中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2013年
4期
308-311
,共4页
髌骨%感染%引流术%外科皮瓣
髕骨%感染%引流術%外科皮瓣
빈골%감염%인류술%외과피판
Patella%Infection%Drainage%Surgical flaps
目的 探讨应用负压封闭引流(VSD)技术结合关节腔内灌洗引流治疗髌骨骨折术后感染的疗效. 方法 回顾性分析2008年6月至2012年3月收治的7例髌骨骨折术后感染患者资料,男5例,女2例；年龄19 ～52岁,平均40.5岁.1例为开放性骨折,6例为闭合性骨折.均于内固定术后14 ～21 d(平均17.7 d)发生感染.1例为浅表感染；6例为深部感染,形成膝关节化脓性关节炎.彻底清创后均给予VSD敷料覆盖,6例深部感染加用关节腔内持续灌注冲洗,每天4000 mL生理盐水匀速滴注,术后支具制动.待创面出现新鲜肉芽组织后直接缝合皮肤或行局部皮瓣转位移植修复.末次随访时根据Neer等评分标准评定膝关节功能. 结果 应用VSD技术治疗7～12d后发现创面及关节腔内非常洁净,髌骨表面出现新鲜肉芽组织.1例表浅感染患者和1例深部感染患者直接缝合皮肤关闭创面,5例深部感染患者因髌骨前皮肤缺损较大,清创后行局部转移皮瓣覆盖伤口.7例患者术后获3～ 48个月(平均21个月)随访.末次随访时膝关节功能根据Neer等评分标准评定:优2例,良3例,可2例. 结论 VSD技术结合关节腔内灌洗引流使浅、深部感染创面引流充分,可促进创面愈合,有效地控制髌骨表面及关节腔内感染,为直接缝合或转移皮瓣关闭创面创造了良好条件.
目的 探討應用負壓封閉引流(VSD)技術結閤關節腔內灌洗引流治療髕骨骨摺術後感染的療效. 方法 迴顧性分析2008年6月至2012年3月收治的7例髕骨骨摺術後感染患者資料,男5例,女2例；年齡19 ～52歲,平均40.5歲.1例為開放性骨摺,6例為閉閤性骨摺.均于內固定術後14 ～21 d(平均17.7 d)髮生感染.1例為淺錶感染；6例為深部感染,形成膝關節化膿性關節炎.徹底清創後均給予VSD敷料覆蓋,6例深部感染加用關節腔內持續灌註遲洗,每天4000 mL生理鹽水勻速滴註,術後支具製動.待創麵齣現新鮮肉芽組織後直接縫閤皮膚或行跼部皮瓣轉位移植脩複.末次隨訪時根據Neer等評分標準評定膝關節功能. 結果 應用VSD技術治療7～12d後髮現創麵及關節腔內非常潔淨,髕骨錶麵齣現新鮮肉芽組織.1例錶淺感染患者和1例深部感染患者直接縫閤皮膚關閉創麵,5例深部感染患者因髕骨前皮膚缺損較大,清創後行跼部轉移皮瓣覆蓋傷口.7例患者術後穫3～ 48箇月(平均21箇月)隨訪.末次隨訪時膝關節功能根據Neer等評分標準評定:優2例,良3例,可2例. 結論 VSD技術結閤關節腔內灌洗引流使淺、深部感染創麵引流充分,可促進創麵愈閤,有效地控製髕骨錶麵及關節腔內感染,為直接縫閤或轉移皮瓣關閉創麵創造瞭良好條件.
목적 탐토응용부압봉폐인류(VSD)기술결합관절강내관세인류치료빈골골절술후감염적료효. 방법 회고성분석2008년6월지2012년3월수치적7례빈골골절술후감염환자자료,남5례,녀2례；년령19 ～52세,평균40.5세.1례위개방성골절,6례위폐합성골절.균우내고정술후14 ～21 d(평균17.7 d)발생감염.1례위천표감염；6례위심부감염,형성슬관절화농성관절염.철저청창후균급여VSD부료복개,6례심부감염가용관절강내지속관주충세,매천4000 mL생리염수균속적주,술후지구제동.대창면출현신선육아조직후직접봉합피부혹행국부피판전위이식수복.말차수방시근거Neer등평분표준평정슬관절공능. 결과 응용VSD기술치료7～12d후발현창면급관절강내비상길정,빈골표면출현신선육아조직.1례표천감염환자화1례심부감염환자직접봉합피부관폐창면,5례심부감염환자인빈골전피부결손교대,청창후행국부전이피판복개상구.7례환자술후획3～ 48개월(평균21개월)수방.말차수방시슬관절공능근거Neer등평분표준평정:우2례,량3례,가2례. 결론 VSD기술결합관절강내관세인류사천、심부감염창면인류충분,가촉진창면유합,유효지공제빈골표면급관절강내감염,위직접봉합혹전이피판관폐창면창조료량호조건.
Objective To investigate the outcomes of infection mauagement after patellar fracture surgery using vacuum sealing drainage (VSD) combined with closed irrigation-suction within the articular cavity.Methods We treated 7 patients who had been inflicted by infection after patellar fracture surgery from June 2008 to March 2012.They were 5 men and 2 women,aged from 19 to 52 years (average,40.5years).There were one open aud 6 close patellar fractures.Their infections occurred 14 to 21 days (average,17.7 days) after internal fixation.One infection was superficial and 6 were deep,resulting in pyogenous arthritis of the knee.All cases were given debridement and VSD treatment and immobilized with braces.The 6 cases of deep infection were irrigated continuously with 4000 mL 0.9％ NaCl every day within the articular cavity.Direct skin suture or transplantation of local skin graft was performed after growth of fresh granulation tissue.Neer system was used to evaluate the knee functions at the last follow-up.Results After the VSD was applied for 7 to 12 days,the wound surface and knee cavity were very clean and fresh granulation tissue emerged.The wound was closed by direct suture for one superficial and one deep infection.Local skin grafts were transplanted for 5 deep infections.The infections were effectively controlled without pain,swelling or local fistula.The patients were followed up from 3 to 48 months (average,21 months).The functional outcome according to Neer' s criteria at the last follow-up was excellent in 2 cases,good in 3 and fair in 2.Conclusion In management of infection after patellar fracture surgery,VSD combined with closed irrigation-suction within the articular cavity can drain sufficiently,control infection effectively and stimulate fresh granulation growth,facilitating wound closure by direct suture or transplantation of a local skin flap.
