【摘要】 目的 探討負壓封閉吸引（vacuum sealing drainage，VSD）敷料在創(chuàng)傷性慢性骨髓炎治療中的作用。 方法 2006年6月-2009年8月收治13例創(chuàng)傷后慢性骨髓炎有較多膿性滲出物患者，其中男9例，女4例；年齡8~56歲，平均34歲。車禍致脛骨開放性骨折9例；腓骨骨折1例；高處墜落致跟骨開放性骨折2例；股骨骨折1例，術后均合并慢性骨髓炎，病程11~35個月。于病灶清除后，先采用VSD治療，待創(chuàng)面清潔、骨面有肉芽組織形成后，8例直接二期縫合傷口，4例通過帶蒂肌皮瓣或皮瓣修復創(chuàng)面，1例采用背闊肌皮瓣游離移植修復創(chuàng)面。 結果 使用VSD平均吸引18 d，更換VSD平均2.1次。創(chuàng)面滲出物逐漸減少，創(chuàng)面面積減小，經(jīng)二期縫合、皮瓣移植等方法封閉創(chuàng)面。13例患者經(jīng)6~31個月隨訪，慢性創(chuàng)傷后骨髓炎均治愈，無復發(fā)。 結論 采用VSD治療創(chuàng)傷性慢性骨髓炎具有引流充分、炎癥控制快、創(chuàng)面肉芽組織生長快、骨髓炎復發(fā)率低的優(yōu)點。
【Abstract】 Objective To evaluate the clinical efficacy of vacuum sealing drainage (VSD) in managing traumatic chronic osteomyelitis. Methods Between June 2006 and August 2009, 13 patients with a lot of purulent exudates after traumatic chronic osteomyelitis were treated in our hospital. There were nine males and four females with their ages ranged from 8 to 56 years old, averaging at 34. Among these cases of traumatic chronic osteomyelitis, nine occurred after operation for open tibial fractures and one occurred after operation for open fibula fracture caused by traffic accident; two occurred after operation for open calcaneal fracture and one occurred after operation for femur fracture caused by falling. The course of the disease ranged from 11 to 35 months. After the focus of infection was debrided completely, they were treated with VSD. As soon as the wound surface was clear and the bone surface was covered with granulation tissue, eight patients were treated with secondary suture, four were treated with local skin flap transplantation or musculocutaneous flap transplantation, and one was treated with free latissimus dorsi musculo-cutaneous flap. Results The exudates in and the area of the wound were both decreased after VSD procedure on the wound for an average of 18 days and replacing the VSD for an average of 2.1 times. The wound was covered by second suture or flap transplantation. After a follow-up of 6-31 months, all 13 cases of traumatic chronic osteomyelitis were healed with no recurrence. Conclusion Application of VSD in treating traumatic chronic osteomyelitis can drain thoroughly, control inflammation faster, promote granulation tissue, and decrease the rate of recurrence.
引用本文： 范偉杰,張永虎,廖瑛. 負壓封閉吸引治療創(chuàng)傷性慢性骨髓炎的近期療效. 華西醫(yī)學, 2011, 26(3): 365-367. doi: 復制
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