负压治疗在胫骨骨折合并骨外露中的临床应用

目的研究负压治疗在严重胫骨骨折合并软组织损伤、骨外露中的应用价值。方法2005年7月～2009年12月．本院收治胫骨开放性骨折合并胫骨外露无法直接闭合创面的患者20例，Gustilo分型：ⅢB型16例，ⅢC型4例。采用急诊扩创、外固定架同定骨折、创面负压吸引治疗，后期根据需要更换VSD敷料、延期缝合或二期植皮、转移皮瓣、换药等措施修复创面。胫骨骨折内固定术后钢板及骨外露的4例采用同样的方法治疗。结果所有创面最终都获得良好愈合。6例采用局部转移皮瓣覆盖，10例创面肉芽生长良好后植皮，5例延期直接缝合创面，3例创面缩小换药后愈合。结论负压吸引技术在胫骨骨折外露中有一定应用价值，可以简化手术、降低风险、减少医疗费用，疗效确切。

The clinical use of vacuum sealing drainage in the treatment of open tibial fracture with soft tissue defect

Objective To investigate the clinical value of vacuum sealing drainage(VSD) in the treatment of severe open tibial fractures with soft tissue defect. Methods From July 2005 to December 2009, patients with open tibial fractures with soft tissue defect were treated in our hospital. Among them, 20 cases with part of tibial exposed, could not closed their wounds directly with primary suturing, and there was 16 cases of ⅢB style and 4 cases of ⅢC style in Gustilo. The emergency surgery was performed by external fixator following debridement, and wound surface with embedded drainage tubes for vacuum sealing suction. The wounds were closed with secondary suturing, or skin transplation, or local flap grafting later. 4 patients with plates and bone exposed after internal tibial fixation were treated with the same way. Results All the wounds of patients healed. 6 cases with local flap grafting; 10 cases with skin transplation after granulation growt; 5 cases with delayed primary suturing; 3 cases healed by dressing on reduced wounds. Conclusion The technique of VSD for open tibial fracture is of certain value in clinic, it can simplify operation, reduce risk and medical costs, is an effective method.