CAJ | 학술논문

目的：探讨负压封闭引流技术在创伤骨科术后感染中的临床应用效果。方法回顾性分析2013年3—11月在该院接受治疗的创伤骨科术后感染患者78例，其中包括股骨干骨折29例，跟腱断裂12例，髌骨骨折18例，骨盆骨折27例。将采用负压封闭引流技术进行治疗的46例患者作为治疗组，治疗时，对患者的创伤面进行彻底清创，再进行负压封闭引流技术。治疗结束7~12 d后，如果引流量还比较多，就需要更换引流装置，采用负压封闭引流技术1~3次。如果引流量比较少，伤口红肿消退，患者体温恢复正常，C反应蛋白、血常规、ESR降到正常水平，还需要再次清创，封闭创面；将使用常规方法进行治疗的32例患者作为对照组。观察比较两组患者的临床治疗效果。结果观察比较两组患者的临床治疗效果，治疗组患者经过清创、负压封闭引流技术治疗7~12 d后，创面水肿有所缓解，有新鲜肉芽组织产生，对36例患者进行直接缝合，修复创面，对10例患者进行组织瓣移植。随访12~18个月，感染无复发。治疗组患者的换药次数、创面完全愈合时间、治疗费用及住院时间明显优于对照组，两组间的比较差异有统计学意义（P<0.05）。结论对创伤骨科术后感染患者清创后，采用负压封闭引流技术进行治疗，能够有效刺激创伤面肉芽的生长，改善血液循环，有效控制感染，具有较好的临床治疗效果，在临床上值得推广应用。
목적：탐토부압봉폐인류기술재창상골과술후감염중적림상응용효과。방법회고성분석2013년3—11월재해원접수치료적창상골과술후감염환자78례，기중포괄고골간골절29례，근건단렬12례，빈골골절18례，골분골절27례。장채용부압봉폐인류기술진행치료적46례환자작위치료조，치료시，대환자적창상면진행철저청창，재진행부압봉폐인류기술。치료결속7~12 d후，여과인류량환비교다，취수요경환인류장치，채용부압봉폐인류기술1~3차。여과인류량비교소，상구홍종소퇴，환자체온회복정상，C반응단백、혈상규、ESR강도정상수평，환수요재차청창，봉폐창면；장사용상규방법진행치료적32례환자작위대조조。관찰비교량조환자적림상치료효과。결과관찰비교량조환자적림상치료효과，치료조환자경과청창、부압봉폐인류기술치료7~12 d후，창면수종유소완해，유신선육아조직산생，대36례환자진행직접봉합，수복창면，대10례환자진행조직판이식。수방12~18개월，감염무복발。치료조환자적환약차수、창면완전유합시간、치료비용급주원시간명현우우대조조，량조간적비교차이유통계학의의（P<0.05）。결론대창상골과술후감염환자청창후，채용부압봉폐인류기술진행치료，능구유효자격창상면육아적생장，개선혈액순배，유효공제감염，구유교호적림상치료효과，재림상상치득추엄응용。
Objective To investigate the clinical application effect of vacuum sealing drainage to postoperative wound infection in Department of Orthopedics and Traumatology. Methods A retrospective analysis was conducted on 78 cases with postoperative wound infection treated in Department of Orthopedics and Traumatology of our hospital from March 2013 to November 2013, in-cluding 29 cases with fracture of femoral shaft, 12 cases with rupture of Achilles tendon, 18 cases with fracture of patella and 27 cases with palvic fracture. 46 cases treated by vacuum sealing drainage were set as the treatment group. The patients underwent vacuum sealing drainage after the wound surface was debrided thoroughly. 7~12 d after the treatment, if the volume of drainage was still much, the drainage system should be changed, then the patients underwent vacuum sealing drainage for 1~3 times. If the volume of drainage was relatively small, the wound swelling subsided, the body temperature of the patients returned to normal, C-reactive protein, blood routine, ESR decreased to normal levels, then the second debridement was needed and the wound was closed. 32 cases treated by the conventional method were set as the control group. And the clinical therapeutic effects of the two groups were observed and compared. Results The observation and comparison of the clinical therapeutic effects of the two groups showed that, in the treatment group, after debridement and treated by vacuum sealing drainage for 7~12 d, the wound swelling eased, fresh granulation tissue grew, 36 cases underwent direct suture and wound repair, 10 cases underwent tissue flap transplan-tation. The follow-up of 12~18 months indicated that no recurrence of infection occurred in the patients. The frequency of dressing change, wound complete healing time, treatment costs and time of hospitalization was significantly better than that of the control group, respectively, the differences between the two groups were statistically significant (P<0.05). Conclusion For patients with postoperative infection in Department of Orthopedics and Traumatology, vacuum sealing drainage after debridement has good clini-cal therapeutic effect, which can effectively stimulate the growth of wound surface granulation and control the infection and im-prove blood circulation, therefore it is worthy of clinical application and promotion.