自制负压封闭引流装置早期干预Sanders III、IV型跟骨骨折术后切口愈合异常
Intervention to Early-Stage Incision Complications in Sanders III and IV Calcaneal Fractures with Self-Made Vacuum Sealing Drainage Device

作者: 宁志刚 * , 王铁翔 , 王汝杰 :吉林省通化市第206医院骨科,吉林 通化;

关键词: 跟骨骨折并发症负压引流Calcaneal Fracture Complication Vacuum Drainage

摘要:
目的:探讨自制简易负压封闭引流装置在预防Sanders III、IV型跟骨骨折外侧切口行钢板内固定术后切口愈合异常的应用价值。方法:2010年10月至2015年10月,收治sanders III、IV型跟骨骨折41例(44足),其中男34例、女7例;年龄:22~51岁,平均年龄38岁,受伤8~13天后均给予外侧切口钢板内固定,其中有8例患者于术后5~9天开始出现淡黄色液体渗出,于处置室无菌条件下沿原切口置入自制负压封闭引流装置,抽吸固定形成恒定负压,至连续3天负压引流管内未见引流液后拔管。41例患者术后均获得随访,时间3~40个月,平均15个月。结果:切口给予自制简易负压吸引1天后切口表面渗出液消失,皮缘均未发生坏死,无浅层或深层感染,无切口裂开、窦道及钢板外露等严重并发症,伤口均获得愈合,无慢性骨髓炎发生,均未行VSD、皮瓣覆盖。结论:早期切口内置入自制简易负压封闭引流装置营造负压环境,排除渗出、消灭死腔,临床操作简便,价格低廉,效果较好,通过其早期的干预,可较明显的降低sanders III、IV型跟骨骨折切口的并发症,且患者易接受,值得临床推广。

Abstract: Objective: To investigate the application of self-made Vacuum sealing drainage device (sVSDD) in preventing of the abnormal incision healing in Sanders III and IV calcaneal fractures. Methods: From October 2010 to October 2015, 41 patients (44 feet), with Sanders III and type IV fractures, were treated, including 34 males and 7 females, 22 - 51 years old (average 38 years old), which were treated by plate internal fixation using lateral L-shaped incision in 8 - 13 days after frac-ture, and 8 incisions with light-yellow exudations in 5 - 9 days after surgery. A sVSDD was placed along the original incision under aseptic conditions in treatment room, and a constant negative pressure was made. 41 patients were followed up for 3 - 40 months, with an average of 15 months. Results: Exudations were disappeared in these incisions treated by sVSDD after 1 day, without incision necrosis, no shallow or deep infection, no serious complications of wound de-hiscence, sinus and plate exposure, without chronic osteomyelitis. VSD or flap was not used. Conclusion: L-shaped incision complications can be reduced by early-stage sVSDDs interventions in the Sanders III, IV type calcaneal fracture, which can create a negative pressure micro- environment, exclusion of leakage, eliminate dead space, patients are easy to accept, worthy of clinical promotion.

文章引用: 宁志刚 , 王铁翔 , 王汝杰 (2016) 自制负压封闭引流装置早期干预Sanders III、IV型跟骨骨折术后切口愈合异常。 外科, 5, 53-57. doi: 10.12677/HJS.2016.53008

参考文献

[1] Zhang, T., Su, Y., Chen, W., et al. (2014) Displaced Intra-Articular Calcaneal Fractures Treated in a Minimally Invasive Fashion: Longitudinal Approach versus Sinus Tarsi Approach. The Journal of Bone and Joint Surgery. American Volume, 96, 302-309. http://dx.doi.org/10.2106/JBJS.L.01215

[2] Kline, A.J., Anderson, R.B., Davis, W.H., et al. (2013) Minally Invasive Technique versus an Extensile Lateral Approach for Intra Articular Calcaneal Fractures. Foot & Ankle International, 34, 773-780. http://dx.doi.org/10.1177/1071100713477607

[3] Schepers, T. (2011) The Sinus Tarsi Approach in Displaced Intra-Articular Calcaneal Fractures: A Systematic Review. 35, 697-703.

[4] Benirschke, S.K. and Kramer, P.A. (2004) Wound Healing Complications in Closed and Open Calcaneal Fractures. Journal of Orthopaedic Trauma, 18, 1-6. http://dx.doi.org/10.1097/00005131-200401000-00001

[5] Kumar, S., Krishna, L.G., Singh, D., et al. (2015) Evaluation of Functional Outcome and Complications of Locking Calcaneum Plate for Calcaneal Fractures. Journal of Clinical Orthopaedics and Trauma, 6, 147-152. http://dx.doi.org/10.1016/j.jcot.2015.05.006

[6] Zhang, W., Chen, E., Xue, D., et al. (2015) Risk Factors for Wound Complications of Closed Calcaneal Fractures after Surgery, a Systematic Review and Meta Analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23, 18. http://dx.doi.org/10.1186/s13049-015-0092-4

[7] 刘刚, 潘世鹏, 陈新鹏. 应用VSD治疗跟骨骨折术后伤口不愈合[J]. 中国骨伤, 2012, 25(9): 782-784.

[8] 龚振华, 姚建, 季建峰, 等. 负压封闭引流技术治疗软组织损伤合并感染创面[J]. 中华创伤杂志, 2012, 28(1): 76- 77.

[9] Brem, M.H., Bail, H.J. and Biber, R. (2014) Value of Incisional Negative Pressure Wound Therapy in Orthopaedic Surgery. International Wound Journal, 11, 3-5. http://dx.doi.org/10.1111/iwj.12252

[10] 彭义, 曲家富, 曹立海, 等. 不同负压引流装置对跟骨骨折术后切口愈合的影响[J]. 中国煤炭工业医学杂志, 2014, 17(9): 1438-1441.

[11] Rammelt, S. and Zwipp, H. (2006) Calcaneal Fractures. Trauma, 8, 197-212. http://dx.doi.org/10.1177/1460408606073367

[12] Rak, V., Matonoha, P., Otahal, M., et al. (2007) Vascularization of the Lateral Heel in Relation to Extensive Skin Incision in Osteosynthesis of Calcaneal Fractures. Rozhledy v Chirurgii, 86, 483-488.

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