负压封闭引流技术在地震伤骨筋膜室综合征中的应用
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摘要
目的探讨负压封闭式引流(VSD)技术在"5.12"汶川大地震所致骨筋膜室综合征切开减压中的应用。方法回顾性研究了自2008年5月12日～2008年6月1日,接受VSD治疗的15例汶川地震伤员18个患肢。术后记录引流量,肢体肿胀消退情况以及全身发热等症状。根据肢体肿胀程度及肉芽生长情况,采用延期缝合、植皮或者皮瓣转移覆盖创面。结果 15例术后病情得到迅速控制,负压引流量在520～2360ml之间。术后7d内有10个创面肿胀消退,肉芽组织新鲜。余下8个创面经过第二次更换VSD敷料,5处筋膜室切开减压创面肿胀消退,肉芽新鲜。经第三次更换VSD敷料后余下3处创面肿胀消退,肉芽新鲜,予闭合创口。上述切开减压创面无一例发生感染。结论地震致骨筋膜室综合征经早期切开减压结合VSD治疗能快速覆盖创面,减少污染,防止继发感染;能有效引流分泌物,减少毒素吸收;减轻肢体水肿,促进新鲜肉芽生长,利于创面修复。
Objective To investigate the application of vacuum sealing drainage (VSD) for the incision decompressions after osteofascial compartment syndrome of injured extremities in the Wenchuan Earthquake.Methods Review was taken in 15 earthquake injured patients (with 18 extremities wound) who were treated by VSD in West China Hospital during May 12,2008 to Jun 1,2008.The amount of drainage ranged from the wound,swell of the limbs,temperature were recorded.If the granulation tissue grew well,swell was extincted,vital sign was well,the wound was covered by direct suture,skin grafting and local tissue flap transfer.If not,another 2 to 3 times of VSD therapy were given.Results Postoperatively,patient’s condition was controlled rapidly,the amount of drainage ranged from 520 ml to 2360 ml.The granulation tissue grew well and swell was extincted in 10 wound after 7 days by first VSD treatment.The granulation tissue grew well and swell was extincted in the 5 of other 8 wound through the second VSD therapy.The last 3 wound grew well by the third VSD therapy,and the wound was closed.The 15 of 18 wound was closed by direct suture.And the other 3 wound's one side was direct suture while another side was healed by skin grafting.No wound infection occurred in all patients.Conclusion VSD could cover the wound rapidly which the incision decompressions after osteofascial compartment syndrome of the Wen chuan Earthquake injured extremities.VSD which locate between the wound and the external environment could prevent contamination and the secondary infection,drain secretion effectively and decrease the absorption of toxin from the wound.And it could decrease the pressure in the tissue and relieve the swelling,and promote capillary and granulationt tissue growing.This is good method for repairing the wound.
Objective To investigate the application of vacuum sealing drainage (VSD) for the incision decompressions after osteofascial compartment syndrome of injured extremities in the Wenchuan Earthquake.Methods Review was taken in 15 earthquake injured patients (with 18 extremities wound) who were treated by VSD in West China Hospital during May 12,2008 to Jun 1,2008.The amount of drainage ranged from the wound,swell of the limbs,temperature were recorded.If the granulation tissue grew well,swell was extincted,vital sign was well,the wound was covered by direct suture,skin grafting and local tissue flap transfer.If not,another 2 to 3 times of VSD therapy were given.Results Postoperatively,patient’s condition was controlled rapidly,the amount of drainage ranged from 520 ml to 2360 ml.The granulation tissue grew well and swell was extincted in 10 wound after 7 days by first VSD treatment.The granulation tissue grew well and swell was extincted in the 5 of other 8 wound through the second VSD therapy.The last 3 wound grew well by the third VSD therapy,and the wound was closed.The 15 of 18 wound was closed by direct suture.And the other 3 wound's one side was direct suture while another side was healed by skin grafting.No wound infection occurred in all patients.Conclusion VSD could cover the wound rapidly which the incision decompressions after osteofascial compartment syndrome of the Wen chuan Earthquake injured extremities.VSD which locate between the wound and the external environment could prevent contamination and the secondary infection,drain secretion effectively and decrease the absorption of toxin from the wound.And it could decrease the pressure in the tissue and relieve the swelling,and promote capillary and granulationt tissue growing.This is good method for repairing the wound.
引文
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2郭林新,洪加源,丁真奇,等.复杂胫腓骨下段骨折治疗方法的选择.中国骨与关节损伤杂志,2009,24(5):452~453
3McQueen MM,Court-Brown CM.Compartment monitoring intibial frac-tures.J Bone Joint Surg(Br),1996,78:99
4Better OS.History of the crush syndrome:from the earth-quakes of Messina,Sicily1909to Spitay,Amrenia1988.Am J Nephro,1997,17(34):392～398
5Hussain A,Kwak HC,Pallister I.Crush syndrome:a comprehensive sur-gical strategy improves outcome.Injury,2006,12:53
6王洪,罗怀灿,杨述华.封闭式负压吸引技术治疗四肢骨筋膜室综合征.中华创伤骨科杂志,2003,5(4):342~343
7裴福兴.1410名地震伤员早期救治体会.中国矫形外科杂志,2008,16(20):1523~1524
8王琪,祖启明,项良碧,等.外固定架在急诊治疗胫腓骨粉碎性开放性骨折中的应用.中国骨与关节损伤杂志,2009,24(3):280～281
2郭林新,洪加源,丁真奇,等.复杂胫腓骨下段骨折治疗方法的选择.中国骨与关节损伤杂志,2009,24(5):452~453
3McQueen MM,Court-Brown CM.Compartment monitoring intibial frac-tures.J Bone Joint Surg(Br),1996,78:99
4Better OS.History of the crush syndrome:from the earth-quakes of Messina,Sicily1909to Spitay,Amrenia1988.Am J Nephro,1997,17(34):392～398
5Hussain A,Kwak HC,Pallister I.Crush syndrome:a comprehensive sur-gical strategy improves outcome.Injury,2006,12:53
6王洪,罗怀灿,杨述华.封闭式负压吸引技术治疗四肢骨筋膜室综合征.中华创伤骨科杂志,2003,5(4):342~343
7裴福兴.1410名地震伤员早期救治体会.中国矫形外科杂志,2008,16(20):1523~1524
8王琪,祖启明,项良碧,等.外固定架在急诊治疗胫腓骨粉碎性开放性骨折中的应用.中国骨与关节损伤杂志,2009,24(3):280～281
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