三步序贯法联合外固定支架在下肢软组织缺损骨外露中的应用效果

The application effect of three-step sequential method combined with external fixation in the treatment of bone exposure in soft tissue defects of lower extremities

目的探究三步序贯法联合外固定支架治疗下肢软组织缺损骨外露的临床效果。方法选取2019年3月—2020年12月内江市中医院92例下肢软组织缺损骨外露患者,根据患者就诊序号采用电脑随机数字表法随机分为研究组和对照组,各46例。对照组采用外固定支架治疗,研究组采用三步序贯法[改良负压封闭引流(VSD)、皮耐克覆盖、自体皮移植]联合外固定支架治疗。比较两组创面治疗效果、康复情况(引流量、创面愈合时间、骨折愈合时间、住院时间)、并发症(皮瓣远端部分坏死、创面感染、骨折不愈合)发生率、感觉功能恢复情况、炎症-氧化应激因子[白细胞介素-6(IL-6)、降钙素原(PCT)、P物质(SP)、前列腺素E2(PGE2)]、组织生长相关因子[透明质酸(HA)、血管内皮生长因子(VEGF)]。结果研究组创面治疗总有效率(95.65%)高于对照组(80.43%)(P<0.05);与本组治疗前比较,两组治疗2周后血清IL-6、PCT、SP、PGE2水平均明显降低,且研究组低于对照组(P<0.05);两组治疗2周后渗出液HA、VEGF水平均明显高于治疗前,且研究组高于对照组(P<0.05);治疗2周后,研究组感觉功能恢复分级高于对照组(P<0.05);研究组引流量少于对照组,创面愈合时间、住院时间、骨折愈合时间均短于对照组(P<0.05);研究组并发症总发生率(6.52%)与对照组(15.22%)比较,差异无统计学意义(P>0.05)。结论采用三步序贯法联合外固定支架治疗下肢软组织缺损骨外露患者,能显著提高创面治疗效果,进一步减轻炎症-氧化应激反应,促进患者康复。

ObjectiveTo explore the clinical effect of three-step sequential method combined with external fixation in the treatment of soft tissue defects of lower limbs with bone exposure.Methods92 patients with soft tissue defects of the lower limbs with bone exposure in the Neijiang Traditional Chinese Medicine Hospital from March 2019 to December 2020 were randomly divided into the study group and the control group,46 cases in each group,according to the patient’s serial number using a computerized random number table.The control group was treated with external fixation stents,and the study group was treated with a three-step sequential method[modified negative pressure closed drainage(VSD),skin-neck cover,autologous skin grafting]combined with external fixation stents.Comparison of wound treatment effects,recovery status(drainage,wound healing time,fracture healing time,hospitalization time),incidence of complications(necrosis of the distal part of the flap,wound infection,fracture nonunion),sensory function recovery,inflammation-oxidative stress factors[Interleukin-6(IL-6),Procalcitonin(PCT),Substance P(SP),Prostaglandin E2(PGE2)],tissue growth-related factors[Hyaluronic acid(HA),vascular endothelial growth factor(VEGF)].ResultsThe total effective rate of wound treatment in the study group(95.65%)was higher than that of the control group(80.43%)(P<0.05);compared with this group before treatment,serum IL-6,PCT,SP,PGE2in the two groups after 2 weeks of treatment,the level was significantly lower,and the study group was lower than the control group(P<0.05);the levels of HA and VEGF in the exudate after 2 weeks of treatment in the two groups were significantly higher than those before treatment,and the study group was higher than the control group(P<0.05);after 2weeks of treatment,the sensory function recovery grade of the study group was higher than that of the control group(P<0.05);the drainage volume of the study group was less than that of the control group,and the wound healing time,hospital stay and fracture healing time were shorter than those of the control group(P<0.05);the total incidence of complications in the study group(6.52%)compared with the control group(15.22%),the difference was not statistically significant(P>0.05).ConclusionThe use of a three-step sequential method combined with external fixation to treat patients with soft tissue defects of the lower limbs with bone exposure can significantly improve the wound treatment effect,further reduce the inflammation-oxidative stress response,and promote the recovery of the patients.