显微手术修复结合VSD治疗手创伤感染的临床研究

Clinical research of microsurgical repair combined with VSD in the treatment of hand trauma infections

目的探讨显微手术修复结合封闭式负压引流术(VSD)治疗手创伤感染的临床观察及术后发生切口感染的影响因素。方法回顾性分析苏州高新区人民医院手足外科2015年11月—2019年12月收治的手创伤感染患者100例,男性62例,女性38例;年龄21~50岁,平均38.7岁;道路交通伤43例,重物砸伤19例,机器挤压伤27例,其他11例;手背62例,手指38例;肌腱伤22例,骨折伤43例,撕脱伤35例。按照治疗方法不同分为对照组和观察组,各50例。对照组接受显微手术修复联合传统换药处理,观察组接受显微手术修复联合VSD处理。对两组患者抗感染药物使用时间、住院时间、创面愈合时间等进行比较,并应用Logistics回归分析影响手创伤术后发生切口感染的危险因素。结果观察组抗感染药物使用时间、住院时间、创面愈合时间分别为(7.72±1.53)d、(16.57±2.18)d、(15.74±1.65)d,而对照组分别为(13.45±1.78)d、(28.63±3.57)d、(26.92±2.17)d,差异有统计学意义(P<0.05);观察组创面修复有效率高于对照组(P<0.05);多因素logistic回归模型分析表明,年龄≥60岁、合并基础疾病(如心脑血管疾病、糖尿病、恶性肿瘤等慢性病)、手术时间≥3h、创面重度感染是手创伤术后切口感染的独立影响因素。结论显微手术修复结合VSD治疗有助于缩短手创伤感染患者抗感染药物使用时间,改善手创伤创面修复效果,手创伤术后发生切口感染与年龄、基础疾病、手术时间、创面感染程度有关。

Objective To explore the clinical observation of microsurgical repair combined with VSD in the treatment of hand trauma infections and influencing factors of postoperative wound infection.Methods Retrospective analysis was performed on 100 patients with hand trauma infection admitted to the Department of Hand and Foot Surgery,People’s Hospital of Suzhou High-tech Zone from Nov.2015 to Dec.2019,including 62 males and 38 females,aged from 21 to 50 years,with an average age of 38.7 years.Causes of injury:43 cases of road traffic injury,19 cases of heavy weight injury,27 cases of machine crush injury,11 cases of other reasons;Injury site:dorsal hand in 62 cases,fingers in 38 cases;Injury nature:tendon injuries in 22 cases,fracture injuries in 43 cases,avulsion injuries in 35 cases.According to the random number table method,the patients were divided into control group and observation group,with 50 patients in each group.The control group received microsurgical repair combined with traditional dressing changing treatment,while the observation group received microsurgical repair combined with VSD treatment.The use time of anti-infection drugs,wound healing time,hospital stay and evaluation of wound repair effect in the two groups were compared.Logistic regression was used to analyze the risk factors of postoperative incision infection after hand trauma.Results The duration of anti-infective drug use,hospital stay and wound healing time in the observation group were(7.72±1.53)days,(16.57±2.18)days and(15.74±1.65)days,respectively,while those in the control group were(13.45±1.78)days,(28.63±3.57)days and(26.92±2.17)days,respectively,with statistically significant differences(P<0.05).The wound repair efficiency of observation group was higher than that of control group(P<0.05).Multi-factor logistics regression model analysis showed that age≥60 years,complicated basic diseases(such as chronic diseases such as cardiovascular and cerebrovascular diseases,diabetes,malignant tumors),operation time≥3 hours,and severe wound infection were independent influencing factors for postoperative incision infection after hand trauma.Conclusion Microsurgical repair combined with vacuum sealing drainage can shorten the use time of anti-infection drugs,wound healing time,hospital stay time in patients with hand trauma,and improve the effect of wound repair,which is worthy of further promotion in clinical practice.Incision infection after hand trauma infections is related to age,basic disease,operation time and degree of wound infection.