Yu Zhong-xiang, Kuang Yong, Tan Yi-wen, Gu Xin-feng
Department of Orthopaedics, Shuguang Hospital of Shanghai, Shanghai 200021, China.
Zhongguo Gu Shang. 2009 Mar;22(3):196-8.
To investigate simple and convenient methods for the treatment of severe open injuries of limbs.
From 2005.1 to 2008.3, 31 patients got limb salvage in 33 cases (Gustilo III B) from emergency, which were divided into two groups(A and B). The 16 patients in Group A (14 male and 2 female) were treated with emergency debridement, sequential dressing change, and finally with skin grafting or free flap. The 15 patients in Group B (11 male and 4 female) were treated with radical debridement (skin and muscle), decompression of fascial compartment routinely and repair of periosteal avulsion lesion. The patients in Group B were also treated with external application of Mangxiao postoperatively and dressing change for first time one week later. The clinical effects were assessed by the skin survival rate of degloving injury, the number of operative procedures (using free flap or not), the number of dressing changes in the first two weeks, body temperature and white cell count (48 h after the first debridement ). Statistical analysis was done with SPSS software. Chi-square analyses was used to compare the enumeration data, and compare means with independent samples T test for measurement data.
All the patients in Group A got limb salvage (10 patients were upper limb, 6 patients were lower limb), and the mean skin survival rate of degloving injury was (77.88 +/- 4.21)%. Five patients in Group A were finally treated with free flap. All the patients in Group B got limb salvage (10 patients were upper limb, 5 patients were lower limb) by a few secondary skin grafting, and the mean skin survival rate of degloving injury was (97.53 +/- 3.09)%. The mean skin survival rate of Group B was obviously better than that of Group A (P<0.01). The number of dressing changes in the first two weeks in Group B was absolutely less than that of Group A (P<0.01). Also, infection rate and the number of operative procedures of Group B was significantly less than that of Group A (P<0.01). All the patients were followed up for at least 3 months.
Radical debridement combined with external application of Mangxiao for the treatment of severe open fractures is simple, convenient and effective. It is better for a lot of people injured simultaneously in accident.
探讨治疗四肢严重开放性损伤的简便方法。
2005年1月至2008年3月，对急诊收治的33例（Gustilo III B型）肢体严重开放性损伤患者中的31例进行保肢治疗，分为两组（A组和B组）。A组16例（男14例，女2例），行急诊清创、序贯换药，最终行植皮或游离皮瓣修复；B组15例（男11例，女4例），行彻底清创（皮肤和肌肉），常规行筋膜室减压及骨膜撕脱伤修复，术后加用芒硝外敷，术后1周首次换药。通过脱套伤皮肤成活率、手术操作次数（是否使用游离皮瓣）、前两周换药次数、体温及白细胞计数（首次清创后48小时）评估临床疗效。采用SPSS软件进行统计学分析。计数资料采用χ²检验比较，计量资料采用独立样本t检验比较均值。
A组患者均保肢成功（上肢10例，下肢6例），脱套伤皮肤平均成活率为（77.88±4.21）%，A组5例患者最终行游离皮瓣修复。B组患者均经数次二期植皮保肢成功（上肢10例，下肢5例），脱套伤皮肤平均成活率为（97.53±3.09）%。B组皮肤平均成活率明显优于A组（P<0.01）。B组前两周换药次数明显少于A组（P<0.01）。B组感染率及手术操作次数也明显少于A组（P<0.01）。所有患者均随访至少3个月。
彻底清创联合芒硝外敷治疗严重开放性骨折简便有效，对于事故中大批伤员同时受伤的情况更适用。
