中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
20期
3246-3251
,共6页
组织构建%骨组织工程%胫骨骨折%腓骨骨折%软组织缺损%封闭负压引流%外固定器%骨折%中厚皮片%植皮%感染%创面愈合
組織構建%骨組織工程%脛骨骨摺%腓骨骨摺%軟組織缺損%封閉負壓引流%外固定器%骨摺%中厚皮片%植皮%感染%創麵愈閤
조직구건%골조직공정%경골골절%비골골절%연조직결손%봉폐부압인류%외고정기%골절%중후피편%식피%감염%창면유합
biocompatible mateirals%drainage%soft tissue injury%skin transplantation
背景：传统的治疗胫腓骨骨折合并皮肤软组织缺损的方法是行简单外固定，创面清创换药待感染控制、肉芽生长旺盛后植皮或皮瓣转移，这种方法不仅费用高、痛苦大、住院时间长，而且有感染扩散、周围组织进一步坏死，最后不得不截肢的可能。<br> 目的：探讨封闭负压引流加外固定架修复胫腓骨骨折并皮肤缺损的临床疗效。<br> 方法：选择本溪市中心医院2009年1月至2013年9月收治胫腓骨骨折皮肤软组织缺损患者38例，皮肤缺损面积>5 cm2，在骨折外固定后给予彻底清创，再行封闭负压引流技术治疗5-7 d，待肉芽组织生长、创面新鲜后行中厚皮片植皮治疗。并回顾性选择15例未采用封闭负压引流治疗的类似病例作为对照组，对其感染控制率及伤口愈合时间等进行比较。<br> 结果与结论：引流5-7d后去除封闭负压引流敷料，伤口感染得到控制，局部创面肉芽组织生长良好，创面及骨折均如期愈合，无骨髓炎及截肢的发生。38例患者治愈23例，显效12例，无效3例，总有效率为92%，与对照组53%的总有效率相比差异有显著性意义(P<0.05)。证实封闭负压引流可以彻底清除创面的分泌物和坏死组织，改善局部微循环和消除感染，联合外固定支架和植皮是治疗胫腓骨骨折并软组织缺损的一种简便有效方法。
揹景：傳統的治療脛腓骨骨摺閤併皮膚軟組織缺損的方法是行簡單外固定，創麵清創換藥待感染控製、肉芽生長旺盛後植皮或皮瓣轉移，這種方法不僅費用高、痛苦大、住院時間長，而且有感染擴散、週圍組織進一步壞死，最後不得不截肢的可能。<br> 目的：探討封閉負壓引流加外固定架脩複脛腓骨骨摺併皮膚缺損的臨床療效。<br> 方法：選擇本溪市中心醫院2009年1月至2013年9月收治脛腓骨骨摺皮膚軟組織缺損患者38例，皮膚缺損麵積>5 cm2，在骨摺外固定後給予徹底清創，再行封閉負壓引流技術治療5-7 d，待肉芽組織生長、創麵新鮮後行中厚皮片植皮治療。併迴顧性選擇15例未採用封閉負壓引流治療的類似病例作為對照組，對其感染控製率及傷口愈閤時間等進行比較。<br> 結果與結論：引流5-7d後去除封閉負壓引流敷料，傷口感染得到控製，跼部創麵肉芽組織生長良好，創麵及骨摺均如期愈閤，無骨髓炎及截肢的髮生。38例患者治愈23例，顯效12例，無效3例，總有效率為92%，與對照組53%的總有效率相比差異有顯著性意義(P<0.05)。證實封閉負壓引流可以徹底清除創麵的分泌物和壞死組織，改善跼部微循環和消除感染，聯閤外固定支架和植皮是治療脛腓骨骨摺併軟組織缺損的一種簡便有效方法。
배경：전통적치료경비골골절합병피부연조직결손적방법시행간단외고정，창면청창환약대감염공제、육아생장왕성후식피혹피판전이，저충방법불부비용고、통고대、주원시간장，이차유감염확산、주위조직진일보배사，최후불득불절지적가능。<br> 목적：탐토봉폐부압인류가외고정가수복경비골골절병피부결손적림상료효。<br> 방법：선택본계시중심의원2009년1월지2013년9월수치경비골골절피부연조직결손환자38례，피부결손면적>5 cm2，재골절외고정후급여철저청창，재행봉폐부압인류기술치료5-7 d，대육아조직생장、창면신선후행중후피편식피치료。병회고성선택15례미채용봉폐부압인류치료적유사병례작위대조조，대기감염공제솔급상구유합시간등진행비교。<br> 결과여결론：인류5-7d후거제봉폐부압인류부료，상구감염득도공제，국부창면육아조직생장량호，창면급골절균여기유합，무골수염급절지적발생。38례환자치유23례，현효12례，무효3례，총유효솔위92%，여대조조53%적총유효솔상비차이유현저성의의(P<0.05)。증실봉폐부압인류가이철저청제창면적분비물화배사조직，개선국부미순배화소제감염，연합외고정지가화식피시치료경비골골절병연조직결손적일충간편유효방법。
BACKGROUND:Traditional treatment of tibia and fibula fractures complicated with skin soft tissue defect is mainly external fixation, wound debridement and dressing plus skin graft or skin flap transplantation after the infection is control ed and granulation grow. This method is disadvantageous due to high cost, great pain, long hospitalization stay, infection and necrosis, even the possibility of amputation. <br> OBJECTIVE:To explore the clinical efficacy of vacuum sealing drainage (VSD) and external fixator in the treatment of tibia and fibula open fractmes complicated with skin defects. <br> METHODS:A total of 38 patients with severe open fractures of tibia and fibula complicated with skin defects were selected from Benxi Central Hospital between January 2009 and September 2013. The size of skin defects was more than 5 cm2. After external fixation, the patients underwent complete debridement and dressing, fol owed by VSD treatment for 5-7 days. After granulation tissue grew and the wound became fresh, the patients received intermedite thickness skin graft. And 15 cases treated without VSD were retrospectively selected, serving as control group. The infection control rate and wound healing time in the two groups were compared. <br> RESULTS AND CONCLUSION:After 5-7 days of VSD treatment, VSD dressings were removed, wound infection was control ed, local wound granulation tissue was fresh. Both the wound and fractures were healed wel , no osteomyelitis or amputation occurred. Among the involved 38 patients, 23 cases were cured, 12 cases were effective, and three cases were ineffective. The total effective rate showed significant differences compared with the control group (92%vs. 53%;P<0.05). VSD can completely remove the wound secretions and necrotic tissue, improve local microcirculation, eliminate the infection, VSD plus external fixator and skin grating is a simple and effective method in treatment of tibia and fibula open fractures with soft tissue defects.
