封闭负压引流术治疗下肢骨折骨外露伴大面积软组织损伤的临床观察

Clinical Observation of Closed Negative Pressure Drainage in the Treatment of Lower Limb Fracture With Extensive Soft Tissue Injury

目的探讨封闭负压引流术治疗下肢骨折骨外露伴大面积软组织损伤的疗效。方法选取我院2015年5月至2017年5月收治的70例腓胫骨开放性骨折合并严重软组织损伤的患者作为观察对象,进行清创及骨折固定后,应用持续负压封闭引流,7-8d后拆除敷料,必要时先行负压封闭引流,再行二期植皮。结果 70例接受封闭负压引流治疗后,创面未出现愈合缓慢、过敏反应等损伤。创面肉芽组织平坦,新鲜,毛细血管丰富,无水肿等影响愈合的症状。所有患者植皮成活,并根据药敏试验选择敏感的抗菌药物。结论 VSD在下肢骨折骨外露伴大面积软组织损伤中有利于彻底清除创面及引流腔隙的渗液,生物透性薄膜具有良好的通透性,能避免创面局部渗液或发生交叉感染。此外,负压还能促进病变部位水肿消退,刺激肉芽生长,患者无需每天换药,既减轻了患者的痛苦,缩短了治疗时间,又减轻了患者的经济负担。封闭负压引流术给临床医生提供了一种简单、安全、经济的创面修复方法,有利于患者创面恢复,改善患者预后,值得临床应用。

Objective To study the vacuum assisted closure in the treatment of open fractures of tibia and fibula complicated with severe soft tissue injury. Methods In our hospital from May 2015 to May 2017 were 70 cases of fibula open fractures with severe soft tissue injury patients as the observation object of tibia, debridement and fracture fixation, application of vacuum sealing drainage, 7-8 d after the removal of dressings, when necessary to vacuum sealing drainage, and two skin. Result 70 cases received closed negative pressure drainage, the wound did not heal slowly, allergic reactions and other injuries. The wound granulation tissue is flat, fresh, capillary rich, no edema and other symptoms affecting the healing. All the patients survived the skin grafting and selected sensitive antimicrobial agents according to susceptibility tests. Conclusion VSD in the lower extremity fracture bone exposed with large area soft tissue injury to thoroughly clean the wound and lacuna of leachate drainage, biological permeable membrane has good permeability, can avoid wound exudation or cross infection. In addition, the negative pressure can promote the edema of the lesion site to subside and stimulate the granulation growth, and the patient does not need to change the dressing every day, thereby reducing the pain of the patient, shortening the treatment time and reducing the patient's economic burden. Vacuum sealing drainage provides a simple, safe and economical method for repairing wounds, which is beneficial to the recovery of wounds and the prognosis of patients, and is worthy of clinical application.