CAJ | 학술논문

目的探讨外固定架联合负压封闭引流(vacuum sealing drainage,VSD)在地震伤员胫骨远端开放性骨折早期治疗的临床价值. 方法早期采用外固定架联合VSD负压吸引术治疗芦山地震中的严重胫骨远端开放性骨折伴软组织缺损伤员22例,其中男9例,女13例；年龄25 ～ 85岁,平均42.6岁.致伤原因:重物砸伤19例,高处坠落伤3例.按照Gustilo分型,Ⅱ型4例,ⅢA型6例,ⅢB型10例,ⅢC型2例. 结果 9例行局部植皮术,11例行皮瓣转移术,2例行截肢手术；17例外固定架固定3周内转化为内固定治疗. 结论采用外固定架联合VSD治疗伴软组织缺损的胫骨远端开放性骨折,在迅速稳定骨折、保护局部软组织的同时,通过持续VSD负压吸引装置可以封闭创腔,降低局部感染,刺激创面产生大量新鲜肉芽组织覆盖骨面,为创面植皮或局部皮瓣转移争取时机,为最终外固定转换为内固定治疗、促进伤员肢体功能恢复提供了有利条件.
목적 탐토외고정가연합부압봉폐인류(vacuum sealing drainage,VSD)재지진상원경골원단개방성골절조기치료적림상개치. 방법 조기채용외고정가연합VSD부압흡인술치료호산지진중적엄중경골원단개방성골절반연조직결손상원22례,기중남9례,녀13례；년령25 ～ 85세,평균42.6세.치상원인:중물잡상19례,고처추락상3례.안조Gustilo분형,Ⅱ형4례,ⅢA형6례,ⅢB형10례,ⅢC형2례. 결과 9례행국부식피술,11례행피판전이술,2례행절지수술；17예외고정가고정3주내전화위내고정치료. 결론 채용외고정가연합VSD치료반연조직결손적경골원단개방성골절,재신속은정골절、보호국부연조직적동시,통과지속VSD부압흡인장치가이봉폐창강,강저국부감염,자격창면산생대량신선육아조직복개골면,위창면식피혹국부피판전이쟁취시궤,위최종외고정전환위내고정치료、촉진상원지체공능회복제공료유리조건.
Objective To investigate the clinical significance of external fixators combined with vacuum sealing drainage (VSD) in early treatment of open distal tibial fractures after Lushan earthquake.Methods The study involved 22 cases of severe open distal tibial fractures associated with soft tissue defects treated with external fixators combined with VSD in the early stage after Lushan earthquake.There were 9 males and 13 females,at age of 25-85 years (mean 42.6 years).Causes for the injury were hitting by heavy objects in 19 cases and fall from height in three cases.Gustilo classification of the open fracture were type Ⅱ in four cases,type ⅢA in six,type ⅢB in 10 and type ⅢC in two.Results Altogether,nine cases had regional skin grafting,11 flap transferring,two amputation.Seventeen cases were transformed to internal fixations within three weeks after the use of external fixators.Conclusions External fixators combined with VSD stabilize displaced fracture fragments rapidly and protect regional soft tissues.Simultaneously,continuous VSD closes wound cavity,reduces regional infection and stimulates wounds producing large amount of fresh granulation tissues over bone surface,which consequently wins time for skin grafting or regional flap transferring as well as creates a favorable condition for the ultimate conversion of external fixation to internal fixation and for the recovery of lower limb function.