摘要
目的探讨负压封闭引流（VSD）在胫腓骨骨折术后早期感染中的应用及近期临床疗效。方法回顾性分析2012年12月—2014年12月采用VSD治疗胫腓骨骨折术后早期感染患者19例，其中男13例，女6例；年龄26—57岁[（37．0．4-5．3）岁]。其中单纯胫骨骨折4例，单纯腓骨骨折2例，胫腓骨双骨折13例；开放骨折13例，闭合骨折6例。所有患者行切开复位内固定，术后14～21d[（18．0±3．3）d]感染，均予庆大霉素局部联合VSD治疗。术后动态观察患者白细胞计数（WBC）、C-反应蛋白（CRP）、红细胞沉降率（ESR）、患肢周径等变化。结果VSD治疗7～10d后，所有患者创面均较干净，18例经I期缝合，保留内固定，1例感染从软组织发展至骨髓腔，行内固定取出术后愈缝合。所有患者均获得随访6—24个月[（11．0±2．3）个月]，未见明显骨折畸形生长、功能障碍、慢性骨髓炎等手术并发症。术后行患肢X线片复查示骨折愈合，WBC、ESR、CRP等炎症标志物检验结果下降。结论VSD使早期感染创面引流充分，肿胀消退，CRP、ESR指标下降，能有效控制胫腓骨表面感染，为直接缝合创面创造了良好条件。
Objective To investigate the short-term outcome of vacuum sealing drainage （VSD） in the treatment of infection early after tibiofibular fracture surgery. Methods A retrospective analysis was performed on 19 patients sustaining early infection after tibiofibular fracture surgery from December 2012 to December 2014. The patients consisted of 13 males and 6 females, aged from 26 to 57 years [ （ 37. 0 ± 5.3 ） years]. There were 4 cases of isolate tibia] fracture, 2 isolate fibular fracture, and 13 tibi- al and fibular fracture. Open fractures were noted in 13 cases and close fractures in 6 cases. Infection occurred 14-21 days [ （18.0 ± 3.3 ）days] after open reduction and internal fixation and was treated with gentamicin and VSD. Parameters were monitored dynamically after operation, including white blood cell count （WBC）, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR） and limb perimeter. Results The wound was basically debrided 7-10 days after VSD. Eighteen cases had one-stage wound closure with instrumentation preservance, and one case with progressed infection from soft tissue to bone marrow had instrumentation removal and wound suture. VSD decreased markers of inflammation including WBC, CRP, and ESR as well as limb perimeter. A follow-up of 6-24 month [ （ 11.0 ± 2. 3 ） months ] showed fracture healing, without complications of detectable deformity growth, dysfunction, or chronic osteomyelitis. Conclusion VSD results in sufficient wound drain, reduction of swelling, decreased levels in CRP and ESR and controlled wound infection, which facilitates wound closure.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2015年第4期303-306,共4页
Chinese Journal of Trauma
关键词
感染
胫骨骨折
腓骨
负压封闭引流
Infection
Tibial fractures
Fibula
Vacuum sealing drainage
