VSD负压引流联合有限固定对Ⅲ度开放性骨折患者感染控制的影响

Infection control effect of negative pressure wound therapy using vacuum-assisted closure combined with limited fixation on open fractures of Ⅲ degree

目的探究负压封闭引流(VSD)技术结合有限固定对Ⅲ度开放性骨折的感染控制效果。方法选取2016年1月至2019年1月西安交通大学附属红会医院收治的Ⅲ度开放性骨折患者112例作为研究对象,按简单随机数表法分为对照组和观察组,每组56例,对照组实施有限固定治疗,观察组实施VSD负压引流结合有限固定治疗。比较两组患者的感染控制情况、控制感染时间、创面愈合时间、骨折愈合时间、住院时间、并发症发生情况以及感染患者细菌学检查情况。结果观察组患者的感染控制优良率为98.21%,明显高于对照组的83.93%,差异有统计学意义(P<0.05);观察组和对照组患者的感染控制时间[(10.97±2.07)d vs(19.42±1.22)d]、创面愈合时间[(21.41±7.28)d vs(38.13±9.56)d]、骨折愈合时间[(7.25±2.83)个月vs(11.59±3.46)个月]、住院时间[(28.91±3.20)d vs(40.94±5.82)d]以及并发症发生率(5.36%vs 19.64%)比较,观察组明显少于或低于对照组,差异均有统计学意义(P<0.05);观察组患者的伤口感染率为1.79%,明显低于对照组的12.50%,差异有统计学意义(P<0.05);8例伤口感染患者细菌学培养分离出8株病原菌,其中对照组感染革兰氏阳性菌3例(金黄色葡萄球菌2例,凝固酶阴性葡萄球菌1例),感染革兰氏阴性菌3例(大肠埃希菌2例,铜绿假单胞菌1例),感染白假丝酵母真菌1例;观察组感染革兰氏阳性菌(金黄色葡萄球菌)1例。结论VSD负压引流结合有限固定可显著减少Ⅲ度开放性骨折的感染发生率,对感染控制效果较好,值得临床推广使用。

Objective To investigate the effect of negative pressure wound therapy(NPWT)using vacuum-assisted closure(VAC)combined with limited fixation on the infection control of open fractures ofⅢdegree.Methods A total of 112 patients with open fractures ofⅢdegree,who admitted to the Affiliated Red Cross Hospital of Xi'an Jiaotong University from January 2016 to January 2019,were selected and divided into the control group and observation group according to simple random number method,with 56 cases in each group.The control group underwent limited fixed treatment,and the observation group underwent negative pressure wound therapy(NPWT)using vacuum-assisted closure(VAC)combined with limited fixation therapy.The infection control,infection control time,wound healing time,fracture healing time,hospitalization time,complications and bacteriological examination of infected patients were compared between the two groups.Results The excellent rate of infection control in the observation group was 98.21%,which was significantly higher than 83.93%in the control group(P<0.05).The infection control time,wound healing time,fracture healing time,hospitalization time,complication rate of the observation group were(10.97±2.07)d,(21.41±7.28)d,(7.25±2.83)months,(28.91±3.20)d,5.36%,respectively,which were significantly shorter or lower than corresponding(19.42±1.22)d,(38.13±9.56)d,(11.59±3.46)months,(40.94±5.82)d,19.64%in the control group(all P<0.05);the infection rate of the observation group was 1.79%,which was significantly lower than 12.50%of the control group(P<0.05).Eight pathogens were isolated from 8 wound infection patients,of which,3 cases of Gram-positive infection(2 cases of Staphylococcus aureus,1 case of coagulase-negative staphylococci),3 cases of Gram-negative bacteria(2 cases of Escherichia coli,1 case of Pseudomonas aeruginosa),and 1 case of fungus infected with Candida albicans were found in the control group;while only 1 case of infected with Gram-positive bacteria(Staphylococcus aureus)was found in the observation group.Conclusion Negative pressure wound therapy using vacuum-assisted closure combined with limited fixation can significantly reduce the incidence of infection ofⅢdegree open fractures,and has a good effect on infection control,which is worthy of popularization.