外固定架联合负压封闭引流术急诊处理严重软组织损伤小腿骨折.docVIP

外固定架联合负压封闭引流术急诊处理严重软组织损伤的小腿骨折 　　作者：鲁波勇，吴刚，祝少博 作者单位：430071，湖北 武汉，武汉大学中南医院骨科;443003湖北 宜昌，宜昌市第三人民医院骨科 　　【摘要】目的 探讨外固定架联合负压封闭引流术(vacuum sealing drainage,VSD)急诊处理合并严重软组织损伤小腿骨折的效果。方法 对41例严重软组织损伤小腿骨折患者均行急诊外固定架联合负压封闭引流术。其中8例合并大块皮肤软组织撕脱创面Ⅰ期打薄皮肤回植，以VSD覆盖。24例软组织缺损创面同期行VSD覆盖创面。9例骨筋膜室综合症者之减张切口亦同期以VSD覆盖。结果 7～10天去除VSD，8例Ⅰ期打薄回植的皮肤绝大部分存活。24例合并软组织缺损创面均未见脓性分泌物，9例骨筋膜室综合症者患肢血运良好，Ⅱ期组织瓣移植和游离植皮均成活。随访6个月～2年，所有病例外固定架均拆除，骨折愈合，无骨髓炎、骨不连发生。结论 外固定架联合负压封闭引流术对于常见的合并严重软组织损伤的小腿骨折有良好的治疗效果，能急诊同期处理骨折和软组织损伤。 　　【关键词】 下肢骨折;软组织损伤;外固定;负压封闭引流 　　Emergency use of external fixation combined with VSD for fracture of lower leg with serious soft tissue injury 　　LU Boyong，WU Gang，ZHU Shaobo 　　(Department of Orthopaedics,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Orthopaedics,Third Hospital of Yichang,Yichang 443003,China) 　　【Abstract】 Objective To explore the effect of external fixation combined with vacuum sealing drainage(VSD) in treating fracture of lower leg associated with serious soft tissue injury in emergency treatment.Methods Totally 41 cases were treated with external fixation and VSD.Eight cases with large area skin avulsion were treated by skin grafting,followed by VSD cover.Totally 24 cases of soft tissue defect and 9 cases of osteofascial compartment syndrome were covered with VSD.Results After 710 days of the application of VSD,8 cases of skingrafting were almost healed.Granulation tissue in 24 cases of soft tissue defect grew well without pus secretion.Good blood supply was found in 9 cases of osteofascial compartment syndrome.Flaps and skin graft after the secondary operation all survived.All cases were healed with no signs of osteomyelitis and nonunion after 6 months to 2 years follow up.Conclusion Using external fixation combined with VSD is an effective and efficient method for treating fracture of lower leg with serious soft tissue injury,which could emergently treat the injury of bone and soft tissue at the same time. 　　【Key words】limb