外固定支架术联合负压封闭引流治疗胫腓骨开放性骨折伴软组织损伤的疗效

目的探讨胫腓骨开放性骨折伴软组织损伤采用外固定支架联合负压封闭引流(VSD)治疗的临床效果。方法将60例胫腓骨开放性骨折伴软组织损伤患者按随机数字表法分为对照组和观察组,每组30例。对照组经清创、外固定支架术后进行传统换药治疗,观察组采用外固定支架术联合VSD治疗。所有患者均于创面新鲜后行植皮术。对2组患者术后组织缺损愈合时间、骨折愈合时间、踝关节功能恢复的优良率及并发症的发生情况进行比较。结果观察组缺损组织愈合时间、骨折愈合时间分别为(10.0±2.2)d、(5.5±1.3)个月;对照组缺损组织愈合时间、骨折愈合时间分别为(40.0±5.8)d、(8.0±2.5)个月,2组比较差异均有统计学意义(均P<0.05)。随访10个月,观察组踝关节功能优良率明显高于对照组(93.3%比66.7%,P<0.05)。2组均无感染、骨折移位等并发症发生。结论采用外固定支架术联合VSD治疗胫腓骨开放性骨折伴软组织损伤可充分引流,保持创面新鲜,促进创面愈合,有效地降低了感染率。

Effects of External Fixation Combined with Vacuum Sealing Drainage on Open Tibiofibular Fractures Associated with Soft Tissue Injuries

Objective To investigate the effects of external fixation combined with vacuum sealing drainage （VSD） on open tibiofibular fractures associated with soft tissue injuries. Methods Sixty patients with open tibiofibular fractures and soft tissue injuries were randomly divided into two groups, with 30 patients in each group. Patients in control group were given traditional dressing treatment after debridement and external fixation. Patients in observation group were treated with external fixation and VSD. Skin grafting was performed after the appearance of fresh wound. Tissue defect healing time, fracture healing time,ankle function restoration exceptionol rate and complications were compared between the two groups. Results Tissue defect healing time,fracture healing time were,respectively, （10.0±2.2）days and（5.5±1.3） months in observation group, and（40.0±5.8） days and（8.0±2.5） months in control group. The differences were significant between the two groups （all P＆lt;0.05）. After follow-up for 10 months, the excellent and good rate of ankle function in observation group was significantly higher than that in control group （93.3% vs 66.7%,P＆lt;0.05）. No infection, fracture displacement and other complications were found in both groups. Conclusion The treatment with external fixation and VSD can provide adequate drainage,keep wound fresh,promote wound healing and reduce infection in open tibiofibular fractures associated with soft tissue injuries.