CAJ | 학술논문

目的:探讨封闭负压引流(vacuum sealing drainage,VSD)技术在地震骨折伤员创面中防治感染、修复创面中的作用. 方法:收集2008年5月12日至2008年6月19日在四川大学华西医院收治并接受VSD治疗的22例开放性四肢骨折合并创面感染病例.所有病例在运用VSD之前,均对创面进行扩创,并全身应用有效抗生素.给伤员施加-18～-14 kPa负压,术后VSD引流8～10 d,严密观察负压引流量、颜色、性质,定期做引流液细菌培养,观察并记录肢体肿胀消退情况及全身炎症反应情况. 结果:22例伤员中无1例出现创面活动性出血或透明薄膜脱落现象.3例术后出现引流管堵塞现象,采用无菌生理盐水冲洗引流管、去除淤塞的坏死组织后保持通畅.13例有骨外露的伤员在封闭负压引流的作用下,肉芽组织生长良好.2例术后局部红肿热痛炎性症状缓解不明显,再次行扩创,彻底清除坏死感染组织后症状缓解,其余病例在术后3～5 d内肿胀明显消退,红肿发热也相应缓解.结论:VSD技术的正确应用能够有效缓解感染创面的炎症反应,限制感染的扩散,在有骨外露的创面,VSD还能促进新鲜肉芽组织从周围向中心平整生长,减少II期为覆盖骨外露转移皮瓣的面积.
목적:탐토봉폐부압인류(vacuum sealing drainage,VSD)기술재지진골절상원창면중방치감염、수복창면중적작용. 방법:수집2008년5월12일지2008년6월19일재사천대학화서의원수치병접수VSD치료적22례개방성사지골절합병창면감염병례.소유병례재운용VSD지전,균대창면진행확창,병전신응용유효항생소.급상원시가-18～-14 kPa부압,술후VSD인류8～10 d,엄밀관찰부압인류량、안색、성질,정기주인류액세균배양,관찰병기록지체종창소퇴정황급전신염증반응정황. 결과:22례상원중무1례출현창면활동성출혈혹투명박막탈락현상.3례술후출현인류관도새현상,채용무균생리염수충세인류관、거제어새적배사조직후보지통창.13례유골외로적상원재봉폐부압인류적작용하,육아조직생장량호.2례술후국부홍종열통염성증상완해불명현,재차행확창,철저청제배사감염조직후증상완해,기여병례재술후3～5 d내종창명현소퇴,홍종발열야상응완해.결론:VSD기술적정학응용능구유효완해감염창면적염증반응,한제감염적확산,재유골외로적창면,VSD환능촉진신선육아조직종주위향중심평정생장,감소II기위복개골외로전이피판적면적.
Objective To investigate the effect of vacuum sealing drainage (VSD) technology on prevention and treatment of infection wound and to repair the infectious fracture wound in earthquake. Methods Twenty-two patients with limb fractures and open infection wound received VSD from May 12, 2008 to June 19, 2008 in West China Hospital of Sichuan University. Before the VSD, we debrided all wounds and gave effective systemic antibiotics. A -18 ～ - 14 kPa pressure was exerted to the wound, and the VSD was used for 8 ～ 10 days. We took a germiculture regularly. The capacity, color, and nature of negative pressure drainage, the regression of limb swelling, and systemic inflammatory responses were observed. Results There was no active bleeding wound or transparent film off in all patients. Three patients had drainage clogging, and were kept flowing freely using the sterile saline pipe to remove the blockage of necrotic tissues. During the VSD, granulation tissues grew well in the 13 patients with bone exposure of the wounded. Two patients whose symptom of inflammatory was not obviousy eased had another debridement to completely remove the necrosis, and the symptom was relieved. After 3-5 days of VSD, swelling and fever in the other 20 patients significantly subsided. Conclusion VSD can alleviate the wound inflammation, facilitate the growth of the fresh granulation tissue from the surrounding to the center, and reduce the flap transfer area for the Stage Ⅱ coverage of the exposed bone.