开放性植骨联合VSD在感染性胫骨骨缺损治疗中的临床应用

目的探讨开放性植骨联合负压封闭引流(VSD)在感染性胫骨骨缺损治疗中的临床疗效。方法 2012年8月~2014年6月安徽省中西医结合医院创伤骨科收治胫骨感染性骨缺损11例,男性7例,女性4例;年龄25~56岁,平均37.5岁;均为GustiloⅢ型胫骨开放性骨折伴软组织不同程度损伤。受伤原因:道路交通伤8例,重物压砸伤3例。患者入院后常规行清创骨折内外固定,出院后定期随访,患肢表现为骨折不愈合,骨坏死形成,创区反复渗液、流脓,胫骨平均缺损长度为(4.5±1.5)cm。先行感染病灶清除术,术后应用负压封闭引流(VSD)覆盖创面,待创面稳定后再行自身髂骨植骨加负压封闭引流(VSD),最后根据植骨创面大小及肉芽生长情况选择植皮或皮瓣修复术闭合创面。结果 11例患者获得随访6~24个月,平均12个月,均获得骨性愈合;术后骨折愈合时间平均6个月(4~12个月)。肉芽组织覆盖植骨区的平均时间为18d(15~35d)。11例中2例植骨区创面直接拉拢缝合,3例予以植皮手术,其余6例中随意筋膜皮瓣修复4例,皮神经营养皮瓣修复2例。所有植皮及皮瓣均成活良好。结论开放性植骨联合负压封闭引流(VSD)在感染性胫骨骨缺损治疗中操作相对简单,可有效控制创面感染,缩短骨折愈合时间,疗效肯定。

Clinical application of bone graft and VSD for the treatment of infectious tibial defect

Objective To investigate the clinical application of bone graft combined with vacuum sealing drainage(VSD) in the treatment of infectious tibial defect.Methods A total of 11 patients (7 males and 4 females,mean age 37.5 years,range 23 to 62 years) with infectious tibial defect were admitted from Aug.2012 to Jun.2014.All cases were Gustilo type III open tibial fractures with different degrees of soft tissue injury.The injury causes included traffic accident in 8 cases and crushing in 3 cases.Patients were managed with routine debridement,external fixation of fracture and regular follow-up after discharge.Nonunion,bone necrosis,wound exudation and pus occurred repeatedly.The average length of bone defect was (4.5±1.5)cm.Infected bone chips were cleared and VSD material was employed to cover the wound.After the wound was stable,autogenous iliac bone graft plus VSD was used.Finally,appropriate method was chosen to close the wound according to the size of the bone graft and the growth of granulation.Results All patients were followed up for an average of 12 months(6-24months).All had bone union,with an average healing time of 6 months(4-12months).The average time of granulation tissue covering the bone graft area was 18d(15-35 d).Of 11 cases,2 cases were sutured directly in bone graft area,and skin grafting was performed in 3 cases,4 cases were covered with fascia flap,and 2 cases were covered with neurocutaneous flap.All skin grafts and flaps survived well.Conclusion Bone graft combined with VSD has good effect in the treatment of infectious tibial defect,which is relatively simple,can effectively control wound infection and shorten the fracture healing time.