负压封闭引流术结合双氧水皮瓣修复在小腿中段开放性骨折合并皮肤缺损创面修复中的应用

Application of closed drainage with negative pressure combined with hydrogen peroxide combined with skin flap in the repair of open fracture of middle leg with skin defect

目的探讨负压封闭引流术(VSD)结合双氧水皮瓣修复在小腿中段开放性骨折合并皮肤缺损创面修复中的应用效果。方法回顾性选取2020年5月至2022年8月南京大学医学院附属鼓楼医院收治小腿中段开放性骨折合并皮肤缺损患者96例作为研究对象,均行骨折复位固定及皮瓣修复术。按随机数字表法将其分为对照组及观察组,每组各48例。对照组予以VSD治疗,观察组则施以VSD结合双氧水治疗。比较两组康复指标(伤口愈合时间、住院时间、移植皮瓣存活率及疼痛程度)、炎症因子[白细胞介素-1(IL-1)、肿瘤坏死因子α(TNF-α)及超敏C反应蛋白(hs-CRP)]水平、微循环参数(管襻长度、白微栓率及管襻畸形率)及安全性。结果两组移植皮瓣存活率比较,差异无统计学意义(P>0.05),观察组伤口愈合时间、住院时间分别为(13.71±2.49)、(18.42±3.34)d,均短于对照组[(15.46±2.82)、(21.36±3.75)d],观察组疼痛视觉模拟评分法(VAS)评分为(1.78±0.85)分,低于对照组[(2.69±1.54)分],差异均有统计学意义(P<0.05)。治疗2周后,两组IL-1、TNF-α及hs-CRP水平均较治疗前降低,且观察组IL-1、TNF-α及hs-CRP水平分别为(12.54±4.92)pg/L、(18.36±6.27)pg/L、(8.13±2.01)g/L,均低于对照组[(18.69±6.17)pg/L、(29.41±8.94)pg/L、(12.96±2.83)g/L],差异均有统计学意义(P<0.05)。治疗2周后,两组的管襻长度有所上升,白微栓率及管襻畸形率均有所降低,观察组管襻长度为(175.42±22.57)μm,高于对照组[(162.34±21.72)μm],白微栓率及管襻畸形率分别为(1.57±0.21)%、(20.15±3.16)%,均低于对照组[(2.31±0.29)%、(25.86±3.78)%],差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论应用VSD结合双氧水对骨折复位内固定及皮瓣修复术治疗的小腿中段开放性骨折合并皮肤缺损患者进行清创引流,疗效确切,有助于加快康复,减轻炎症反应,改善微循环,且并发症较少,具有较高安全性。

Objective To investigate the effect of vacuum sealing drainage(VSD)combined with hydrogen peroxide combined with skin flap in the repair of open fracture of the middle leg with skin defect.Methods A retrospective analysis was performed on 96 patients with open fracture of the middle leg combined with skin defect admitted to Nanjing Drum Tower Hospital,The Affiliated of Nanjing University Medical School from May 2020 to August 2022,all of which were treated with fracture reduction and fixation and flap repair.They were divided into control group and observation group according to the random number table method.The control group was treated with VSD,and the observation group was treated with VSD combined with hydrogen oxygen.The rehabilitation indexes(wound healing time,hospital stay,survival rate of flap graft and pain situation),inflammatory factor[interleukin-1(IL-1),tumor necrosis factor-α(TNF-α)and hypersensitive C-reactive protein(hs-CRP)]levels,microcirculation parameters(loop length,white thrombus rate,and loop deformity rate)and safety were compared between the two groups.Results There was no statistically significant difference in the survival rate between the two groups of transplanted flaps(P>0.05).The wound healing time and hospitalization time of the observation group were(13.71±2.49)and(18.42±3.34)days,respectively,which were shorter than those of the control group[(15.46±2.82)and(21.36±3.75)days],the pain visual analogue scale(VAS)score of the observation group was(1.78±0.85)points,which was lower than that of the control group[(2.69±1.54)points],and the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of IL-1,TNF-α,and hs-CRP in two groups were lower than those before treatment,and the levels of IL-1,TNF-αand hs-CRP in the observation group were(12.54±4.92)pg/L,(18.36±6.27)pg/L,and(8.13±2.01)g/L,which were lower than those in the control group[(18.69±6.17)pg/L,(29.41±8.94)pg/L,and(12.96±2.83)g/L],and the differences were statistically significant(P<0.05).After 2 weeks of treatment,the length of the loop in two groups were higher than those before treatment,while the rates of white thrombus and loop deformity were lower than those before treatment,the loop length in the observation group was(175.42±22.57)μm,which was higher than that in the control group[(162.34±21.72)μm],the rates of white microthrombus and loop malformation were(1.57±0.21)%and(20.15±3.16)%,respectively,which were lower than those of the control group[(2.31±0.29)%and(25.86±3.78)%],and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion VSD combined with hydrogen peroxide for debridement and drainage of open fracture of middle leg with skin defect treated by fracture reduction and internal fixation and flap repair is effective,which is helpful to accelerate recovery,reduce inflammation,improve microcirculation,and has high safety with fewer complications.