Ilizarov external fixation combined with vacuum sealing drainage for the repair of limb fractures with osteofascial compartment syndrome

doi:10.3969/j.issn.2095-4344.2014.44.020

Abstract

Abstract:

BACKGROUND: Osteofascial compartment syndrome is usually due to application of external fixation for fracture treatment. Vaseline gauze is used to cover and compress the wound. Frequent dressing change induces infection and is harmful to wound drainage and tissue granulation, finally causing prolonged time of hospitalization and bad results.
OBJECTIVE: To investigate the clinical efficacy of Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome.
METHODS: A total of 32 patients with limb fractures with osteofascial compartment syndrome were randomly divided into two groups. All patients adopted the same fasciotomy and drug treatment. In treatment group, the fracture was fixed with Ilizarov external fixation and the wound was covered with the vacuum sealing drainage dressing. In control group, the fractures were treated by unilateral external fixation and the wound was covered with the vaseline gauze. The fracture healing, clinical effects, hospitalization duration and costs between two groups were compared.
RESULTS AND CONCLUSION: In the treatment group, there were 10 cases of healing well, 4 cases of muscle contracture and 2 cases of amputation. In the control group, there were 7 cases of healing well, 6 cases of muscle contracture and 3 cases of amputation. No significant difference in clinical outcome measures was detected between the two groups. Fracture healing rate and costs were higher in the treatment group than in the control
group (P < 0.05), but hospitalization duration, skin grafts and the incidence of infection were lower in the treatment group than in the control group (P < 0.05). Results suggested that on the basis of timely fasciotomy and decompression, Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome has a high limb salvage rate, which can effectively treat fractures, elevate the healing rate of fractures, reduce infection rate and skin grafting rate, shorten hospital stays. However, the hospitalization expense is higher.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: myofascial pain syndromes, fractures, bone, external fixators, drainage

CLC Number:

R318

Cheng Jian-wen, Su Wei, Tan Zhen, Liu Wei. Ilizarov external fixation combined with vacuum sealing drainage for the repair of limb fractures with osteofascial compartment syndrome[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(44): 7162-7166.

Figures/Tables 3

两组患者在性别构成比、患侧构成比、年龄、就诊时间、骨折类型构成比、入院后测得筋膜室压力差异无显著性意义(P > 0.05)；两组患者致伤原因均以交通伤为主，次之为挤压伤、坠落伤、重物砸伤，两组患者在致伤原因方面差异无显著性意义(P > 0.05)；两组患者骨折发生部位以胫腓骨骨折为主，尺桡骨和肱骨次之，两组骨折发生部位差异无显著性意义(P > 0.05)。由上可知，两组患者基线资料差异无显著性意义(P > 0.05)，具有良好可比性。 2.3 骨折愈合、植皮愈合率等情况的比较两组患者经治疗后，临床疗效如表2所示。在骨折治疗比较上已剔除截肢患者，治疗组患者采用Ilizarov技术固定骨折端，治愈13例，1例不愈合；对照组治愈7例，畸形愈合4例，不愈合2例，作者认为发生骨折畸形愈合及不愈合与粉碎性骨折采用单边外固定架固定不牢固、感染及血供不良等因素密切相关。治疗组患者共有4例患者采取植皮覆盖创面，而对照组有10例患者创面无法缝合而采取植皮治疗，两者比较差异有显著性意义(P < 0.05)。治疗组有2例患者发生感染，其中1例患者发生胫骨外露，经皮瓣转移覆盖创面治愈，另外1例患者合并糖尿病，经胰岛素调控血糖，加强抗炎、清除更换负压封闭引流装置3次后植皮治愈；对照组共有7例发生感染，其中5例患者发生创面化脓性感染，经分泌物培养及药敏结果使用抗生素抗炎后，炎症控制，采取植皮治愈，2例患者为开放性骨折骨外露，经抗炎、换药控制感染后，行皮瓣覆盖创面治疗。对照组感染发生率明显高于治疗组(P < 0.05)。两组临床结局上，治疗组有10例患者得到治愈，发生缺血性肌挛缩4例，截肢2例；对照组治愈7例，缺血性肌挛缩6例，截肢3例，两组临床结局比较差异无显著性意义(P > 0.05)。"

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