CAJ | 학술논문

目的探讨外固定支架结合负压封闭引流(VSD)技术治疗Gustilo Ⅲ型胫腓骨开放性骨折的疗效.方法 2006年10月至2009年11月采用外崮定支架结合VSD技术治疗19例Gustilo Ⅲ型胫腓骨开放性骨折患者,男14例,女5例;年龄17～62岁,平均30.1岁.开放性损伤按Gustilo分型:ⅢA型9例,ⅢB型8例,ⅢC型2例.所有患者均行急诊清创、骨折复位后外固定支架固定,采用VSD技术关闭创面,待创面洁净、肉芽生长后通过直接缝合(5例)、游离植皮(9例)或转移皮瓣(5例)等方法修复软组织创面.结果 19例患者术后获12～24个月(平均16.3个月)随访.所有患者经VSD治疗5～17 d(平均9.3 d)后关闭创面.2例因创面感染、组织坏死渗出,经多7欠清创并更换VSD敷料后,创面最终通过转移皮瓣得以修复.骨折愈合时间为4～10个月(平均5.6个月).结论外固定支架结合VSD技术治疗Gustilo Ⅲ型胫腓骨开放性骨折能在迅速有效地稳定骨折的同时,早期闭合创面,促进骨折愈合,减少并发症的发生.
목적 탐토외고정지가결합부압봉폐인류(VSD)기술치료Gustilo Ⅲ형경비골개방성골절적료효.방법 2006년10월지2009년11월채용외고정지가결합VSD기술치료19례Gustilo Ⅲ형경비골개방성골절환자,남14례,녀5례;년령17～62세,평균30.1세.개방성손상안Gustilo분형:ⅢA형9례,ⅢB형8례,ⅢC형2례.소유환자균행급진청창、골절복위후외고정지가고정,채용VSD기술관폐창면,대창면길정、육아생장후통과직접봉합(5례)、유리식피(9례)혹전이피판(5례)등방법수복연조직창면.결과 19례환자술후획12～24개월(평균16.3개월)수방.소유환자경VSD치료5～17 d(평균9.3 d)후관폐창면.2례인창면감염、조직배사삼출,경다7흠청창병경환VSD부료후,창면최종통과전이피판득이수복.골절유합시간위4～10개월(평균5.6개월).결론외고정지가결합VSD기술치료Gustilo Ⅲ형경비골개방성골절능재신속유효지은정골절적동시,조기폐합창면,촉진골절유합,감소병발증적발생.
Objective To report clinical efficacy of vacuum sealing drainage(VSD)and external fixation in the treatment of tibiofibular fractures of Gustilo type Ⅲ. Methods From October 2006 to November 2009,19 cases of Gustilo type Ⅲ tibiofibular fracture were treated in our department.They were 14men and 5 women,with an average age of 30.1 years(from 17 to 62 years).There were 9 cases of type ⅢA,8 cases of Type ⅢB 2 cases of typeⅢC.After emergency debridement,all the fractures were fixed with an extemal fixator following indirect reduction.The wounds were sealed with VSD.When the wounds were clean and granulation appeared,they were repaired by direct suture(5 cases),split-thickness skin graft(9 cases)and flap transposition(5 cases). Results The 19 cases were followed up for 12 to 24 months,with an average of 16.3 months.A11 the wounds were closed'after VSD for 5 to 17 days.Wound infection occurred in 2 cases and was finally repaired by flap transposition following repeated debridement and VSD.The fractures healed after 4 to 10 months(average,5.6 months). Conclusion External fixation combined with VSD is a simple and effective treatment for tibiofibular fractures of Gustilo type Ⅲ.because it can provide not only rapid fixation but also early wound sealing to facilitate fracture healing and reduce incidence of complications.