摘要
目的探讨运用保留内植物结合负压封闭引流（Vacuum sealing drainage,VSD）技术治疗四肢骨折术后早期感染的临床疗效。方法回顾性分析2007年12月-2013年6月收治的12例四肢骨折术后早期感染患者病例资料,其中男8例,女4例;年龄22-58岁,平均42.5岁。胫骨平台骨折6例,股骨干骨折3例,胫骨干骨折3例,均为闭合性骨折。均于内固定术后5-14天（平均10天）发生感染。表皮葡萄球菌感染7例,金黄色葡萄球菌感染3例,大肠埃希氏菌感染2例。术中保留内植物,彻底清创后应用VSD技术分层封闭创面,5-7天更换VSD敷料的同时行创缘部分减张缝合处理,待创面肉芽组织生长新鲜后完全关闭创口。结果应用VSD技术治疗7-15天后,所有患者均创面洁净及肉芽组织生长新鲜,细菌培养均为阴性,此期间更换VSD敷料1-3次（平均2次）。末次手术均采用直接缝合方式完全关闭创面。所有患者术后获12-28个月（平均18个月）随访。骨折均于末次手术后20-32周（平均25周）获骨性愈合。末次随访时所有患者创面均愈合良好,局部感染无复发,采用Enneking下肢功能评分为22-29分,平均26分。结论运用保留内植物结合VSD技术治疗四肢骨折术后早期感染,骨折维持稳定的同时能有效地控制感染,有利于创面早期愈合,为肢体功能恢复创造条件。
Objective To explore the clinical effects of implant retainment combined with vacuum sealing drainage（VSD）technique in the treatment of early postoperative infection of limbs fracture. Methods A retrospective analysis of the clinical information of 12 cases with early postoperative infection of limbs fracture from December 2007 to June 2013. There were 8 males and 4 females, aged from 22 to 58 years（average, 42.5 years）. There were 6 cases of tibial plateau fractures,3 cases of femoral shaft fractures, 3 cases of tibial shaft fractures, and all cases were closed fracture. Their infections occurred 5 to 14 days（average, 10 days） after internal fixation. There were 7 cases of cuticle staphylococcus aureus infection, 3 cases of staphylococcus aureus infection and 2 cases of escherichia coli infection. All cases were given implant retainment, thorough debridement and the layer-wise application of VSD technique. The VSD dressing was replaced after 5 to 7 days application, and meanwhile the wound edge was partly sutured, and completely closed wound was performed after growth of fresh granulation tissue. Results After the VSD was applied for 7 to 15 days, the wound surface was clean,the growth of granulation tissue was fresh, and the bacterial cultures were negative in all cases, and the replacement of VSD dressing was 1 to 3 times（average, 2 times）. Direct skin suture was performed to completely close the wound at last operation. All patients were followed up from 12 to 28 months（average, 18 months）, and all fractures healed from20 to 32 weeks（average, 25 weeks）after the last operation. All patients with wound healed well, local infection without recurrence, and the mean Enneking score was 26（range, 22 to 29） at last follow-up. Conclusion The application of implant retainment combined with VSD technique in the treatment of early postoperative infection of limbs fracture, which can maintain fracture stability and effectively control the infection, is beneficial to wound healing and limbs function recovery.
出处
《生物骨科材料与临床研究》
CAS
2015年第6期54-57,63,共5页
Orthopaedic Biomechanics Materials and Clinical Study
关键词
骨折
四肢
感染
引流术
封闭敷料
Fracture
Limbs
Infection
Drainage
Occlusive dressings
