CAJ | 학술논문

目的探讨急诊使用外固定架联合负压封闭引流术(vacuum sealing drainage,VSD)治疗合并严重软组织损伤的四肢开放性骨折的临床效果.方法对38例有严重软组织损伤的四肢开放性骨折患者急诊采用外固定架辅以有限内固定固定骨折,并早期联合VSD.其中11例面积较大皮肤软组织撕脱创面I期打薄皮肤回植,20例软组织缺损创面无法I期修复,经VSD后创面缺损由新生肉芽组织填充,行皮瓣或自体中厚皮片移植术修复;7例软组织严重污染并高度肿胀,经2次清创术并联合使用VSD,行直接拉拢缝合或自体中厚皮片移植术修复创面.结论11例I期回植的皮肤绝大部分存活;20例合并软组织缺损创面未发生感染,7例软组织严重污染并高度肿胀患者患肢肿胀消退,未发生骨筋膜室综合症,Ⅱ期修复均成活.随访15-24个月,所有病例骨折愈合,无骨髓炎、骨不连发生,外固定架及内固定均拆除.结论外固定架联合VSD急诊处理合并严重软组织损伤的四肢开放性骨折疗效良好.
목적탐토급진사용외고정가연합부압봉폐인류술(vacuum sealing drainage,VSD)치료합병엄중연조직손상적사지개방성골절적림상효과.방법대38례유엄중연조직손상적사지개방성골절환자급진채용외고정가보이유한내고정고정골절,병조기연합VSD.기중11례면적교대피부연조직시탈창면I기타박피부회식,20례연조직결손창면무법I기수복,경VSD후창면결손유신생육아조직전충,행피판혹자체중후피편이식술수복;7례연조직엄중오염병고도종창,경2차청창술병연합사용VSD,행직접랍롱봉합혹자체중후피편이식술수복창면.결론11례I기회식적피부절대부분존활;20례합병연조직결손창면미발생감염,7례연조직엄중오염병고도종창환자환지종창소퇴,미발생골근막실종합증,Ⅱ기수복균성활.수방15-24개월,소유병례골절유합,무골수염、골불련발생,외고정가급내고정균탁제.결론외고정가연합VSD급진처리합병엄중연조직손상적사지개방성골절료효량호.
@@@@Objective To investigate the clinical effect of external fixation combined with vacuum sealing drainage(vacuum sealing drainage,VSD) in emergency treatment of open fractures of extremities with severe soft tissue injury. Methods Totally 38 cases open limb fractures with serious soft tissue injury were treated with external fixator supplemented with limited internal fixation and combined with VSD in emergency. 11 cases with large area skin avulsion were treated by skin grafting. Totally 24 cases of soft tissue defect cannot be repaired in one-stage. Skin defects were filled by granulation tissue after the application of VSD and repaired by flaps and free skin graft. Totally 7 cases of Soft tissue serious pollution and high swelling, after two times debridement and application of VSD,were repaired by suture or autologous split-thickness skin graft. Results 11 cases of skin grafting were almost healed. 20 cases of soft tissue defect were not infected.7 cases of Soft tissue serious pollution and high swelling regress without the occurrence of osteofascial compartment syndrome.Laps and skin graft after the secondary operation all survived. During follow-up ranging from 6-24 months, all cases were healed without the occurrence of osteomyelitis and nonunion. External fixation and internal fixation were removed. Conclusion Using external fixation combined with VSD is an effective and efficient method for treating open fracture of extremities with Serious soft tissue injury.