VSD联合外固定架治疗GustiloⅢ型尺桡骨开放性骨折的临床疗效

摘要

目的:探讨封闭式负压引流技术(VSD)联合外固定架治疗GustiloⅢ型尺桡骨开放性骨折的临床疗效.方法:回顾性分析2014-12～2016-12在内蒙古自治区中医医院创伤骨科收集60例GustiloⅢ型尺桡骨开放性骨折病人,其中压砸伤15例,交通伤25例,机器绞伤20例.创面大小为5.0cm×6.0cm～20.0cm×30.0cm,骨外露范围1 cm×3 cm～5 cm×10 cm.按照随机数字表法进行分组,治疗组(30例) VSD技术联合外固定架治疗,对照组(30例)应用常规换药联合外固定架治疗.对比两组在术后创面细菌检出率、换药次数、植皮时间、住院天数及恢复情况,应用相应的统计学方法予以分析比较.结果:首先对比两组在清创术前做细菌培养结果均检出阳性率＞清创后,差异有统计学意义(x2＝100.752,P＝0.000＜0.01);治疗组分别在术后第3 d与第7 d天细菌检出率较对照组明显降低,差异均均有统计学意义( x2分别是112.730和156.596,P＝0.000＜0.01);治疗组在换药次数1.560±0.505次,植皮时间8.653±0.396d,和住院时间25.400±2.849d,对照组依次分别是10.607±0.273次、13.714± 2.800d和35.357±1.906d,均明显缩短;差异有统计学意义(t或t′分别是-59.337、-6.608、和-7.671,均P＝0.000＜0.01).结论:在VSD技术联合外固定架治疗GustiloⅢ型尺桡骨开放性骨折在术后管理及恢复情况优于用传统清创换药治疗该型疾病.%Objective:To investigate the clinical efficacy of VSD( vacuum sealing drainage) com-bined with external fixator in the treatment of open fractures of GustiloⅢulnar radius.Methods:Retro-spective analysis of our hospital in december 2014 to december 2016 in the Inner mongolia autonomous region chinese medicine hospital trauma orthopedic collection of 60 cases of Gustilo Ⅲ ulnar radius open fractures of the patients as the object of study,including 15 cases of pressure injury,traffic injury in 25 cases,machine twist Injured in 20 cases.The wound size is 5.0cm ×6.0cm～20.0cm ×30.0cm, bone exposed range 1 cm ×3 cm～5 cm ×10 cm.According to the random number table method,the treatment group(30 cases)VSD technique combined with external fixation treatment,the control group (30 cases) using conventional dressing combined with external fixation treatment. The results showed that the detection rate of bacteria,the number of dressing,the time of skin grafting,the number of days of hospitalization and the recovery of the two groups were compared and analyzed by the corresponding statistical methods.Results:First compared two groups of bacteria culture in debridement surgery done results the detection positive rate＞After debridement,the difference was statistically significant ( x2＝100.752,P＝0.000＜0.01) ;The detection rate of bacteria in the treatment group was significantly lower than that in the control group on the 3 rd and 7 th day after operation,the difference was statistically significant( x2respectively 112.730and 156.596P＝0.000＜0.01) ;The number of dressing change in the treatment group(1.560+0.505),Skin graft time(8.653±0.396)day,and hospitalization time(25.400± 2.849)day;the control group was(10.607±0.273)times,(13.714±2.800)day and(35.357±1.906) day,were significantly shortened;the difference was statistically significant( t or t′are-59.337,-6.608, and-7.671,respectively,P＝0.000＜0.01). Conclusion:Treatment of Gustilo Ⅲ open fractures with VSD combined with external fixation is superior to conventional debridement for the treatment of this disease.