负压封闭引流在肢体毁损伤保肢术的急诊应用
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摘要
目的回顾性分析我院负压封闭引流(vacuum sealing drainage,VSD)治疗肢体毁损伤的病例,探讨肢体毁损伤的急诊治疗方法。方法回顾性研究。2007年3月~2010年12月收治343例开放骨折,21例经急诊行负压封闭引流治疗的肢体毁损伤病例被纳入本研究。男14例,女7例,年龄17~52岁,平均31岁。车祸伤16例,地震伤2例,机器绞砸伤3例。上肢13例,下肢8例。GustiloⅢb型15例,Ⅲc型6例。肢体创伤程度评分(mangled extremityseverity score,MESS评分):9例<6分,6例6~7分,6例>7分。手术按外科清创术原则清创,修复血管、神经、肌腱,组织覆盖骨外露创面,外固定架固定构建肢体稳定性,负压封闭引流吸引封闭创面。结果 21例患者经1~5次负压封闭引流治疗,12例无骨外露,肉芽组织生长良好、创面游离植皮成功;5例骨外露面积小,肉芽组织粗盖骨外露后游离植皮,创面愈合;3例骨外露,行组织瓣转移覆盖创面;1例并发严重感染,截肢。结论负压封闭引流适用于肢体毁损伤的急诊保肢治疗,可控制感染、刺激肉芽组织生长,为二期创面修复提供了良好的条件。
Objective To evaluate the emergency therapeutic effect of traumatic destructive limb treated with vacuum sealing drainage(VSD).Methods A retrospective study was designed.From Mar 2007 to Dec 2010,343 victims of open fractures hospitalized in Mianyang central hospital,21 cases of traumatic destructive limb treated with vacuum sealing drainage were selected to enter this study,including 14 males and 7 females with an average age 31 years(range,17~52),16cases of accident injuries,2 cases of earthquake victims,3 cases of strangulation injury,13 cases of upper limbs and 8 cases of lower limbs.15 patients were type Ⅲb and 6 patients were Ⅲc by Guistilo classification,respectively.The mangled extremity severity score(MESS score) were as following : 9 cases of < 6 points,6 cases of 6~7 points,6 cases of > 7 points.In accordance with the principles of surgical debridement,repaired blood vessels,nerves,tendons,bone exposed in wound tissue coverage,be fixed to constructed physical stability of bone by external fixation,closed suction by VSD.Results 21 patients with VSD treatment form once to 5 times,20 cases were successful of limb salvage,only 1 case with serious infection was amputated.Conclusion VSD could control infection,stimulated the growth of granulation tissue and provided good conditions for the second phase of wound repair.This treatment could be applied for limb salvage in traumatic destructive limb.
Objective To evaluate the emergency therapeutic effect of traumatic destructive limb treated with vacuum sealing drainage(VSD).Methods A retrospective study was designed.From Mar 2007 to Dec 2010,343 victims of open fractures hospitalized in Mianyang central hospital,21 cases of traumatic destructive limb treated with vacuum sealing drainage were selected to enter this study,including 14 males and 7 females with an average age 31 years(range,17~52),16cases of accident injuries,2 cases of earthquake victims,3 cases of strangulation injury,13 cases of upper limbs and 8 cases of lower limbs.15 patients were type Ⅲb and 6 patients were Ⅲc by Guistilo classification,respectively.The mangled extremity severity score(MESS score) were as following : 9 cases of < 6 points,6 cases of 6~7 points,6 cases of > 7 points.In accordance with the principles of surgical debridement,repaired blood vessels,nerves,tendons,bone exposed in wound tissue coverage,be fixed to constructed physical stability of bone by external fixation,closed suction by VSD.Results 21 patients with VSD treatment form once to 5 times,20 cases were successful of limb salvage,only 1 case with serious infection was amputated.Conclusion VSD could control infection,stimulated the growth of granulation tissue and provided good conditions for the second phase of wound repair.This treatment could be applied for limb salvage in traumatic destructive limb.
引文
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[6]杨润功,张宇鹏,侯树勋,等.GustiloⅢ型胫骨干开放性骨折的治疗与临床分析[J].中华创伤骨科杂志,2010,12(9):824-829.
[7]曹文德,王树锋,等.胫骨开放性骨折保肢术后的远期功能随访[J].中华骨科杂志,2002,22:546-550.
[8]Sven Gregor,Marc Maegele,Stefan Sauerland.Negative PressureWound Therapy a Vacuum of Evidence[J].Arch Surg,2008,143(2):189-196.
[9]王学文,范小淘,李伟,等.负压封闭引流技术在骨科的临床应用[J].中国骨与关节损伤杂志,2006,21(7):583-584.
[10]林阳,陈安民,李锋.负压封闭引流技术在四肢皮肤软组织缺损中的应用[J].生物骨科材料与临床研究,2007,4(4):12-14.
[11]Derick A Mendonca,Remo Papini,Patricia E Price.Negative-pres-sure wound therapy:a snapshot of the evidence[J].InternationalWound Journal,2006,3(4):261-271.
[12]杨润功,张伟佳,侯树勋,等.负压封闭引流在GustiloⅢB和GustiloⅢC型开放性骨折感染治疗中的应用.中国骨肿瘤骨病[J],2008,7(4):193-197.
[2]Howe HR Jr,Poole GV Jr,Hansen KJ.Salvage of lower extremitiesfollowing combined orthopedic and vascular trauma.A predictivesalvage index[J].Am Surg,1987 Apr,53(4):205-8.
[3]Puno RM,Grossfeld SL,Henry SL,et al.Functional outcome of Pati-ents with salvageable limbs with gradesⅢB andⅢc open fractu-res of the tibia[J].Microsurgery,1996,17:167-173.
[4]张贵春,梁进.创伤性截肢治疗体会[J].中国矫形外科杂志,2005,13(6):479-480.
[5]夏睿,王彬,孔荣,等.外伤性肢体毁损伤急诊截肢43例治疗分析[J].职业卫生与病伤,2008,23(4):196-197.
[6]杨润功,张宇鹏,侯树勋,等.GustiloⅢ型胫骨干开放性骨折的治疗与临床分析[J].中华创伤骨科杂志,2010,12(9):824-829.
[7]曹文德,王树锋,等.胫骨开放性骨折保肢术后的远期功能随访[J].中华骨科杂志,2002,22:546-550.
[8]Sven Gregor,Marc Maegele,Stefan Sauerland.Negative PressureWound Therapy a Vacuum of Evidence[J].Arch Surg,2008,143(2):189-196.
[9]王学文,范小淘,李伟,等.负压封闭引流技术在骨科的临床应用[J].中国骨与关节损伤杂志,2006,21(7):583-584.
[10]林阳,陈安民,李锋.负压封闭引流技术在四肢皮肤软组织缺损中的应用[J].生物骨科材料与临床研究,2007,4(4):12-14.
[11]Derick A Mendonca,Remo Papini,Patricia E Price.Negative-pres-sure wound therapy:a snapshot of the evidence[J].InternationalWound Journal,2006,3(4):261-271.
[12]杨润功,张伟佳,侯树勋,等.负压封闭引流在GustiloⅢB和GustiloⅢC型开放性骨折感染治疗中的应用.中国骨肿瘤骨病[J],2008,7(4):193-197.
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