背景：创伤后骨髓炎是开放性骨折或其他骨关节手术后出现的骨感染，可遗留窦道或有骨外露、伤口较多分泌物，其治疗周期长，并可导致骨折延期愈合，甚至不愈合。治疗的关键在于彻底清创，充分引流，以及对治疗干扰小、远离病区置钉的外固定支架的使用。 目的：观察负压封闭引流联合外固定架修复创伤性骨髓炎的近期疗效，并与传统置管冲洗引流进行对比。 方法：自2010年6月至2013年6月纳入创伤后骨髓炎患者21例，其中负压封闭引流组11例，传统置管引流组10例。负压封闭引流组患者一期行病灶清除及负压封闭引流填塞死腔，覆盖创面。骨折未愈合者行外固定架治疗，其中10例内固定改为外固定架，1例原有外固定架继续保留。所有患者均Ⅱ期闭合伤口，9例伤口直接缝合，2例行皮瓣移植，其中1例因骨缺损，Ⅲ期行自体骨移植。传统置管引流组行病灶清除，术后常规置管冲洗引流，3例因创面不能闭合，行普通换药，二期皮瓣移植，骨折未愈合者行骨外固定架治疗。治疗后观察患者有无局部红肿痛及全身发热，记录总住院时间及骨折愈合时间。 结果与结论：负压封闭引流组较传统置管组更能较快的控制治疗前红肿痛及发热等症状(P<0.05)。总住院时间两组差异无显著性意义(P>0.05)。两组患者均通过门诊获得随访，随访时间24-36个月，负压封闭引流组骨折愈合时间短于传统置管引流组(P<0.05)。至随访结束，负压封闭引流组患者感染均未复发，传统置管组2例再发感染。结果提示负压封闭引流联合骨外固定架修复创伤后慢性骨髓炎具有感染控制快、方便护理、缩短治疗时间、降低治疗后再发感染率等优点，且骨外固定架可作为创伤后骨髓炎最终的固定方式。%BACKGROUND:Posttraumatic osteomyelitis is bone infection after surgery of open fractures or other joint, which leads to more secretions in antrum or bone exposed wounds, long treatment cycle, delayed healing of fracture, even disunion. The key link in the treatment is complete debridement, adequate drainage, and the use of external fixators with low interference and far away from lesions. OBJECTIVE:To observe the clinical efficacy of external fixator combined vacuum sealing drainage (VSD) in the treatment of post-traumatic osteomyelitis, and compared with conventional catheter drainage. METHODS:Since June 2010 to June 2013, 21 patients of post-traumatic chronic osteomyelitis were included in this study and divided into VSD group (n=11) and conventional catheter drainage group (n=10). Al patients in VSD groups underwent debridement and VSD was used to fil dead space, then the wounds were sutured. Cases appeared nonhealing fractures underwent external fixation, 10 cases using external fixators and 1 case retained original external fixator. Al patients achieved the closed wounds at the second phase, 9 cases were directly sutured, and 2 cases received skin flap transplantation. Among them, 1 case received autologous bone graft at the third phase because of bone defects. In the conventional catheter drainage group, al patients underwent debridement and conventional catheter drainage to rinse the wounds after surgery, 3 cases failing to close the wounds changed to receive ordinary dressing and skin flap transplantation at the second phase. Cases appeared nonhealing fractures underwent external fixation. Local swel ing, pain and fever were observed after treatment. The time of total hospitalization stay and fracture healing was recorded. RESULTS AND CONCLUSION:The VSD group quickly control ed preoperative symptoms such as swel ing and pain and fever than the conventional catheter group (P<0.05). The length of hospital stay showed no significant difference between the two groups (P>0.05). Al patients were obtained through clinic service and fol owed up for 24-36 months. The healing time in the VSD group was shorter than that in conventional catheter group (P<0.05). Until the end of fol ow-up, no patients in the VSD group appeared infection recurrence, and two cases in the conventional catheter group had recurrent infection. The results suggest that VSD combined with external fixator can repair post-traumatic chronic osteomyelitis due to rapid control of infection, easy care, shortened treatment time, and reduced rate of postoperative recurrence. In addition, external fixator can be used as the final fixation for post-traumatic chronic osteomyelitis.
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