脉冲冲洗联合负压封闭引流术在开放性骨折中的应用研究

Application of pulsating pressure flushing combined with vacuum sealing drainage technology in open fractures

目的探讨脉冲冲洗联合负压封闭引流技术(vacuum sealing drainage,VSD)在四肢开放性骨折伴严重软组织损伤患者早期清创中的临床效果。方法回顾性分析2015年1月至2018年6月本院收治的四肢开放性骨折伴严重软组织损伤96例患者的资料。按照清创方式不同分为观察组(脉冲冲洗联合VSD组)49例及对照组47例。观察组伤口清创时采用脉冲冲洗伤口、清创后原位植皮、VSD覆盖创面。对照组采用传统方法冲洗伤口、清创后原位植皮、加压打包。观察两组患者植皮成活情况、检测术后1周血浆C反应蛋白(CRP)水平、创面细菌培养情况。结果观察组治疗有效率95.92%(47/49),对照组治疗有效率78.72%(37/47),组间比较差异有统计学意义(P<0.05)。观察组术后1周CRP仅1例患者高于10.0 mg/L,对照组仍有6例患者高于10.0 mg/L,组间比较差异有统计学意义(P<0.05)。清创后创面培养阳性率观察组为4.08%,对照组为19.15%,组间比较差异有统计学意义(P<0.05)。结论脉冲冲洗联合负压封闭引流技术在开放性骨折清创治疗中可显著提高清创效率、提高皮肤软组织成活率、降低伤口感染率,是一种安全、有效、理想的方法。

Objective To investigate the clinical effect of Pulsating pressure flushing combined with vacuum sealing drainage technology (VSD) in early detraumatization of open fracture of extremities. Methods A total of 96 cases of open fracture of extremities with severe soft tissue injury from January 2015 to June 2018 were analyzed retrospectively. According to the different treatment methods, they were divided into 49 cases of observation group(Pulsating pressure flushing combined with VSD group) and 47 cases of control group. The wound in observation group was treated with pulse irrigation, skin grafting in situ after debridement and VSD coverage.In the control group, the wounds were washed with traditional methods, skin grafting in situ after debridement and packing under pressure. The survival rate of skin graft, the level of plasma C-reactive protein (CRP) and the bacterial culture of wound were observed one week after operation. Results The effective rate of treatment was 95.92 %(47/49) in the observation group and 78.72 %(37/47) in the control group. The difference was statistically significant(P<0.05). One week after operation, CRP in the observation group was higher than 10.0 mg/L in only one case, while in the control group, 6 cases were higher than 10.0 mg/L in all cases. The difference was statistically significant (P<0.05). The positive rate of wound culture after debridement was 4.08% in the observation group and 19.15% in the control group. The difference was statistically significant (P<0.05). Conclusion Pulsating pressure flushing combined with vacuum sealing drainage technology can significantly improve the loss removal efficiency, improve the survival rate of skin and soft tissue, reduce wound infection rate,it is a safe, effective and ideal method for open fracture debridement.