扩创术联合封闭负压引流及局部氧疗治疗慢性骨外露创面的疗效观察

摘要

目的 探讨应用扩创术联合封闭负压引流(VSD)及局部氧疗治疗慢性骨外露创面的临床疗效.方法 对2014年12月至2017年1月32例慢性骨外露创面的患者应用扩创术清除病灶死骨,术后联合应用封闭负压及局部氧疗,观察创面的生长及愈合时间、细菌学变化情况、相关的术前影像学检查等情况.结果 14例患者X射线检查示:局部骨质密度减低,正常骨结构消失,骨外膜增厚;10例患者X射线检查示:骨皮质及骨松质的局部缺失;4例患者X射线检查示:骨质局限性密度增高;其余4例患者X射线检查均提示病灶区有不同程度的骨膜反应,但不能明确骨组织破坏.32例慢性骨外露创面,经扩创术联合封闭负压吸引和局部氧疗,肉芽组织生长迅速,迅速覆盖骨质暴露区,创面分泌物及渗出明显减少,经数次换药后愈合,术后均无继发感染.术后愈合时间16~30 d,平均(23.6±3.6) d.随访6~12个月,创面愈合良好,未发生破溃,无复发,创面瘢痕愈合.分泌物检查提示:20例患者分泌物细菌培养转为阴性,6例细菌培养示金黄色葡萄球菌,6例细菌培养示表皮葡萄球菌.结论 在明确病灶范围的基础上应用扩创术清除病灶死骨,术后联合封闭负压引流及局部氧疗治疗慢性骨外露创面,能明显缩短创面愈合时间,避免复发.%Objective To explore the therapeutic effect of epluchage combined with vacuum sealing drainage and topical oxygen therapy in the treatment of chronic bone exposed wounds.Methods Thirty-two patients with chronic bone exposed wounds were enrolled in this study from December 2014 to January 2017.All these patients were treated by epluchage combined with vacuum sealing drainage and topical oxygen therapy.Observed the growth and healing time,bacteriology changes,and related preoperative imaging studies of the wounds.Results The X-ray examination showed that there were 14 cases of decrease of the local bone density,disappearance of normal bone structure,and thickening of the outer membrane;10 patients with local defects of bone cortex and cancellous;4 cases of bone density increase;and 4 cases of periosteal reaction with different degree and unclear bone tissue damage.After epluchage combined with vacuum sealing drainage and topical oxygen therapy,granulation tissue of all the 32 cases grew rapidly,and the bone exposure areas were quickly covered.Wound secretions and exudate were significantly reduced,and the wounds were crued after several dressing change,without any postoperative infection.The healing time was 16 to 30 days,with the average time of (23.6±3.6)days.After being followed-up for 6 to 12 months,it was showed that the wound healed well without ulceration and recurrence.Secretions examination showed that there were 20 cases of secretions bacterial cultured to negative,while there were 6 cases of staphylococcus aureus and 6 cases of staphylococcus epidermidis.Conclusion On the basis of definite lesion range,remove the lesions dead bone through epluchage and cure the chronic bone exposed wounds with postoperative vacuum sealing drainage and topical oxygen therapy can significantly shorten the wound healing time and avoid recurrence.