负压封闭引流在骨科的应用(附79例报告)

摘要

目的 介绍负压封闭引流在骨科的应用体会.方法 对2007年7月至2009年1月我院使用负压封闭引流(vacuum sealing drainage,VSD)治疗的骨创伤79例进行回顾性分析.结果 4例骨髓炎经2～4次VSD治疗后,创面明显缩小,有新鲜的肉芽组织生长,经治疗后痊愈;骨折术后钢板外露6例,经2～4次VSD治疗,创面明显缩小,有新鲜的肉芽组织生长,且肉芽组织部分覆盖钢板,后经游离皮瓣及皮瓣转位修复创面;8例感染创面应用VSD后,配合敏感抗生素的使用,感染均得到控制,平均使用14d;植皮10例使用VSD1次全部存括;开放性骨折外周定支架固定18例,经1～3次VSD洽疗后,创面无明显感染,明显有新鲜的肉芽组织生长,后期行皮瓣、植皮、内固定治疗或继续外固定支架治疗;半6例新鲜的软组织缺损创面经1次VSD治疗后,均能一期缝合创面或植皮修复创面;8例脓肿切开.引流后经1～2次VSD治疗后有肉芽组织生长,均能填平创面或直接缝合创面;褥疮3例经1～3次VSD治疗后,创面有新鲜的肉芽组织生长,无明显渗液后行皮瓣修复创面;8例皮肤脱套伤,经1～2次VSD治疗后植皮全部存活.所有病例均经5～20个月的随访,均未有慢性炎症的发生.结论 负压封闭引流是非常有效的引流手段,促进创面的愈合,减少换药的次数.减轻患者的痛苦,减轻医护人员的工作量.%Objective To introduce the clinical features of vacuum sealing drainage(VSD)to repair skin and soft tisue defects in skfetal trauma.Methods The clinical data of VSD to repair skin and soft tissue defects in 79 cases were reirospectively analyzed.(July,2007 to January,2009).Results In 4 cases of osteomyelitis.After application of VSD device 2～4 times the wounds generally were clean,and had no signs of infection or bacterial colonjzation.All wound dimensions were decreased,the granulation in the surface of wound were all fresb,second stagc closure or skin grafting was done successfully to close the wound.In 6 cases of exposed bones and plates after operation,After application of VSD device 2～4times.All wound dimensions were decreased,the granulation in the surface of wound were all fresh and a part of the granulation in the surface of wound cover the plates,second stage closure or skin grafting was done sccessfully to close the wound In 8 cases of infected wounds.After application of VSD,with positive bacte rigalculture ,application 14 days average.In 10 cases,the skin grafts survived completely;In 18 cases of open fracture were treated by external fixator following debridement.Wound surface or cavitieswere filled with pllyvinyl alclhol feams with embedded drainage tubes connected to vacuum bottle.After application of VSD device 1～3 times.All wotind with optinfect,the granulation in the surface of wound were all fresh.second stage closure or skin grafting was done successfully to close the wound or by extemal fixator.In 16 cases of fresh soft tissue defects After application of VSD device survived completely.In 8 cases of abscess,after cut application of VSD device 1～2 times.the granulation in the surface of wound were all fresh.In 3 cases of bedsore.application of VSD device 1～3 times,the granulation were all fresh.In 8 cases of skin press off,application of VSD device 1～2 times,the granulation were all fresh,the skin grafts survived completely;all patients were followed up for a mean duration of 18.4 months(rang,5 to 25 months)without ebronic inflammation.Conclusion VSD appeared to be the effective treatment of open foft tissue injuries.reduce the times of the traditional method of dressing wound,and facilitate wound.alleviate patient's suffering,lighten the docror and nurse burden.