surgical flaps in the treatment of type Gustilo type Ⅲ fracture of the middle and inferior segment of tibia and fibula

目的探讨改良间歇负压封闭引流联合外科皮瓣治疗胫腓骨中下段Gustilo Ⅲ型骨折的临床效果。方法选取我院2015年1月~2016年6月收治的39例胫腓骨中下段Gustilo Ⅲ型开放性骨折局部软组织损伤Ⅰ期缝合患者,根据VSD方法不同分为观察组(20例)和对照组(19例)。观察组采用改良间歇VSD治疗,对照组采用普通持续VSD治疗,观察两组的治疗效果。结果观察组的总有效率为95.00%,显著高于对照组的57.89%(P<0.05);观察组的二次皮瓣或植皮率为10.00%,低于对照组的47.39%,差异有统计学意义(P<0.05);观察组的并发症发生率为30.00%,低于对照组的78.94%,差异有统计学意义(P<0.05)。结论在治疗胫腓骨中下段Gustilo Ⅲ型骨折中采用改良间歇负压封闭引流联合外皮瓣治疗的有效率、阻管频次及住院时间较普通持续VSD优越,可减少VSD更换次数,缩短住院时间,节省治疗费用。

Objeetive To investigate the clinical effect of modified intermittent vaeuum sealing drainage （VSD） combined with surgical flaps in the treatment of Gustilo type m fractures of the middle and inferior segment of tibia and fibula.Methods 39 cases of primary suture of soft tissue injury of Gustilo type Ⅲ open fractures of the middle and inferior segment of tibia and fibula in our hospital fiom January 2015 to June 2016 were selected and divided into the ob- servation group （20 cases） and the control group （19 eases） according to the VSD method.The observation group was treated with modified intermittent VSD,while the control group was treated with general continuous VSD.The effect of the two groups was compared.Result The total effective rate of the observation group was 95.00%,which was significantly higher than that of the control group （57.89%）（P〈0.05）.The two times skin flap and skin grafting rate in the observation group was 10.00%,whieh was lower than tha in the control group （47.39%）,with significant difference （P〈0.05）. The incidence rate of complication in the observation group was 30.00%,which was lower than that of the control group （78.94%）,with significant difference （P〈0.05）.Conclusion The effective rate,the frequency of catheter obstruction and the length of hospital stay of modified intermittent VSD combined with surgical flaps in the treatment of type Gustilo type m fraeture of the middle and inferior segment of tibia and fibula is better than that of the conventional continuous VSD in the treatment of Gustilo type Ill fractures,which can reduce the number of replacement of VSD,shorten the hospitalization time, save the cost of treatment.