三种创面处理治疗胫腓骨骨折合并骨筋膜室综合征的临床效果观察
삼충창면처리치료경비골골절합병골근막실종합정적림상효과관찰
Clinical effect of three kinds of wound treatments on tibia and fibula fracture with osteofascial compartment syndrome
  • 万方数据
    中国医药 중국의약
    CHINA MEDICINE
    2014年 5期 698-702 ,共5页

    魏任远%姜卓男

    위임원%강탁남

    胫腓骨骨折%骨筋膜室综合征%封闭负压引流技术%脱细胞异种皮 脛腓骨骨摺%骨觔膜室綜閤徵%封閉負壓引流技術%脫細胞異種皮
    경비골골절%골근막실종합정%봉폐부압인류기술%탈세포이충피
    Tibia and fibula fracture%Compartment syndrome%Vacuum assisted closure%Xenogenic skin
    目的 观察胫腓骨骨折合并骨筋膜室综合征(OCS)患者应用手术切开复位且内固定后,辅助常规引流包扎敷贴覆盖、负压封闭引流技术和DR脱细胞异种皮三类伤口处置技术治疗的临床效果.方法 筛选67例胫腓骨骨折合并OCS患者的临床资料,根据创面伤口处理方法的不同分为A、B、C3组.A组患者32例,经皮肤切开直视复位和内固定术后采用凡士林纱布覆盖创面治疗;B组患者18例,经皮肤切开直视复位和内固定后采用负压封闭引流技术治疗;C组患者13例,经皮肤切开直视复位和内固定后采用DR脱细胞异种(猪)皮覆盖治疗.所有患者至伤口软组织恢复后,再行二次手术游离植皮肤修复.观察术后不同时间3组患者的伤口感染情况、创面渗液量以及疼痛情况、小腿周径,以及患者的住院时间、换药次数和二期创面修复时间.结果 A组第4、7、10天伤口感染率分别为15.6％ (5/32)、18.8％ (6/32)、25.0％ (8/32),B组未见细菌培养阳性患者,C组于第10天有1例(7.7％)细菌培养阳性;B、C组术后伤口感染率明显低于A组,差异有统计学意义(P＜0.05).A组术后1、2、3d创面渗液量均明显多于B、C组[术后1 d:(516 ±57)ml比(196±37)、(464±59) ml;术后2 d:(502±62)ml比(142±31)、(388±40) ml,术后3 d:(372±51)ml比(77±31)、(291±51)ml],并且B组渗液量明显少于C组,差异均有统计学意义(均P＜0.05).A、B、C3组术后1、4、7d疼痛评分差异均有统计学意义[术后1 d:(8.17±0.52)、(0.91±0.35)、(5.89±0.51)分;术后4 d:(8.81±0.39)、(0.75±0.26)、(5.67±0.43)分;术后7 d:(8.63±0.47)、(0.74±0.33)、(5.46±0.47)分;均P＜0.05].术后2、4、6、8、10、12、14 d,B组小腿周径均低于A、C组[分别为:(3.09±0.74)cm比(6.96±0.52)、(5.72±0.48) cm,(3.56±0.48) cm比(8.27±0.47)、(6.72 ±0.51)cm,(3.43±0.42) cm比(8.32±0.46)、(6.27±0.39) cm,(2.41 ±0.35)cm比(5.27±0.42)、(3.15±0.41)cm,(1.87±0.44)cm比(4.22±0.34)、(2.78±0.51) cm,(0.68±0.11)cm比(2.59±0.31)、(2.09±0.18)cm,(0.01±0.08)cm比(0.12±0.11)、(0.08±0.04) cm],差异均有统计学意义(均P＜0.05).伤后2、4、6、8、10 d,C组小腿周径均明显低于A组,差异均有统计学意义(均P＜0.05).A、B、C3组住院时间、换药次数、二期创面修复时间比较,差异均有统计学意义[分别为:(32±9)、(22±7)、(29±5)d,(13.8±5.3)、(2.6±0.5)、(7.6±2.7)次,(10.7±5.1)、(5.3±2.3)、(7.7±5.1)d,均P＜0.05].结论 直视复位结合内固定术后,负压封闭引流技术治疗胫腓骨骨折合并OCS可减少治疗住院时间,减少伤口感染率和创面渗液量,避免过度肿胀和减轻疼痛.DR脱细胞异种皮治疗效果不及负压封闭引流技术,但适合经济困难患者选用.
    목적 관찰경비골골절합병골근막실종합정(OCS)환자응용수술절개복위차내고정후,보조상규인류포찰부첩복개、부압봉폐인류기술화DR탈세포이충피삼류상구처치기술치료적림상효과.방법 사선67례경비골골절합병OCS환자적림상자료,근거창면상구처리방법적불동분위A、B、C3조.A조환자32례,경피부절개직시복위화내고정술후채용범사림사포복개창면치료;B조환자18례,경피부절개직시복위화내고정후채용부압봉폐인류기술치료;C조환자13례,경피부절개직시복위화내고정후채용DR탈세포이충(저)피복개치료.소유환자지상구연조직회복후,재행이차수술유리식피부수복.관찰술후불동시간3조환자적상구감염정황、창면삼액량이급동통정황、소퇴주경,이급환자적주원시간、환약차수화이기창면수복시간.결과 A조제4、7、10천상구감염솔분별위15.6％ (5/32)、18.8％ (6/32)、25.0％ (8/32),B조미견세균배양양성환자,C조우제10천유1례(7.7％)세균배양양성;B、C조술후상구감염솔명현저우A조,차이유통계학의의(P＜0.05).A조술후1、2、3d창면삼액량균명현다우B、C조[술후1 d:(516 ±57)ml비(196±37)、(464±59) ml;술후2 d:(502±62)ml비(142±31)、(388±40) ml,술후3 d:(372±51)ml비(77±31)、(291±51)ml],병차B조삼액량명현소우C조,차이균유통계학의의(균P＜0.05).A、B、C3조술후1、4、7d동통평분차이균유통계학의의[술후1 d:(8.17±0.52)、(0.91±0.35)、(5.89±0.51)분;술후4 d:(8.81±0.39)、(0.75±0.26)、(5.67±0.43)분;술후7 d:(8.63±0.47)、(0.74±0.33)、(5.46±0.47)분;균P＜0.05].술후2、4、6、8、10、12、14 d,B조소퇴주경균저우A、C조[분별위:(3.09±0.74)cm비(6.96±0.52)、(5.72±0.48) cm,(3.56±0.48) cm비(8.27±0.47)、(6.72 ±0.51)cm,(3.43±0.42) cm비(8.32±0.46)、(6.27±0.39) cm,(2.41 ±0.35)cm비(5.27±0.42)、(3.15±0.41)cm,(1.87±0.44)cm비(4.22±0.34)、(2.78±0.51) cm,(0.68±0.11)cm비(2.59±0.31)、(2.09±0.18)cm,(0.01±0.08)cm비(0.12±0.11)、(0.08±0.04) cm],차이균유통계학의의(균P＜0.05).상후2、4、6、8、10 d,C조소퇴주경균명현저우A조,차이균유통계학의의(균P＜0.05).A、B、C3조주원시간、환약차수、이기창면수복시간비교,차이균유통계학의의[분별위:(32±9)、(22±7)、(29±5)d,(13.8±5.3)、(2.6±0.5)、(7.6±2.7)차,(10.7±5.1)、(5.3±2.3)、(7.7±5.1)d,균P＜0.05].결론 직시복위결합내고정술후,부압봉폐인류기술치료경비골골절합병OCS가감소치료주원시간,감소상구감염솔화창면삼액량,피면과도종창화감경동통.DR탈세포이충피치료효과불급부압봉폐인류기술,단괄합경제곤난환자선용.
    Objective To observe the clinical effects of conventional drainage bandage wrap cover,vacuum sealing drainage and DR leather on the wound of tibia and fibula fracture with compartment syndrome (OCS) treated with open reduction and internal fixation surgery.Methods All 67 cases of tibia and fibula fracture with OCS were screened.All patients were divided into three groups according to the methods of wound treatment.The patients in group A(32 cases)were treated with a conventional drainage;group B (18 cases)were treated with vacuum sealing drainage and group C (13 cases)received DR Xenogenic leather cover.The wound infection,wound exudation,pain score,calf circumference,the hospitalization time,the times of dressing changes and two phase wound repair time after operation were compared among three groups.Results The infection rates of wound in group B and C were significantly lower than those in group A (P ＜ 0.05).The wound exudation 1,2,3 day after operation in group A was more than that in group B and C [1 d postoperation:(516 ± 57)ml vs (196 ± 37),(464 ± 59) ml ; 2 d postoperation:(502 ± 62) ml vs (142 ± 31),(388 ± 40) ml ; 3 d postoperation:(372 ± 51) ml vs (77 ± 31),(291 ± 51)ml] ; the wound exudation in group B was significantly less than that in group C,(all P ＜ 0.05).There were significant differences of pain score 1,4,7 d after operation among A,B and C groups[1 d postoperation:(8.17 ± 0.52),(0.91 ± 0.35),(5.89 ± 0.51)scores; 4 d postoperation:(8.81 ± 0.39),(0.75 ± 0.26),(5.67 ± 0.43) scores ; 7 d postoperation:(8.63 ± 0.47),(0.74 ± 0.33),(5.46 ± 0.47) scores ;all P ＜ 0.05].The calf circumferences in group B was less than that in group A and C 2,4,6,8,10,12,14 d after operation [(3.09 ± 0.74) cm vs (6.96 ± 0.52),(5.72 ± 0.48) cm; (3.56 ± 0.48) cm vs (8.27 ± 0.47),(6.72 ±0.51)cm;(3.43 ±0.42)cm vs (8.32 ±0.46),(6.27 ±0.39)cm; (2.41 ±0.35) cm vs (5.27 ± 0.42),(3.15 ±0.41)cm;(1.87 ±0.44)cm vs (4.22 ±0.34),(2.78 ±0.51)cm;(0.68 ±0.1)cm vs (2.59 ± 0.31),(2.09 ±0.18)cm;(0.01 ±0.08)cm vs (0.12 ±0.11),(0.08 ±0.04)cm,respectively] ; the calf circumferences in group C was significantly less than that in group A 2,4,6,8,10 d after operation (all P ＜ 0.05).The hospitalization time,the times of dressing changes and two phase wound repair time among group A,B and C were significantly different[(32 ± 9),(22 ± 7),(29 ± 5) d ; (13.8 ± 5.3),(2.6 ± 0.5),(7.6 ± 2.7) ; (10.7 ± 5.1),(5.3 ± 2.3),(7.7 ± 5.1) d,all P ＜ 0.05].Conclusion The vacuum sealing drainage on wound of patients with tibia and fibula fractures combined with OCS can reduce the hospitalization time and the rate of infection; it can avoid excessive swelling and relieve pain.
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