CAJ | 학술논문

背景：近年来国内外学者将负压封闭引流技术运用于各种骨科创面的治疗或促进移植皮肤的成活，均取得了良好的效果。 　　目的：观察负压封闭引流技术在骨外科四肢开放性骨折、软组织缺损、压疮、慢性骨髓炎的创面修复中的疗效。 　　方法：选择解放军273医院54例骨折合并软组织缺损、术后骨外露、骨髓炎、大面积压疮或重度感染等患者，根据患者意愿随机分两组治疗，试验组36例局部清创后采用聚乙烯乙醇水化海藻盐封闭式负压引流，对照组18例按常规换药处理。对比两组创面清洁时间、换药次数及创面愈合时间。 　　结果与结论：与对照组比较，试验组创面清洁时间及创面愈合时间明显缩短，换药次数明显减少(P<0.05)。试验组去除海绵敷料后，创面肉芽新鲜，将残余坏死组织清除，再次更换负压封闭引流，肉芽生长明显，表面无分泌物；骨外露患者创面缩小，甚至不再有骨外露；游离植皮后经负压封闭引流负压吸引及加压，植皮全部成活；慢性骨髓炎患者更换负压封闭引流三四次后，分泌物逐渐减少直至无分泌物，细菌培养未找到致病菌；大面积压疮在清创联合负压封闭引流负压吸引治疗后，有较多新鲜肉芽生长，多次更换负压封闭引流后，肉芽生长至与周围皮肤同样高度。
배경：근년래국내외학자장부압봉폐인류기술운용우각충골과창면적치료혹촉진이식피부적성활，균취득료량호적효과。 　　목적：관찰부압봉폐인류기술재골외과사지개방성골절、연조직결손、압창、만성골수염적창면수복중적료효。 　　방법：선택해방군273의원54례골절합병연조직결손、술후골외로、골수염、대면적압창혹중도감염등환자，근거환자의원수궤분량조치료，시험조36례국부청창후채용취을희을순수화해조염봉폐식부압인류，대조조18례안상규환약처리。대비량조창면청길시간、환약차수급창면유합시간。 　　결과여결론：여대조조비교，시험조창면청길시간급창면유합시간명현축단，환약차수명현감소(P<0.05)。시험조거제해면부료후，창면육아신선，장잔여배사조직청제，재차경환부압봉폐인류，육아생장명현，표면무분비물；골외로환자창면축소，심지불재유골외로；유리식피후경부압봉폐인류부압흡인급가압，식피전부성활；만성골수염환자경환부압봉폐인류삼사차후，분비물축점감소직지무분비물，세균배양미조도치병균；대면적압창재청창연합부압봉폐인류부압흡인치료후，유교다신선육아생장，다차경환부압봉폐인류후，육아생장지여주위피부동양고도。
BACKGROUND:In recent years, vacuum sealing drainage technology has been widely used in the treatment of orthopedic wounds or to facilitate skin graft survival, both of which have achieved good results. OBJECTIVE:To observe the curative effects of vacuum sealing drainage technology in the wound healing after limb open fractures, soft tissue defects, pressure sores, and chronic osteomyelitis. METHODS:Fifty-four patients of fractures combined with soft tissue defects, postoperative exposed bone, osteomyelitis, a large area of pressure ulcers or severe infections, selected from the 273rd Hospital of PLA, were randomly divided into test and control groups according to the wishes of patients. The test group included 36 patients who were treated with vacuum sealing drainage using polyethylene ethanol hydration seaweed salt after debridement, and the control group included 18 patients who were treated with conventional dressing. Wound cleaning time, number of dressings, and wound healing time were detected and compared in the two groups. RESULTS AND CONCLUSION:Compared with the control group, the wound cleaning time and wound healing time were shorter in the test group, and the number of dressings was also decreased in the test group (P<0.05). After removal of sponge dressings, in the test group, wound granulation was fresh and grew obviously with no exudates after the necrotic residue was removed and vacuum sealing drainage was changed. For the bone exposure patients, the wound area was reduced, or even there was no exposed bone any more. After skin grafting, vacuum suction and pressure due to vacuum sealing drainage technology made al skin grafts survive. In the patients with chronic osteomyelitis, the exudates were gradual y reduced until disappeared after vacuum sealing drainage was exchanged three or four times, and pathogens were not found in bacterial culture. After combined treatment of debridement and vacuum sealing drainage, there were many fresh granulations in the patients with large areas of pressure sores;after replacement of vacuum sealing drainage several times, the granulation grew to the same height with the surrounding skin.