CAJ | 학술논문

目的探讨持续负压封闭引流（VSD）治疗四肢骨折术后感染的临床疗效。方法收集41例四肢骨折术后感染患者，使用 VSD 治疗技术，使用 VSD 过程中，需根据培养结果使用敏感抗生素，创面彻底清创后使用 VSD，VSD 调整压力为300～500 mm Hg 负压，维护 VSD 管腔通畅，确保创面进行有效负压吸引，5～12 d 后拆除 VSD，观察创面愈合情况，确定是否需要再次行清创、VSD 置入，VSD 使用次数2～13次。结果14例（34％）患者经过 VSD 治疗后创面一期愈合，21例（51％）患者经过 VSD 治疗后再联合植皮、转移皮瓣创面愈合，6例（15％）患者经过 VSD 治疗后，创面缩小明显，肉芽组织新鲜，辅助联合换药后愈合。结论四肢骨折术后感染彻底清创后使用 VSD，可以改善创面血液循环，抑制创面细菌增殖，刺激肉芽组织生长，可直接闭合创面，或为植皮、转移皮瓣提供良好条件，预防感染复发，治疗结果满意。
목적탐토지속부압봉폐인류（VSD）치료사지골절술후감염적림상료효。방법수집41례사지골절술후감염환자，사용 VSD 치료기술，사용 VSD 과정중，수근거배양결과사용민감항생소，창면철저청창후사용 VSD，VSD 조정압력위300～500 mm Hg 부압，유호 VSD 관강통창，학보창면진행유효부압흡인，5～12 d 후탁제 VSD，관찰창면유합정황，학정시부수요재차행청창、VSD 치입，VSD 사용차수2～13차。결과14례（34％）환자경과 VSD 치료후창면일기유합，21례（51％）환자경과 VSD 치료후재연합식피、전이피판창면유합，6례（15％）환자경과 VSD 치료후，창면축소명현，육아조직신선，보조연합환약후유합。결론사지골절술후감염철저청창후사용 VSD，가이개선창면혈액순배，억제창면세균증식，자격육아조직생장，가직접폐합창면，혹위식피、전이피판제공량호조건，예방감염복발，치료결과만의。
Objective To explore the clinical effect of vacuum sealing drainage (VSD)on the postoperative infection after extremity factures.Method Forty-one cases with postoperative infection after extremity fractures in or-thopedics department were enrolled in this study from May 2012 to May 2014.The VSD technique was applied to trea-ted all of the cases.During the treatment,sensitive antibiotics were used according to the culture results.The VSD technique was applied after the thorough debridement of the infection wounds and the negative pressure was adjusted to 300-500mmhg to maintain the patency of the VSD tube which will ensure the effective negative pressure suction of the wound surface.The VSD was removed after 5-12 days and wound surface was observed to decide whether debride-ment and VSD placement was continue necessary.The VSD was performed 2-13 times in our cases.Results Fourteen cases (34%)were primary healed after VSD treatment.Twenty-one cases (51%)were healed with the VSD treat-ment combined with skin grafting and local flap grafting.Six cases (15%)were decreased obviously in wound surface and covered with fresh granulation tissue after VSD treatment and were finally healed with the adjuvant therapy.Con-clusions The good clinical efficacy is obtained with application of VSD in the postoperative infection after extremity fractures by facilitating the blood circulation of the wound,inhibiting the proliferation of bacteria and stimulating the growth of granulation tissue which brings further benefit for skin grafting.