自制负压封闭引流装置早期干预Sanders III、IV型跟骨骨折术后切口愈合异常

Intervention to Early-Stage Incision Complications in Sanders III and IV Calcaneal Fractures with Self-Made Vacuum Sealing Drainage Device

目的:探讨自制简易负压封闭引流装置在预防Sanders III、IV型跟骨骨折外侧切口行钢板内固定术后切口愈合异常的应用价值。方法:2010年10月至2015年10月,收治sanders III、IV型跟骨骨折41例(44足),其中男34例、女7例;年龄:22~51岁,平均年龄38岁,受伤8~13天后均给予外侧切口钢板内固定,其中有8例患者于术后5~9天开始出现淡黄色液体渗出,于处置室无菌条件下沿原切口置入自制负压封闭引流装置,抽吸固定形成恒定负压,至连续3天负压引流管内未见引流液后拔管。41例患者术后均获得随访,时间3~40个月,平均15个月。结果:切口给予自制简易负压吸引1天后切口表面渗出液消失,皮缘均未发生坏死,无浅层或深层感染,无切口裂开、窦道及钢板外露等严重并发症,伤口均获得愈合,无慢性骨髓炎发生,均未行VSD、皮瓣覆盖。结论:早期切口内置入自制简易负压封闭引流装置营造负压环境,排除渗出、消灭死腔,临床操作简便,价格低廉,效果较好,通过其早期的干预,可较明显的降低sanders III、IV型跟骨骨折切口的并发症,且患者易接受,值得临床推广。

Objective: To investigate the application of self-made Vacuum sealing drainage device (sVSDD) in preventing of the abnormal incision healing in Sanders III and IV calcaneal fractures. Methods: From October 2010 to October 2015, 41 patients (44 feet), with Sanders III and type IV fractures, were treated, including 34 males and 7 females, 22 - 51 years old (average 38 years old), which were treated by plate internal fixation using lateral L-shaped incision in 8 - 13 days after frac-ture, and 8 incisions with light-yellow exudations in 5 - 9 days after surgery. A sVSDD was placed along the original incision under aseptic conditions in treatment room, and a constant negative pressure was made. 41 patients were followed up for 3 - 40 months, with an average of 15 months. Results: Exudations were disappeared in these incisions treated by sVSDD after 1 day, without incision necrosis, no shallow or deep infection, no serious complications of wound de-hiscence, sinus and plate exposure, without chronic osteomyelitis. VSD or flap was not used. Conclusion: L-shaped incision complications can be reduced by early-stage sVSDDs interventions in the Sanders III, IV type calcaneal fracture, which can create a negative pressure micro- environment, exclusion of leakage, eliminate dead space, patients are easy to accept, worthy of clinical promotion.