# 负压封闭引流(VSD)联合间断快速冲洗技术在下肢开放性骨折合并软组织缺损中的应用研究Study on the Application of Negative Pressure Sealed Drainage (VSD) Combined with Intermittent Rapid Irrigation in the Treatment of Open Fractures of Lower Limbs Complicated with Soft Tissue Defects

Abstract: Objective: To investigate the application of negative pressure closed drainage (VSD) combined with intermittent rapid irrigation in the treatment of open fractures of lower limbs complicated with soft tissue defects. Methods: A total of 50 patients with open fractures of lower extremity combined with soft tissue defects admitted to the Department of Trauma and Orthopedics of our hospital from January 2020 to October 2020 were selected after VSD negative pressure drainage. The patients were divided into the experimental group (n = 25) and the control group (n = 25), who were rapidly and discontinuously irrigated with normal saline. The nursing effects of the two groups were compared respectively. The frequency of blockage of drainage tube, pain index score of patients, average treatment time with VSD, wound healing effect and curative effect appearance time, and satisfaction of discharged patients were recorded. Results: After VSD negative pressure drainage by intermittent flush with continuous irrigation to prevent drainage pipe blockage effect difference (P > 0.05), the experimental group level of pain is lower than the control group (P < 0.05), the experimental group used the VSD treatment time is shorter than the control group on average, the experimental group wound healing effect is better than that of control group (P < 0.05), the experimental group curative effect appears shorter than the control group (P < 0.05), the satisfaction degree of the experimental group is higher than control group (P < 0.05). Conclusion: The technique of negative pressure sealed drainage (VSD) combined with intermittent rapid irrigation can significantly promote the wound healing of lower extremity open fracture combined with soft tissue defect, reduce the pain degree of patients, shorten the treatment time and improve patient satisfaction, which is worthy of promotion and application.

1. 引言

2. 资料与方法

2.1. 一般资料

2.2. 护理方法

2.2.1. 实验组

2.2.2. 对照组

2.2.3. 观察指标

2.2.4. 统计学处理

3. 结果

3.1. 实验组与对照组VSD管道堵塞次数比较

Table 1. Comparison of VSD pipeline blockage times between experimental group and control group

3.2. 实验组与对照组疼痛评分比较

Table 2. Comparison of pain scores between experimental group and control group ( $\stackrel{¯}{x}±s$ )

3.3. 实验组与对照组使用VSD平均治疗时间比较

Table 3. The average treatment time of VSD was compared between experimental group and control group ( $\stackrel{¯}{x}±s$ )

3.4. 实验组与对照组临床疗效比较

Table 4. Comparison of clinical efficacy between experimental group and control group ( $\stackrel{¯}{x}±s$ )

3.5. 实验组与对照组所需疗效显现时间比较

Table 5. Comparison of therapeutic effect appearance time between experimental group and control group ( $\stackrel{¯}{x}±s$ .d)

3.6. 实验组与对照组出院患者满意度比较

Table 6. Comparison of satisfaction of discharged patients between experimental group and control group ( $\stackrel{¯}{x}±s$ )

4. 讨论

1) 开放性骨折合并较大软组织缺损的病人在创伤骨科中很常见，发生外露骨和肌腱的频率更高，最大威胁是发展成感染和骨髓炎，甚至出现截肢从而危及生命。为减少相关并发症的发生，促进骨折周围软组织愈合，需积极治疗伤口。VSD能够较好符合临床治疗要求，在清创后的治疗过程中，显著降低并发症，缩短愈合及疗效显现时间。罗明星等 [3] 研究表明，VSD在骨科手术患者创面治疗中可促进新鲜肉芽生长，改善血液循环，感染控制效果较好。朱庭标等 [4] 在胫骨慢性骨髓炎治疗中联合使用VSD，有效缩短了治疗时间，且安全可靠无复发。

2) 负压封闭引流技术是在一个相对密闭的环境内进行工作，临床上可以通过采用具有良好透气、透氧性能的生物贴膜进行患处密封，这样就可以有效防止外界细菌入侵，从而降低交叉感染风险。同时给予患者有效的负压，不仅可以有效促进患处毛细血管的增生，而且创面血运也得以进一步改善，促进患者创面愈合。

3) 用生理盐水持续冲洗VSD管道，虽使伤口处在湿性环境，但易引起新生肉牙组织的水肿。改用生理盐水快速间断冲洗创面既能维持创面在湿性环境，又能在一定程度上防止肉牙组织水肿。本次研究实验组使用VSD平均治疗时间均少于对照组。

4) 综上所述，负压封闭引流(VSD)联合间断快速冲洗技术能显著促进下肢开放性骨折合并软组织缺损创面的愈合，降低患者的疼痛程度，提高患者满意度，值得推广应用。

NOTES

*通讯作者。

[1] Li, Z., Wu, W., Liu, S., et al. (2017) Effect of Vacuum Sealing Drainage in Dermatoplasty of Large Area of Cutaneous Defects. International Journal of Surgery, 42, 143-146.
https://doi.org/10.1016/j.ijsu.2017.04.059

[2] 李春蕊, 张雯, 樊碧发. 数字评分法(NRS)与口述评分法(VRS)在老年慢性疼痛患者中的比较[J]. 中国疼痛医学杂志, 2016, 22(9): 683-686.

[3] 罗明星, 林向进. 负压封闭引流技术在创伤骨科术后感染中的应用[J]. 保健文汇, 2019(4): 61-62.

[4] 朱庭标, 李智, 任静, 等. 病灶清除联合VSD及自体植骨治疗胫骨慢性骨髓炎[J]. 中国骨与关节损伤杂志, 2019, 34(2): 205-207.

Top