VSD结合外固定术及皮瓣移植治疗开放胫腓骨骨折并软组织缺损的疗效

Efficacy of VSD Combined with External Fixation and Skin Flap Transplantation in the Treatment of Open Tibiofibular Fractures with Soft Tissue Defects

目的:观察负压封闭引流技术(Vacuum sealing drainage,VSD)结合外固定术及皮瓣移植治疗开放胫腓骨骨折并软组织缺损的效果。方法:选取2018年1月-2022年1月在笔者医院治疗的64例开放性胫腓骨骨折并软组织缺损患者作为研究对象,按照随机数字表法将其分为观察组与对照组各32例。对照组给予传统换药+外固定术+二期皮瓣移植治疗,观察组给予VSD+外固定术+二期皮瓣移植治疗,两组二期手术均在创面肉芽组织生长满意后进行。一期治疗后7 d后,比较两组创面指标(创面细菌清除率、创面肉芽组织覆盖率、创面组织液分压、肉芽组织生长良好时间)及治疗前后血清炎性因子[白介素-6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)]水平;二期术后3个月,评估两组临床疗效,比较两组踝关节活动度、踝关节功能及并发症。结果:一期治疗7 d后,观察组创面细菌清除率、创面肉芽组织覆盖率、创面组织液分压均高于对照组(P<0.05),观察组肉芽组织生长良好时间短于对照组(P<0.05)。治疗前,两组血清炎性因子IL-6、CRP、TNF-α比较差异无统计学意义(P>0.05);治疗7 d后,观察组患者血清IL-6、CRP、TNF-α水平低于对照组(P<0.05)。二期术后3个月,观察组临床总有效率93.75%高于对照组的68.75%(P<0.05)。二期术后3个月,观察组踝关节活动度、关节功能评分(足部对线、地面步行、疼痛、最大步行距离)均高于对照组(P<0.05)。治疗期间,观察组并发症总发生率低于对照组(P<0.05)。结论:VSD结合外固定术及皮瓣移植治疗开放胫腓骨骨折并软组织缺损,可有效清除创面细菌,降低炎性因子水平,促进创面愈合及早期关节功能恢复。

Objective To observe the effects of vacuum sealing drainage(VSD)combined with external fixation and skin flap transplantation in the treatment of open tibiofibular fractures with soft tissue defects.Methods 64 patients with open tibiofibular fractures and soft tissue defects who were treated in the author's hospital from January 2018 to January 2022 were selected as the observation subjects,and they were divided into the observation group and the control group with 32 cases in each group according to the random number table method.The control group was given traditional dressing change+external fixation+stage II skin flap transplantation,while the observation group carried out VSD+external fixation+stage II skin flap transplantation.The stage II surgery was performed after the satisfying granulation tissue growth in both groups.At 7 days after the stage I treatment,the wound indicators(wound bacterial clearance rate,wound granulation tissue coverage rate,partial pressure of wound tissue fluid,good time of granulation tissue growth)and levels of serum inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]before treatment and after 7 days of treatment were compared between the two groups.The clinical efficacy of the two groups was evaluated at 3 months after stage II surgery,and the ankle range of motion,ankle function and complications of the two groups were compared.Results The wound bacterial clearance rate,wound granulation tissue coverage rate and wound tissue fluid partial pressure in the observation group after 7 days of stage I treatment were higher compared with those in the control group(P<0.05),and the good time of granulation tissue growth was shorter than that in control group(P<0.05).Before treatment,there were no statistical difierences in serum inflammatory factors such as IL-6,CRP and TNF-αamong the two groups(P>0.05).After 7 days of treatment,serum IL-6,CRP and TNF-αlevels of the observation group were lower than those of the control group(P<0.05).At 3 months after stage II surgery,the total clinical efiective rate of 93.75%in the observation group was higher than 68.75%in the control group(P<0.05).The ankle range of motion and joint function scores(foot alignment,ground walking,pain,maximum walking distance)in the observation group at 3 months after stage II surgery were higher compared to the control group(P<0.05).During treatment,the total incidence rate of complications was lower in the observation group than that in the control group(P<0.05).Conclusion VSD combined with external fixation and skin flap transplantation is efiective in the treatment of open tibiofibular fractures with soft tissue defects.It can efiectively remove bacteria from the wound,reduce the levels of inflammatory factors,and promote the wound healing and early joint function recovery.