“拉链式”负压封闭引流结合外固定架治疗GustiloⅢ型胫腓骨骨折

Treatment of Gustilo Type Ⅲ Tibiofibular Fractures with Zipper Negative Pressure Close Drainage Combined with Externalfixator

目的探讨"拉链式"开门负压封闭引流结合外固定架治疗GustiloⅢ型胫腓骨开放性骨折的疗效。方法2014年4月至2017年5月采用"拉链式"开门负压封闭引流结合外固定架治疗GustiloⅢ型胫腓骨开放性骨折患者20例,男15例,女5例,年龄17~58岁,平均(35.60±2.65)岁。开放性损伤按Gustilo分型,ⅢA型5例,ⅢB型10例,ⅢC型5例。所有患者均行急诊清创、骨折复位后外固定支架固定,采用"拉链式"开门负压封闭引流保护创面,待创面清洁、肉芽生长良好后通过直接缝合、游离植皮及皮瓣覆盖等方法修复创面。结果 20例患者术后获得12~30个月,平均(20.95±1.16)个月随访。所有患者经"拉链式"开门负压封闭引流治疗4~30d后关闭创面。2例患者因创面感染、组织坏死,经多次清创及"拉链式"开门负压封闭引流治疗,最后通过游离植皮及转移皮瓣修复创面。钉道感染1例,经换药及抗生素治疗后痊愈。20例骨折均愈合,骨折愈合时间为6~16个月,平均(12.60±0.65)个月。2例发生骨延迟愈合。2例出现骨不连,拆除外固定支架行髂骨植骨钢板螺丝钉内固定,最终骨折愈合。末次随访时按照Johner-Wruhs评分标准评定膝、踝关节功能恢复情况,优12例,良7例,差1例,优良率95%。结论 "拉链式"开门负压封闭引流结合外固定架治疗GustiloⅢ型胫腓骨开放性骨折可有效防止创面感染,每天观察创面情况,掌握病情,选择最佳治疗方法,从而缩短治疗时间,为骨折愈合和功能恢复提供有利条件,是一种安全、有效的治疗方法。

Objective To investigate the efficacy of zipper negative pressure close drainage combined with external fixator in the treatment of Gustilo typeⅡI tibiofibular fractures.Methods From April 2014 to May 2017,20 cases of Gustilo type Ⅲ open fracture of tibia and fibula were treated with zipper type open door negative pressure drainage com- bined with external fixation.There were 15 males and 5 feimales,aged 17-58 years with an average of 35.6 years old. According to Gustilo typing,there were 5 cases of type Ⅲ A,10 cases of type - B,5 cases of type Ⅲ C.All patients underwent emergency debriderment.Close drainage with zipper was used to protect the wound surface,.The wound was cosed by direct suture, free skin graft or skin flap.Results 20 patients were followed up for 12 to 30 months（20.95± 1.16）months.All the patients were treated with zipper open door negative pressure drainage and the wound was closed after 4-30 days late.2 patients suffered from wound infection and tissue necrosis. After debridement and zipper open door negative pressure drainage,the wound was repaired by free skin grafting and transfer flap. 1 cases of nail infection were cured by dressing and antibiotic therapy.20 cases of fracture were healed and the healing time was 6-16 months （ 12.60 - 0.65） months, 2 cases had delayed union of bone, 2 cases had nonunion, removal of the external fixator and bone dreat plate screw fixation,and finally healed.At the last follow-up,the function of knee and ankle was evaluated accord- ing to the Johner-Wruhs score standard.Excellent in 12 cases,good in 7 cases and poor in 1 cases,excellent rate 95 per cent.Conclusion Open the zipper type vacunm sealing drainage combined with external fixation in the treatment of Gustilo type - tibiofibular fractures can effectively prevent wound infection.It,is a safe and effective method of treat ment.