摘要
目的探讨负压封闭引流技术(vacuum sealing drainage,VSD)辅助治疗Lisfranc骨折脱位伴严重软组织损伤的临床疗效。方法选取2016-08/2018-01月作者医院收治的53例Lisfranc骨折脱位伴严重软组织损伤的患者。根据术后是否采用VSD治疗分为VSD组(n=29)和常规组(n=24)。VSD组患者术后给予创面持续VSD引流,常规组给予无菌敷料覆盖及常规换药处理。比较两组患者术后切口愈合情况(换敷料次数、消肿时间、抗生素使用时长、一期愈合率),炎症指标和末次随访时足踝功能。结果与常规组相比,VSD组患者术后敷料更换次数更少,抗生素使用时间、消肿时间更短,切口一期愈合率更高,切口需延长换药比例更低,住院时间更短,差异均具有统计学意义(P<0.01或0.05)。两组患者血浆C反应蛋白(C-reactive protein,CRP)和白细胞计数(white blood cell count,WBC)在不同时间点均呈降低趋势,不同检测点与分组之间存在交互作用(P<0.05)。平均随访时间1.8(1.0~2.5)年,术后复查显示53例患者骨折愈合良好,其中VSD组美国足与踝关节协会(American orthopedic foot and ankle society,AOFAS)评分优良率为82.76%,高于常规组54.17%的优良率,但差异无统计学意义(P>0.05)。结论VSD在辅助治疗Lisfranc骨折脱位伴严重软组织损伤患者临床疗效显著,可在减轻患者炎性指标的基础上,提高伤口一期愈合率,缩短住院时间,但在改善患者远期足踝功能方面无明显优势。
Objective To investigate the clinical efficacy of vacuum sealing drainage(VSD)assisted therapy for Lisfranc fracture-dislocation with severe soft tissue injury.Methods Fifty-three patients admitted to authors′hospital from August 2016 to January 2018 were enrolled.Patients were divided into VSD group(n=29)and routine group(n=24)according to whether they were treated with VSD.Patients in VSD group were given continuous negative pressure drainage after operation.The conventional group was given a sterile dressing and the wounds were changed on time.The incision healing status of the two groups(dressing replacements,swelling time,duration of antibiotic use,first-stage healing rate),inflammation indexes and long-term ankle function were observed.Results Compared with the routine group,patients in VSD group had fewer dressing replacements,shorter antibiotic use time,shorter swelling time,higher first-stage wound healing rate,less prolonged dressing in the incision,and shorter hospitalization time,the differences were all significantly different(P<0.01 or0.05).The plasma C-reactive protein(CRP)and white blood cell count(WBC)of the two groups showed a decreasing trend at different time points before and after surgery.There was interaction between different detection time and groups(P<0.05).The average follow-up time was 1.8(1.0 to 2.5)years.The postoperative reexamination showed that the fractures healed well in 53 patients.The excellent rate of the American orthopedic foot and ankle society(AOFAS)score in VSD group was 82.76%,which was higher than that in the routine group(54.17%),but the difference was not significantly different(P>0.05).Conclusion VSD has a significant clinical effect in the assisted treatment of Lisfranc fracture-dislocation with severe soft tissue injury,which can improve the wound healing rate and shorten the hospitalization time on the basis of alleviating the inflammatory indexes of patients,but has no obvious advantage in improving the long-term foot and ankle function of patients.
作者
吴海洋
蔡贤华
刘曦明
尚冉冉
陈岩召
王芸
WU Haiyang;CAI Xianhua;LIU Ximing;SHANG Ranran;CHEN Yanzhao;WANG Yun(Wuhan School of Clinical Medicine,Southern Medical University,Wuhan Hubei 430070,China)
出处
《华南国防医学杂志》
CAS
2019年第10期685-690,共6页
Military Medical Journal of South China
关键词
负压封闭引流
软组织损伤
跖跗关节
骨折
骨折固定术
Vacuum sealing drainage
Soft tissue injuries
Tarsometatarsal joint
Fracture
Fracture fixation
