一期内固定结合置管冲洗负压封闭引流技术治疗下肢开放性骨折的护理

目的：探讨一期内固定结合置管冲洗负压封闭引流（vacuum sealing drainage,VSD）治疗下肢开放性骨折的临床护理疗效。方法：对2008-05-2010-05我院收治的27例下肢开放性骨折患者行一期清创,骨折采用髓内钉或锁定接骨板内固定,伤口内置管冲洗,创面用VSD材料封闭,持续负压引流的方法进行治疗,做好术前护理、术后一般护理、保持冲洗及引流通畅和有效负压吸引,观察治疗效果。结果：27例患者中19例术后创面获得一期愈合,8例患者行二期植皮或皮瓣修复获得愈合,25例患者获得随访,通过6～18个月的随访,23例患者如期愈合,2例延迟愈合,无一例发生骨髓炎。结论：正确合理的护理措施能确保一期内固定结合置管冲洗负压封闭引流技术治疗下肢开放性骨折（Gustilo-AndersonⅢ型）的成功。

The clinical care of lower extremity open fractures treated by primary internal fixation combined with irrigation and vacuum sealing drainage

Objective：To evaluate the efficacy of clinical care of lower extremity open fractures treated with primary internal fixation combined with irrigation and vacuum sealing drainage.Method：Twenty-seven patients suffered from lower extremity open fractures from May 2008to May 2010were included in this study.After the debridement,fractures were reduced and fixed by either intramedullary nail or locking compression plate.The wound was closed with VSD system.Good perioperative care was ensured,including maintaining the patency of the flushing and drainage.Result：Primary healing of the wounds was achieved in 19cases,while 8cases were cured by secondary stages of split skin graft or flap.Twenty-five cases were followed up for 6to 18months.Among these cases,23cases had bone union in primary stage,and the other two cases had delayed bone union.No osteomyelitis occurred in our study.Conclusion：The correct and reasonable clinical care measures can ensure the treatment of lower extremity open fractures（Gustilo-Anderson Ⅲ type） by primary internal fixation combined with irrigation and vacuum sealing drainage.