负压封闭吸引治疗创伤性慢性骨髓炎的近期疗效

【】　目的　探讨负压封闭吸引（vacuumsealingdrainage，VSD）敷料在创伤性慢性骨髓炎治疗中的作用。　方法　2006年6月-2009年8月收治13例创伤后慢性骨髓炎有较多脓性渗出物患者，其中男9例，女4例；年龄8~56岁，平均34岁。车祸致胫骨开放性骨折9例；腓骨骨折1例；高处坠落致跟骨开放性骨折2例；股骨骨折1例，术后均合并慢性骨髓炎，病程11~35个月。于病灶清除后，先采用VSD治疗，待创面清洁、骨面有肉芽组织形成后，8例直接二期缝合伤口，4例通过带蒂肌皮瓣或皮瓣修复创面，1例采用背阔肌皮瓣游离移植修复创面。　结果　使用VSD平均吸引18d，更换VSD平均2.1次。创面渗出物逐渐减少，创面面积减小，经二期缝合、皮瓣移植等方法封闭创面。13例患者经6~31个月随访，慢性创伤后骨髓炎均治愈，无复发。　结论　采用VSD治疗创伤性慢性骨髓炎具有引流充分、炎症控制快、创面肉芽组织生长快、骨髓炎复发率低的优点。【Abstract】　Objective　Toevaluatetheclinicalefficacyofvacuumsealingdrainage(VSD)inmanagingtraumaticchronicosteomyelitis.　Methods　BetweenJune2006andAugust2009,13patientswithalotofpurulentexudatesaftertraumaticchronicosteomyelitisweretreatedinourhospital.Therewereninemalesandfourfemaleswiththeiragesrangedfrom8to56yearsold,averagingat34.Amongthesecasesoftraumaticchronicosteomyelitis,nineoccurredafteroperationforopentibialfracturesandoneoccurredafteroperationforopenfibulafracturecausedbytrafficaccident;twooccurredafteroperationforopencalcanealfractureandoneoccurredafteroperationforfemurfracturecausedbyfalling.Thecourseofthediseaserangedfrom11to35months.Afterthefocusofinfectionwasdebridedcompletely,theyweretreatedwithVSD.Assoonasthewoundsurfacewasclearandthebonesurfacewascoveredwithgranulationtissue,eightpatientsweretreatedwithsecondarysuture,fourweretreatedwithlocalskinflaptransplantationormusculocutaneousflaptransplantation,andonewastreatedwithfreelatissimusdorsimusculo-cutaneousflap.　Results　TheexudatesinandtheareaofthewoundwerebothdecreasedafterVSDprocedureonthewoundforanaverageof18daysandreplacingtheVSDforanaverageof2.1times.Thewoundwascoveredbysecondsutureorflaptransplantation.Afterafollow-upof6-31months,all13casesoftraumaticchronicosteomyelitiswerehealedwithnorecurrence.　Conclusion　ApplicationofVSDintreatingtraumaticchronicosteomyelitiscandrainthoroughly,controlinflammationfaster,promotegranulationtissue,anddecreasetherateofrecurrence.