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[封闭式负压引流治疗足部复杂骨折脱位伴严重软组织损伤的临床疗效]

[Clinical effect of vacuum sealing drainage in the treatment of complex fracture and dislocation of foot with severe soft tissue injury].

作者信息

Ma H D, Gao Y, Li S G, Bai J, Du X J, Liu H D, Li J J, Liang W D, Cao L H, Qu J F

机构信息

Department of Foot and Ankle, the Second Hospital of Tangshan, Hebei 063000, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2017 Sep 19;97(35):2746-2750. doi: 10.3760/cma.j.issn.0376-2491.2017.35.007.

Abstract

To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of complex fracture and dislocation of foot with severe soft tissue injury. From March 2012 to January 2015, a retrospective analysis of 108 cases of the foot closed complex fracture dislocation with severe soft tissue injury in Department of Foot and Ankle, the Second Hospital of Tangshan City, Tangshan.Injury mechanisms included press and crush injury, traffic accident.According to the operation the cases were divided into the VSD group (56 cases) and the control group (52 cases). The injury foot swelling after treated by open reduction and internal fixation or fusion joint fracture and dislocation. VSD technique was used to cover the wound and wound in group VSD. The wound was sutured, the sterile dressing was covered and the dressing was changed regularly in the control group. Preoperative hospitalization time: 16 days in group VSD, 28 days in the control group; the total hospitalization time: 33 days in group VSD, 53 days in the control group; wound healing: 29 cases in VSD group, 12 cases in the control group; prolonged healing after dressing: 16 cases in VSD group, 13 cases in the control group; after skin grafting healing: 9 cases in VSD group, 17 cases in the control group; healed after flap transposition: 2 cases in VSD group and 10 cases in thecontrol group.The difference of the data of the two groups was statistically significant, <0.05.Maryland foot score: 55-98 (average: 88.8, median: 91.5) points in VSD group, 38-97 (average: 84.85, median: 91) points in control group, compared with median by rank sum test, value: -2.755, the difference was statistically significant, < 0.05.The late recovery effect rating: 39 casesexcellent, good 12 cases, can be 5 cases, no poor in VSD group, excellent 29 cases, good 8 cases, can be 11 cases, poor 4 cases in the the control group, the difference was statistically significant, <0.05. VSD can shorten the preoperative waiting time and total hospitalization time, improve the wound healing rate directly, reduce the skin grafting and flap transfer replacement rate, reduce the secondary injury, increased fracture risk reduction and internal fixation, reduce joint fusion rate in the treatment of foot closed complex fracture and dislocation with severe soft tissue injury.

摘要

观察封闭式负压引流(VSD)技术治疗足部复杂骨折脱位并严重软组织损伤的临床疗效。回顾性分析2012年3月至2015年1月唐山市第二医院足踝科收治的108例足部闭合性复杂骨折脱位并严重软组织损伤患者的临床资料。致伤原因包括挤压伤、交通事故伤等。将患者按手术方式分为VSD组(56例)和对照组(52例)。两组均行切开复位内固定或关节融合术治疗骨折脱位,VSD组术后采用VSD技术覆盖创面,对照组术后常规缝合伤口、覆盖无菌敷料并定期换药。术前住院时间:VSD组16天,对照组28天;总住院时间:VSD组33天,对照组53天;伤口愈合情况:VSD组甲级愈合29例,对照组12例;延期愈合情况:VSD组16例,对照组13例;植皮后愈合情况:VSD组9例,对照组17例;皮瓣转移后愈合情况:VSD组2例,对照组10例。两组数据差异有统计学意义(P<0.05)。Maryland足部评分:VSD组55~98分(平均88.8分,中位数91.5分),对照组38~97分(平均84.85分,中位数91分),秩和检验比较中位数,Z值为-2.755,差异有统计学意义(P<0.05)。术后恢复效果评定:VSD组优39例,良12例,可5例,差0例;对照组优29例,良8例,可11例,差4例。两组差异有统计学意义(P<0.05)。VSD技术治疗足部闭合性复杂骨折脱位并严重软组织损伤,可缩短术前等待时间和总住院时间,直接提高伤口愈合率,降低植皮及皮瓣转移替代率,减少二次创伤,降低骨折不愈合及内固定失败风险,降低关节融合率。

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