封闭式负压引流、抗生素骨水泥联合皮瓣修复对合并多重耐药细菌感染的Gustilo Ⅲ型胫腓骨骨折的疗效分析

Curative effect of vacuum sealing drainge,antibiotic bone cement combined with flap repair on patients with multidrug resistant bacterial infection after Gustilo type Ⅲ tibiofibular fracture surgery

目的探讨封闭式负压引流(vacuum sealing drainge,VSD)、抗生素骨水泥联合皮瓣修复对Gustilo Ⅲ型骨折术后多重耐药细菌感染的临床疗效。方法对包头市第三医院2015年3月至2019年3月收治的7例Gustilo Ⅲ型骨折术后感染多重耐药细菌患者进行回顾性分析,患者术前采用敏感抗生素抗感染,术中对创面进行彻底清创,使用VSD技术5~7 d后行手术皮瓣修复创面,在感染严重的区域放置抗生素骨水泥。结果 6例皮瓣成活,1例游离股前外侧皮瓣术后发生血管危象,急诊手术探查见主要供血动脉栓塞、皮瓣坏死,清创后再次行游离胸脐皮瓣修复,皮瓣成活,感染均得到有效控制,伤口愈合拆线。病程为25~65 d,平均(42.3±13.6)d。术后随访时间为15~36个月,平均(29.3±7.6)个月。7例患者中,5例优,皮瓣外观、血运、质地、弹性、色泽均良好;1例良,皮瓣外形稍臃肿,患者满意度较好,拒绝行皮瓣二次整形治疗;1例可;均无窦道形成、继发感染。结论 VSD、抗生素骨水泥联合皮瓣修复治疗合并多重耐药细菌感染的创面,可缩短使用抗生素抗感染的时间,减少住院时间,预后较佳,可以作为控制多重耐药细菌感染创面的一种有效方法。

Objective To investigate the clinical efficacy of vacuum sealing drainage (VSD),antibiotic bone cement combined with flap repair in the treatment of multidrug resistant bacteria infection after Gustilo type Ⅲ fracture operation.Methods From March 2015 to March 2019,7 patients with postoperative infection of Gustilo type Ⅲ fracture were treated by skin flap repair combined with VSD and antibiotic bone cement in the Third Hospital of Baotou were retrospectively analyzed.Sensitive antibiotics were used to resist infection before operation,and the wound was thoroughly debridement during operation.VSD was used for 5~7 days.The skin flap was cut according to the preoperative design,and antibiotic bone cement was placed in the area with severe infection.Results 6 flaps survived.1 case developed vascular crisis after free anterolateral thigh flap operation.Emergency surgical exploration showed embolism of the main blood supply artery and necrosis of the flap.After debridement,the free thoracolumbar flap was repaired again.The flap survived,the infection was effectively controlled,and the wound healed.The course of disease was 25~65 days,average(42.3±13.6)days.All patients were followed up for 15~36 months,average(29.3±7.6)months.Among the 7 cases,5 cases were excellent in appearance,blood supply,texture,elasticity and color;1 case was good,the appearance of the flap was slightly bloated,and the patient’s satisfaction was good;1 case was acceptable.There were no sinus formation or secondary infection.Conclusion VSD,antibiotic bone cement combined with skin flap in the treatment of wounds with multi drug resistant bacteria infection can shorten the time of antibiotic anti infection,reduce the length of hospital stay,and have a better prognosis.It can be used as an effective method to control the wound with multi drug resistant bacteria infection.