CAJ | 학술논문

目的评估负压封闭引流（ VSD）技术在治疗儿童四肢软组织缺损中的作用。方法以收治的18例四肢创伤合并皮肤软组织缺损伴或不伴骨、软骨、肌腱外露的儿童病例为实验组，给予彻底清创后行VSD治疗，1～2疗程后行植皮或皮瓣转移术。植皮病例术后再行VSD治疗。以20例四肢创伤合并皮肤软组织缺损、采用常规换药治疗的儿童病例为对照组。结果实验组VSD治疗1～2疗程后15例创面肉芽生长良好，其中包括创面骨外露5例，软骨外露3例，肌腱外露4例，均行游离植皮；3例创面肉芽生长少，其中2例软骨外露范围较大，1例为足背大片肌腱外露，均行皮瓣转移。所有病例创面均修复愈合。与常规换药方法比较，实验组伤后至Ⅱ期手术时间及住院时间均比对照组明显缩短（P＜0.01），换药次数比对照组明显减少（P＜0.01），植皮成活率较对照组高（P＜0.05），并发症（感染、外露骨坏死）发生率与对照组比较无显著差异（P＞0.05）。结论 VSD技术能刺激肉芽生长、减少皮瓣手术、减轻痛苦、缩短疗程，是治疗儿童四肢软组织缺损的有效方法之一。应用时应根据患儿全身及创面局部特点适当调整，对软骨外露范围较大的创面多数需配合皮瓣手术。
목적평고부압봉폐인류（ VSD）기술재치료인동사지연조직결손중적작용。방법이수치적18례사지창상합병피부연조직결손반혹불반골、연골、기건외로적인동병례위실험조，급여철저청창후행VSD치료，1～2료정후행식피혹피판전이술。식피병례술후재행VSD치료。이20례사지창상합병피부연조직결손、채용상규환약치료적인동병례위대조조。결과실험조VSD치료1～2료정후15례창면육아생장량호，기중포괄창면골외로5례，연골외로3례，기건외로4례，균행유리식피；3례창면육아생장소，기중2례연골외로범위교대，1례위족배대편기건외로，균행피판전이。소유병례창면균수복유합。여상규환약방법비교，실험조상후지Ⅱ기수술시간급주원시간균비대조조명현축단（P＜0.01），환약차수비대조조명현감소（P＜0.01），식피성활솔교대조조고（P＜0.05），병발증（감염、외로골배사）발생솔여대조조비교무현저차이（P＞0.05）。결론 VSD기술능자격육아생장、감소피판수술、감경통고、축단료정，시치료인동사지연조직결손적유효방법지일。응용시응근거환인전신급창면국부특점괄당조정，대연골외로범위교대적창면다수수배합피판수술。
Objective To evaluate the efficacy of vacuum sealing drainage ( VSD) in treating soft tissue de-fect of extremity in children .Methods Eighteen paediatric patients with post-traumatic soft tissue defects with or without bone or cartilage exposure of extremities were treated with VSD following debridement ,and were then treated with dermatoplasty or skin flap grafting after one or two therapy courses ,who received VSD treatments after dermato-plasty .Twenty patients with soft tissue defects in control group received traditional dressing .Results Fresh gran-ulation grew well after VSD treatments in 15 cases(5 with bone exposure,3 with cartilage exposure and 4 with tendon exposure).Wound closure was performed by dermatoplasty .Two patients with large-area cartilage exposure and one patient with large-area tendon exposure received skin flap grafting because of poor granulation growth after VSD treatment.All cases recovered .Compared with the control group ,the time from injury to Ⅱ period operation and the hospitalization time were significantly shortened (P<0.01),and the dressing time was significantly reduced (P<0.01),and the healing of skin grafting was significantly elevated (P<0.05), but there was no statistical differ-ence in the complication rate between the two groups ( P>0.05) .Conclusion The VSD procedure can accelerate granulation tissue growth ,reduce operations of skin flap ,allay patient's pain and shorten healing time .It's an effec-tive method for treatment of soft tissue defect of extremity in children .But it should be adjusted according to the wound characteristics .Most of the cases with large-area cartilage exposure need skin flap operation besides VSD .