负压封闭引流联合过氧化氢灌洗治疗骨折内固定术后感染

Vacuum sealing drainage combined with hydrogen peroxide lavage in the treatment of postoperative infection after fracture fixation

目的研究负压封闭引流(VSD)联合过氧化氢灌洗在治疗骨折内固定术后感染的临床疗效。方法对17例骨折内固定术后感染患者,彻底清创后给予VSD敷料覆盖持续引流,并联合应用过氧化氢灌洗,待创面新鲜感染消退后采取直接缝合或皮瓣移植修复创面。结果 15例早期感染(<2周)患者经1次VSD治疗后直接缝合或局部皮瓣转移修复创面成功,2例慢性感染患者(>10周)经2次VSD治疗后关闭创面,感染复发,再次清创取出内固定物及VSD治疗,伤口愈合。随访13~25个月,术区无再发感染,骨折均获愈合。结论负压封闭引流联合过氧化氢灌洗是治疗骨折内固定术后早期感染的有效方法,可保留内固定物,缩短治疗周期,值得推广。

Objective To investigate the clinical efficacy of vacuum sealing drainage（VSD） combined with hydrogen peroxide lavage in the treatment of postoperative infection after internal fixation for fracture.Methods Seventeen patients with postoperative infection after fracture fixation were involved in this study.After thorough debridement,the infection was dressed with VSD continuous drainage combined with hydrogen peroxide lavage.After the infection subsided and the wound was fresh,direct suture or skin flap transplantation was applied to repair the wound.Results Fifteen cases of early infection were successfully repaired by direct suture or local flap transplantation after1 time of VSD treatment.Two patients with chronic infection were treated with 2 times of VSD treatment,who recurred infection after closing the wound,and were then successfully treated by re-debridement,removal of internal fixation and VSD treatment.After 13-25 months＇ follow-up visits,there was no recurrence of infection,and all the fractures healed.Conclusion VSD combined with hydrogen peroxide lavage is an effective way to treat early infection after internal fixation of fracture without removal of internal fixation.It can shorten the course of treatment and is worth widely using in clinical trial.