Gustilo Ⅲ型胫腓骨开放性骨折急诊清创后伤口闭合的时机与方法选择

摘要

目的探究 Gustilo Ⅲ型胫腓骨开放性骨折急诊清创后伤口闭合的时机与方法选择。方法选取我院在2014年1月～2015年1月期间收治的 Gustilo Ⅲ型胫腓骨开放性骨折患者共42例，将其设为观察组，所有患者均进行急诊清创后骨折固定，清创后立即进行创口分泌物培养，若培养结果为阳性，则再次清创，直至培养结果为阴性时方可于　　48 h 后闭合伤口。选取以往我院收治的 Gustilo Ⅲ型胫腓骨开放性骨折患者共38例，这38例患者均为进行急诊清创骨折固定后常规处理闭合伤口，将其设为对照组，比较两组患者伤口的感染率和骨折愈合情况。结果观察组患者骨折固定后伤口感染率显著低于对照组，差异具有统计学意义（P ＜0.05）；观察组患者伤口愈合和骨折愈合情况均显著优于对照组，差异具有统计学意义（P ＜0.05）。结论 Gustilo Ⅲ型胫腓骨开放性骨折急诊清创后伤口闭合时机应根据伤口分泌物培养结果而定，培养结果为阴性时即可进行伤口闭合，根据软组织损伤的程　　48 h 后闭合伤口。选取以往我院收治的 Gustilo Ⅲ型胫腓骨开放性骨折患者共38例，这38例患者均为进行急诊清创骨折固定后常规处理闭合伤口，将其设为对照组，比较两组患者伤口的感染率和骨折愈合情况。结果观察组患者骨折固定后伤口感染率显著低于对照组，差异具有统计学意义（P ＜0.05）；观察组患者伤口愈合和骨折愈合情况均显著优于对照组，差异具有统计学意义（P ＜0.05）。结论 Gustilo Ⅲ型胫腓骨开放性骨折急诊清创后伤口闭合时机应根据伤口分泌物培养结果而定，培养结果为阴性时即可进行伤口闭合，根据软组织损伤的程　　度大小，选择合适的伤口闭合方式。%Objective To explore the Gustilo Ⅲ type tibiofibula open fractures after emergency debridement in the timing of wound closure and the choice of methods. Methods Select our hospital from January 2014 to January 2015 in admitted during the period of Gustilo Ⅲ type, a total of 42 patients with tibiofibula open fractures, it is set as the observation group, all patients were performed emergency fracture fixation after debridement and wound secretion culture immediately after debridement, if the training result is positive, the debridement, again until the training results for negative when square in 48 hours after closing a wound. Select our hospital before Gustilo Ⅲ type, a total of 38 patients with tibiofibula open fractures, the prompt debridement 38 cases were fracture fixed routine treatment after closing the wound, it is set to the control group, compared two groups of patients with wound infection and fracture healing. Results The observation group of patients after fracture fixed wound infection rate was significantly lower than the control group, difference has statistical significance (P<0.05), Patients with wound healing and fracture healing of observation group were significantly better than control group, the difference is statistically significant (P<0.05).Conclusion Gustilo Ⅲ type emergency open tibiofibula fracture after debridement of the wound closure time should be according to the results of wound secretion culture, cultivate the results can be achieved when the negative for wound closure, according to the degree of injury of soft tissue, to choose the right means of wound closure.