VSD配合灌注冲洗方案对四肢骨折内固定术后感染及创面愈合的影响

Effect of VSD combined with perfusion irrigation on infection and wound healing after internal fixation of extremities fractures

目的 探讨负压封闭引流技术(VSD)配合灌注冲洗方案对四肢骨折内固定术后感染及创面愈合的影响。方法 96例行内固定术且发生术后感染的四肢骨折患者,按照电脑随机法分为A组和B组,每组48例。A组采用传统灌注冲洗治疗,B组采用VSD配合灌注冲洗治疗。比较两组患者治疗效果、临床指标(骨折愈合时间、肉芽组织生长时间、创面愈合时间、住院时间)、血清炎性因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、血沉(ESR)]水平。结果 B组患者的总有效率为97.92%(47/48),A组患者的总有效率为85.42%(41/48),B组患者的治疗总有效率优于A组,差异具有统计学意义(P<0.05)。B组患者的骨折愈合时间、肉芽组织生长时间、创面愈合时间、住院时间分别为(8.25±1.17)周、(8.95±1.25)d、(9.68±1.47)d、(22.31±4.65)d,均明显短于A组的(11.25±2.16)周、(15.47±1.78)d、(15.43±1.25)d、(43.26±6.58)d,差异具有统计学意义(P<0.05)。治疗后,B组患者的hs-CRP、IL-6、IL-8、IL-10、ESR分别为(3.21±1.02)mg/L、(79.32±16.23)pg/ml、(85.69±20.48)pg/ml、(4.13±2.07)pg/ml、(14.09±2.49)mm/h,均明显低于A组的(5.36±1.23)mg/L、(112.08±23.61)pg/ml、(122.86±16.45)pg/ml、(6.29±2.17)pg/ml、(20.36±4.65)mm/h,差异具有统计学意义(P<0.05)。结论 四肢骨折内固定术后感染患者应用VSD配合灌注冲洗,可有效改善患者的临床指标,加速创面愈合速度,缩短患者的住院时间,效果显著,值得广泛推广和应用。

Objective To discuss the effect of vacuum sealing drainage(VSD) combined with perfusion irrigation on infection and wound healing after internal fixation of extremities fractures.Methods A total of 96 patients with postoperative infection after internal fixation of extremities fractures were divided into group A and group B according to the computerized randomization method,with 48 cases in each group.Group A was treated with conventional perfusion irrigation,and group B was treated with VSD with perfusion irrigation.Both groups were compared in terms of therapeutic effect,clinical indexes(fracture healing time,granulation tissue growth time,wound healing time,hospitalization time),serum inflammatory factors [high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10),and erythrocyte sedimentation rate(ESR)] levels.Results The total effective rate was 97.92%(47/48) in group B and 85.42%(41/48) in group A;the total effective rate of group B was better than that of group A,and the difference was statistically significant(P<0.05).The fracture healing time,granulation tissue growth time,wound healing time and hospitalization time in group B were(8.25±1.17) weeks,(8.95±1.25) d,(9.68±1.47) d and(22.31±4.65) d,which were significantly shorter than(11.25±2.16) weeks,(15.47±1.78) d,(15.43±1.25) d and(43.26±6.58) d in group A,and the differences were all statistically significant(P<0.05).After treatment,the hs-CRP,IL-6,IL-8,IL-10 and ESR in group B were(3.21±1.02) mg/L,(79.32±16.23) pg/ml,(85.69±20.48) pg/ml,(4.13±2.07) pg/ml,and(14.09±2.49) mm/h,which were significantly lower than(5.36±1.23) mg/L,(112.08±23.61) pg/ml,(122.86±16.45) pg/ml,(6.29±2.17) pg/ml,and(20.36±4.65) mm/h in group A,and the differences were all statistically significant(P<0.05).Conclusion The application of VSD with perfusion irrigation in patients with postoperative infection after internal fixation of extremities fractures can effectively improve the clinical indexes,accelerate the wound healing of patients and shorten their hospitalization time with significant effects,which is worthy of wide promotion and application.